NATIONAL INSTITUTES OF HEALTH II 3 3 Dec 9 Aug 4 4 Sep 5 5 Oct Today's date: 6 6 Nov 7 7 Dec MONTH YEAR 8 8 9 9 Jan 2010 |___|___| In what were you Feb 2011 0 0 born? Mar 2012 1 1 Apr 2013 2 2 Jan In what year were May 2014 3 3 Feb you born? Jun 2015 Mar 4 Jul 2016 19 |___|___| Are you male or Apr 5 Aug 2017 female? 0 0 May 6 Sep 2018 1 1 Jun Oct 2019 7 Male 2 2 Jul Nov 2020 8 Female Over the past month, how often did you drink ½ to 1¼ cups (4 to 10 ounces) More than 1¼ cups (10 ounces) carrot juice? NEVER (GO TO QUESTION 2) 2. Over the past month, how often did you drink tomato juice or other vegetable juice? 1 time in past month 1 time per day (Please do not include carrot juice.) 2–3 times in past month 2–3 times per day 1–2 times per week 4–5 times per day NEVER (GO TO QUESTION 3) 3–4 per week 6 or more times per day 5–6 times per week 1 time in past month 1 time per day 2–3 in past month 2–3 times per day 1a. Each time you carrot juice, how much 1–2 times per week 4–5 times per day did you usually drink? 3–4 times per week 6 or more times per day 5–6 times per week Less than ½ cup (4 ounces)
NATIONAL INSTITUTES OF HEALTH II Today's date: MONTH YEAR Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec |___|___| 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 0 0 1 1 2 2 3 3 4 5 6 7 8 9 In what were you born? Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec In what year were you born? 19 |___|___| 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 Are you male or female? Male Female Over the past month, how often did you drink carrot juice? NEVER (GO TO QUESTION 2) 1 time in past month 1 time per day 2–3 times in past month 2–3 times per day 1–2 times per week 4–5 times per day 3–4 per week 6 or more times per day 5–6 times per week 1a. Each time you carrot juice, how much did you usually drink? Less than ½ cup (4 ounces) ½ to 1¼ cups (4 to 10 ounces) More than 1¼ cups (10 ounces) 2. Over the past month, how often did you drink tomato juice or other vegetable juice? (Please do not include carrot juice.) NEVER (GO TO QUESTION 3) 1 time in past month 1 time per day 2–3 in past month 2–3 times per day 1–2 times per week 4–5 times per day 3–4 times per week 6 or more times per day 5–6 times per week
dhq2_pastmonth.docx