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WIC Dietary Assessment
Validation Study
Executive Summary
United States Department of Agriculture
Food and Nutrition Service
USDA Contract #53-3198-2-032
Freeman, Sullivan & Co.
131 Steuart Street, Suite 500
San Francisco, California 94105
415 777-0707 - Fax 415 777-2420
JUl 1 4 1^
United States Food and 3101 Park Cantar Drive
Oapartmant of Nutrition Alexandria, VA 22302
Agriculture Service
Subject: WIC Dietary Assessment Validation Study j^. „ ■* iWLi
To: Dear Colleague:
We are pleased to provide you with the attached copy of the
Executive Summary from the WIC Dietary Assessment Validation
Study Final Report. The study compares the performance of two
sets of food frequency questionnaires (FFQs) in a WIC-eligible
population consisting of women and children who are African-
American, White, and Hispanic. Each set of FFQs consists of a
woman's FFQ and a child's FFQ. A survey of State WIC agencies
conducted by the Food and Consumer Service (FCS) in 1988 showed
-*hat a wide range of methodologies were being used for dietary
assessment and that few, if any, of the instruments had been
tested for validity and reliability. The findings of this study
provide estimates of validity for two sets of FFQs and a direct
comparison of their ability to accurately assess dietary intake
in this study population.
Results of the validation study will be shared with WIC State
agencies. WIC State agencies may use the validated FFQs or
continue to develop/select their own methods for assessing
dietary intake.
Due to the voluminous data included in the Final Report, we are
sending a copy of the Executive Summary only. Included in the
Executive Summary are a brief description of the study design, a
summary of the findings, copies of both sets of FFQs, and
instructions on how to complete them. A copy of the complete
Final Report is available from this office upon request; however,
the number of available copies is limited.
If you have comments or questions related to this report, please
contact Michele Lawler at (703) 305-2554.
Thank you.
fj "RONALD J. VOGEL
Acting Director
Nutrition and Technical Services Division
Attachment
Acknowledgments
The WIC Dietary Assessment Validation Study was conducted by Freeman,
Sullivan & Co. (FSC) under a contract with the U.S. Department of Agriculture, Food
and Nutrition Service (USDA Contract #53-3198-2-032). Freeman, Sullivan & Co. is
a private research firm providing research design, data collection and statistical analysis
services to health organizations, government agencies, universities, foundations and
private institutions. The study was directed by Gladys Block, Ph.D., Principal
Investigator, and Charles DiSogra, Dr.P.H., Project Director. Data collection was
supervised by Philip Bellman, M.P.H., Project Manager.
Freeman, Sullivan & Co. wishes to acknowledge the following individuals and
public agencies who contributed to the completion of this study: Michele Lawler, M.S.,
R.D., Contracting Officer Representative, USDA Food and Nutrition Service; Brenda
Lisi, Patricia McKinney and J.P. Passino, Technical Review Panel, USDA Food and
Nutrition Service; Magdalene Louie, R.D., M.S., Alameda Co. WIC Program,
Oakland, CA; Ellen Sirbu, M.S., R.D., City of Berkeley WIC Program, Berkeley, CA;
Nori Grossman, M.P.H., R.D., La Clinica de la Raza, Oakland, CA; Barbara Hadden,
Hamilton County WIC Program, Cincinnati, OH; Faye Walker, M.S., R.D., L.D.,
Dorcas Adeleye and Mara Drais, R.D., City of Houston Dept. of Health & Human
Services, Houston, TX; Susan McKenna, M.A., R.D., Nassau Co. Dept. of Health,
Hempstead, NY; and Yolanda Torres, R.D., Brentwood Health Center, Brentwood, NY.
Additionally, FSC acknowledges those WIC staff contributing to the Food Frequency
Questionnaire usability assessment including Wanda Agnew, L.R.D., North Dakota State
Health Department; Maria de los Angeles Diaz, M.Ed., L.N.D., Puerto Rico WIC
Program; and Elizabeth Fearnow, M.Ed., M.P.H., R.D., Delaware WIC Program.
Freeman, Sullivan & Co. acknowledges the tireless work of the many project staff
in California, Ohio, New York and Texas who made this research possible. Project staff
and consultants included Sandra Chien Butts, M.P.H., R.D.; Laura Bachmann, R.D.;
Mary Grace Jue Leong, R.D.; Lynne Ludlum; Marta Clunie; Nishma Daya; r«
Moncloa; Owen Barajas Dallas; Elisa Kim Lee; R.D.; Bill Patt; Angela Lee; R.D.;
Jennifer Ushijima; R.D.; Cecilia Meza; Paul Miller; Gabriela Villarreal; M.D.; Dr.P.H.;
and Laura Brainin-Rodriguez, R.D., M.P.H.
The project also acknowledges the assistance of the Harvard School of Public
Health in providing the Harvard Food Frequency Questionnaire and scoring software for
use during this study. Information provided by Jane D. Gardner, Ph.D., and Qiang
Wang, Ph.D., was especially helpful.
Finally, very special appreciation is extended to the 969 WIC participants, women
and their children, who volunteered to take part in this validation study. Their belief that
their participation would assist the WIC program nation-wide made this study possible.
11
SECTION 1 - EXECUTIVE SUMMARY
The Food and Nutrition Service (FNS) of the U. S. Department of Agriculture
initiated research in September 1992 to validate two sets of food frequency questionnaires
(FFQs) in a study population made up of women and children eligible for the Special
Supplemental Food Program for Women, Infants and Children (WIC). The purpose was
to determine the comparative performance of these FFQs in ranking respondents with
respect to the " true " dietary intake. In this study, true dietary intake was measured by
three non-consecutive 24-hour diet recalls collected through a telephone interview. The
two food frequency questionnaires tested were the:
• HarvardFFQ - Women's Food Frequency Questionnaire (WFFQ) and Children's
Food Frequency Questionnaire (CFFQ) developed by Dr. Jane Gardner at Harvard
University; and the
• Block FFQ - developed by Dr. Gladys Block at the University of California,
Berkeley.
Food frequency questionnaires attempt to estimate dietary intake of an individual
by asking how often specific foods are consumed. Based upon previous studies, the
Harvard and Block FFQs each ask about a list of foods most commonly consumed by
participants in the WIC program. These two FFQs differ on several dimensions, such as
the number of food items (Harvard, 80 items; Block, 65 items), specific food items, the
way food items are grouped, the frequency categories, and scoring methods. The Block
FFQ also differs from the Harvard FFQ in that it asks an individual to approximate the
usual portion size (small, medium or large) of each food item consumed.
Both the Harvard and Block FFQs have a woman's version and a child's version.
The woman's version is designed for a woman to fill out about her own diet while the
child's version is designed for a mother to fill out about the diet of her child (age 1-4).
Study Population
The population for this study consisted of four WIC categories and three
ethnic/raciil groups. The four WIC categories studied were:
• Pregnant women;
• Breastfeeding, postpartum women;
• Non-breastfeeding, postpartum women; and
• Children ages 1.0 through 4.9 years.
Within each of these four WIC categories, study participants were recruited to represent
the following three "self-identified" ethnic/racial groups:
• African American;
• Hispanic; and
• White.
The study population was recruited from within the East, West, Southwest and Central
regions of the United States. The specific field sites selected for recruitment were:
• Hempstead, New York;
• Berkeley and Oakland, California;
• Houston, Texas; and
• Cincinnati, Ohio.
Sample Design and Size
A stratified, rectangular sample design was used in this study. For each of the two
FFQs (Harvard and Block), approximately 75 women in each of the three WIC categories
(pregnant, breastfeeding and non-breastfeeding) and 75 children were sought. On the
dimension of ethnicity, the target sample size was approximately 75 women in each of
the three ethnic groups. Based on this design, a minimum of 600 participants, i.e., 300
for each of the two FFQs recruited across the four geographic regions, constituted this
validation study's desired sample size. By the completion of the data collection period
(July 1993 to January 1994) a combined total of 969 women and children had been
recruited, and of these, 650 had sufficiently adequate 24-hour recall data to be used in the
final analyses.
Study Data
Participants recruited into the study were required to complete an initial
administration of either the Harvard FFQ or the Block FFQ (FFQ-1), three non-consecutive
24-hour diet recalls, and a second administration of the FFQ (FFQ-2). The
three diet recalls were collected by telephone interviews utilizing two-dimensional food
models and were analyzed with the Minnesota Nutrition Data System (NDS 32). The
recalls were used as the reference data for the validation study, providing an estimate of
usual intake for the nutrients of interest to FNS and the WIC program. In analyzing the
study data, the recall reference data were compared to the nutrient intake estimates
resulting from the FFQ administrations. The study also compared manual and
computerized scoring methods for both types of FFQs.
The following nutrients are targeted by the WIC Program and were examined in
this study: protein, vitamin A, vitamin C, iron and calcium. Additionally, estimates of
total energy were assessed because energy is important to pregnancy, lactation, growth
and child development, and because the estimates are potentially useful for performing
nutrient density calculations.
In addition to the validation and scoring investigations, an evaluation of FFQ
usability was conducted. Data were collected systematically for both sets of FFQs, on
each of the following:
Usability for the client
• Time required for FFQ completion by participants
• Amount of assistance required by participants
• Number and type of errors
Usability for WIC staff
• Time required to manually score FFQs
• Ease of manual scoring
Assessment of Usability by WIC Agencies
• Usefulness of FFQs to WIC staff for nutrition education and determining
eligibility
• Opinions and recommendations from WIC staff.
Analytic Approach
A central purpose of FFQs, both for research and for WIC purposes, is to place
individuals along a distribution of intake from low to high. Accuracy of the point
estimates (group means), while useful for some purposes, provides no test whatsoever of
the ability of an instrument to determine correctly whether an individual's intake is low
or high. FFQ group means can be identical to diet recall group means and yet provide
no ability to rank individuals; and conversely, FFQ group means can be significantly
different from the diet recall means, but the FFQ may rank individuals quite well.
Therefore, to be relevant for estimating whether an individual is at increased nutritional
risk, a proposed FFQ must produce adequate correlations with reference data. It is
correlation or categorization that forms the criterion for whether an instrument can
provide a reasonably accurate estimation of an individual's loci .on along the continuum
from low to high intake.
Results
A Balaam 'Study Population
The recruited Harvard and Block study populations were well balanced, that is,
not statistically different from each other in age, distribution among WIC categories,
ethnicity, prior WIC experience, language (Spanish and English) and education. This
remained true after cases with questionably high diet recall nutrient values were dropped
from the analyses.
Rapid Completion of FFQs
Both types of FFQs were completed in less than 10 minutes by both African-
American and White study subjects, and in less than 15 minutes oy Hispanic study
subjects. For all women, the Block FFQ took longer to complete than the Harvard FFQ
with a median time of 9.5 minutes for Block versus 8 minutes for Harvard.
The Brock FFQ Is More Valid for White and African-American Women
The Block FFQ achieved higher correlations than the Harvard FFQ in three- fourths
of the nutrient correlations examined (see Table 1, page 6). Among African-American
and White women, 9 of the 1?. Block FFQ correlations (six nutrients per ethnic group)
were equal to or greater than 0.4, while only one of 12 Harvard FFQ correlations was that
high (note: perfect correlation = 1.0). In addition to agreement as estimated by
correlations, the Block FFQ performed better than the Harvard FFQ for African-American
and White women in its ability to categorize them as high, medium or low with respect
to their true dietary intake. The Block FFQ showed significant agreement between
quartile rankings by FFQ and 24-Hour Recall nutrient estimates for all six nutrients of
interest (energy, protein, vitamin A, vitamin C, iron and calcium). For the Harvard FFQ,
statistically significant agreement was seen for protein and calcium only.
Use of Small-Medium-Large Portion Sizes Improves Validity of the Block FFQ
The Block FFQ permits respondents to describe their usual portion of each food
item as small, medium or large. These reported portion sizes were used in the analyses
of this validation study. The effect of eliminating these multiple portion sizes from the
questionnaire for purposes of simplification was examined. When a medium portion size
was substituted for all responses and the correlations recalculated, the results were poorer.
The use of a standard medium portion size with the Block FFQ is therefore not
recommended.
Neither FFQ b Valid for Hispanic Women
Although the Harvard FFQ had generally higher correlations than Block for
Hispanic women, validity correlations for both were quite poor and thus neither FFQ is
recommended in a self-administered form for either nutrient estimates or to evaluate WIC
TABLE 1
Validity Coefficients for Harvard and Block
African American
Hispanic
White
All Woman
Pregnant
Breast feeding
Non-Breastfeeding
Children
All Cases Included
Harvard Block
Energy 0.18 0.53
Protein 0.22 0.46
Vitamin A 0.00 0.28
Vitamin C -0.36 0.32
Iron 0.02 0.40
Calcium 0.27 0.46
Energy 0.19 0.14
Protein 0.13 0.09
Vitamin A 0.40 0.15
Vitamin C 0.28 0.17
Iron 0.28 -0.01
Calcium 0.18 0.15
Energy 0.27 0.44
Protein 0.33 0.53
Vitamin A 0.28 0.62
Vitamin C 0.33 0.20
Iron 0.27 0.47
Calcium 0.40 0.56
Energy 0.19 0.37
Protein 0.24 0.35
Vitamin A 0.21 0.32
Vitamin C 0.13 0.30
Iron 0.20 0.26
Calcium 0.29 0.42
Energy 0.22 0.30
Protein 0.29 0.32
Vitamin A 0.29 0.26
Vitamin C 0.12 0.18
Iron 0.32 0.05
Calcium 0.41 0.37
Energy 0.23 0.25
Protein 0.18 0.22
Vitamin A 0.23 0.26
Vitamin C 0.05 0.22
Iron 0.06 0.28
Calcium 0.17 0.31
Energy 0.14 0.48
Protein 0.18 0.44
Vitamin A 0.09 0.38
Vitamin C 0.17 0.38
Iron 0.20 0.37
Calcium 0.23 0.43
Energy 0.13 0.14
Protein 0.19 0.15
Vitamin A 0.28 0.03
Vitamin C 0.10 0.19
Iron 0.01 0.15
Calcium 0.27 0.04
eligibility. For Hispanic women, both FFQs could possibly be used for nutrition education and
counseling purposes but not for eligibility determination.
Neither FFQ h Valid for Oiildren
Among mothers and caretakers reporting for children, ages 1-4, it was found that neither
FFQ can be recommended for use in a self-administered form to estimate nutrient intake or to
evaluate WIC eligibility. It is possible, however, that a simple set of brief behavioral questions,
such as "How often do you give your child fruit?" or "How often do you give your child
vegetables?," may be more appropriate for this group. This approach could provide sufficiently
useful information for education and counseling purposes and perhaps for eligibility as well.
Obtaining precise nutrient estimates to evaluate WIC eligibility for children may not be possible
by any method because of the measurement errors associated with proxy reporting.
Manual Scoring May Be Useful to Evaluate Eligibility
It was found that the manual scoring of both instruments is rapid and easy, once
familiarity with the scoring system is attained. The amount of time to manually score the
participants* first FFQ (FFQ-1) was virtually identical for both Harvard and Block FFQs, with
a median time of 3.0 minutes and an average of just under 4 minutes for both. These identical
averages both went down to 3.2 minutes for the second FFQ administration (FFQ-2).
In terms of validity, flexibility, and the ability to distinguish between groups with lower
or higher nutrient intakes, the Block manual scoring system performed better than the Harvard
manual scoring. Among African-American and White women classified as either "low" or
"adequate" using the Block manual scores, the "low" group had a significantly lower mean
nutrient intake (24-hour recall data) than the "adequate" group for all five nutrients of interest.
Only one Harvard FFQ manual score (calcium) achieved statistical significance. Because groups
with low nutrient intakes can better be identified by the Block manual score, this score may be
useful for evaluating eligibility.
Below the RDA for One or More Nutrients is an Inappropriate Eligibility Criterion
On the basis of the diet recall data alone, 95% of the participants in this validation study
were below 100% of the RDA on at least one of the five nutrients of interest (protein, vitamin
A, vitamin C, iron, calcium). An eligibility criterion of falling below 100% of the RDA on one
or more of the five nutrients would then qualify virtually all income-eligible women and children.
Usefulness for Nutrition Education
Opinions were solicited from WIC clinic staff in three states unconnected with the
research project. They voluntarily provided assessments of the FFQs* usability. They reported
that both FFQs were generally useful in collecting dietary assessment information that was
helpful in providing nutrition education to WIC clients. Some believed that the Haivard manual
score related better to WIC eligibility criteria and to nutrition education models such as the "food
pyramid," and they liked the manual score's easy, pass-fail system for rating each food group.
WIC agency staff also felt that the Block portion quantity question regarding how much each
time proved useful for discussing portion sizes with clients.
Few Error* by Most Participants
Relatively little assistance was required by respondents in completing the FFQs. Average
assistance scores for both Harvard and Block FFQs were between no assistance and little
assistance. Neither the Harvard nor the Block FFQ had a sufficiently large number of skipped
food items to be considered a serious source of error.
Further Research
1) Although the FFQs cannot be recommended for Hispanic women, this limitation may
be possible to correct with further work. Some examples would be: examination of FFQ validity
when administered by interview; and investigating culturally-specific issues related to concepts
of food, diet and frequency of food intake.
2) The Block estimates of vitamin C and calcium can be improved by modifying the
frequency categories that were used to assess juices and milk in this study's version of the Block
FFQ. Estimates of these nutrients in other validation studies with the Block FFQ were much
better using different frequency categories for juices and milk.
3) Block manual score cutpoints can be identified that will more accurately reflect the
proportion of the population with nutrient intake below the RDA. The cutpoints for manual
8
scoring used in this study were set before the intake distribution for this WIC population was
known.
4) Because neither FFQ worked well for children, a brief set of questions can be identified
and tested for assessing appropriate dietary intake among children.
Summary
In 1985 the General Accounting Office (GAO) called for a more valid and consistent
method of assessing dietary risk in the WIC program and recommended that there be more
standardization in the way that WIC eligibility is determined throughout the country. This study
has provided a basis for meeting these recommendations. The validity and limitations of these
two FFQs are now known. These results provide a foundation for achieving the desired validity
and consistency in dietary assessment in the WIC program.
Among mothers and caretakers reporting for children, ages 1-4, neither the Harvard nor
Block FFQ can be recommended for use in a self-administered form to estimate nutrient intake
or to evaluate WIC eligibility. For women, however, improvements are still needed and are
possible for both FFQs. Even in its present state, the Block FFQ produces correlations with
reference data for White and African-American WIC-eligible women which are not substantially
different from correlations previously demonstrated in better educated groups. Neither FFQ
performs adequately for Hispanic women. Some of the reasons for this may pertain as much to
the adequacy of the reference data as to the adequacy of the FFQs themselves. Thus, the
potential usability of FFQs for Hispanic populations should not be discounted, but further
investigation is clearly needed.
APPENDIX A
BLOCK FOOD FREQUENCY QUESTIONNAIRE
• Cover Page for Block FFQ (Women's English Version)
• Block FFQ for Women (English Version)
• Block FFQ for Women (Spanish Version)
• Block FFQ for Children (English Version)
• Block FFQ for Children (Spanish Version)
The Block Food Frequency Questionnaires
can be purchased from:
Dr. Gladys Block
419 Warren Hall
University of California at Berkeley
Berkeley, California 94720
(510) 643-7896
Fax (510) 643-6981
/0
WIC Dietary Ai*ej»menl Validation Study
Final Report - September 22, 1994
Appendix A
Cover Page for Block FFQ Women's English Version
Foods You Ate in the Past 4 Weeks
Your Name:
This form will take about 15 minutes to complete.
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WIC Dieury Aitesiment Vilidiuon Study
Final Report - September 22,1994
AppmdiiA
Block FFQ for Women Instructions
Foods You Ate in the Past 4 Weeks
• This form asks about some of the foods you ate in the past 4 weeks.
Remember to include meals and snacks eaten at home or out.
• For every food, please mark with an "X" how often you ate that food.
For example, ifyou drank orangeJuice twice a week In the past 4 weeks,
put an "X'tn the box under "2per week"(see example below).
• Please tell us how much of that food you usually eat each time.
Put an "X" under"How MuJi Each Tune?" for small, medium, or large
is the amount small, medium or large compared to other women vour aee?
Look at the example belowfor a large glass oforangeJuice.
• For some foods the "How Much" will be very specific
For example, Ifyou ate bread twice a day and usually bad about one
• slice each time, you would put an 'X'over the "l'for I slice (see example).
Example:
How Often in the Past 4 Weeks?
How Much
Each Tune?
Foods You Ate in
the Past 4 Weeks
Orange Juice
Brad, inriirtngMfidw^chca,
bageii and burger roth
11
KB MONTH HJtVEEI PEHDAY
'■ 1) "" 1 M W 1 2*
X
X
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>
WIC Dietary AMCionenl Validation Study
Final Report - September 22,1994
AiawdtaA
Block FFQ for Women
Foods YouAte in
the Past 4 Weeks
Banana*
Oranges
Peaches, cantaloupe
Apple*, grapes or
any other fruit
How Often in the Fast 4 Weeks?
How Much
Each Time?
I PER MONTH PER WEEK PER DAY AMOUNT
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s Tomatoes
« Broccoli
7 Greens, spinach
1 Cole slaw, cabbage
• Carrots
10 Green salad
11 Salad dressing
1Z
Potatoes including
French fries
13 Sweet potatoes, yams
14
Cooked green peppers,
chile rellenos
1S Any other vegetable
PER MONTH
IS
PER WEEK
lw< 2 M S-6
PER DAY
2.
AMOUNT
1 § 1
Page 1
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Scale 75% of ontinal
/3
WIC Dieury Aiieinnenl Validation Study
Final Report - Sepember 22. 1994
Appendli A
Block FFQ for Women Page 2
How Often in the Past 4 Weeks?
How Much
Each Tune?
Foods YouAte in
the Past 4 Weeks
IB
17
Cooked cereals, grits
Cold cereals, such as Cheenos,
with or without milk
Milk on cereal
Eggs
Bacon, sausage, links
Spaghetti with tomato
sauce
Hamburgers, cheeseburgers
bee/ burntos, tacos
Beef (steak or roast), ribs
Muted dishes wiih bee/
like bee/ stew
Liver including
chicken liver
Pork, pork chops, roasts
Fried chicken
Other chicken (stewed,
baked or roasted)
Tuna sandwich or
tuna casserole
Fish. Csh sandwich
1sE3
PER MONTH PER WEEK PER DAY
lime
Usi
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23
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month
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W1C Dietary Assessment Validation Study
Final Report - September 22. 1994
Appendix A
Block FFQ for Women Page 3
Foods YouAte in
the Past 4 Weeks
32
33
34
35
36
37
a
Beans like pinto or
re Tried beans
Rice
Chili with meat or beans
(American style)
Vegetable soup,
tomato soup
Any other soup
Pizza
Lunch meats, sliced ham
Hot dogs
n Biscuits, muffins
«0
4?
45
Com bread, com muffins
Margarine or butler
Cheese and cheese spread
Mixed dishes with cheese,
macaroni and cheese
Salsa, uco sauce, ketchup.
hot red peppers
Itrad. including sandwiches
bagels and burger rolls
Com lortillas
Hour tortillas
How Often in the Past 4 Weeks?
!
PER MONTH PER WEEK PER DAY
1 MM
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2 J
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1 Mm
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2
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PER MONTH PER WEEK PER DAY
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WTC Dieury Aiseiimeni Validation Study
Fmal Repon - Septanbrr 22. 1994
Appendix A
Et9
Block FFQ for Women Page 4
FoodsYou Ate in
the Past 4 Weeks
*a
49
50
52
53
Chips, popcorn, crackers,
pork skins
Peanuts, peanut butter
Ice cream or pudding
Yogurt, frozen yogurt
(including lowfat)
Donuts, pastry
Cake, cookies
Chocolate candy, candy bars
Orange juice
Apple juice, grape juice
Kool Aid, fruit dnnks, HiC
Lowfat and slum mil* (not
including milk on cereal)
Regular milk (not
including milk on cereal)
Milk or cream in coffee
or tea
Regular soft dnnks
(not diet soda)
Beer (all types)
All types of wine,
wme coolers
Liquor (all types)
Sugar in coffee, tea or on
cereal (not sugar substitutes))
How Often in the Past 4 Weeks?
How Much
Each Time?
1
■3
PERMWTH PER WEEK PER DAY
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2 H
p»
■i»y
3-4
P"
diy
AMOUNT
■3
E f
AMOUNT
=3
E3fz5
.
Teaspoons
1 1 2 1 3*
Pige4
a
n
am□omla,
Sale 73% of on|inal
/(,
W1C Dieury Assessment Validation Study
Final Report - September 22.1994
Appendix A
Block FFQ for Women Page 5
WfW!'!^55WR7?T™ff7T!,!W^
•aft
During the past 4 weeks, how
many pills did you usually take?
Multiple Vitamins
66
6?
Prenatal vitamins
Multiple vitamins like
Onc-a Day tablets
Single Vitamins
6fl
n
Iron pills
Calcium pills
Vitamin E pills
Vitamin C pills
1
PER WEEK PER DAY
IS
P"
wttk
1
f
2
P"
3
p»
4
P» P»
I
PER WEEK PER DAY
IS
V
44
P»
week
P»
2 3f
**
4
P» p"
1/ you take Vitamin C, how many milliitrams
of Vitamin C is in each tablet'
■
100 230 MO 1000 Don't
Imam
Thank you for completing this form!
Do Not Write
P*ft 1
PM<2
P»«e5
P*c4
TOTAL *...
i
:'»■''
;:><W
'•
Scale 73% of ongui.l
/?
WIC Dietary Asieiimeni Validation Study
Find Report - September 22. 1994
Append!. A
Block FFQ for Women (Spanish Version) Instructions
Alimentos Que Usted Comio en las Ultimas 4 Semanas
• Este cucstionario le pregunta sobrc algunos de los alimentos que usted comio en
las ultimas 4 semanas. Acuerdese de incluir comidas y meriendas/entre comidas
dentro y afuera de su casa.
• Pan cada alimento. por favor marque con una "X" debafo de la casilla que indica
que tan seguido usted comi6 ese alimento. For ejemplo, si usted bebidjugo de
naranja dos t/eces por semana en las ultimas 4 semanas, marque con una "X"
en la casilla bajo '2por semana' (vea el ejemplo que sigue).
• Por favor dejenos saber la cantidad de ese alimento que se come cada vez. <Es la
canudad pequena. mediana o grande romparada con otras m»jfM de ffl ttatrtl
Marque con una "X" bajo "<Cuanto Cada Vez?", escogiendo entre ChicQ, Mediano
y Giandc Fijese en el ejemplo que sigue para un vaso dejugo de naranja
grande.
• Para algunos alimentos. "<Cuanto Cada Vez?" sera muy especifico. Por ejemplo,
si usted comid pan dos veces at dta y usuabnente se comld una rebanada
cada fez, usted marca con una "X'sobre et'l'por una rebanada (vea el
ejemplo que sigue).
Ejemplo:
cQue Tan Seguido en
las IJhimas 4 Semanas'
(Cuanio
Cidi Vez?
Comidas Que Comio en
las Ultimas 4 Semanas
Juapdc nanr^L/ctmrm
Pan induycndo
batch r pandc
1
3
"Of MES KM SEMANA •ORDIA
m4
M '- I H K
«•
I.
X
X
OJANTO
1 i
1 iX
|CMn>ia*ial
XI 2 |3*
Sole 75* at ongin.1
n
WIC Dieury Aneiunenl ViJidalioo Study
Final Repon - September 22.1994
AppeadJi A
Block FFQ for Women (Spanish Version) Pagel
—-?
■*orJk*eairfta'$m
rt»Afc«*>:§
(QucTan Seguido en
las Ultimas 4 Scmanas?
Comidas Que Comio en
las Ultimas 4 Scmarias
PUlancM/guineos/bananoA
Nannjas/chinas
Mclocoiones/duraznoa o
mel6n cantalupo
Mirnrav uvas u otra fruu
5
6
7
t
»
10
11
1?
13
Tomalc
Broccoll/hrccol
Espinaca
Enaalada dc col, rrpollo
Zanahonai
II
Ensalada dc lechuga
Adcmo para ensalada. o
mayonesa. abno
Papa* IncJuycndo papa fnuu
Biuui. Auna. amoia
Chile rcllcnoa
Cualquier oira vcrdura/vrpjcLal
31
3
FORMES PORSEMANA P0RD1A
lia
ad
M
ad
MMfc
1 «n I H
——
l
at
I*
At
1 1
1
1.
1 . .-. .-. -i
(Cuanto
CadaVez?
9
i3
P0RME5 PORSEMANA P0RD1A OJANT0
lia
ad
■a
-d>
H
ad
■a
HUM
P»
2
P»
5-4
1"
1
fit
1«
1
oi1
aiAvro
ll 3
—
Pl«C 1
IptJIIP
**1 i!iPe™£
-0>!
O
OS
r ■■ &
■
■
iffff;
TTTT
ri'Illi
Sole 73% of on|inal
/?
WIC Dietary Asiesimenl Validation Study
Final Repor. ■ September 22. 1994
Appendix A
Block FFQ for Women (Spanish Version) Page 2
iQueTan Scguido en
las Ultimas 4 Scmanas?
Comidas Que Comio en
las Ultimas 4 Semanas
20
Cereal coado
Cereales fricM, como Cheems
con o tin leche
Lcche en cereal
Hucros/b lanquiUCM
Todnela/tocino, sale hie has
21
22
23
24
hspaRhcli con salsa
dc lomalc
Hamburgucss, hamburguesas
con queao bumu» de res. tacos
Bisiec o rotbU/camc dc res,
coaiillas
Caldoderes
Higado tncluycndo higado
de polio
Cerdo incluvendo chulelas.
aaadoa, pucroD/numno
2' PoUofnio
(dro polio (polio en caldo.
homcadoo asado)
Sandwich dc alun o
*uma nmrrole*
Peacado o sandwich de
peaodo
i•
3
PORMES PORSEMANA PORMA
1 «n
ad
■a
MM*
H
tad
■ o
MM*
lia
V
1
r* f p» P»
J.
P»
as
3
t
3
PORMES PORSEMANA PORDU
I "i
ad
13
ad In 2 M v»
*■
I*
OS
' 1
(Cuinio
CadaVez'
dlANTO
1
Oi1
41
J
Karros
1 |2|3*
(C«iMo'
1 | 2 |3+|
QJANTO
1
oi1
1
Page 2
Par Faroe
B»crtb«
to
T
"*$SmDD1
Scale 75% of or aJ
jSi
WIC Dieury Aiseiimenl Validalion Study
Filial Repon - September 22.1994
Appcftdii A
Block FFQ for Women (Spanish Version) Page 3
cQuc Tan Scguido en
las Ultimas 4 Semanas?
Comidas Quc Comio en
las Ultimas 4 Semanas
31
33
35
37
Frijoles como frijo' pinto o
refritos o habichuelas
Arroz
'Chili con came" atilo
amcricano
Sopa o caldo dc verdures/
vegctales o tomales sin res
o polio
Otres sopas o caldos
Pizza
Jamon. fiambres, carries (nay
came de lonche
Hoi dog/pcrro caliente
*0
O
'$
4?
Paneallos. btzcochos/
bisquetes
Pan de maiz. panccilkx
dc maiz
Manzanna o manicquilU
Quoo y qucso cretna
PUUlkM con quno incJuycndo
macarron con quoo
Salaa. kcichup chiles ro,os
ptcanics
Pan incluycndo sandwiches,
luge Is y pan dc hamhurjtucsa
Tool] Las dc nuu/miu
Tortillas dc hanru
31I
FORMES PORSEMANA PORDU
1 *I 1J
ad
F""b
1 «a 1 H •>*,
<M
u
•>
(Cuinto
CadaVrz'
s
r.
3
FORMES PORSEMANA PORDU OIANTO
1 m
F—*>
1-3
ad
F~*>
Im 2 5-4 *4
eki
1* 1
O
•8
j
IdMUdB
1|2|3*
Rcfewadas
1 1 2 |3*
Hot Dap
1 1 2 [§♦
(UANTO
J
•sI
41
J
Catfawz
1 1 2 |3*
> 1 2 13*
1 | 2 |3*
Page 5
IGD
Scale 75* of origin.)
21
WIC Diuary Aiieisment Validation Study
Final Report - September 22.1994
AppcftdliA
Block FFQ for Women (Spanish Version) Page 4
*sn
fQutTan Seguidoen
las Ultimas 4 Scmanas?
(Cuinto
CadaVez'
Comidas Quc Comio en
las Ultimas 4 Scmanas
Bocaditos salados como
papilas frilas, palomitas de
mm. chicharron de pucrco
Maniea/cacahualea, manlcyuiBa
de mani/crema dc cacahuate
Helado/nieve/mantecado,
budin/pudin
Yogurt o yogurt congclado
Donas, pan duJcc
Pastel, torus, galletts
Dulce de chocolate
55
56
50
60
6'
62
63
65
Jugo de naranp/chiru
Jugo de minuru o dc uva
KoolAid o bcbidas de fruu,
aguas frescas
Lee he deacTemada/"lowfal*
(•in Incluir leche en cereal)
Lee he entera/" whole"
(sin incluir leche en cereal)
Leche o crcma con ca/e o le
Sodas (sin incluir sodas
de dieu)
Cerrexa
Todo upo de vino, 'wine
coolers*
Ucor, todo 'ipo dc lie or
Alucar en ca/e. te o con cereal
(sin incluir azucar de dicta)
1sI
FORMES PORSEMANA PORDU CUANTO
lit!
r»d
MS
1-3
■ts
RWdD
In 2
HIMH1
M
P»
MBMS mmtm
1
f
4.
J.
P» 1
o
1 1
• • • 1 ' 1 > > 4)
3»
I
15
mrl
PORSEM^SA PORDU
1 «a 1-4 u
tt
1
a*
M
aiA.vro
Page 4
PorftwrorNo
Q
O
IQ
Scalr ""5% of original
A* WIC Dietary Assessment Validation Study
Final Report - September 22. 1994
Appendix A
Block FFQ for Women (Spanish Version) Page 5
<Durante las ultimas 4 scmanas, cuantas
pildoras sc tomo usualmcnte?
Vitaminas Multiples
67
Vitaminas prcnaules
Vitammas multiples como
VHamina Una al Dia
1
PORSEMANA FOR DIA
1-3 44 ' 2 J 4 5»
Vitaminas Individuates
Pildoras/tabletas de hierro
PildorasAabletas de calao
VitaminaE
Vitamina C
PORSEMANA PORMA
1-5 44 ' I J 4 »♦
T!
«Si usied toma Vitamina C. cuantos mUicrajnoa
de Vitamina C tienc cada piidon'
100 HO wo 1000
No
*
iGraclas por completar este cuestlonario!
Scale 75% of on|maJ
JL3
WIC Dietary Assessment Validation Study
Final Report - September 22.1994
AppendliA
Block FFQ for Children Instructions
Foods Your Child Ate in the Past 4 Weeks
• This form asks about some of the foods your child ate in the past 4 weeks.
Remember to include foods eaten at day care or with relatives or friends.
• For every food, please mark with an "X" how often your child ate that food.
For example, ijyour child drank orangejuice twice a week In the past 4 weeks,
put an "X'tn the box under "2per week'(see example below).
• Please tell us how much of that food your child usually eats each time. Is the
amount small, medium or large compared to other children of the same age?
Put an "X" under"How Much Each Tune?" for small, medium, or large.
Look at the example belowfor a large glass of orangejuice.
• For some foods the "How Much" will be very specific.
For example. Ifyour child ate bread twice a day and usually bad about one
slice each time, you would put an 'X'over the "I 'for 1 slice (see example).
Example:
How Often in the Past 4 Weeks'
Compared lo
OUMrCMloNn
How Much
Each Tune'
Foods Your Child Ate
in the Past 4 Weeks
Orange )uicc
i*rad, inducknR nnclwKhes.
bagelt ind burfcr rofl*
1
HJMOVTH PEBWEE* PER DAY
2 M $4
•nfc
1
V
X
X
AMOUNT
! | *
X
XI * |3-
Scale 73% of onfmai
-m WIC Dietary Aiieiimeni Validation Study
Final Report - September 22. 1994
AppeadliA
Block FFQ for Children Page 1
Child's Name:.
Foods Your Child Ate
in the Past 4 Weeks
Bananas
Oranges
Peaches, cantaloupe
Baby food fruit
Apples, grapes or
any other fruit
10
15
Tomatoes
Broccoli
Greens, spinach
Cole slaw, cabbage
(arrots
Green salad
Salad dressing
Potatoes including
French fries
Sweet potatoes, yams
Cooked green peppers,
chile rellenos
Any otner vegetable
1 » Often in the Past 4 Weeks?
I PERMOVTH PER WEE* PER DAY
1 tune
mon 111
2}
tax
mon*
IBM
V
wttk
2
f
wttk wttk wttk
1
P"»
2*
V*
Is
■3
PERMOVTH PER WEEK PER DAY
IMw
fcu
■MM*
25
hsl
■M*
P»
wttk
2
r*
wttk
M
wttk
S-o
V
wttk
2*
P"
i
■
1
L_ 1
1
1
Compared lo
OUKT Children
How Much
Each Time?
AMOUNT
1
e
%z 1
AMOUNT
iz !
Piael
DoNbtTrrte ;-#*:Below. ■
•D
:QP^[X]J
<*:^x '>,:■'; ■<>■(/ <:*'. ;"
.<s
:■%;.**
SS3SI;*■-<!
Scale 75* of ongmil
Xi
WIC Dieury Assessment Validation Study
Final Report - September 22. 1994
AppestdiiA
Block FFQ for Children
Child's Name:
How Often in the Past 4 Weeks?
Foods Your Child Ate
in the Past 4 Weeks
Cooked cereals, grits,
hoi baby food cereals
Cold cereals, such as Cheches,
with or without milk
Milk on cereal
Sugar on cereal
Eggs
Bacon, sausage, links
n
24
24
26
27
Spaghetti with tomato
sauce
Hamburgers, cheeseburgers
beef burn tos, tacos
Bee/ (steak or roast), ribs
?s
Mixed dishes with beef
like beef stew
Liver including
chicken liver
Pork, pork chops, roasts
Fned chicken
Other chicken (stewed,
baked or roasted)
1 una sandwich or
tuna casserole
Fish, fish sandwich
lie
Other CMUkm
How Much
Each Time?
!
!
PERMOKTH PER WEEK PER DAY
IMM
kat
■oaft
M
ksi
■MM*
IMM
V*
wttk
2 r*
wttk
M
P»
wttk
*-*
wttk
9-
Ciy
2*
V
!
I3
PER MONTH PER WEEK PER DAY
1 tar
MSI
•KM*
2 J
koi
•KM*
P»
■eat
2
P»
wttt
f
wttk
f
wttk
1
Vm
2*
V
<-Y
AMOUNT
I
I I 1
Teaspoons
1|2|3+
1 | 2 [3*
Pwui
1 | 2 |3*
AMOUNT
1
E a1Z f
•
P»ge2
Page 2
□an
: :
oinii
iiip
liilii
Sale 75ft of original
yjo
WIC Dietary Aiieumcni Validation Study
Final Repor. - September 22.1994
Appendix A
Block FFQ for Children Page 3
Child's Name:
Foods Your Child Ate
in the Past 4 Weeks
33
Beans like pinto or
refried beans
3* Rice
35
Chili with meat or beans
(American style)
36
Vegetable soup,
tomato soup
37 Any other soup
38 Pizza
30 Lunch meats, slued ham
40 Hot dogs
Biscuits, muffins
«; Com bread, com muffins
43
44
a
48
Margarine or butter
Cheese and cheese spread
Muted dishes with cheese,
macaroni and cheese
Salsa, taco sauce, ketchup,
hot red peppers
Bread, inducing sandwiches
bagels and burger rolls
Com tortillas
Hour tortillas
How Often in the Past 4 Weeks?
I
3
PER MWTH PER WEEK PER DAY
IMe
tail
mon*
2-3
tad
1 M*
P"
wrtk
2
f
seek
H
P»
«Mfc
54
f
•Mk
1
P»
2*
V
11
1
1 PER MONTH PER WEEK PER DAY
m*
23
■0**
1 t» 2 54 1 2*
P»
Coaparadto
Othar Oildm
How Much
Each Time'
AMOUNT
1 E I
SLces
1 1 2 |J4
Stca
1 | 2 13*
Hol&op
AMOUNT
1 E
1
Il2|j*
1 | 2 |3*
tanflai-AiM
lilal*
PtajeS
Not Write
Briow
■
m
■™
Q::::
y i,.j
\wrt~t' •* ..... ... X:,.. *
■p|.|«pg:::«s^;:ip;
Scale 75% of ongmal
^7
WIC Dieury Astesiment Validation Study
Final Report - September 22.1994
Appendii A
Block FFQ for Children Page 4
Child's Name:
How Often in the Past 4 Weeks?
Foods Your Child Ate
in the Fast 4 Weeks
50
5,
52
53
54
55
56
Chips, popcorn, crackers,
porkikins
Peanuts, peanut butler
lec cream or pudding
Yogurt, frozen yogurt
(including lowfat)
Donuts, pastry
Cake, cookies
Chocolate candy, candy bars
57
5*
be
SO
81
•?
Orange juice
Apple |uice, grape juice
Kool Aid. fruit drinks. I!i-C
Lowfat and skim milk (not
including milk on cereal)
Regular milk (not
including milk on cereaj)
Regular soft drinks
(not diet soda)
It*
OMOUta
How Much
Each Time'
1 PER MONTH PERWEH PER DAY AMOUNT
IHK
■oa*
23 2
«cek
M
«uk
1 2*
3 Iat *
I
J
1)
PER WES PER DAY
law 2-4 S-i l 2
Scale 75% of onimaJ
#
WIC Dietary Aiseiiment Validatiori Study
Final Repon - September 22.1994
Appeadii A
Block FFQ for Children Page 5
Child's Name:
During the past 4 weeks, how many
pills did your child usually take?
Multiple Vitamins
Pills, chcwiule ubieu or liquid
63
Multiple unms like One-a-Day
tablets, children's vitamins
PERWEEX PER DAY
1-3 44 1 2 3 4 3+
I P» r* r» ¥* f P» P»
aeek wk *r ** ** «> *y
Single Vitamins
Pills, chcwible ubteu or liquid
64
65
66
67
M
Iron pills
Calcium pills
Vitamin E pills
Vitamin C pills
1
PER WEEK PER DAY
IS
P»
aofc
4-6
P"
seek
1
V
2
f
3
P»
4
f i»
Aw,
V your child takes Vitamin C, how many
milligrams of Vitamin C is in each uhki'
100 2S0 300 1000 Don!
fan*
Thank you for completing this form!
Page I
rHac 2
Pa«e4
TOTAL
SKaScBiK
Do Not Write
Below ,
r:m
■■:■
m
■a
.y>.v
.f
wt'irm
Scale 73% of onginal
^f
W1C Dieury Assessment Validation Study
Final Report - September 22. 1994
Appendix A
Block FFQ for Children (Spanish Ve.*ion) Instructions
Alimentos Que Su Nino/a Comio en las Ultimas 4 Semanas
• Estc cuestionario 1c pregunta sobre algunos de los alimentos que su nino/a sc
comio en las liitimas 4 semanas. Acuerdese de incluir los alimentos que se hayan
contido en la guarderia infant il o con familiares o amistades.
• Para cada alimento, por favor marque con una "X" debajo de la casilla que indica
que tan seguido su nino/a com16 ese alimento. Por ejemplo, si su niflo/a bebld
jugo de naranja dos veces a la semana en las ultimas 4 semanas, marque con
una "X'enla casilla debajo de "2 por semana' (vea el ejemplo que stgue).
• Por favor dejenos saber la cantidad de ese alimento que su nino/a sc come cada
vez. <Es la cantidad pequena. mediana o grande comparada con otros ninos de la
misma edad? Marque con una "X"bajo"«Cuanto Cada Vez?". escogiendo entre
Quco, Mediano y Grande Fljese en el ejemplo que stgue para un vaso de jugo
de naranja grande
• Para algunos alimentos."<Cuanto Cada Vez'" serf muy especifico. Por ejemplo,
si su nMo/a comtd pan dos veces al dia y usualmenle se comld una rebanada
cada vez. usled marca con una 'X'sobre el'I'por una rebanada (vea el
ejemplo que stgue)
Ejemplo:
«Que Tan Seguido en
las Ultimas 4 Semanas'
Gompando a
tt/o* nftm
<Cuanto
Cada Vez?
Comi das Que Su
Nino/a Comio en las
Ultimas 4 Semanas
Juav de naranta/cluna
Pin induvrrulo auidwtche*,
tmnett y pan dc hamburfueaa
i
nmc POR SEMANA POR DIA
i« n
m a • •) laa I M S4 1
r*
•*
u
p"
•fa
| X
X
OJA.VT0
1 9
I -8
J
X
XI2I*
Scale 75% at onfinil
2><>
VIC Dieury Aiienment Validation Study
Final Report - September 22, 1994
Appendix A
Block FFQ for Children (Spanish Version) Pagcl
Nombrc del Nino/a:
cQueTan Scguido en
las Ultimas 4 Semanas?
Comidas Quc Su
Nino/a Comio en las
Ultimas 4 Scmanas
PlaUnos/gulncos/bananos
Naranjaa/chinaa
Mclocotoncs/dununos o
melon carnalupo
Corokla de mho fruu
Manzanas. uvas u olra fruu
Tomates
Broccoli/brecol
hsp ruca
Enulada de cx>l. repollo
Zanahonas
Enulada de krehuoa
Adentzo para ensalada. o
mayonesa. ahno
Papal Incluvendo papas fniaa
Batatas names, camoies
Chile rcltcnos
CuaJquier olra vrrdur»/ve»eial
OUXM nines
(Ciiinio
Cada Vez'
2a
3
PORMES PORSEMANA PORDIA
1 <a
tad
■a
n
cad
■wt
P—to
In
■ !■■■■
t 3-4
P"
1
P» *•
1*
•a
3
9
PORMES PORSEMANA PORDU
1 «a u
cad lea 2 H ♦4 l It
—
1 1
I— i
|
i
t
i 11
1
1
auvro
1
o11
|
CUAWTO
3
ei
1
*
Pue 1
:SS
!:V'S"U:W;'!!
D
Dt.::,
. D. ■
Sale 75* of original
3/ WIC Dieury Asseinnent Validation Sludy
FinaJ Report - September 22. 1994
Appendli A
Block FFQ for Children (Spanish Version) Page 2
Nombrc del Nino/a:
iQueTan Seguido en
Us Ultimas 4 Scmanas?
Comidas Que Su
Nino/a Comio en las
Ultimas 4 Scmanas
17
18
19
20
21
72
Cereal coodo, comida dc
ninos cereal calienle
Cereales fnos, como Cheertoa.
conont lechc
Leche en cereal
Azucar en cereal
Huevos/bUnquillos
Toaneu/locino, ulchlchas
23
n
26
2'
29
»
hsnagheti con salsa
de tomate
Hamburguesas, hamburguesas
con queso. bun-lias de res, am
Biiict o rosbuVcarnc de res,
coalillas
Caldo de res
HiRado incluycndo higado
dc polio
Cerdo incluycndo chuleta*.
asadoa, pucrco/manrano
Poilo (nto
Otro polio (poilo en caldo.
homcado o aaado)
Sandwich dc aiun o
*tuna cauerole*
Pcscado o tandwicn de
2
t
3
PORMES PORSEMANA PORDIA
cad
l-l
p-*to
1 M M
•>
I*
"""" """ uaui
otrra ntAo*
<Cuinto
CadaVez'
s
3
PORMES PORSEMANA PORDIA
lm
cad
M
•ad In I M W 1 t*
OJANT0
1
sI
J
OKaanuacu
1 | 2 ! 3+
Huero*
1 | 2 13*
,c*«to'
1 1 2 13*
OAVTO
1
ei1
•«
J
Page 2
COT:■■':;■ ■:■
w\ 1 1 !
1 1
? 1 1 1 ' □ ■&%
?|s I m
ifSIQQ
Sole 75% of onimal
w- WIC Dietary AJleumen! Validauon Sludy
Final Report - September 22. 1994
AppendliA
Block FFQ for Children (Spanish Version)
Nombre del Nino/a:
cQueTan Scguido en
las Ultimas 4 Scmanas?
Comidas Quc Su
Nino/a Comio en las
Ultimas 4 Scmanas
33
34
35
36
37
36
38
40
Frijoles como frqol pinto o
refhlos o habichueU*
Arroz
'Chili con came' eslilo
amcricano
Sopa o caldo dc verdures/
vcgetales o tomato no
induyendo res o polio
Otras sopas o caldos
Pizza
Jamon, fiambrcs, carncs frias.
came de lonche
Hot dog/perro caHcntc
42
43
45
47
49
PancalkB bucochos/
bisqueles
Pan dc maiz. panecUlos
de maiz
Manzanna o manlequilb.
Queso y queso crcma
PlatJIos con queso incluycndo
macarron con queso
Salsa, ketchup, chiles rojot
picantes
Pan induyendo sandwiches,
haaeb y pan de hambunjnjcsa
Tortilla* de maiz/maaa
Tortilla* de hanna
is3
POBMES PORSfMANA PORDU
if
mtt
13 l"o 1 H U
•a
1.
iki
ocraintiWa
(Cuinto
CadaVez?
8
3
FORMES PORSEMANA PORDU
tad
SKI
1-3
tad l«B I H M 1 1*
aa
OUNTO
1
ei
I J
trtiisiitoi
1 | 2 |3*
ktnMsdss
• 1 2 |3*
Hot Dap
1 1 2 |3*
aiAvro
3
ei
I •8
Caaata
1 1 2 |3*
IM4I-I -J
1 | 2 |3*
1 I 2 |3*
Page 3
Page 3
•JFjr/orNo
SscrabaAbaJo
v,S
n
ir
o
a
S&
Scale 75% of original
33
WIC Dietary Aiienmeni Validation Study
Final Report - September 22.1994
AppeiKsli A
Block FFQ for Children (Spanish Version) Page 4
Nombre del Nino/a:
i QucTan Scguido en
las Ultimas 4 Scmanas?
oum riAm
(Cuinio
CadaVei'
Comidas Quc Su
Nino/a Comio en las
Ultimas 4 Scmanas
50
51
52
53
5*
55
56
Bocaditos salados como
pa pitas fritas, palomius de
maiz, < hicharron de puerco
Manies/cacahuates, manirquiOa
dc mani/crema dc cacahuatc
Hclado/nievc/mantecado,
budin/pudin
Yogurt o yogurt congebdo
Donas, pan d jlec
Pastel, torus, galletas
Dulcc de chocolate
S7
M
w
60
II
Jugo de narania/china
Jugo dc manzana o de ura
Kool Aid o bebida* de fruta.
aguas frcscas
Lethe descremadaTlowfat*
(sin incluir leche en cereal)
Lee he entera/" whole"
(sin incluir leche en cereal)
Sodas (sin incluir sodas
de dieu)
iz3
PORMES PORSEMANA PORDLA OAVTO
1 WI
ad
■a
Mud»
1-3
ad
■a
pwdD
1 us
p»
WSJ
2
P»
■mini
3-4
P"
34
MAMM
P»
1*
P»
#i 1
oiI
j
s13
I-J
ad
PORSEMAM PORDIA OJANT0
I ti 1-4 U
■i
2 3-4 34 i
oi1
■8
Page 4
PorFarrorNo
Stratha Abad)r>
D
.DC
D:;:
tDDfeD
DQIC!
?:>
wm*■■■■■ *
Scale 75% of original
3^
WIC Dietary Assessment Validation Study
Final Report ■ September 22. 1994
Appendix A
Block FFQ for Children (Spanish Version) Page 5
Nombre del Nino/a:
jDurante las ultimas 4 scmanas, ?uantas
pildoras usuaJmcnte tomo su nino/a?
Vitaminas Multiples
Pildoras lablelas. o en huuido
63
Viumuus multiples como ViUmiru
I IU al Dia. vitaminas para ninos
Vitaminas Individuals
Pildoras uhleus o en liquid..
M Pildoras/tablelas de hierro
65 Pildoras/tablelas de caJcio
66 Viiamina E
6? Viumina C
I
#
PORSEMANA PORDU
15
P"
VflUAl
4-t
V*
■rnuAi
i
P«
du
2
a.
5
P»
du
4
P"
du
5.
P»
dii
i■
m
PORSEMAM PORDU
l-J
V*
wmam
4-e
P»
KIUM
I
P»
du
l
p"
du
5
P"
to
4
P»
du
P"
du
(Si su runo/a toma Viumina C. cuamo* miligramo*
de Viiamina C Uene cada pildora'
1 100 I 2S0 soo 1000 No
■
(Graclas por completer este cuesllonario?
Pa«e 1
Pa»e2
Page J
Page 4
TOTAL
Por Favor No
Encrtt)« Ab«Jo
s= £ I ! I
Scale 751 of ongmal
3S
WIC Dietary Asiesimeni Validauon Study
Final Report - September 22. 1994
Appendli A
APPENDIX B
HARVARD FOOD FREQUENCY QUESTIONNAIRE
• Harvard FFQ Administration Instructions
• Harvard FFQ Manual Scoring Templates
• Cover Page for Harvard FFQ (Women's English Version)
• Harvard FFQ for Women (English Version)
• Harvard FFQ for Women (Spanish Version)
• Harvard FFQ for Children (English Version)
• Harvard FFQ for Children (Spanish Version)
Important Note: The actual Harvard Women's and Children's questionnaires have the
alternate items printed on a shaded background tofacilitate reading across thefrequency
response categories. This is an important design feature which, unfortunately, could not
be faithfully photo-copied on the examples printed in this Appendix. The questionnaires
used in this validation study, obtained directly from Harvard School of Public Health,
had the shaded items on them. An example ofalternate shaded items can be seen on the
Block FFQs in Appendix A.
The Harvard Food Frequency
Questionnaires can be purchased from:
Dr. Jane Gardner
Department of Maternal and Child Health
Harvard School of Public Health
677 Huntington Avenue
Boston, Massachusetts 02115
(617) 432-1080
Fax (617) 432-3755
E-mail:JGardner@HSPH.HARVARD.EDU
3&
WIC Dietary Assessment Validation Study
Final Report - September 22, 1994
Appendix B
Harvard FFQ Administration Instructions
Ricoumdid Verbal Instruction for Administering the
■Qitn'i anc children's Food Frequency Questionnaires
1. Pill in the client identification information in the upper
right hand corner. Be sure to fill this in completely as
the information is necessary to carry out the analyaes.
2. Provide the appropriate questionnaire, clipboard, and
pencil. Say to the woman,
"This is the form we would like you to fill out. It has
three sides. He want you to think about what you ate (or
your child ate) during the last four weeks. He know you
can't remember exactly, but you probably have a good idea."
Read the direction on the form aloud while pointing to them.
"You select how often you ate the food froa zero tiaes in
the last four weeks to six or sore tiaes each day," [point
to the scale above the column].
"Suppose you (or your child) drank one glass of milk [point
to ailk] everyday [point to per day]. Then you put an X or
a check here [point]. Thia column is for foods you had just
one to three tiaes in the laat four weeka [point]."
"He are saking about serving of food, not taatea. So if you
put an X here [point to ice cream, 6+/day], that would aay
that you had eaten aix or store bowls of ice cream every day
for the paat four weeks. Use this column only for foods you
ate a lot of every day. Remember to make a mark in thia
coluan [never] If you did not eat the food. It helps you to
keep your place and it helps us to know that you did not
forget a food."
3. Hatch as the client fills out the first three foods to be
sure she understands the instructions.
4. Collect the finished form and check for errors in
completion, i.e., pages or rows not filled in, double marked
rowa, number of eggs.
Scale 75% of ongmal
\1
WIC Dietary Assessment Validation Study
Final Report - September 22,1994
AppcadliB
Harvard FFQ Manual Scoring Template 1
Template to Score Women's and Children's Nutrition Questionnaires
Pl« tha Diractioaa in tha Order divan
Milk Producta aad Pruite
1. Placa thia template en Page 1 ao
that tha two ahadad boxti ahow
through tha holaa in tha taaplata.
2. Count tha ehaeka in aach column,
and writa tha numbera in tha boxaa
banaath aach column.
3. Uaing tha colora abova tha boxaa
and ha nunbara in tha boxaa,
compare with tha following
combinationa (or a match working
from right to laft. Onca a match
la found, mark tha ahadad box on
tha queetionnaire with tha eymool
in tha gray box (X or -) next to
tha matchad combination.
In tha combinationa, any number
that croaaaa two or mora amall
boxaa ia tha TOTAL of thoaa amall
boxaa.
4. Onca you hava markad tha ahadad
box, go to tha naxt food group.*
Hilk Product* Combinationa
1
4 1 1 -
il X
z2 t X
*2 1 6 X
£1 1 1 0 X
2 0 1 1 0 X
«3 0 0 X
No match -
fruit* Combination*
| iiO 1 1 -
ti
ft] 0
<«| : 0
1 •* 3 1 0
! tl 2 1 0
1 *s 1 1 0
1 t^ 6 1 0
1 t"> 6 0
£2 6 6 S
14 S 0 0
ti 4 0 0
a J fi 6
No match -
Tha ahadad boa with tha mark ]X|
indieataa tha minimum intaaa nee
baan mat or axcaadad.
Tha ahadad box witn tha mark !•]
indieataa tha minimum intaka haa
not baan mat.
Coavrifkl IWl. Harvard School of Public Health
Scak75%ofonsiaal
WIC Dietary Areeaarneat Validation Study
Final Report • September 22.1994
AppaadlxB
3?
Harvard FFQ Manual Scoring Template 2
Vegetablee
1. Place Chi* tMDlltl on Paga 2 ao
that tin ahadad box ehowa through
tha ho la in tha template.
2. Count tha chacka in aach column,
and writa tha numbara in tha boxaa
banaath aach column.
3. Multiply tha numbar in tha box
undar B2 by 2. Add that raault to
tha numbar in tha box undar Bl,
and writa tha aun in tha circle.
«. Using tha colors above tha boxaa,
tha numbara in tha boxaa, and tha
circlt, compara with tha following
combinationa for a match working
from riqht to laft. Onca a match
la found, mark tha ahadad box on
tha questionnaire with tha eymool
in tha gray box (X or -) naxt to
tha matched combination.
In tha combinationa, any numbar
that croaaaa two or more amall
boxaa ia tha TOTAL of thoaa amall
boxaa.
5. Onca you hava markad tha ahadad
box go to tha naxt food group.*
Vegetafciaa Combinationa
Page 2
—1—1 1 1 1 I
ts ( )
( )
( )
( )
( )
( *2)
( *7)
( )
( «2>
( «9)
(214)
( )
{ *1>
( *»)
(111)
(216)
(121)
0 0
22 X
21 1 H X
23 ft I X a i 6 f x
i i 0 X
0 i ft X
l) l ft X
L 3 • 6 X
1 . a X
| 5 ■ 0 X
ti 0 0 X
4 6 6 X
5 0 Oil
J 6 6 I x
i 6 0 X
4 8 a X
No maten -
Bl B2
Bl ♦ ( B2 2 >
Tha ahadad box with tha mark
indlcataa tha minimum intaka
been mac oi axceadad.
Tha ahadad box with the mark
indicataa tha minimum intaka
not brnan mat.
na.
Coornthl 1991. Harvard School of Public Health
Scale 75% of original
3^
W1C Dietary Anommi Validation Study
Final Report - September 22. 1994
Appendix B
Harvard FFQ Manual Scoring Template 3-1
NMta
1. Place this template on Page 3 ao
that tha ahadad box ahowa through
tha hola in tha template.
2. Count tha chacka in aach column,
and write tha numbara in tha boxaa
banaath aach column.
3. Maka an adjuatment for aqge by
adding 1 to tha numbtr of ona bos,
aa ahown balow:
Page 3-1
Numbar of
agga/wk
Chlldran
1
2 or 3
45
or mora
Non
♦ 1 I*1
!♦!
♦1
♦1 !♦!! I
4. Uaing tha colora abova tha boxaa
and tha numbara in tha boxaa,
compare with tha following
combinationa for a match working
from right to laft. Onca a mater
la found, mark tha ahadad box on
tha quaationnaira with tha eymbol
in tha gray box (X or -) next to
tha matched combination.
In tha combinationa, any numbar
that croaaaa two or mora amall
boxaa la tha TOTM. of thoaa amall
boxaa.
5. Onca you have marked tha ahadad
box, go to tha naxt food group.*
Jtaata Combination*
"TI £6 0 0 || -
2i D x
ti 0 1 X
ti l 0 1 x
21 l l 0 X
ft] 0 1 i 6 X
fti 0 6 X
zi } 6 0 X
ii I i 0 6 X
24 0 1 0 6 X
tS 1 u J) X
21 4 l 6 6 X
ft3 i i 6 6 X
2S i 1 0 fl X
•> i l u 6 X
2* 6 B 0 X
ftj b 0 0 0 X
4 4 0 0 0 X
Mo match -
Tha ahadad box with tha mark
indicataa tha minimum intaka
baan mat or axcaadad.
Tha ahadad box with tha mark
indicataa tha minimum intaka
not baan mat.
3-3 ft4
1 ♦ I ♦ 1
| •1 ♦ I ♦ 1
1 3-4 «»
ha.
Cmliaraa
rgge
Co.rr.thi 1991, Harvard School of Public HaaJib
Scale 75% of ongical
WIC Dietary AtaetsTneat Validation Study
Fiaal Report - September 22, 1994
Appaadli B
</0
Harvard FFQ Manual Scoring Template 3-2
Oraiai
1. Plac» this r.tmpliti on Page 3 ao
that tha ahadad box ahowa through
tha hola in tha template.
2. Count tha chacka in aach column,
and writa tha nuabara in tha boxaa
banaath aach column.
3. Uaing tha colora abova tha boxaa
and tha numbara in tha boxaa,
compare with tha following
combinationa for a match working
from right to left. Onca a match
ia found, nurk tha ahadad box on
tha queationnaire with tha aymbol
in the gray box (X or -) next to
tha matchud combination.
In tha combinationa, any number
that croaaaa two or more amall
boxaa ia tha TOTAL of thoaa amall
boxaa.
Grain* Combination* I
[is 0 - 1
1 1*1 x |
4. If you have marked the ahadad box,
■top.* Otherwiae, continue the
following atepa.
I. Multiply tha numbara in tha boxaa
by the numbera anown on tha
template, and write the reaulta in
tha circlaa abova tha boxaa. Add
the valuea in tha circlea under
the yellow, and write the aum in
tha white box. Add the valuea in
the cicclea under the green, and
write the aum in tha box under the
blue.
a. Compare the numbera in the white
box and tne box under the blue
with the following combinationa
for a match working from right to
left. Once a match ia found, mark
the ahadad box on tne
queationnaire with the aymool in
tna gray box (X or -) next to tne
matched combination.
7. Once you have marked the gray boa,
atop.•
Grain* CoaBroatloae 1
H i—
lb X
n 1 X
114 4 X
til 3 X
*i* i X
M 1 X
m 0 X
Ho match -
Tha ahaded boa with the mark [I I
indicataa the minimum intake* naa
been met or exceeded.
The ehaded box with the mark I-]
indicataa the minimum intake naa
not been mat.
Page 3-2
r HI
■ t la] I .S 1*1 >2 «4
Coeyncai 1991. Harvard School of Public Health
Scak7J%ofongioaJ
WIC Dietary Afaessmeat Validation Study
Final Report - September 22. 1994
Appeadli B
Q
Cover Page for Harvard FFQs Women's English Version
Foods You Ate in the Past 4 Weeks
Your Name:
This form will take about 15 minutes to complete.
lof rr«v»"A»| MndM
of
.far
OtVtof
"•"•■I
•J
I DMtanMM
■ mtmmtm* m «•* Ha 10 M ■■ml i p*f M/mtt, mdndinj fc» W»
4 ■■ an ■« •» 4M waded, ud cwf.^knr^ ud rmcwMt, **
■ ta «W Ufa of fa cofcaon of mfannao*. mdodwt
B—IOtMrWpI InlMI Vt*Mflos,DC202y>;iadlotK
0MB W * -»*)U) ■■tuilm, D C 20MS
BWE 5
Scale 75% of original
9^
WIC Dieury Aiicmnoii Vibdauon Study
Final Rcpon September 22. 1994
Appendii B
Harvard FFQ for Women Page I
Women's Nutrition Questionnaire
What Have You Been Eating Lately?
During the past 4 weeks, how often did you eat
a serving of each of the foods listed here?
Mark only one X for each food
Name.
ID
Date
DOB
Pregnant
EDC
Breastfeeding
lat 6 months
Breastfeeding
2nd 6 month*
Not Breastfeeding
Ust4
weeks each week each day
Number of Unit* 0 1-3 1 2-4 5* 1 2-3 « 6*
Milk
Hot chocolate
Cheese, plain or in aandwiches
Yogurt
Icecream
Pudding i
What kind of milk do you dnnk-1
[ (whole
I llowfat
I lakim
□
I -Jai sack weak •ackaay
Number of (IBM* 0 1-3 1 3-4 M 1 [23 ** 6.
Orange or grapefruit
Orange juice or grapefruit juice
[ Apple juice
Other fruit drinks I Hi-C. Knot -aid. lemonade >
—^- — i |
Banana ^
Apple or applesauce
! '
Grapes , 1
Peaches
Strawberries 1 1
Cantaloupe
Watermelon
Pineapple 1
Raisins or prunes
7
8
9
10
II
12
13
14
15
16
17
18
10
I i □
CasyrsjM ISS3. Harare Sdwal af Plane Kasha
I I
I I
I I
Scale 75S of origins]
73
WIC Dietary Assessmeat Validaboa Study
Fiaal Report - September 22,1994
AppsaeaiB
Harvard FFQ for Women Page 2
Mark only one X for each food
How often did you eat a nerving of thete foods during the past 4 weeks?
Uwt4
WMkl •MhwHk •aeh day
Number of times 0 1-3 1 2A &* 1)2-3 4-5 6.
Corn
Peas (canned, frozen, or fresh)
7bmatoes
Peppers (green, red, hot)
Carrots
Broccoli
Green beans
Spinach
Greens (mustard, turnip, coUards)
Squash, orange or winter
French fries, fried potatoes
Potatoes (baked, boiled, or mashed)
Sweet potatoes or yams
Cabbage or coleslaw
Lettuce salad
Salad dressing or mayonnaise
o
Copm«h! It*3. Harvard Sdml afNsS* NasM
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
□
Lw.4 each w««li earn day
Nuatbrraf uasaa 0 ! 1-3 1 2-4 ^6 1 2-3 4* 6.
Chips (potato, corn, others)
Nut*
Cookies or brownies
Cake or cupcake
Pie i pumpkin, sweet potato, or squash i
Other pie
Jello 1
Chocolate candy '
Other candy
Coffee or tea
Soft drinks
Sugar-free soft dnnks I
36
37
38
39
40
41
42
43
44
45
46
47
Scak 75% of original
QQ
W1C Dietary Assessment Validation Study
Final Report - September 22.1994
AppeadliB
Harvard FFQ for Women Page 3
Mark only one X for each food
How often did you eat ■ serving or these foods during the past 4 weeks1
Iaat4
week. each we*k ••eh day
Number of limes 0 1-3 1 1 24 bS 1 1 2 3 44 6.
Baked beans or chili beans 48
Other dned beans, peas, or Lima beans 49
Rice 50
Spaghetti or other pasta with sauce 51
Pizza 52
Macaroni and cheese 53
Hot dogs 54
Hamburgers, meatballs, or meatloaf 55
Canned tuna 56
Cold cuts (baloney, ham. salami) 57
Peanut butter
^__
58
Bread, toast, or rolls 59
Margarine or butter 60
Chicken or turkev 61
Pork chops, roast pork, or ribs 62
1 Steak or roast beef 63
Fish 64
Liver i 65
Sausage 66
Bacon 67
Hot cereal or gnu 68
Cold breakfast cereal 69
| Donut 70
Sweet roll <tr muffin 1
71
! Pancake, waffle, or French toast 72
Knglish muffin or bagel 73
1 1 Biscuit 74
Cornbread or tortilla." 75
Vegetable soup | | 76
Other soup 77
Crackers | 78
How many eggs do you eat in one week*1 o
oooooo
(opvr.rr.1 ISWJ KarraH School af Putt* Hash*
□
□
Scale 7S% of ongisal
VS
WIC Dietary Assenmeat Validation Study
Final Report - Sclember 22, 1994
AppeaatiB
Harvard FFQ for Women (Spanish Version) Pagel
Cuestionario de Nutricion de Mujeres
tQue ha estado usted comiendo ultimamente?
^.Durante las ultimas 4 semanas, qui tan a menudo comio
usted una porcion de cada alimento en la lista que sigue?
Marque solamente una X por cada comida
Nombre .
ID
Fecha.
Fecha de Nacimiento .
Embarmzada
EDC
D16 el Pecho
Loe pnmeros 6 mews
Di6 el Pecho
Los aegundos 6 meaes
No Dio el Pecho
lultima* 4
1 ■■■■■— cada KUU cada dia
Numero de veces ' 0 ' 1-3 1 1 2-4 M 1 2-4 44 6*
Leche
Chocolate caliente
Queso, solo o en sandwich
Yogurt 1
Helado. nreve
Budin, pudin i |
» ■
tQue clase de leche Lebe usted9
( | leche enters
[ ) leche pamalmente descremada i lowfat i
I I leche descremada o desnaud i nonfat '
Copyn«t.i 1093 Hanirt School of PubUt rWak*
□
; .J..—< .-.H. Hi.
\umrrrt a* *ece» |i 1.1 1 1-4 S* 1 24 « 6.
China i naranja) o toronja ! i
Jugo de china i naranja > o jugo de toronja
Jugo de minima
Otros jugos de frulaR <Hi-C Kool ajd kemunada
Guineo. platano o banano
Manzana n pure de manzana 1
Uvaa
? •
Melocoton. durazno !
Fresas ]
Melon 1
Sandia. melon de agua
■ i
Pina , ?
Paaaa o aruelas I I
7
8
9
10
II
12
13
14
15
16
17
18
19
□
Scale 75% oronginaJ
y6
WIC Dietary AaKtsmeat Validation Study
Fiaal Report - September 22, 1994
AppaadUB
Harvard FFQ for Women (Spanish Version) Page 2
Marque solamente una X por cada comida
iQu* tan a menudo comio usted una porcibn de ellos alimentos en las ultimas 4 semanas''
ultiaua4
HBUU
n 1 1.1
cada MI
1 i 9-1 W5 1
cadi
2-4
dia
rfuxncro ae veces 4-6 fi •
Maiz.elote
Guisante. chicharo (eniaudo. congelado o fresco)
Ibmataa
Pimientos (verde, rojo o picante)
Zanahoha
Broccoli o brecol
Habichuelaa verde. ejote
Espinaca
Verduras (nabo o acelga)
CaJabaza
Papaafritaa
Papas (asada o hemda o en pure)
Batata o name, camote
Repollo o ensalada de col
Enaalada de lechuga
Aderezo para ensalada o mavonesa
o
Cofrnctit ISM Hmri Sch«( «f f«*fc> HaU
20
21
22
23
24
2.',
26
27
28
29
30
31
32
33
34
35
□
—" ~~—^rJ ctAm HUU cada dia
Numrm oV ■««»» f> 10 1 2-4 ' 5-6 1 2-4 4-6 6.
Papitas fritaa. doradilas. chips da mais o ecraa j
Nueces
Galletaa , |
Bizcocho. bizcochilo redondo pasirl
■ ' T
Pastel, pie o empanad* iralahaia o caa>*a■ {
Otro pastel, pie o em panada
1
Jaleas. mercneladaj
Dulce de chocolate 1
OtrosduloM { 1
Cafe e it 1
Rafraacos
Refrescos sin axucar 1
36
37
3H
39
40
41
42
43
44
45
46
47
Scak75%ofongiaaJ
V7
W1C Dietary Assessnvnt VsJidstiaa Study
Final Report - September 22,1994
Appeadii B
Harvard FFQ for Women (Spanish Version) Page 3
Marque aolamente una X por cada comida
,'.Qu* tan a menudo comio usted una portion de ellof ahmentoe en las ultimas 4 wmanas''
iCuantoa hurvoa com* uated en una i
u)tiau*4
HBUU cada Mnana cadadia
Numero d» vec*« 0 1-3 1 ?-4 5* 1 2-4 I 4-5 «♦
Habichuelaa aaadaa con chile, fnjoles guiaadoa 48
Otras habichuelaa, Fruoln HOI. iu»»»ni*, chicara o haba 49
Arroz 50
Espaguetti u otra pasta con saiga 51
Pizza 52
Macarrones con queso 53
Hot dog 54
Hamburguesa, albondiis o earn* mechsda. d«sh«brads 55
Atun de lata 56
Fiambres (bologna, jambn. salami), carries fnas 57
Mantequilla de maiii. cacahuate 58
Pan. tostado o bolillos 59
Margarina o mantequilla 60
Polio o pavo 61
ChuJetaa, came de ree o metillaa 62
Biatec o rosbif 63
Peacado 64
Higado 65
Salchichaa 66
Tbcino 67
Ceraal caiiente, avena o atole 68
Cereal friopara el desavuno 69
Donaa 70
1 Pandulce 71
Panque, hot cakea o French toaat 72
' English mufTin o bagel 73
Bizoocho, htaquetea j 74
Pan de man o tortilla 75
Sopa de verdure, caldo de verdure 76
Otraa aopaa. caldoa 77
1 ' ! GaJletaa aaladaa 1 1 __..!_ i . 78
;0
oooooo
C*»m«hi !N1HimnlScW^r>M.HaU
□
□
Scale 75* of origiaal
VS
WIC Dietary Assessmeat Validatioa Study
Final Report - September 22, 1994
Aepeadli B
Harvard FFQ for Children Pagcl
*"«* -11 • »T A •■• aTV »• • Name
tnii' rens iNutntion questionnaire
What Has Your Child Been Eating Lately?
During the past 4 weeks, how often did your child
eat a serving of each of the foods listed here?
Mark only one X for each food
ID
Hats
DOB
**e
Respondent
Mother [ 1
Other 1 1
last 4
weeks aacb week each day
i
2
3
4
5
6
Number of tim«>« 0 1-3 1 2-4 S6 1 2-3 4-5 6.
Milk
Hot chocolate
Cheeae, plain or in aandwichea
Yogurt
Ice cream
Pudding 1
What kind of milk does your child drink''
1 1 who'i-
1 1
1 1 □
[ llowfat
1 1 ski in
las* 4 1 1Mb each week each day
7
8
9
10
11
12
13
14
15
16
17
18
19
SumurofunH ■ 0 1-3 1 ' 2-4 ' M 1 | 2-3 | 4-6 | 6.
Orange
Orange juice
Apple juice
Other fruit drinks iHt-C. Kool aid. lemonadei
Banana
Apple or applesauce
Grapes
Peaches 1
Strawberries
Cantaloupe
Watermelon
Pineapple I
RaWoJ
: ; 1 ; □
C•oprnshi 1W3 Harvard School of Public HaaJlh 1
Scale 75% of original
<r? ?*?
W1C Dietary Assessment Validation Study
Final Report - September 22, 1994
AppeadUB
Harvard FFQ for Children Page 2
Mark only one X for each food
How often did your child eat a serving of these foods during the past 4 weeks1
last 4
weeks each week each day
Number of limes 0 i 1-3 1 I 2-4 te 1 2-3 ! 4-5 6*
Corn
Peas (canned, frozen, or fresh 1
lbmatoes
Peppers (green, red. hot)
Carrots
Broccoli
Green beans
Spinach •
Greens (mustard, turnip, coUards)
Squash, orange or winter i
French fries, fried potatoes
Potatoes (baked, boiled, or mashed)
Sweet potatoes or yams
Cabbage or coleslaw 1
Lettuce salad
Salad dressing or mayonnaise 1 i
o
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
□
U«4
W***a M(b*Mk each day
Number of ume* I) 10 1 IM 5-6 1 | 2-3 | 4-6 6*
Chips (potato, corn, others)
111
1 | •
Nuts I
Cookies or brownies
f '
Cake or cupcake
Pie (pumpkin, sweet potato. or squash > i
' i
Other pie
Jello
I
Chocolate candy
Other candy
T1
1 |
Tea
Softdnnka
Sugar-free soft dnnks
36
37
18
39
40
41
42
43
44
46
46
47
Coprnfhl 1993 rUr»H School of Publ« rWM*
Scale 75% of original
50
WIC Dietary Assessment Validation Study
Final Report - September 22, 1994
Append!. I
Harvard FFQ for Children Page 3
Mark only one X for each food
How often did your child eat a serving of these foods during the past 4 weeks'
Ho* many eggs does your child eel in one week1* . f)
oooooo
CopmcM 1M3 H.r»«rt SrhMl <d PuM. HaaM
weak* each weak each day
Numbtr of tim*s 0 1-3 1 2-4 545 1 23 4-5 It
Baked beans or chili bearm 48
Other dned beans, peas, or Lima beans I
49
Rice 50
Spaghetti or other pasta with sauce 1 51
Pizza 52
Macaroni and cheese 53
Hot dogs 54
Hamburgers, meatballs, or meatloaf H
Canned tuna 56
Cold cuts (baloney, ham. salamii 57
Peanut butter M
Bread, toast, or rolls 59
Margarine or butter 60
Chicken or turkev 61
Pork chops, roast pork, or nbs 62
j Steak or roast beef 63
Fish 64
1 Liver 65
Sausage 66
Bacon 67
Hot cereal or gnu 68
1 Cold breakfast cereal i 69
Donut 70
Sweet roll or muffin 71
Pancake, waffle, or French toast 72
English muffin or bagel 73
I 1
Biscuit 74
Cornbread or tortillas 75
Vegetable soup 76
(Hher soup 77
Crackers 78
□
□
ScaJc75SofonfiatJ
s/
WIC Dietary Asseumrat Validslioa Study
Fiaal Report • September 22,1994
AwpcadliB
Harvard FFQ for Children (Spanish Version) Pagel
Cutistionario de Nutricion de Ninos
iQue ha estado comiendo su nino ultimamente?
,,Durant€ las ultimas 4 semanas, quc tan a menudo comio
su nino una porcion de cada alimenlo en la lista que sigue?
Marque aolamente una X por cada comida
Nombre.
ID
Fecha
Fecha de Nacimiento.
EDAD
Retpondedor
Madrel )
Olro I 1.
ultiaama 4
Wlllll cada HBUU cadadia
Nmncrod* veen o : \-3 1 | 2-4 5* 1 2-4 « 6.
Leche
Chocolate caliente
Queao, a61o o en sandwich
Yogurt
Helado, nreve
Budin. pudin
tQue clase de leche bebe su nino'*
[ I leche enters
I I leche paraalmente deacremada • lowfat >
I 1 leche descremada o desnaud ' nonfat *
Coprn«M Itt3. Hanwd Sthml rf Public Haakk
□
aiu—4 cadadia
Vu*m«m o i.i 1 H V6 1 I 2-4 4-6 6.
Cluna (naranja) | 1
JURO de china i naranja i
Jugo de manzana
i1
OtroajugosdefrutaslHi-C. Kool-aid kmonftda1
Guineo. plitano o banano f
Manzana o pure de manzana
Uvas ! 1
Meloroton. durazno 1
Freaas
T
1
Melon ,
■Sandla. melon de agua 1 !
Pina
Paaaa 1 i i 1
□
Scale 75% of original
WIC Dietary Aaaeatmeal Validation Study
Fiaal Report -September22. 1994
AppeadliB
52
Harvard FFQ for Children (Spanish Version) Page 2
Marque nolamentr Una X por cada comida
(Qne tan a menudo cnmio su nifrn una portion de ellos alimentoe en las ultimas 4 semanas1
iiltiau>4 cada WBiiu cada dia
Nunwro ir vecw 0 1 1-3 1 2-4 56 1 2-4 4-5 6»
Maiz.elote
GuisanU, chicharo lenlatado. congelado o frescoi
IbmatM
Pimientos iverde. rojo o picanlei
Zanahoria
Broccoli o brecol
Habichuelaa verde, ejotc
Espmaca
Verduraa (nabo o acelga)
Calabaza
Papas fritas
Papas (asada o hervida o en pure)
Batata o name, camote
Repollo o ensalada de col
Enaalada de lechuga
Ac'.ereio para enaalada o mayonesa
o
( o^mitii Ull Hanrart Scnaol ml Paktw Haahh
20
21
22
23
24
25
26
27
2fl
29
30
31
32
33
34
35
ahiama.4 A *■ •aaaaataa
Nua*rasr>fm 0 1-3 1 W iMi 1 1 7A 4-5 6.
Papitaa fntaa, doraditaa, chips de mail o otras I
Nuece* 1 ,
Galletas
Biirocho. bizcochito redondo. pastel
Pastel, pie o empanada (calabasa o camotai
< Mm pastel, pie o empanada
Jaleas. mcrmeladas
Dulce de chocolate 1
Otrosdulrea |
Te
Raflmen
Refrescoa sin axucar 1
36
37
3fl
39
40
41
42
43
44
45
46
47
□
Scale 75% of original
W1C Dietary Assessmeat Validation Study
Final Report - September 22. 1994
AppeadliB
53
Harvard FFQ for Children (Spanish Version) Page 3
Marque •olamente uot X por cada comida
iQue tan a menudo ramie su mfto una porrion de ellos alimentoe en las ultimas 4 scmanas''
I- ullimaa 4
•fmanai cada MBana cada dia
Ncimrrti de VMM 0 1-3 1 2-4 5-6 1 2-4 4-S 6.
Habichuelaa aaadaa con chile, fnjolea guiaadoa
Otras hahirhuelas. fnjoln a«os. fuiunw rhicam n haba 1
Aim
Espaguetti u otra pasta con salsa
Pizza
Macarrones con quesn
Hot dog
Hamburguesa.albondiitaocamr nwthwU d*ih*brada
Atundelata
Fiambres (bologna,jamon. salami 1. cames fhas
Mantequilla de noanl, cacahuate
Pan. tostado o bolillos
Marganna o mantequilla
Polio o pavo
Cbuletas, came de re* o coatillas
Bistec o rosbif
Peacado
Higado
Salchicbas
1 Tocino
1
Cereal caliente, a vena o atole
Cereal fno para el desavuno 1
Donas
Pan dulce
| Panque, hot cakes o French loaat
English muffin o bagel
Bizcocho, biaquetes
Pan de man o tortilla
1 '1
, Sopa de verdura, caldo de verdura 1»
Otras sopas. caldoi>
Galletaa aaladaa .
, Cuanlos huevoa come su nino en una
oooooo
(opm«t.i ItW HarwdSrtwoiafrW- Hmkh
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
□
□
Scale 75% of original
W1C Dietary Astessmeal Validation Study
Fiaal Report - September 22, 1994
AppcadliB
S9
Home Economics and Household Collection
