Released: January 2008

United States Department of Health and Human Services
Office of Disease Prevention and Health Promotion
Food and Drug Administration

(also available in PDF)

TABLE OF CONTENTS

• Foreword
• Acknowledgements
• Purpose
• Background
• Methodology
• Overall Findings
• Detailed Findings
  • Self Perceptions
  • Attitudes
  • Information-Seeking (Federal Government Sources)
  • Awareness/Familiarity of the Dietary Guidelines for Americans
  • Intentions and Behavior
  • Knowledge of Whole Grains
• Conclusions
• APPENDIX A: DATA TABLES
• APPENDIX B:  2005 SURVEY INSTRUMENT
  • QUESTIONNAIRE (English)
  • QUESTIONNAIRE (Spanish)

Foreword

The choices we make every day of what to eat and how much physical activity to get play a vital role in how long we live, how much energy we have, and how healthy we are.  We live in a time of widespread availability of food options and choices. More so than ever, Americans need good advice to make informed decisions about their diets. The Department of Health and Human Services (HHS) is committed to encouraging and helping the public adopt long-lasting, healthy lifestyles. The Dietary Guidelines for Americans (Dietary Guidelines) provide the science-based information we need to make smart choices from every food group, get the most nutrition out of the calories we consume and find a balance between eating and physical activity.

The Health and Diet Survey: Dietary Guidelines Supplement tracks national change of Americans' attitudes, awareness, knowledge, and behavior regarding various elements of nutrition and physical activity.  The Office of Disease Prevention and Health Promotion (ODPHP) collaborated with the Food and Drug Administration (FDA) to leverage FDA's on-going household survey mechanism and include information based on the key recommendations from the Dietary Guidelines.   HHS initiated the baseline survey just prior to the launch of the Sixth Edition, Dietary Guidelines for Americans in January, 2005, and repeated the survey a year later.   

The survey findings indicate that although Americans believe healthy eating habits are important, sometimes knowledge and good intentions do not add up to making better choices and changing behavior.  Not surprising, there are differences in how Americans view their health and what is important to them related to their gender, age and education.  The survey also inquired where Americans turn for nutrition information, how reliable they consider Federal government nutrition information, how easy they think it is to access the information, and their familiarity with specific government nutrition offerings such as the Dietary Guidelines. 

The information from the Dietary Guidelines provides a blueprint for action.  However, putting knowledge into practice can be challenging and changing behavior is usually a long-term proposition.  Future fielding of this survey will help us monitor American eating habits and lifestyle choices over time, recognizing that adopting more healthy, active lifestyles will take a concerted effort - from the Federal government to health experts to the food and agriculture sectors to business leaders, state and local governments, scientists and researchers, and teachers and parents and individuals.

We hope you find this information helpful and encourage all of us to consider the role we can play to reinforce that developing healthy habits early in life is great, and it's also never too late to start.  Children need a healthy diet for normal growth and development, and Americans of all ages may reduce their risk of chronic disease by adopting a nutritious diet and engaging in regular physical activity.  At any age, at every stage of life, everyone can make healthier choices.

[ASH Signature]

John O. Agwunobi
Assistant Secretary for Health

Acknowledgements

This U.S. Department of Health and Human Services (HHS) acknowledges the work of those who contributed to the development of this report: 

Project Team/Oversight:
Christine Dobday, HHS, Office of Disease Prevention and Health Promotion
Chung-Tung Jordan Lin, Ph.D., HHS, Food and Drug Administration
Adam Burns, M.S., Porter Novelli, Inc.

In conjunction with the HHS review team: 
Woodie Kessel, M.D., M.P.H., Office of Disease Prevention and Health Promotion
Kathryn Y. McMurry, M.S., Office of Disease Prevention and Health Promotion
Steven Bradbard, Ph.D., Food and Drug Administration
Camille Brewer, M.S., R.D., Food and Drug Administration
Jean Lloyd, M.S., R.D., Administration on Aging
Yvonne Jackson, Ph.D., R.D. Administration on Aging
Rebecca Payne, M.P.H., Centers for Disease Control and Prevention

HHS also acknowledges staff contributions by:   
Penelope Slade Royall, P.T., M.S.W., Office of Disease Prevention and Health Promotion
Barbara Schneeman, Ph.D., Food and Drug Administration
Carter Blakey, Office of Disease Prevention and Health Promotion
Gloria Barnes, Office of Disease Prevention and Health Promotion
Supriya Janakiraman, M.D., M.P.H., Office of Disease Prevention and Health Promotion
G. Bruce G. Vanderver, M.D., M.P.H., Office of Disease Prevention and Health Promotion
Ira Dreyfuss, Office of the Assistant Secretary for Public Affairs
And the support of the PSC/Visual Communications Branch

The Department also recognizes the contribution of Kimberly Stitzel, M.S., R.D., and Deanne Weber, Ph.D, Porter Novelli, Inc.

This survey received U.S. Office of Management and Budget clearance and was conducted by Synovate, Inc.    

Porter Novelli, Inc. conducted the data analyses for the Health and Diet Survey: Dietary Guidelines Supplement. Findings were reviewed in partnership with ODPHP and FDA.

Purpose

The U.S. Department of Health and Human Services (HHS) Health and Diet Survey: Dietary Guidelines Supplement was designed to track and to understand the attitudes, awareness, knowledge, and behavior regarding various elements of nutrition and physical activity. Fundamentally, it provides a snapshot over time as these components change. This permits both an immediate view of current knowledge, attitudes, and behavior, and a method to track changes over time. The survey therefore presents several potential tools for enhancing dietary and physical activity behaviors in the future.

Due to its focus on knowledge, attitudes, and behavior, the survey permits a comparison of those areas, and key discrepancies between them that may emerge. This will allow for identification of areas for further analysis, and potential intervention. It will also allow for the strengthening of interventions during their implementation as their impact is monitored.

The survey is designed as a multi-year study. When the survey is repeated multiple times and over a longer period of time, it will permit the identification and analysis of trends in consumer knowledge, attitudes, and behavior. In particular, since the 2004 data were obtained before the release of the Dietary Guidelines, it serves as a pre-intervention reference, allowing for the tracking of changes in attitudes, knowledge, and behavior as a result of the Dietary Guidelines. By focusing on temporal trends over several years, fluctuations in responses due to year-to-year sample and other extraneous variations are expected to be minimized. 

There are a variety of survey mechanisms that focus on diet and physical activity that contribute to a better collective understanding of individual and our nation's perspective on health.  This survey, at this starting point, strives to offer another dimension with its true value only increasing over the coming years, as the connections between the factors are followed, and the increase in trend data help to shed light on the impact of the Dietary Guidelines on the health of the American people.

Background

Using Health and Diet Survey, the on-going household survey mechanism of the Food and Drug Administration (FDA), a Dietary Guidelines Supplement was developed.  The 2005 version of the survey represents the instrument's second administration, with the baseline study fielded in late 2004.⁽¹⁾

The survey questions were developed by FDA and the Office of Disease Prevention and Health Promotion, which is the focal point for coordination of nutrition policy within HHS.  The questions relate to recommendations and information from the Dietary Guidelines for Americans, 2005 (6^th Edition), and take into consideration qualitative consumer research HHS conducted.   In addition, questions were included to get a general sense of adults' propensities to garner nutrition information from Federal government sources, the reliability of this information, the ease with which it can be obtained, and familiarity with specific Federal government nutrition offerings such as the Dietary Guidelines for Americans.  Additional research expertise and project team support was provided through the HHS Dietary Guidelines communication contract under which the qualitative research was conducted. An emphasis was placed on design and methodology consistency to enable future analyses of trends from data comparisons over-time.  Minor year-to-year adjustments in questionnaires were made to address emerging or topical issues. The questionnaire can be found in Appendix B.

This report focuses on overall findings from the 2005 survey.  Where appropriate, it also illustrates differences among the following subgroups:  gender, education level, and age.⁽²⁾  Prominent differences from the inaugural study conducted a year earlier are provided as well (italicized in text) for the purpose of highlighting potential areas of change that may deserve further investigation. Data tables from both surveys are included in Appendix A.

Methodology

This survey was conducted via telephone from November 14, 2005 to February 6, 2006 by Synovate, Inc., utilizing a random-digit dialing (RDD) methodology.⁽³⁾ Professional telephone interviewers administered the surveys in English or Spanish, depending on the preference of the respondent.⁽⁴⁾ A Computer Assisted Telephone Interviewing (CATI) system managed data collection for each interview.   The sampling frame included English- or Spanish-speaking non-institutionalized adults 18 years of age or older in households with telephones in the 50 states and the District of Columbia.  Households were selected from a nationally representative list-assisted, single-stage sample of telephone numbers.  The eligible respondent in a household was selected using the most-recent birthday method.  In addition, an over-sample of African-Americans and Hispanics was used to ensure adequate representation of these groups.

Pretests were conducted to detect and address potential problems in respondent understanding of and response to the questionnaire and in field administration of the survey.  For the 2005 survey, 9 pretest interviews were conducted on October 27, 2005.  For the 2004 survey, 15 first-round pretest interviews were conducted on November 15, with six second-round pretest interviews on November 22, 2004.  All interviews were conducted on the telephone and monitored by HHS and FDA project personnel.  The survey relied on self-reported information.  Self-reported weights and heights were used to calculate Body Mass Index (BMI). ⁽⁵⁾ 

Identical survey methodologies were employed for both the 2004 and 2005 surveys.  In 2004, a total of 1,253 U.S. adults 18 years of age or older completed the survey, yielding a response rate of 32%.  In 2005, a total of 1,221 U.S. adults 18 years of age or older completed the survey, yielding a response rate of 31%.  The response rates were calculated according to Response Rate 3 definition by the American Association for Public Opinion Research.  Data were weighted each year to match the corresponding year's Current Population Survey of the U.S. Census and to adjust for the number of land-phone residential lines and adults in a household.

Significance testing between subgroups in the 2005 survey was not conducted due to inflation of the overall Type I error rate that would occur with this large number of comparisons.  Instead, the following report focuses on meaningful differences.  For percentages, meaningful differences are defined as those that lie at least outside of the margin of error for the specific subgroups reviewed.⁽⁶⁾ For questions with mean scores, changes of 0.4 or higher represent meaningful differences.⁽⁷⁾ Error rates were calculated a priori, and results which were outside of the error range are noted.  No adjustment was made for multiple comparisons.  All reported between-group differences must therefore be interpreted accordingly.

This report also mentions some prominent differences observed between 2004 and 2005. The differences are italicized for ease-of-use. The report, however, does not make any attempt to attach meaning or significance of these differences due to the closeness of the two iterations of the survey.  Mentions of prominent differences are simply meant to highlight potential changes in areas that may deserve further investigation.  Any meaningful or prominent differences will be monitored and examined in future survey iterations. 

Lastly, text references to data tables in Appendix A appear in brackets with the numbers corresponding to question numbering in the questionnaire.

Overall Findings

The data are remarkably consistent across the two years of the study, both among adults overall and among demographic subgroups.  Overall, American adults believe it is important to have healthy eating habits and to think about nutrition when shopping for food.  Also, many Americans are confident that they know how to choose healthy foods and the amount of physical activity they should be doing to be healthy.  Despite these findings, their knowledge and good intentions are not always reflected in their behavior.

General tendencies among gender, age, and education level subgroups are presented below.

• Women are more likely than men to identify nutrition as important and are also more likely than men to adopt healthy behaviors (e.g., avoid saturated fat, drink fat-free milk).  Women are also more likely than men to have heard of the Dietary Guidelines for Americans and other governmental nutrition programs.  Women are also more likely than men to identify themselves as overweight, even though after calculating Body Mass Index scores from self-reported heights and weights, men are more likely to be categorized in the overweight category.
• Adults under the age of 65 are more likely than their older counterparts to self-report a good state of health, and the youngest group (18-34 year-olds) are more likely to report they are "about the right weight."  Fewer adults in the youngest group than older groups consider nutrition very important when food shopping.  Adults in the 18-34 years old group also are less likely to avoid unhealthy nutrients such as cholesterol, sodium and trans fat.  But younger adults (under 65 year of age) are more likely to seek nutrition information from Federal government sources.  On the other hand, adults 65 years of age or older use Federal government Web sites for nutrition information less often than any other age groups.  They are also less likely to have heard about the Dietary Guidelines for Americans and other government information sources on nutrition.   
• A number of patterns exist across education level as well.  Adults who have attained at least some college education are more likely than those with a high school education or less to report a better current state of health, to say that nutrition is very important, and to look for nutrition information from Federal government sources.  Given these findings, it is not surprising that adults with at least some college education are more likely than their less-educated peers to adopt nutrition-focused behavior. 

Detailed findings for each portion of the survey are discussed in the subsequent sections of the report.

Detailed Findings

Self Perceptions

American adults, for the most part, believe that they are in good health and are "about the right weight."  In addition, many adults who believe they are overweight note that they are currently attempting to lose weight.  When self-report numbers for height and weight were calculated to derive BMI, it revealed that Americans are actually heavier than what they perceive as their weight status.  This survey relied on the self-reporting of height and weight, which are explored along with how they relate to perceived weight and health status, as well as, the calculated BMI based on these numbers.

Specifically, 53% of American adults self-reported that their health is excellent or very good. [B3]

• There is little difference between genders on this measure, with just over half of both men (51%) and women (55%) reporting that their health is excellent or very good. [B3]
• Americans with at least some college education are more likely than Americans with a high school education or less to report their health as excellent or very good (65% vs. 41%). [B3]
• Majorities of adults under 65 think they are in excellent or very good health (53% 18-34; 58% 35-54; 56% 55-64), whereas only four in ten (41%) Americans 65 years of age or above self-report excellent or very good health. [B3]

Americans' assessments of their weights mirror their evaluation or own perception of their health.  Over half of Americans (57%) self-report that they are "about the right weight," and over one-third (39%) self-report that they are overweight. [B4] and [B6]

• Across gender, women are more likely than men to say they are overweight (43% vs. 34%), and conversely, men are more likely than women to say they are "about the right weight" (60% vs. 54%).  This differs from 2004, when men and women were equally likely to say that they were overweight (42%). [B4]
• Fifty-nine percent (59%) of Americans with at least some college education think that they are "about the right weight," compared to 54% of their less-educated counterparts. [B4]
• Eighteen-to-thirty-four years old Americans are the least likely of all age groups to report that they are overweight (27%) and are the most likely to report that they are "about the right weight" (69%).  At least four in ten Americans age 35 and above report that they are overweight (44% 35-54; 51% 55-64; 40% 65+). [B4]
• Among those Americans who say they are overweight, 75% say they are currently trying to lose weight. [B6]
  • Although attempts to lose weight are consistent across overweight men and women who perceive themselves as overweight, those with some college education or higher are more likely than their less-educated peers to self-report that they are currently trying to lose weight (81% vs. 70%).  This latter number is different from 2004, where eight in ten (80%) Americans who self-reported being overweight and had a high school education or less indicated that they were trying to lose weight. [B6]
  • At least seven in ten adults in all age groups who self-report being overweight are currently trying to lose weight (77% 18-34; 74% 35-54; 79% 55-64; 71% 65+). In 2004, there were more adults 18-34 who self-reported being overweight and were currently trying to lose weight (91%) than 2005 (77%). [B6]

In each year of this survey, respondents' self-reported heights and weights are used to calculate BMI scores.  In 2005, according to calculated BMI, only slightly more than one-third of adults (36%) scored in the normal BMI range, while 36% are in the overweight range and 25% were in the obese range.  Only 2% fell into the underweight range.  [C1-C14] Compared to adults' own self-perceptions of their weight, BMI scores show that adults are actually heavier than they believe themselves to be (39% perceived overweight vs. 61% BMI score overweight or obese [B4/C1-C14]).

• Women are more likely than men to be in the normal BMI range (42% vs. 31%), and are less likely to be in the overweight or obese ranges (57% vs. 67%).  [C1-C14]
• Almost four in ten (39%) adults with some college education or more are in the normal BMI range, while 37% are in the overweight range, and 22% are in the obese range.  Those with a high school education or less are slightly more likely to be obese, with 30% in the obese range. [C1-C14]
• Larger percentages of the youngest and oldest age groups have BMI scores in the normal range when compared to adults 35-64 years of age (42% 18-34; 33% 35-54; 29% 55-64; 37% 65+).  Comparatively, 36% of 18-34 year olds, 35% of 35-54 year-olds, 42% of 55-64 year-olds, and 37% of adults 65 years of age or above were in the overweight range.  With the exception of 18-34 year-olds, where only 19% are obese, the percentage of people in the obese category are consistent across the remaining age categories (30% 35-54; 27% 55-64; 25% 65+).  In addition, the percentage of underweight adults is consistent across all age categories (2% 18-34; 2% 35-44; 1% 45-54; 1% 65+). [C1-C14]

Attitudes

One of the surveys' primary foci was to identify American adults' attitudes, knowledge, and behavior associated with recommendations from the Dietary Guidelines. Regarding the former item, data reveal that adults hold nutrition in high regard and believe it to be a priority.  In addition, healthy eating and making good nutritional choices are important to them.  American adults are also confident that they know how to make these healthy food choices and how much physical activity they should be doing.

Specifically, over six in ten (62%) report that nutrition is very important to them when shopping for food, and an additional 35% think that nutrition is a somewhat important consideration. [A1]

• Women are more likely than men to share the opinion that nutrition is very important while food shopping (70% vs. 54%).  However, virtually all men (96%) and women (98%) report that nutrition is at least somewhat important to them while food shopping. [A1]
• Americans with at least some college education are also more likely than those with at most a high school education to say that nutrition is very important to them while food shopping (66% vs. 57%), though almost all of both groups agree that it is at least somewhat important (98% and 96%, respectively). [A1]
• Nutrition's importance while food shopping increases with age, with more older Americans than younger Americans reporting that nutrition is very important (52% 18-34 vs. 64% 35-54; 69% 55-64; 71% 65+), but as with other demographic groups, almost all find nutrition at least somewhat important (96% 18-34; 98% 35-54; 99% 55-64; 97% 65+). [A1]

In both surveys, respondents were asked whether they agree or disagree with a series of attitude statements regarding health and nutrition.  Responses to these statements parallel nutrition attitudes noted above.  Most Americans strongly agree or agree with the statements, "Healthy eating habits are very important to me" (95%), and "I am actively trying to eat a healthy diet" (90%). [A10]

• Women are more likely than men to agree with these statements (98% vs. 91% "Healthy eating habits..." and 93% vs. 86% "I am actively..."), although overwhelming majorities of each do so. [A10]
• Americans with at least some college education are more likely than their less-educated peers to say that they are actively trying to eat a healthy diet (92% vs. 87%).  Responses regarding the item "Healthy eating habits are very important to me" are consistent across education.  Data for these two attitude items are consistent across age as well. [A10]

Most Americans are also confident⁽⁸⁾ that they know how to choose healthy foods (95%) and how much physical activity they should be doing (92%). [A10]

• Both men and women, and adults with some college education and adults with a high school education or less are similarly confident that they know how to choose healthy foods.  There is little difference across age as well. [A10]    
• Larger percentages of women than men are confident that they know how much physical activity they should be doing (95% vs. 89%).  Over nine in ten of each education level grouping concur as well (95% some college; 90% high school or less).  Adults younger than 35, though, are less likely than their older counterparts to agree that they know how much physical activity they should be doing (88% 18-34; 95% 35-54; 96% 55-64; 92% 65+), although large percentages of all age categories are confident that they know the proper amount. [A10]

Over eight in ten Americans also agree or strongly agree that the amount of food they should eat depends on how many calories they burn each day (85%). [A10]

• Data are consistent across gender and education level. [A10]
• Older and younger Americans are less likely than adults age 35-64 to hold the opinion that the amount of food they should eat depends on how many calories they burn each day (81% 65+ and 81% 18-34 vs. 89% 35-54 and 90% 55-64). [A10]

Information-Seeking (Federal Government Sources)

The 2004 and 2005 Health and Diet Surveys also measured the extent to which American adults use Federal government sources for nutrition information, their ease of use, and reliability.  This exploration also includes use of Federal government Web sites and awareness of specific government nutrition information programs, such as the Dietary Guidelines for Americans.

Use of Federal government sources for nutrition information is relatively limited, with many adults admitting they never use Federal government Web sites for nutrition information. [A2]

• One-quarter of Americans (25%) have looked for nutrition information from Federal government sources in the past six months. [A2]
  • Women are more likely than men to have looked for such information from the Federal government (27% vs. 22%). [A2]
  • Adults with at least some college education are more likely than adults with less education to have recently looked for nutrition information from Federal government sources (31% vs. 18%). [A2]
  • The youngest segment of adults are the most likely to be recent nutrition information seekers from Federal government sources, with 31% doing so in the past six months.  Around one quarter of 35-64 year-olds report similar activity (25% 35-54 and 24% 55-64).  Less than one in five (18%) adults age 65 or older have done so as well. [A2]
• Only 15% of adults indicate it is very easy to get nutritional information from Federal government sources, with just over half (54%) saying they do not know how easy it is to get such information, an expected result given that only one quarter of Americans have recently looked for nutrition information from Federal government sources.[A3]
  • These data are consistent across gender but not across education.  Adults with at least some college education are more likely than those with less education to say that getting the information is very or somewhat easy (41% vs. 31%).  Also, 60% of this latter group is unsure of how easy it is to get this information from the Federal government. [A3]
  • Adults age 18-34 are more likely than their 35-54 and 55-64 year-old peers to find getting information at least somewhat easy (48% vs. 34% and 37%, respectively), and only one in five (20%) adults 65 or older share this sentiment.  Seventy percent (70%) of this oldest age group is not sure how easy it is to obtain nutrition information from the Federal government. [A3]
  • The share of 18-34 year-olds who find getting nutrition information from the Federal government very or somewhat easy was 48% in 2005, compared to 31% in 2004.  Data were more consistent across years among the remaining age categories. [A3]
• One-in-five Americans (21%) find the nutrition information provided by the Federal government to be very reliable, with a majority (58%) finding it to be at least somewhat reliable. [A4]
  • Perceived reliability is relatively consistent across gender, but adults with a high school education or less are more likely than those with more education to say that they do not know the reliability of the information provided by the Federal government (37% vs. 28%). [A4]
  • Just under half of adults 65 years of age or older (47%) find Federal government nutrition information to be at least somewhat reliable, compared to 63% of 18-34 year-olds, 57% of 35-54 year-olds, and 64% of 55-64 year-olds. [A4]
  • While the number of 18-34 year-olds who do not know the reliability of Federal government information was lower in 2005 (23%) than in 2004 (37%), the number of adults age 65 or older who are unsure was higher in 2005 (44%) than in 2004 (34%). [A4]
• Approximately three-quarters (74%) of Americans say they never use Federal government Web sites to look for nutrition information. [A5]
  • These data are consistent across gender, but differ in terms of education.  Eight in ten (80%) adults with a high school education or less have never used such sites, compared to 68% of adults with at least some college education. [A5]
  • Adults under 65 are more likely than their older peers to have used Federal government Web sites for nutrition information.  Specifically, one-third (33%) of 18-24 year-olds have used Federal government Web sites to look for information compared to about 25% of 35-64 year-olds, and 13% of adults 65 or older. [A5]

Awareness/Familiarity of the Dietary Guidelines for Americans

The survey also explored the degree to which adults had heard of government programs and/or publications that focus on nutrition and physical activity.  It also delved into the familiarity with the Dietary Guidelines for Americans and into from which information sources adults may have heard about them.  Of note, the 2005 survey was fielded a year after the 2004 survey, which was fielded just prior to the release of the Sixth Edition, Dietary Guidelines for Americans in January, 2005. 

Almost half (48% in 2005) of American adults have heard about the Dietary Guidelines for Americans.  At the same time a year ago, 33% had heard about the Dietary Guidelines for Americans.  [A6]

• Women and adults with more education are more likely than their counterparts to have heard about the Dietary Guidelines for Americans.  Over half (53%) of women have done so, compared to 41% of men.  In addition, almost six in ten (58%) adults with some college education have heard about the Dietary Guidelines for Americans, compared to 37% of those with less education. [A6]
• Those under 65 are more likely than adults 65 and older to have heard about the Dietary Guidelines for Americans.  Specifically, 60% of 55-64 year-olds, 53% of 35-54 year-olds, and just under half (48%) of 18-34 year-olds have heard about them, compared to less than one-third (30%) of adults 65 years of age or older. [A6]
• Although the awareness of the Dietary Guidelines for Americans was higher in 2005 than in 2004 across gender, the same was not the case in terms of education and age. [A6]
  • In education, a difference was most pronounced among those with at least some college education.  The percentage of adults in this category who are aware of the Dietary Guidelines for Americans was 58% in 2005 compared to 38% in 2004, whereas the difference was 37% and 28%, respectively, for adults with a high school education or less. [A6]
  • Regarding age, most differences are found among adults under 65 years of age.  The percentages of adults aware of the Dietary Guidelines for Americans are 48% (2005) and 29% (2004) among those aged 18-34, 53% and 36% among adults aged 35-54, and 60% and 40% among adults aged 55-64.  There was only a one percentage point difference in awareness among adults 65 or older. [A6]

The survey also asked American adults about their awareness of other government nutrition programs, such as the MyPyramid program (introduced just before the fielding of the 2005 survey as the nation's new Food Guidance system) and the Five-A-Day program. [A6] Results include:

• Almost half of all American adults (49%) have heard of the MyPyramid Program.⁽⁹⁾  As was the case with the Dietary Guidelines for Americans, women and those with more education were more likely to report having heard of it than their peers (54% women vs. 44% men; 63% some college vs. 35% high school or less).  Awareness of the MyPyramid program also decreases with age, with 61% of adults age 18-34 reporting that they are aware of the program, compared to 52% of adults age 35-54, 46% of adults age 55-64, and 27% of adults age 65 or older. [A6] ⁽¹⁰⁾
• Almost four in ten (38%) Americans have heard of the Five-A-Day program, again with women, adults with at least some college education, and younger adults being the most likely to be aware of this program (45% women vs. 30% men; 50% some college  vs. 25% high school or less; 46% 18-34, 41% 35-54, 39% 55-64 vs. 18% 65+).  Compared to 2004, there is little difference in awareness of the Five-A-Day program across gender and most age groups.  However, there were prominent differences among less-educated adults (25% in 2005 and 36% in 2004) and among adults 65 years of age or older (18% in 2005 and 31% in 2004). [A6]
• Over a quarter of adults (27%) have heard of "A Healthier You:  Based on the Dietary Guidelines for Americans."  This number is consistent across gender, education, and age.⁽¹¹⁾ [A6]

In both survey years, additional questions were asked among those who have heard about the Dietary Guidelines for Americans to garner more information about their level of familiarity with them and when and how they have heard of them. [A7-A9]

• Fourteen percent (14%) of this subset are very familiar with the Dietary Guidelines for Americans, with another 52% somewhat familiar. [A7]
  • Although numbers are consistent across gender regarding those who are somewhat familiar (51% women; 54% men), women are more likely than men to say they are very familiar with the Dietary Guidelines for Americans (19% vs. 8%). [A7]
  • Likewise, similar percentages of those with at least some college and those who have no college education among this subset are somewhat familiar with the Dietary Guidelines for Americans (51% and 55%, respectively), but the gap widens among those who are very familiar (18% of those with some college vs. 9% of those without). [A7]
• Over half of Americans (56%) who are aware of the Dietary Guidelines for Americans indicate they have heard news about them in the past six months.  Though this information is consistent across education, women are more likely to have heard recent news about them than men (60% vs. 52%). [A8]
• Those who indicated that they are aware of the Dietary Guidelines for Americans were given a list of sources where people may have heard about them and were asked whether or not they have heard about them from that source. [A9]  Specifically, the top five sources where adults may have heard or read about the Dietary Guidelines for Americans are: 
  • On television (77%)
  • In a magazine (67%)
  • In a newspaper (66%)
  • In supermarket brochures or pamphlets (46%)
  • On the radio (45%)
• Almost one in five Americans listed a government Web site (19%) as a source that they may have heard or read about the Dietary Guidelines for Americans; almost a third (32%) listed a non-government Web site as a source. [A9]
• The top three sources adults have heard or read about the Dietary Guidelines for Americans —on television, in a magazine, in a newspaper—are consistent across gender, education, and age, and they mirrored the top tier from 2004.  However, "from a doctor" ranked much higher last year, coming in as the fourth most listed place (52%), rather than seventh, as was the case this year (40%). [A9]

Intentions and Behavior

As previously mentioned, adults contend that nutrition is important when shopping for food and that having healthy eating habits is important.  Also, many Americans are confident that they know how to choose healthy foods and how much physical activity they should be doing to be healthy. 

The following data suggest though, that Americans' self-reported intentions to eat healthier are not necessarily reflected in their behavior.  Although many Americans agree that they are actively trying to balance the amount of food they eat with the exercise they get and that they are making healthier choices than they were six months ago, their reported intake of whole grains, milk products, fruits and vegetables, and avoidance of saturated fat, trans fat, cholesterol, carbohydrates, sodium, and sugar reveal mixed adherence to attitudes and intentions. [A10]

• Overall, nutrition intentions are positive.  Specifically, eight in ten (80%) American adults strongly agree or somewhat agree that they are actively trying to balance the amount of food they eat with the amount of exercise they get, with women more likely to agree with this statement than men (83% and 77%, respectively). [A10]
• When asked whether they agree or disagree that they are making healthier choices than they were six months ago, three-quarters (75%) of American adults concur with the statement. [A10]
  • Women are more likely than men to contend that they have been making healthier choices recently (77% vs. 72%). [A10]
  • Also, all age groups show similar levels of agreement regarding making healthier choices than they were six months ago (76% 18-34; 75% 35-54; 74% 55-64; 70% 65+). [A10]
• Over six in ten (63%) adults strongly agree or somewhat agree that they are more physically active than they were six months ago. [A10]
  • Men are more likely than women to agree that they are more physically active now than they were six months ago (66% vs. 60%), representing one of the only measures where men report a positive practice more than women. [A10]
  • Less-educated adults are more likely than those with at least some college education to note an increase in physical activity (69% vs. 58%). [A10]
  • Younger adults are more likely than their older counterparts to concur with this physical activity statement, with over two-thirds of 18-34 year-olds (69%) and 66% of 35-54 year-olds agreeing, compared to just over half of 55-64 year-olds (54%) and adults 65 years of age or older (51%). [A10]

In addition to physical activity, the survey specifically explored a number of eating and healthy lifestyle behaviors as well. [A11-A13]

• First, few American adults are calorie counters.  Overall, adults average keeping track of the calories they eat less than one day a week (mean = 0.9 days/wk).  This lack of calorie-counting is consistent across age and gender, although those with at least some college education do so an average of 1.2 days per week compared to 0.7 days per week among those with less education. [A11]
• The survey also reviewed a number of foods to determine the frequency with which adults eat them.  Of those listed in the survey, Americans report eating whole grain breads or cereals most often—an average of almost five days per week (mean = 4.8 days/wk).  The corresponding average is 4.4 days/wk in 2004. [A11]
  • Although eating whole grains this frequently is consistent across gender and education level, the youngest and oldest respondents eat them more often than their counterparts (5.0 days/wk 18-34; 4.5 days/wk 35-54; 4.7 days/wk 55-64; 5.2 days/wk 65+). [A11]
• Other healthy eating behaviors that adults undertake at least four days per week include the following: [A11]
  • Having three servings of milk, yogurt, or cheese (4.5 days/wk), which is different from 4.1 days per week reported in 2004.  Those with some college education eat these products more often than those with a high school education or less (4.7 days/wk and 4.2 days/wk, respectively). [A11]
  • Eating at least five servings of fruits or vegetables (4.0 days/wk), with women meeting this serving recommendation more often than men (4.2 days/wk vs. 3.6 days/wk), as are older adults compared to younger ones (3.8 days/wk 18-34; 3.9 days/wk 35-54; 4.2 days/wk 55-64; 4.3 days/wk 65+). [A11]
  • Getting at least 30 minutes of exercise or physical activity (4.0 days/wk).  Interestingly, even though men were more likely than women to indicate that they have become more physically active in the last six months, results are somewhat similar among the genders on this measure (women: 3.9 days/wk; men: 4.2 days/wk). [A10-A11]
• The 2005 survey also revealed that adults drink sugar-sweetened beverages with some frequency.  They report drinking these beverages an average of almost three days per week (2.9 days/wk).  [A11]
  • Men do so more frequently than women (3.3 days/wk vs. 2.5 days/wk). [A11]
  • Those with less education do so more frequently as well, compared to those with at least some college education (3.4 days/wk and 2.4 days/wk, respectively). [A11]
  • Not surprisingly, younger adults drink sugar-sweetened beverages more frequently than their older counterparts.  Adults 18-34 years of age report drinking these beverages an average of almost four days per week (3.8 days/wk).  This number drops to an average of 2.9 days per week among 35-54 year-olds, 2.2 days per week among 55-64 year-olds, and 2.0 days per week among adults 65 years of age or older. [A11]
• Adults eat beans or peas and fish less often than other foods included on the survey.  They eat the former an average of just under two-and-a-half days per week (2.4 days/wk) and the latter just over one day a week (1.2 days/wk), with those who have some college education eating fish more often (1.4 days/wk) than those with less education (1.0 day/wk). [A11]

A series of eating behavior questions explored the extent to which American adults make healthier choices regarding specific food options, including meat, chicken, salt, cheese, and milk. [A12]

• Regarding nutritious food choices, Americans are making better decisions about meat and poultry than other foods included on the survey. 
  • Specifically, a majority of Americans (55%) indicate they always select lean meat over fatty meat.  Approximately six in ten (62%) women and those with at least some college education (60%) always make this choice, compared to 46% of men and 50% of those without some college education.  Older adults are also more likely than younger ones to make this choice.  Sixty-five percent (65%) of adults 65 or older do so, compared to 55% of 35-64 year-olds and 49% of 18-34 year-olds. [A12]
  • A majority (51%) of Americans also always select chicken without the skin over chicken with the skin on.  This percentage is different from that shown in the 2004 survey (41%)  [A12] Demographically, those most likely to do so mirror those most likely to select lean meat:
    • Women are more likely than men (61% vs. 41%).
    • More-educated are more likely than less-educated adults (56% vs. 47%).
    • Older Americans are more likely than younger Americans (49% 18-34; 51% 35-54; 53% 55-64; 58% 65+).
    The largest differences on this measure between 2004 and 2005 occurred among the younger adults; 18-34 year-olds witnessed a 14-point difference, and 35-54 year-olds saw a 15-point difference. [A12]
• Salty products, however, are a bit more problematic for the population.  Only around one-quarter (27%) of American adults always choose foods with reduced salt content over foods with regular salt content.  Over four in ten (42%) rarely or never do it.  These practices are consistent across gender and education.  Older adults are more likely than younger ones to always select the low-salt option.  Thirty-seven percent (37%) of those 65 years old or older and 36% of 55-64 year-olds always make this choice, compared to approximately one in five (22%) of adults under 55 years of age. [A12]
• Turning to milk and milk products, one in five (20%) American adults always choose reduced-fat cheese over regular cheese [A12], and a similar percentage (19%) drink fat-free milk most often when they drink milk. [A13] Another 17% drink 1% milk.  [A13]
  • A majority of adults (51%) rarely or never choose reduced-fat cheese over regular cheese.  Older adults are among the most likely to make this choice, but even less than one-third of them do so (15% 18-34; 17% 35-54; 26% 55-64; 29% 65+). [A12]
  • A number of demographic differences exist regarding milk consumption.  First, women are more likely than men to drink fat-free milk (23% vs. 15%), as are adults with some college education, compared to those with at most a high school education (26% vs. 12%).  Second, older adults are more likely than their younger counterparts to not drink milk at all (3% 18-34; 6% 35-54; 13% 55-64; 15% 65+). [A13]

The survey also conducted an exploration of special diet considerations.  All participants were asked whether or not they had tried to limit any of the following nutrients in their diet in the past 30 days:  saturated fat, trans fat or trans fatty acid, calories, cholesterol, carbohydrates, sodium, and sugar.  Although some of the demographic patterns uncovered in previous findings are consistent here as well—specifically, women being more likely than men to have tried to limit a number of these items—differences across age are less so.  [B1]

• Overall, more adults have tried to limit sugar (65%) and saturated fat (62%) in the past 30 days than the other items asked. [B1]
  • Women are more likely than men to have tried to limit sugar in the past 30 days, but over six in ten of both groups have done so (women: 68%; men: 63%).  Also, 68% of those with at least some college education have tried to limit sugar, as have 63% of adults with a high school education or less.  Interestingly, almost three-quarters (74%) of 55-64 year-olds indicate their attempts to limit sugar, compared to 66% of 18-34 year-olds, 64% of 35-54 year-olds, and 61% of those 65 or older. [B1]
  • Similar demographic differences exist for limiting saturated fats.  Again, women are more likely to do so than men (66% vs. 58%), as are those with more education than less education (67% vs. 57%).  Additionally, 55-64 year-olds are the most likely age group to have tried to limit saturated fats.  Seventy-five percent (75%) of this group has, compared to 65% of those 65 or older, 63% of 35-54 year-olds and 56% of 18-34 year-olds.   
• Fifty-five percent (55%) of American adults are trying to limit cholesterol.  Close to six in ten women (59%) are doing so, whereas 51% of men indicate they are trying to reduce cholesterol intake.  Cholesterol avoidance declines steadily as age decreases.  Seventy-one percent (71%) of adults 65 or older, 61% of 55-64 year-olds, 55% of 35-54 year-olds, and 44% of 18-34 year-olds recently tried to avoid cholesterol. [B1]
• About half (51%) of adults have tried to reduce trans fat intake over the past 30 days.  Some wide disparities exist across demographic categories.  Almost six in ten (58%) women have tried to avoid trans fats, whereas 44% of men have done so.  Sixty-one percent (61%) of those with at least some college education have attempted to avoid trans fats, while only 41% of adults with less education have tried over the past 30 days.  Fifty-five to 64 year-olds lead the other age categories in avoiding trans fats, with two-thirds (67%) attempting to do so, compared to 59% of those 65 years of age or older, 50% of 35-54 year-olds, and 42% of 18-34 year-olds.⁽¹²⁾ [B1]
• Similar percentages of adults have attempted to reduce calories (48%), sodium (47%), and carbohydrates (46%). [B1]
  • Women are more likely than men to have tried to avoid calories (52% vs. 43%).  This behavior is mixed across age ranges.  Over half (52%) of 35-54 year-olds and adults over 64 years of age (51%) have tried to limit calorie intake.  Only 44% of 55-64 year-olds and 41% of 18-34 year-olds note a similar behavior. [B1]
  • Regarding sodium, 54% of women and 41% of men have tried to specifically limit the element in the past 30 days.  Adults 55 or over are more likely than their younger counterparts to do so as well.  Sixty-one percent (61%) of 55-64 year-olds and 58% of adults over 64 years of age have tried to reduce sodium intake, compared to 45% of 35-54 year-olds and 39% of 18-34 year-olds. [B1]
  • Women are more likely than men to have tried to avoid carbohydrates (50% vs. 42%), and adults 55 or over are more likely than their younger counterparts to do so as well (52% 65+; 51% 55-64 vs. 43% 35-54; 44% 18-34). [B1]

Knowledge of Whole Grains

Given the Dietary Guidelines for Americans recommendation to eat three or more ounce-equivalents of whole grains per day,⁽¹³⁾ the seemingly high reported frequency of whole grain intakes in the 2004 survey, and increased media attention and marketing focus on whole grain products, the 2005 survey addressed how well American adults could distinguish whole grain foods from non-whole grain foods.

To gauge this knowledge, the 2005 survey included a special section that presented six foods—whole wheat bread, oatmeal, popcorn (whole grain foods); and, French bread, corn flakes, and rye bread (non-whole grain foods)—and asked respondents if each was a whole grain food. Whole wheat bread, oatmeal, and popcorn represent some of the most common whole grain products; whereas, French bread and corn flakes represent some of the most common refined grain products.  Although rye bread can be considered a whole grain food, most commercially prepared rye bread is usually not 100% whole grain.  As a result, it was not considered a whole grain food for this report.

Overall, 62% of adults correctly identified at least four of the six foods.  Only 3% identified all six foods correctly. [A11a]

• Overwhelming majorities of American adults know that whole wheat bread and oatmeal are whole grain foods (90% and 90%, respectively).  Knowledge of these whole grain foods is consistent across age, gender, and education. [A11a]
• Just over three-quarters (78%) of adults correctly note that French bread is not a whole grain food. Women are more likely than men to have this knowledge (81% vs. 74%), as are more-educated adults compared to their counterparts with less education (88% vs. 67%).  Regarding age, over eight in ten 35-54 year-olds and 55-64 year-olds know this information (80% and 83%, respectively), compared to 76% of 18-34 year-olds and 68% of adults 65 or older. [A11a]
• Fifty-three percent (53%) correctly indicates that corn flakes are not a whole grain food.  As with French bread, more women than men (61% vs. 45%) and more higher-educated adults than less-educated adults (61% vs. 46%) have the correct knowledge.  Also, the oldest respondents are the least likely to know that corn flakes are not a whole grain food (51% 18-34; 59% 35-54; 58% 55-64; 43% 65+). [A11a]
• Adults are much less likely to know that popcorn is a whole grain food, and rye bread is not.  Similar percentages identified these foods correctly (popcorn 29%; rye bread 28%), although almost one in ten (9%) of adults admitted they did not know rye bread's correct classification.  Six percent (6%) did not venture a guess about popcorn.  These findings are relatively consistent across gender and education, but interestingly, adults 65 or older are more likely than other age groups to know that popcorn is a whole grain food (19% 18-34; 28% 35-54; 34% 55-64; 45% 65+). [A11a]

Conclusions

As a multi-year study, the Health and Diet Survey: Dietary Guidelines Supplement should help provide fundamental snapshots of relevant knowledge, attitudes, and behavior at specific points in time.  The benefit of this survey will become increasingly apparent overtime with more repetitions of data collection in the future.

For now, the data as a snapshot reveal that most Americans believe it is important to have healthy eating habits, think about nutrition when shopping for food, and are confident in how to choose healthy foods and about the amount of physical activity needed to be healthy.  Most self-report that their health is excellent or very good, regardless of gender.

Nevertheless, data also demonstrate that Americans' knowledge and good intentions are not reflected in behavior. Compared to adults' own self-perceptions of their weight, BMI scores (derived from self-reported height and weight) show that adults are actually heavier than they believe themselves to be.  At the same time, of those self-reported being overweight, at least seven in ten adults in all age groups are currently trying to lose weight.  Although many Americans agree that they are actively trying to balance the amount of food they eat with the exercise they get and that they are making healthier choices than they were (six months ago), their reported intake of whole grains, milk products, fruits and vegetables, and avoidance of saturated fat, trans fat, cholesterol, carbohydrates, sodium and sugar revealed mixed adherence to attitudes and intentions.

The two waves of the survey so far serve as a data foundation offering an immediate view of current knowledge, attitudes and behavior—serving as a pre-intervention reference and a starting point leading off of the Dietary Guidelines for Americans, 2005 release.  Fundamentally, the survey has already begun to yield areas related to diet and physical activity that may be worth monitoring but still need the test of time in order to draw conclusions.  

The survey will also allow for the strengthening of interventions during their implementation as their impact is monitored.  The coming years, with the increase in trend data, will ultimately provide insight into the impact of Dietary Guidelines information that can help shape and influence the health of the American people.

APPENDIX A: DATA TABLES^(*)

• In Questionnaire Order
• Data by Gender, Education and Age
• Data by Year: 2005 and 2004

Health and Diet Survey: Dietary Guidelines Supplement

Importance of Nutrition

[A1.]    First, let's talk a little bit about grocery shopping.  How important is nutrition to you when you shop for food? Would you say nutrition is very important, somewhat important, somewhat unimportant, or not at all important to you when you shop for food?

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Use of Federal Government Sources

[A2.]    Have you looked for nutrition information from any Federal government sources in the past 6 months?

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Ease of Using Federal Government Sources

[A3.]    How easy or difficult would you say it is to get nutrition information from Federal government sources?  Would you say it is [READ OPTIONS]?

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Reliability of Federal Government Information

[A4.] How reliable would you say nutrition information provided by the Federal government is?  Would you say it is [READ OPTIONS]?

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Frequency of Using Federal Government Web Sites

[A5.]    How often do you use Federal government Web sites to look for nutrition information?  Would you say you do this [READ OPTIONS.  ACCEPT ONE]

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Awareness

[A6.]    Have you heard anything about the following information on diet and health? Have you heard anything about... yes or no?  What about...

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Familiarity with the Dietary Guidelines for Americans

[A7.]    How familiar would you say you are with the Dietary Guidelines for Americans?  Would you say you are [READ OPTIONS.  SELECT ONE] 

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Heard News of the Dietary Guidelines for Americans

[A8.]    In the past 6 months, have you heard any news about the Dietary Guidelines for Americans?

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Places Heard or Read about Dietary Guidelines for Americans 

[A9.] Now, I am going to read a list of places that people may have heard or read about Dietary Guidelines for Americans.  First, have you yourself heard or read about Dietary Guidelines for Americans [RANDOM START; KEEP ITEMS G, H, and I TOGETHER AND IN THAT ORDER.], yes or no? Have you heard about Dietary Guidelines for Americans [READ SECOND ITEM], [REPEAT "Have you heard about Dietary Guidelines for Americans" FOR OTHER ITEMS WHEN NECESSARY.]?  What about ...?

^*Unweighted sample size ranges from 333 to 337

^*Unweighted sample size ranges from 225 to 228

Attitudes

[A10.] Next, I am going to read some statements about health, food, and exercise.  As I read each statement, please tell me how much you agree or disagree with it. The first statement is... "[RANDOM START]..." Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it? ...The next statement is "..." [REPEAT RESPONSE OPTIONS WHEN NECESSARY.]...The next statement is...

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Activities

[A11.]  Next, I would like to ask you how many days per week you do a variety of things.  If you don't usually do these things at least once a week, please say zero.   Now, thinking of a typical seven-day week, how many days per week do you [RANDOM START] And how many days per week do you....?  What about...

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Knowledge of Whole Grains (No Data for 2004)

[A11a.] Next, I am going to mention six different foods.  As I mention each one, please tell me whether you would say it is a whole grain food?  First, is [RANDOM START] a whole grain food, yes or no? Is [SECOND ITEM] a whole grain food, yes or no?  What about ....?  [REPEAT "Is [ITEM] a whole grain food, yes or no" WHEN NECESSARY.]

"n" denotes unweighted sample size

Food Choices

[A12.] Now think about the foods you eat. Would you say you always, sometimes, rarely, or never [RANDOM START]

"n" denotes unweighted sample size

Milk Consumption

[A13.] When you drink milk, which of the four kinds of milk do you drink most often, fat-free, one percent, two percent, or whole milk?

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Awareness of and Action Regarding Trans Fats (No Data for 2005)

[A14.] 

"n" denotes unweighted sample size

Limitations on Diet

B.  SPECIAL DIET AND WEIGHT CONTROL

[B1.] Have you tried to limit any of the following things in your diet in the past 30 days?  Have you tried to limit the amount of [READ AND ROTATE LIST.] in your diet, yes or no? .... What about ....?

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Health

[B3.] How do you describe your health?  In general, would you say your health is...? 

"n" denotes unweighted sample size

"n" denotes unweighted sample size

Weight and Weight Loss

[B4.] Do you consider yourself to be overweight, underweight, or about the right weight? [IF RESPONDENT MENTIONS OTHERS' OPINIONS, E.G., MY DOCTOR SAYS I'M OVERWEIGHT, READ: "What we really want to know is how YOU yourself think about your weight."

[B6.] [IF B4 = "OVERWEIGHT"] Are you currently trying to lose weight?

Demographics

[C1-C14.]

"n" denotes unweighted sample size

APPENDIX B:  2005 SURVEY INSTRUMENT

No. 0910-0545 
Expiration Date:  9/30/2007       

HEALTH AND DIET SURVEY:
DIETARY GUIDELINES SUPPLEMENT
QUESTIONNAIRE (2005)

SCREENER AND INTRODUCTION

SCREENER

Hello, I'm ________________ with Synovate. I'm calling on behalf of the United States Food and Drug Administration, the FDA.  We're doing a study about people's opinions about nutrition and health to help the FDA design better programs to improve the Nation's health.   May I speak to the member of your household who is aged 18 or over and has had the most RECENT birthday?  Would that be you?

[IF NOT AVAILABLE, ASK FOR THE FIRST NAME OF THE ELIGIBLE RESPONDENT FOR CALL-BACK PURPOSE.]

[REINTRODUCE AS NECESSARY.]

INTRODUCTION

This call may be monitored for quality control purposes. Your answers to this survey are voluntary and will be kept confidential. The survey will take about 10 minutes.

INTERVIEWER:  CODE SEX WITHOUT ASKING.

A. DIETARY GUIDELINES FOR AMERICANS

A1. First, let's talk a little bit about grocery shopping.  How important is nutrition to you when you shop for food? Would you say nutrition is very important, somewhat important, somewhat unimportant, or not at all important to you when you shop for food?

1. The Five-A-Day Program
2. The Dietary Guidelines for Americans
3. The MyPyramid Program
4. A Healthier You: Based on the Dietary Guidelines for Americans

[IF "DIETARY GUIDELINES" = "YES," GO TO A7.  IF "DIETARY GUIDELINES" = "NO/DK/NS/RF," SKIP TO A10.]

A7. How familiar would you say you are with the Dietary Guidelines for Americans?  Would you say you are... [READ OPTIONS.  SELECT ONE]

1. On the radio
2. On television
3. From a government Web site
4. From a non-government Web site
5. In a magazine
6. In a newspaper
7. From a doctor
8. From a dietician or nutritionist
9. From another health care provider
10. From family
11. From friends
12. At work or from co-workers
13. In supermarket brochures or pamphlets

A10. Next, I am going to read some statements about health, food, and exercise.  As I read each statement, please tell me how much you agree or disagree with it. The first statement is..."[RANDOM START]..." Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with it? ...The next statement is "..." [REPEAT RESPONSE OPTIONS WHEN NECESSARY.]...The next statement is...

1. Having healthy eating habits is very important to me
2. I am actively trying to eat a healthy diet
3. I am confident that I know how to choose healthy foods
4. I am confident that I know how much physical activity I should be doing
5. I am making healthier food choices now than I was 6 months ago
6. I am more physically active now than I was 6 months ago
7. The amount of food you should eat depends on how many calories you burn each day
8. I am actively trying to balance the amount of food I eat with the amount of exercise I get

A11. Next, I would like to ask you how many days per week you do a variety of things.  If you don't usually do these things at least once a week, please say zero.   Now, thinking of a typical seven-day week, how many days per week do you [RANDOM START] And how many days per week do you ...?  What about...?
[IF RESPONDENT SAYS SOMETHING LIKE "I DON'T EAT FISH AT ALL" OR "I NEVER KEEP TRACK OF CALORIES," ACCEPT THE ANSWER WITHOUT PROBING.]

[IF RESPONDENT GIVES A RANGE, ASK FOR ONE ANSWER.  FOR EXAMPLE IF RESPONDENT SAYS "2 TO 3," ASK IS IT 2 OR 3?] 

1. Keep track of the calories you eat
2. Get at least 30 minutes of exercise or physical activity
3. Eat at least five servings of fruits or vegetables
4. Eat whole grain breads or cereals
5. Have 3 servings of milk, yogurt, or cheese
6. Eat fish
7. Drink sugar-sweetened beverages
8. Eat beans or peas

A11a. Next, I am going to mention six different foods.  As I mention each one, please tell me whether you would say it is a whole grain food?  First, is [RANDOM START] a whole grain food, yes or no? Is [SECOND ITEM] a whole grain food, yes or no?  What about ...?  [REPEAT "Is [ITEM] a whole grain food, yes or no" WHEN NECESSARY.]

1. Rye bread
2. oatmeal
3. popcorn
4. corn flakes
5. French bread
6. whole wheat bread

A12. Now think about the foods you eat. Would you say you always, sometimes, rarely, or never [RANDOM START]

1. Choose lean meat over fatty meat
2. Choose chicken without skin over chicken with the skin on
3. Choose foods with reduced salt content over foods with regular salt content
4. Choose reduced-fat cheese over regular cheese

A13. When you drink milk, which of the four kinds of milk do you drink most often, fat-free, one percent, two percent, or whole milk?

B. SPECIAL DIET AND WEIGHT CONTROL

B1. Have you tried to limit any of the following things in your diet in the past 30 days?  Have you tried to limit the amount of [READ AND ROTATE LIST.] in your diet, yes or no? .... What about ....? [REPEAT "YES OR NO" WHEN NECESSARY]

1. saturated fat
2. trans fat or trans fatty acid
3. calories
4. cholesterol
5. carbohydrates
6. sodium
7. sugar

B3. How do you describe your health?  In general, would you say your health is ...?  [READ OPTIONS.  ACCEPT ONE]

IF B4 = "OVERWEIGHT," GO TO B6 (ARE YOU CURRENTLY TRYING TO LOSE WEIGHT?)

(B5 is not used)

B6. Are you currently trying to lose weight?

[All respondents]

C. DEMOGRAPHICS AND HEALTH STATUS

Finally, I have some questions for statistical purposes. 

C1. Are there any telephone numbers in addition to (the telephone number being called) in your home that you receive calls on?  Please do not include cellular phone numbers or numbers used only for fax or computer.

[RESPONDENT AGE = 2005 – C8.]

C9. The next two questions may seem a bit personal, but we need this information because our research is about nutrition and health. How tall are you without shoes? [ROUND UP TO THE NEXT WHOLE NUMBER. FOR EXAMPLE, 3.5 INCHES SHOULD BE CODED AS 4 INCHES.]

(C11 omitted)

C12. Have you ever been told by a doctor or other healthcare professional that you have any of the following health conditions?  I don't need to know which condition, just whether you have ANY of them.  [READ: "high blood pressure, diabetes, high cholesterol, heart disease, obesity, overweight, or cancer."]

[READ: THOSE ARE ALL THE QUESTIONS I HAVE. THANK YOU FOR YOUR TIME AND COOPERATION.  I'D LIKE YOU TO KNOW THAT YOU HAVE MADE AN IMPORTANT CONTRIBUTION TO OUR STUDY.]

[IF THE RESPONDENT ASKED ABOUT WHERE TO GET INFORMATION ABOUT THE TOPICS DISCUSSED IN THE SURVEY, SAY "I AM NOT AN EXPERT ON THESE TOPICS AND I DON'T HAVE THE INFORMATION.  BUT YOU CAN CALL 1-888-723-3366 OR VISIT WWW.HEALTHFINDER.GOV.]

X1. [INTERVIEWER: Did the respondent ask for additional information?]

OMB No. 0910-0545    
Expiration Date:  9/30/2007       

HEALTH AND DIET SURVEY:
DIETARY GUIDELINES SUPPLEMENT
QUESTIONNAIRE, SPANISH VERSION (2005)

SCREENER AND INTRODUCTION

SCREENER

Notes

• ⁽¹⁾ The baseline survey was fielded before the January 2005 release of the 6^th Edition of the Dietary Guidelines for Americans.
• ⁽²⁾ Additional analyses for other subgroups will be released at a later date.
• ⁽³⁾ Calling was halted 11/24-25/05 and again 12/23/05 – 1/2/06 due to holidays.
• ⁽⁴⁾ The final 2005 survey instrument (in both English and Spanish) is included in Appendix B. 
• ⁽⁵⁾ Source:  Evidence Report of the Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 1998. NIH/National Heart, Lung, and Blood Institute (NHLBI).  (Formula: weight (lb)/[height (in)]²x703).
• ⁽⁶⁾ For example, gender differences of at least plus-or-minus five percentage points are reported.
• ⁽⁷⁾ This difference lies outside of the margin of error for mean comparisons of the 2004 and 2005 samples.
• ⁽⁸⁾ The term "confident" refers to respondents who agree or strongly agree with the statement.
• ⁽⁹⁾ It is important to note that some respondents may have been confused by this item since the new Food Guidance System was introduced as MyPyramid (or MyPyramid.gov and introduced in April, 2005). Also, the 2005 data cannot be compared to 2004 because the item under consideration in that survey was "The Food Guide Pyramid."
• ⁽¹⁰⁾ "MyPyramid," introduced in April, 2005, was listed as the Food Guide Pyramid in the 2004 survey.
• ⁽¹¹⁾ Reference to this item was stated differently in the 2005 and 2004 surveys.
• ⁽¹²⁾ The high-than-expected awareness of trans fat found in the 2004 survey prompted using different questions to obtain trans fat information in the 2005 survey.
• ⁽¹³⁾ A Healthier You: Based on the Dietary Guidelines for Americans. Page 284.
• ^(*) Data for cells with n<100 are not presented.