The first two questions are about fruit and vegetables:
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Q1. How many servings of vegetables does [child's name] usually eat each day? (one serving = 1/2 cup cooked vegetables or 1 cup of salad vegetables) |
1. ______ servings per day |
2. ______ servings per week |
3. Doesn't eat vegetables |
4. Don't know |
5. Refused |
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Q2. How many servings of fruit does [child's name] usually eat each day? (one serving = one medium piece or two small pieces of fruit or one cup of diced pieces) |
1. ______ servings per day |
2. ______ servings per week |
3. Doesn't eat fruit |
4. Don't know |
5. Refused |
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The next few questions ask how often your child eats some foods:
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Q3. How often does [child's name] eat red meat, such as beef or lamb? Include all steaks, chops, roasts, mince, stir fries and casseroles. Do not include pork or chicken. |
Longer list (do not read out): Veal, offal (liver, kidney), mutton, game (buffalo, crocodile, goanna, goat, hare, kangaroo, rabbit, snake, venison, wild boar) |
1. ______ times per day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Q4. How often does [child's name] eat meat products such as sausages, frankfurters, devon, ham, hamburgers or chicken nuggets? |
Longer list (do not read out): Salami, bacon, meat pies, sausage rolls, luncheon meats, delicatessen meats, meat paste, liver paste, pate, saveloys, cheerios, hot dogs, rissoles, canned meats, smoked chicken, other smoked meats |
1. ______ times per day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Q5. How often does [child's name] eat hot chips, French fries, wedges or fried potatoes? |
1. ______ times per day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Q6. How often does [child's name] eat potato crisps or other salty snacks (such as Twisties or corn chips)? |
1. ______ times per day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Q7. How often does [child's name] have meals or snacks such as burgers, pizza, chicken or chips from places like McDonalds, Hungry Jacks, Pizza Hut, KFC, Red Rooster or local take-away food places? |
1. _______ times per day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Q8. How often does [child's name] have snack foods such as sweet or savoury biscuits, cakes, doughnuts or muesli bars? |
1. ______ times per day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Q9. How often does [child's name] eat confectionery, such as lollies and chocolate? |
1. ______ times per day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Q10. How often does [child's name] usually have something for breakfast? |
1. Every day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Q11. How often does [child's name] eat dinner in front of the television? |
1. Every day |
2. ______ times per week |
3. ______ times per month |
4. Rarely/never |
5. I don't know/can't say |
6. Refused |
Appendix
Continued
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The next few questions are about the quantity of drinks your child usually consumes:
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Q12. How many cups of milk does [child's name] usually drink in a day? Includes cow's milk, soya milk, milk on cereal, flavoured milks (one cup = 250 ml, a household tea cup) |
1. ______ cups per day |
2. ______ cups per week |
3. ______ cups per month |
4. Doesn't drink cow's milk or other milk |
5. Don't know |
6. Refused |
Q13. What type of milk does [child's name] usually consume? |
1. Whole milk (regular, full-cream) |
2. Low – reduced fat milk |
3. Skimmed milk |
4. Evaporated or sweetened condensed |
5. Soya milk, regular. Please specify _______________ |
6. Soya milk, reduced fat. Please specify_______________ |
7. None of the above |
8. Don't know |
9. Refused |
Q14. How many cups of soft drink, cordials or sports drink, such as lemonade or Gatorade does [child's name] usually drink? (1 cup = 250 ml. One can of soft drink = 1
cups. One 500 ml bottle of Gatorade = 2 cups) |
1. ______ cups per day |
2. ______ cups per week |
3. _______ cups per month |
4. Doesn't drink soft drink |
5. Don't know |
6. Refused |
Q15. How many cups of diet soft drink or diet cordial such as Diet Coke or Diet Sprite or Coke Zero does [child's name] usually drink? (1 cup = 250 ml. One can of soft drink = 1
cups. One 500 ml bottle of Gatorade = 2 cups) |
1. _______ cups per day |
2. ______ cups per week |
3. ______ cups per month |
4. Doesn't drink diet soft drink |
5. Don't know |
6. Refused |
Q16. How many cups of fruit juice does [child's name] usually drink? (1 cup = 250 ml, a household tea cup or 1 large popper) |
1. _______ cups per day |
2. ______ cups per week |
3. ______ cups per month |
4. Doesn't drink juice |
5. Don't know |
6. Refused |
Q17. How many cups of water does [child's name] usually drink in a day? (1 cup = 250 ml, a household tea cup, 1 average bottle of water = 2
cups) |
1. ______ cups per day |
2. ______ cups per week |
3. ______ cups per month |
4. Doesn't drink water |
5. Don't know |
6. Refused |