NATIONAL INSTITUTES OF HEALTH II 3 3 9 Dec 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 month were Feb 2011 0 0 you 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 Are you male or 19 |___|___| 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 carrot juice? 1 time in past 1 time per day NEVER 2–3 times in past month 2–3 times per day 1–2 times per week 4–5 times per day 1 time in past month 1 time per day 3–4 times per week 6 or more times per day 2–3 times in past month 2–3 times per day 5–6 times per week 1–2 times per week 4–5 per day 3–4 times per week 6 or more times per day 5–6 times per week 3. Over the past month, how often did you drink 2. Over the past month, how often did you drink orange juice or grapefruit juice? tomato juice or other vegetable juice? (GO TO QUESTION 4) (Please do not include carrot juice.)
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 month 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 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 per day 3–4 times per week 6 or more times per day 5–6 times per week 2. Over the past month, how often did you drink tomato juice or other vegetable juice? (Please do not include carrot juice.) 1 time in past 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 times per week 6 or more times per day 5–6 times per week 3. Over the past month, how often did you drink orange juice or grapefruit juice? (GO TO QUESTION 4)
dhq2_pastmonth_noportion.docx