| Question |
Choice 1 |
Choice 2 |
Choice 3 |
Choice 4 |
Choice 5 |
| Do you feel that you have changed your eating habits recently for the better? | Strongly Disagree | Disagree | Not Sure | Agree | Strongly Agree |
| Do you feel that you have changed your eating habits recently for the worse? | Strongly Agree | Agree | Not sure | Disagree | Strongly Disagree |
| How often do you drink fruit juice? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you drink milk? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you drink soft drinks, soda, or pop? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you drink beer? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you drink wine or wine coolers? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat oatmeal or grits? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat apples? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat bananas? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat pears? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat dried fruit, such as prunes or raisins? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat peaches, cherries, or plums? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat melons (such as cantaloupe, watermelon or honeydew)? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat strawberries? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat oranges, tangerines, or tangelos? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat grapefruit? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat cooked greens (such as spinach, turnip, collard, mustard, chard, or kale)? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat raw greens (such as spinach, turnip, collard, mustard, chard, lettuce or kale)? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |
| How often do you eat coleslaw, sauerkraut or cabbage? | Never | Once or more per month | Once or more per week | Once daily | More than once daily |