View or Download Validated Short Dietary Assessment Instruments
The following instrument files are in PDF format. All files were formatted for accessibility and compliance with section 508 of the Americans with Disabilities Act.
NCI-Developed Short Diet Assessment Instruments
Click the plus sign below to expand each section and view or download the instrument files.
For more information about these instruments and the surveys and studies in which they were administered, see the Short Dietary Assessment Instruments website.
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Dietary Screener Questionnaire, 2010 & 2015
Fruit/Vegetables, Fiber, Added Sugars, Dairy, Calcium, and Red & Processed Meat
As used in the 2015 National Health Interview Survey (NHIS) Cancer Control Supplement (CCS)
- DSQ in NHIS CCS 2015 English Version [PDF - 870 KB]
- DSQ in NHIS CCS 2015 Spanish Version [PDF - 875 KB]
As used in National Health and Nutrition Examination Survey (NHANES) 2009-10
- DSQ in NHANES 2009-10 Interviewer-Administered English Version [PDF - 142 KB]
- DSQ in NHANES 2009-10 Interviewer-Administered Spanish Version [PDF - 187 KB]
- DSQ in NHANES 2009-10 Self-Administered English Version [PDF - 126 KB]
As used in the 2010 NHIS CCS
- DSQ in NHIS 2010 English Version [PDF - 904 KB]
- DSQ in NHIS 2010 Spanish Version [PDF - 939 KB]
Five-Factor Screener, 2005
Fruit/Vegetables, Fiber, Added Sugars, Dairy, Calcium
As used in the 2005 National Health Interview Survey (NHIS) Cancer Control Supplement (CCS)
The food and diet questions in these files are labeled NAC.010 – NAC.138 (roughly pages 5-16).
- Five Factor Screener in NHIS 2005 English Version [PDF - 1.20 MB]
- Five Factor Screener in NHIS 2005 Spanish Version [PDF - 1.97 MB]
Multifactor Screener, 2000
Fruit/Vegetables, Fat, Fiber
As used in the 2000 National Health Interview Survey (NHIS) Cancer Control Supplement (CCS)
The food and diet questions in these files are labeled NAC.010 – NAC.160 (roughly pages 7-13).
As used in the Observing Protein and Energy Nutrition (OPEN) Study
Dietary Screener, 2009
Fruit/Vegetables, Added Sugars
As used in the 2009 California Health Interview Survey (CHIS)
The food and diet questions in these files are labeled QA09_C13 to QA09_C21 (roughly pages 35-37).
Dietary Screener, 2005
Fruit/Vegetables, Added Sugars
As used in the 2005 California Health Interview Survey (CHIS)
The food and diet questions in these files are labeled QA05_C14 to QA05_C24 (roughly pages 23-25).
As used in the 2000 California Health Interview Survey (CHIS)
As used in the Eating at America’s Table Study (EATS)
- EATS All-day Screener [PDF - 226 KB]
- EATS By-meal Screener [PDF - 345 KB]
Percentage Energy from Fat Screener, 1996
Fat
Investigator-Developed Short Diet Assessment Instruments
- Charlton: Salt Screener [PDF - 53 KB]
- Fialkowski: Shellfish Assessment Survey [PDF - 699 KB]
- Harnack: Calcium Questionnaire [PDF - 587 KB]
- Głąbska: Folate-Intake Calculation-Food Frequency Questionnaire (Fol-IC-FFQ) [PDF - 189 KB]
- Głąbska: IODINE-FFQ [PDF - 208 KB]
- Głąbska: IRONIC-FFQ [PDF - 197 KB]
- Głąbska: VIDEO-FFQ [PDF - 201 KB]
- Johnson: Adolescent Food Habits Checklist [PDF - 91 KB]
- Lean: Eating Questionnaire [PDF - 55 KB]
- Segal-Isaacson: Rapid Eating Assessment for Participants - Shortened Version [PDF - 55 KB]
- Williams: Diet Related to Soy Beans Questionnaire [PDF - 62 KB]
- Yang: Brief Calcium Assessment Tool [PDF - 103 KB]
If you have questions about the instruments on this page or would like to suggest a validated short dietary assessment instrument for inclusion on this page, please contact the Risk Factor Assessment Branch at RFAB@mail.nih.gov.
