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.

Dietary Screener Questionnaire, 2010 & 2015
Fruit/Vegetables, Fiber, Added Sugars, Dairy, Calcium, and Red & Processed Meat

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).

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).

Fruit and Vegetable Screener, 2000
Fruit/Vegetables

As used in the 2000 California Health Interview Survey (CHIS)

Fruit & Vegetable Intake Screener, 1997
Fruit/Vegetables

As used in the Eating at America’s Table Study (EATS)

Percentage Energy from Fat Screener, 1996
Fat

Investigator-Developed Short Diet Assessment Instruments

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.