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| Question | Answer |
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| How many times did you eat restaurant or fast food last week? (For example Chili’s, McDonald’s, Burger King, etc.) | 0 1 2 3 4 5 6 7 more than 7 |
| How many times do you typically eat restaurant or fast food in one week (7 days)? | 0 1 2 3 4 5 6 7 more than 7 |
| How many cans of non-diet soda pop did you drink yesterday? (For example Coke, Pepsi, Sprite) | 0 1 2 3 4 5 6 7 more than 7 |
| How many cans do you typically drink non-diet soda pop in one day? | 0 1 2 3 4 5 6 7 more than 7 |
| How many times did you drink juice or punch yesterday? (For example orange juice, apple juice, Sunny Delight) | 0 1 2 3 4 5 6 7 more than 7 |
| How many times do you typically drink juice or punch in one day? | 0 1 2 3 4 5 6 7 more than 7 |
| How many times did you eat vegetables yesterday? (For example broccoli, spinach, greens, salad, etc.) | 0 1 2 3 4 5 6 7 more than 7 |
| How many times do you typically eat vegetables in one day? | 0 1 2 3 4 5 6 7 more than 7 |
| How many times did you eat fruit yesterday? (For example an apple, an orange, a hand full of grapes, etc.) | 0 1 2 3 4 5 6 7 more than 7 |
| How many times do you typically eat fruit in one day? | 0 1 2 3 4 5 6 7 more than 7 |
| How many times do you typically eat breakfast in one week (7 days)? | 0 1 2 3 4 5 6 7 |
| When eating restaurant food or fast food, do you eat all of the food served to you at one time? | Never Rarely Occasionally Sometimes Often Usually Always |
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