(a) What year is this? |
(b) What season is this? |
(c) What month is this? |
(d) What is today's date? |
(e) What day of the week is this? |
(f) What country are we in? |
(g) What province are we in? |
(h) What city/town are we in? |
(i) What is the name of this building? |
(j) What room are we in? |
2. Smoking habits
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(a) I smoke everyday. |
How many cigarettes/day: |
Started at age: |
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(b) I don't smoke every day. |
How many cigarettes/week: |
Started at age: |
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(c) I don't smoke but I've smoked every day in the past. |
How many cigarettes/day: |
Started at age: |
Stopped at age: |
(d) I never smoked. |
3. Sedentary behavior
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Time spent on a typical weekday
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None
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-15min
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15–30 min
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30–60 min
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1–2 h
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2–3 h
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3–4 h
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4–5 h
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5–6 h
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>6 h
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1. Sitting at work |
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During your leisure time
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2. Sitting watching television |
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3. Sitting on the computer |
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4. Sitting during meals |
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5. Sitting listening music or reading a book |
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6. Sitting with friends or family |
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7. Sitting and driving a car, bus or train |
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8. Sitting during leisure time |
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9. Taking a nap |
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4. Nutritional habits
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1
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2
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3
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1. How many meals do you eat per day? |
3 meals/day |
A fourth |
1-2 meals/day |
2. Do you eat between meals? |
No, I have a snack when I need it |
I eat in the evening |
I often nibble between meals |
3. Do you eat prepared foods? |
<1/week |
1–2/week |
≥3/week |
4. How many portions of vegetables do you eat? |
≥4/day |
2–3/day |
≤ 1/day |
5. How many portions of fruits do you eat? |
≥3/day |
2/day |
≤ 1/day |
6. How often do you eat deli or fatty meats? |
<1/week |
1–2/week |
≥3/week |
7. How often do you eat baked products (muffins, brioche, croissant, etc.)? |
≤ 1/week |
2–3/week |
≥4/week |
8. How often do you eat sweets? |
≤ 3/week |
4–5/week |
everyday |
9. Do you drink sweet drinks, including 0% calories? |
250mL or less/day |
250mL/day |
250mL or more/day |
|
1 |
2 |
3 |
10. What is your average alcohol consumption? |
<1/day |
2/day |
>2/day |