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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

SINGAPORE POPULATION HEALTH STUDIES – MEC PHASE III MAIN QUESTIONNAIRE – PERSONAL INFORMATION

Name: (Mr / Ms / Mrs)* ______

Gender: 1) Male 2) Female

NRIC: D.O.B

D D M M Y Y Y Y

Ethnicity: 1) Chinese 2) Malay 3) Indian 4) Others, please specify: ______

Preferred Language: 1. ______2. ______

Mailing Address Residential Address □ Same as residential address Block Street / Building Name Unit No # - # - Postal Code Home No Mobile No Office No Contact 1 Contact 2

Contact 3 (Relative’s mobile): ______Relation: ______As an additional option and source of contact to facilitate follow-up

Email Address:

INTERVIEW DETAILS STUDY ID

Interviewer’s Name

Interview Language

Interview Date / /

Interview Time AM / PM*

Page 1 of 63 Annex I, IRB V3, 8 March 2019_MECIII

SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Interviewed by: Document the full name of the interviewer.

Name: [*Mr/Ms/Mrs] Circle the appropriate salutation. Document the name as it is printed on the participant’s NRIC.

Gender: * M / F Document the gender as printed on the NRIC

Ethnicity Document as per NRIC. Specify Other, e.g. Bugis, Sikh, Pakistani

D.O.B: Document the date of birth as printed on the NRIC.

Residential Address: Document the main address that the participant is currently staying at.

Mailing Address [fill in only if different from Document mailing address only if different from the above]: residential address.

Contact No. Obtain telephone number where applicable/contactable. If no contact number is available, document 77777777.

Preferred Language: 1.___ 2.____ Document the language(s) that is spoken according to the order of preference

1. Date and time of interview commences: Document the date and time the interview was conducted.

Note to Interviewer:

Each correction of entry must be signed and dated. Do not interpret or make assumptions while interviewing; document participant’s response accordingly. All are single answer questions. Circle the appropriate answer number. Do not leave any blanks unless instructed. Enter all date fields in the format “DDMMYYYY”. For other fields:

Day, Month or String/Text Numeric Year Where not applicable, enter: 77 / 7777 NNN 777 Where Participant refuses to answer, enter: 88 / 8888 RRR 888 Where Participant does not know, enter: 99 / 9999 DDD 999

Page 2 of 63 Annex I, IRB V3, 8 March 2019_MECIII

SPHS - MEC3 ONLINE NUTRITION SURVEY Annex H IRB v1, dated 28 Nov 2018

Page Questions Answer options Number Instructions Thank you for agreeing to take part in this survey about the foods you usually eat. 1. Please recall your usual intake over the past year. 1 2. There are no right or wrong answers; please respond as honestly as possible. 3. Some of the questions allow you to give multiple answers. This will always be indicated in the question. If you would like to watch a short tutorial about this questionnaire, please click on 2 the link below. If you would like to skip the tutorial and go straight to the survey, please click 'Next'. BREAD White bread (including ) Wholemeal bread Which of the following items do you 3 Bread with dried fruit/nuts/seeds e.g. walnut bread, raisin consume at least once a month? bread, corn bread, multigrain None of these (You can choose more than one) How often do you consume 2 slices of:

4 Daily Weekly Monthly White bread (including naan) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 2 slices of:

5 Daily Weekly Monthly Wholemeal bread 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 2 slices of:

6 Bread with dried fruit/nuts/seeds Daily Weekly Monthly e.g. walnut bread, raisin bread, corn 4+ times 4 - 6 times 2 - 3 times bread, multigrain 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number BREAD SPREADS Margarine e.g. olive spread, Planta® Kaya Which of the following items do you 7 butter consume at least once a month? 1 Jam/Marmalade/Honey Chocolate spread e.g. Nutella® None of these (You can choose more than one) How often do you consume 1 teaspoon of:

8 Daily Weekly Monthly Margarine 4+ times 4 - 6 times 2 - 3 times e.g. olive spread, Planta® 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 teaspoon of:

9 Daily Weekly Monthly Butter 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 teaspoon of:

10 Daily Weekly Monthly Kaya 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 teaspoon of:

11 Daily Weekly Monthly Peanut butter 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 teaspoon of:

12 Daily Weekly Monthly Jam/Marmalade/Honey 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 teaspoon of:

13 Daily Weekly Monthly Chocolate spread 4+ times 4 - 6 times 2 - 3 times e.g. Nutella® 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number OTHER BREADS French toast Pizza Thosai, plain or with filling e.g. potato prata, plain or with egg/cheese (including ) 1 Which of the following items do you 14 consume at least once a month? (deep-fried Indian bread) Sweet filled buns (including pau) e.g. red bean, coconut, Savoury filled buns (including pau) e.g. chicken, char siew, cheese, None of these (You can choose more than one) How often do you consume 2 triangular slices of:

15 Daily Weekly Monthly French toast 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 slice (from 14” pizza) OR 2 slices (from 9" pizza) of:

16 Daily Weekly Monthly Pizza 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 piece of:

17 Daily Weekly Monthly Thosai, plain or with filling 4+ times 4 - 6 times 2 - 3 times e.g. potato 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 piece of:

18 Daily Weekly Monthly Roti prata, plain or with egg/cheese 4+ times 4 - 6 times 2 - 3 times (including paratha) 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 piece of:

19 Daily Weekly Monthly Chapati 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1/4 of a whole OR 2 small pieces of:

20 Daily Weekly Monthly Murtabak 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time

How often do you consume 1 piece of:

21 Daily Weekly Monthly Puri (deep-fried Indian bread) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 piece of:

22 Daily Weekly Monthly Sweet filled buns (including pau) 4+ times 4 - 6 times 2 - 3 times e.g. red bean, coconut, custard 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 piece of:

23 Daily Weekly Monthly Savoury filled buns (including pau) 4+ times 4 - 6 times 2 - 3 times e.g. chicken, char siew, cheese, hot dog 2 - 3 times 2 - 3 times 1 time 1 time 1 time RICE Rice, plain, boiled/steamed (excluding ) Flavoured rice porridge e.g. chicken, , duck, fish, vegetarian Plain rice porridge Fried rice Flavoured rice e.g. chicken rice, briyani, , pilau, , yellow rice, olive rice, tomato rice, saffron rice, Which of the following items do you 24 yam rice consume at least once a month? Flavoured rice dish (mixed with meat/veg) e.g. bi bi bap, claypot, mui fan, fan choy e.g. lor mai kai, bak chang / (steamed rice , savoury) Rice roll e.g. chwee kway, chee cheong fun None of these (You can choose more than one) SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume

Daily Weekly Monthly Rice, plain, boiled/steamed 4+ times 4 - 6 times 2 - 3 times (excluding porridge) 25 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time Which photograph is closest to how much plain rice you eat in a typical meal? How often is the Rice: Always Mostly Mixture of white and brown/red Half the time Sometimes Never/Rarely Always Mostly 26 Brown or red rice (unpolished) Half the time Sometimes Never/Rarely Always Mostly White rice (including basmati) Half the time Sometimes Never/Rarely How often do you consume:

Daily Weekly Monthly Flavoured rice porridge 4+ times 4 - 6 times 2 - 3 times e.g. chicken, pork, duck, fish, vegetarian 2 - 3 times 2 - 3 times 1 time 27 1 time 1 time Less than 1 medium bowl Which photograph is closest to how 1 medium bowl much flavoured rice porridge you eat in a Between 1 and 2 medium bowls typical meal? 2 or more medium bowls

How often is the Flavoured rice porridge Always Mostly Mixture of white and brown/red Half the time Sometimes Never/Rarely Always 28 Mostly Brown or red rice (unpolished) Half the time Sometimes Never/Rarely Always Mostly White rice (including basmati) Half the time Sometimes Never/Rarely SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume:

Daily Weekly Monthly Plain rice porridge 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 29 1 1 time 1 time Less than 1 medium bowl Which photograph is closest to how 1 medium bowl much plain rice porridge you eat in a Between 1 and 2 medium bowls typical meal? 2 or more medium bowls How often is the Plain rice porridge Always Mostly Mixture of white and brown/red Half the time Sometimes Never/Rarely Always Mostly 30 Brown or red rice (unpolished) Half the time Sometimes Never/Rarely Always Mostly White rice (including basmati) Half the time Sometimes Never/Rarely How often do you consume:

Daily Weekly Monthly Fried rice 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 31 1 time 1 time Less than 1 medium bowl Which photograph is closest to how 1 medium bowl much fried rice you eat in a typical meal? Between 1 and 2 medium bowls 2 or more medium bowls How often is the Fried rice Always Mostly 32 With Half the time Sometimes Never/Rarely SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often is the Fried rice Always Mostly Mixture of white and brown/red Half the time Sometimes Never/Rarely 1 Always Mostly 33 Brown or red rice (unpolished) Half the time Sometimes Never/Rarely Always Mostly White rice (including basmati) Half the time Sometimes Never/Rarely How often is the Fried rice Always Mostly Prepared at home Half the time Sometimes 34 Never/Rarely Always Mostly Prepared by food outlet Half the time Sometimes Never/Rarely How often do you consume: Flavoured rice Daily Weekly Monthly e.g. Chicken rice, briyani, nasi lemak, 4+ times 4 - 6 times 2 - 3 times pilau, nasi minyak, yellow rice, olive rice, 2 - 3 times 2 - 3 times 1 time 35 tomato rice, saffron rice, yam rice 1 time 1 time Less than 1 medium bowl Which photograph is closest to how 1 medium bowl much flavoured rice you eat in a typical Between 1 and 2 medium bowls meal? 2 or more medium bowls How often do you consume 1 medium bowl of:

36 Flavoured rice dish (mixed with Daily Weekly Monthly meat/veg) 4+ times 4 - 6 times 2 - 3 times e.g. bi bim bap, claypot, mui fan, fan choy 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 rice bowl OR 1 piece of:

37 Daily Weekly Monthly Glutinous rice 4+ times 4 - 6 times 2 - 3 times e.g. lor mai kai, bak chang 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

How often do you consume 4 pieces of:

38 Daily Weekly Monthly Lontong/ketupat 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time

How often do you consume 2 pieces of:

39 Daily Weekly Monthly Idli (steamed rice cake, savoury) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 piece of:

40 Daily Weekly Monthly Rice roll 4+ times 4 - 6 times 2 - 3 times e.g. chwee kway, chee cheong fun 2 - 3 times 2 - 3 times 1 time 1 time 1 time GRAVY Gravy, with coconut (extra on top of rice or as a side dish) e.g. gravy Which of the following items do you 41 Gravy, without coconut (extra on top of rice or as a side dish) consume at least once a month? e.g. braised gravy, sambhar None of these (You can choose more than one) How often do you consume 1 scoop (4-5 dessertspoons) of:

42 Gravy, with coconut (extra on top of rice Daily Weekly Monthly or as a side dish) 4+ times 4 - 6 times 2 - 3 times e.g. curry gravy 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 scoop (4-5 dessertspoons) of:

43 Gravy, without coconut (extra on top of Daily Weekly Monthly rice or as a side dish) 4+ times 4 - 6 times 2 - 3 times e.g. braised gravy, sambhar 2 - 3 times 2 - 3 times 1 time 1 time 1 time Noodles, fried e.g. , mee, hor fun Noodles, in gravy e.g. , , , , curry noodles Which of the following items do you Noodles, in e.g. , mee , , instant 44 consume at least once a month? soup, fishball noodles, sliced fish bee hoon Noodles, dry e.g. instant, dry wanton noodles, fishball noodles, mincemeat and mushroom noodles None of these (You can choose more than one) SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume:

Daily Weekly Monthly Noodles, fried 4+ times 4 - 6 times 2 - 3 times e.g. mee goreng, , hor fun 2 - 3 times 2 - 3 times 1 time 45 1 1 time 1 time Less than 1 serving Which photograph is closest to how 1 serving much you eat in a typical Between 1 and 2 servings meal? 2 or more servings How often do you consume:

Noodles, in gravy Daily Weekly Monthly e.g laksa, mee rebus, mee siam, lor 4+ times 4 - 6 times 2 - 3 times mee, curry noodles 2 - 3 times 2 - 3 times 1 time 46 1 time 1 time Less than 1 serving Which photograph is closest to how 1 serving much noodles in gravy you eat in a Between 1 and 2 servings typical meal? 2 or more servings How often do you consume: Noodles, in soup Daily Weekly Monthly e.g. yong tau foo, mee soto, ramen, 4+ times 4 - 6 times 2 - 3 times instant , fishball noodles, 2 - 3 times 2 - 3 times 1 time 47 sliced fish bee hoon 1 time 1 time Less than 1 serving Which photograph is closest to how 1 serving much noodles in soup you eat in a typical Between 1 and 2 servings meal? 2 or more servings How often do you consume: Noodles, dry Daily Weekly Monthly e.g. instant, dry wanton noodles, fishball 4+ times 4 - 6 times 2 - 3 times noodles, mincemeat and mushroom 2 - 3 times 2 - 3 times 1 time 48 noodles 1 time 1 time Less than 1 serving Which photograph is closest to how 1 serving much dry noodles you eat in a typical Between 1 and 2 servings meal? 2 or more servings SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often are the Noodles Always Mostly White Half the time e.g. bee hoon, kway teow, mee tai mak Sometimes Never/Rarely 1 Always Mostly Brown rice noodles Half the time e.g. brown rice bee hoon Sometimes 49 Never/Rarely Wheat noodles Always e.g. yellow noodles, ban mian, mee hoon Mostly kueh, you-mian, sheng mien, yee mien, Half the time , mee kia, mee sua, ramen, Sometimes , Never/Rarely Always Mostly Instant noodles Half the time Sometimes Never/Rarely How often are the Noodles Always Mostly Prepared at home Half the time Sometimes 50 Never/Rarely Always Mostly Prepared by food outlet Half the time Sometimes Never/Rarely

Which of the following items do you Pasta, plain (without meat/ fish//veg) e.g. aglio olio 51 consume at least once a month? Pasta with meat/fish/seafood/veg None of these (You can choose more than one) How often do you consume 1 plate of:

52 Daily Weekly Monthly Pasta, plain (without meat/ 4+ times 4 - 6 times 2 - 3 times fish/seafood/veg) 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 plate of:

53 Daily Weekly Monthly Pasta with meat/fish/seafood/veg 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often is the Pasta: Always Mostly 54 Wholemeal Half the time Sometimes Never/Rarely 1 How often is the Pasta Always Mostly Made with tomato sauce Half the time Sometimes Never/Rarely Always Mostly 55 Made with creamy sauce Half the time e.g. cheese sauce Sometimes Never/Rarely Always Mostly Without any sauce Half the time Sometimes Never/Rarely How often do you consume 1 regular serving of:

Daily Weekly Monthly 56 (including wedges, crinkle Never cut) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time CEREAL

Oats e.g. rolled oats, instant 3-in-1 breakfast cereal e.g. Nestum®, Nutremill® Flavoured breakfast cereal, containing wholegrains e.g. Koko Krunch®, ®, Honey Stars® Flavoured breakfast cereal, not wholegrain e.g. Coco Pops®, Which of the following items do you Frosties® 57 consume at least once a month? Plain breakfast cereal, containing wholegrains e.g. Weet-Bix® Plain breakfast cereal, not wholegrain e.g. Cornflakes Breakfast cereal with dried fruit or nuts, containing wholegrains e.g. Special K®, Post Great Grains® Breakfast cereal with dried fruit or nuts, not wholegrain e.g. Almond cornflakes, Crunchy Nut Cornflakes® None of these (You can choose more than one) How often do you consume 1 medium bowl of:

58 Daily Weekly Monthly Oats 4+ times 4 - 6 times 2 - 3 times e.g. rolled oats, instant 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 cup of:

Daily Weekly Monthly 59 3-in-1 breakfast cereal 4+ times 4 - 6 times 2 - 3 times e.g. Nestum®, Nutremill® 2 - 3 times 2 - 3 times 1 time 1 time 1 time 1 How often do you consume 1 medium bowl of:

60 Flavoured breakfast cereal, containing Daily Weekly Monthly wholegrains 4+ times 4 - 6 times 2 - 3 times e.g. Koko Krunch®, Milo®, Honey Stars® 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 medium bowl of:

61 Flavoured breakfast cereal, not Daily Weekly Monthly wholegrain 4+ times 4 - 6 times 2 - 3 times e.g. Coco Pops®, Frosties® 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 medium bowl of:

62 Plain breakfast cereal, containing Daily Weekly Monthly wholegrains 4+ times 4 - 6 times 2 - 3 times e.g. Weet-Bix® 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 medium bowl of:

63 Daily Weekly Monthly Plain breakfast cereal, not wholegrain 4+ times 4 - 6 times 2 - 3 times e.g. Cornflakes 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 medium bowl of:

64 Breakfast cereal with dried fruit or nuts, Daily Weekly Monthly containing wholegrains 4+ times 4 - 6 times 2 - 3 times e.g. Special K®, Post Great Grains® 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 medium bowl of: Breakfast cereal with dried fruit or nuts, 65 Daily Weekly Monthly not wholegrain 4+ times 4 - 6 times 2 - 3 times e.g. Almond cornflakes, Crunchy Nut 2 - 3 times 2 - 3 times 1 time Cornflakes® 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number POULTRY DISHES Chicken/turkey ham Processed chicken products e.g. nugget, sausage, burger, Which of the following items do you 66 hotdog consume at least once a month? Unprocessed chicken/duck (fresh/ frozen) None of these 1 (You can choose more than one) How often do you consume 4 slices of:

67 Daily Weekly Monthly Chicken/turkey ham 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 6 nuggets OR 1 sausage OR 1 burger of:

68 Daily Weekly Monthly Processed chicken products 4+ times 4 - 6 times 2 - 3 times e.g. nugget, sausage, burger, hotdog 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 palm-sized piece of:

69 Daily Weekly Monthly Unprocessed chicken/duck (fresh/ frozen) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you remove the skin from: Always 70 Mostly Fresh chicken/duck (not processed) Half the time Sometimes Never/Rarely SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often is the Fresh chicken/duck Always Mostly In curry with coconut e.g. curry chicken Half the time with potato, ayam lemak Sometimes Never/Rarely 1 Always In curry without coconut e.g. ayam Mostly masak merah, chicken masala with Half the time yoghurt Sometimes Never/Rarely Always Mostly Stir-fried/pan-fried Half the time Sometimes Never/Rarely Always Mostly 71 Deep-fried Half the time Sometimes Never/Rarely Always Mostly Stewed / braised Half the time Sometimes Never/Rarely Always Mostly Roasted / grilled / baked Half the time Sometimes Never/Rarely Always Mostly Boiled / steamed / in soup Half the time Sometimes Never/Rarely How often is the Fresh chicken/duck Always Mostly Prepared at home Half the time Sometimes 72 Never/Rarely Always Mostly Prepared by food outlet Half the time Sometimes Never/Rarely SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number FISH AND SEAFOOD DISHES

Raw fish/sashimi Sushi roll/nigiri Salted fish/ e.g. ikan bilis 1 Canned fish e.g. tuna, sardines, dace White fish e.g. pomfret, snapper, bream, catfish, grouper, sea Which of the following items do you bass, stingray, kuning, cod, dory, , fish cake 73 consume at least once a month? Oily/fatty fish e.g. mackerel/kembong/batang/saba, yellowtail trevally, salmon, sardine, tuna Prawns Crab Squid/sotong/cuttlefish/octopus/ Oysters/cockles/mussels/scallops None of these (You can choose more than one) How often do you consume 1 piece of:

74 Daily Weekly Monthly Raw fish/sashimi 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 3 pieces OR 1 handroll of:

75 Daily Weekly Monthly Sushi roll/nigiri 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 dessertspoon of:

76 Daily Weekly Monthly Salted fish/dried fish 4+ times 4 - 6 times 2 - 3 times e.g. ikan bilis 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 can (150g) of:

77 Daily Weekly Monthly Canned fish 4+ times 4 - 6 times 2 - 3 times e.g. tuna, sardines, dace 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 fish fillet OR 1 palm-sized piece of: White fish 78 Daily Weekly Monthly e.g. pomfret, snapper, bream, catfish, 4+ times 4 - 6 times 2 - 3 times grouper, sea bass, stingray, kuning, cod, 2 - 3 times 2 - 3 times 1 time dory, fish ball, fish cake 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 fish fillet OR 1 palm-sized piece of:

79 Oily/fatty fish Daily Weekly Monthly e.g. mackerel/kembong/batang/saba, 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 yellowtail trevally, salmon, sardine, tuna 1 time 1 time How often do you consume 1 scoop OR 4 medium prawns of:

80 Daily Weekly Monthly Prawns 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume half a small crab of:

81 Daily Weekly Monthly Crab 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

82 Daily Weekly Monthly Squid/sotong/cuttlefish/octopus/abalone 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 scoop (without shells) of:

83 Daily Weekly Monthly Oysters/cockles/mussels/scallops 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often is the Fish/seafood Always Mostly In curry with coconut e.g. prawn lemak Half the time Sometimes Never/Rarely 1 Always Mostly In curry without coconut e.g. asam Half the time pedas, asam rebus, Sometimes Never/Rarely Always Mostly Stir-fried/pan-fried Half the time Sometimes Never/Rarely Always Mostly 84 Deep-fried Half the time Sometimes Never/Rarely Always Mostly Stewed / braised Half the time Sometimes Never/Rarely Always Mostly Roasted / grilled / baked Half the time Sometimes Never/Rarely Always Mostly Boiled / steamed / in soup Half the time Sometimes Never/Rarely How often is the Fish/seafood Always Mostly Prepared at home Half the time Sometimes 85 Never/Rarely Always Mostly Prepared by food outlet Half the time Sometimes Never/Rarely SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number MEAT DISHES Organ meat (spare parts) e.g. liver, paru/lung, kidney, intestines burger (including bread bun) Cured pork products e.g. bacon, ham, lap cheong, luncheon Which of the following items do you 86 meat 1 consume at least once a month? Beef, fresh (excluding burgers) Pork, fresh Mutton/Lamb None of these (You can choose more than one) How often do you consume 1 scoop of:

87 Daily Weekly Monthly Organ meat (spare parts) 4+ times 4 - 6 times 2 - 3 times e.g. liver, paru/lung, kidney, intestines 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 sausage OR 2 slices bacon / ham OR 1 slice luncheon meat of: 88 Cured pork products Daily Weekly Monthly e.g. bacon, ham, lap cheong, luncheon 4+ times 4 - 6 times 2 - 3 times meat 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 palm-sized piece of:

89 Daily Weekly Monthly Pork, fresh 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 burger of:

90 Daily Weekly Monthly Beef burger (including bread bun) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 palm-sized piece of:

91 Daily Weekly Monthly Beef, fresh (excluding burgers) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 palm-sized piece of:

92 Daily Weekly Monthly Mutton/Lamb 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often is there: Always Mostly 93 Visible fat on the meat you consume Half the time Sometimes Never/Rarely 1 How often is the Meat: Always Mostly In curry with coconut, e.g: , Half the time kurmah Sometimes Never/Rarely Always Mostly In curry without coconut, e.g: asam Half the time pedas, keema Sometimes Never/Rarely Always Mostly Stir-fried/pan-fried Half the time Sometimes Never/Rarely Always Mostly 94 Deep-fried Half the time Sometimes Never/Rarely Always Mostly Stewed / braised Half the time Sometimes Never/Rarely Always Mostly Roasted / grilled / baked Half the time Sometimes Never/Rarely Always Mostly Boiled / steamed / in soup Half the time Sometimes Never/Rarely How often is the Meat Always Mostly Prepared at home Half the time Sometimes 95 Never/Rarely Always Mostly Prepared by food outlet Half the time Sometimes Never/Rarely SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number EGG AND EGG DISHES Egg, fried/scrambled/braised Egg, boiled/half-boiled/steamed Egg-based mixed dishes e.g. omelette, steamed egg, chawanmushi Which of the following items do you Containing pork 961 consume at least once a month? Containing chicken Containing fish/seafood Containing beancurd Containing vegetables None of these (You can choose more than one) How often do you consume 1:

Daily Weekly Monthly 97 Egg, fried/scrambled/braised 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1:

Daily Weekly Monthly 98 Egg, boiled/half-boiled/steamed 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 scoop OR 1 piece of:

99 Egg-based mixed dishes containing pork Daily Weekly Monthly e.g. omelette, steamed egg, 4+ times 4 - 6 times 2 - 3 times chawanmushi 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 scoop OR 1 piece of: Egg-based mixed dishes containing 100 Daily Weekly Monthly chicken 4+ times 4 - 6 times 2 - 3 times e.g. omelette, steamed egg, 2 - 3 times 2 - 3 times 1 time chawanmushi 1 time 1 time How often do you consume 1 scoop OR 1 piece of: Egg-based mixed dishes containing 101 Daily Weekly Monthly fish/seafood 4+ times 4 - 6 times 2 - 3 times e.g. omelette, steamed egg, 2 - 3 times 2 - 3 times 1 time chawanmushi 1 time 1 time How often do you consume 1 scoop OR 1 piece of: Egg-based mixed dishes containing 102 Daily Weekly Monthly beancurd 4+ times 4 - 6 times 2 - 3 times e.g. omelette, steamed egg, 2 - 3 times 2 - 3 times 1 time chawanmushi 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 scoop OR 1 piece of: Egg-based mixed dishes containing 103 Daily Weekly Monthly vegetables 4+ times 4 - 6 times 2 - 3 times e.g. omelette, steamed egg, 2 - 3 times 2 - 3 times 1 time 1 chawanmushi 1 time 1 time How often are the Egg-based mixed dishes Always Mostly Prepared at home Half the time Sometimes 104 Never/Rarely Always Mostly Prepared by food outlet Half the time Sometimes Never/Rarely LEAFY DISHES Broccoli Chye sim/ greens/xiao bai cai Which of the following items do you Kailan 105 consume at least once a month? Kang Kong Spinach None of these (You can choose more than one) How often do you consume 1 scoop of:

106 Daily Weekly Monthly Broccoli 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

107 Daily Weekly Monthly Chye sim/mustard greens/xiao bai cai 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

108 Daily Weekly Monthly Kailan 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

How often do you consume 1 scoop of:

109 Daily Weekly Monthly Kang kong 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time

How often do you consume 1 scoop of:

110 Daily Weekly Monthly Spinach 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time BEAN AND LEGUME DISHES Dhal/lentils Peas Which of the following items do you Long beans/french beans 111 consume at least once a month? Other beans e.g. kidney bean, baked beans, chick peas Soy beancurd//taukwa/taupok/ None of these (You can choose more than one) How often do you consume 1 scoop of:

112 Daily Weekly Monthly Dhal/lentils 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

113 Daily Weekly Monthly Peas 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

114 Daily Weekly Monthly Long beans/french beans 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

115 Other beans Daily Weekly Monthly e.g. kidney bean, baked beans, chick 4+ times 4 - 6 times 2 - 3 times peas 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1/4 block (3cm x 3cm) OR 1 piece of:

116 Daily Weekly Monthly Soy beancurd/tofu/taukwa/taupok/tempeh 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time STARCHY VEGETABLES DISHES Carrot Pumpkin Lotus root Which of the following items do you Corn 117 consume at least once a month? Yam Begedil (potato patty) Potato, including mash (excluding french fries) None of these (You can choose more than one) How often do you consume 1 scoop of:

118 Daily Weekly Monthly Carrot 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

119 Daily Weekly Monthly Pumpkin 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

120 Daily Weekly Monthly Lotus root 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 scoop OR 1 cup of:

121 Daily Weekly Monthly Corn 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 slice of:

122 Daily Weekly Monthly Yam 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

How often do you consume 1 piece of:

123 Daily Weekly Monthly Begedil (potato patty) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time How often do you consume half a potato OR 1 cup of:

124 Daily Weekly Monthly Potato, including mash (excluding fench 4+ times 4 - 6 times 2 - 3 times fries) 2 - 3 times 2 - 3 times 1 time 1 time 1 time OTHER VEGETABLE DISHES Cabbage, white Beansprouts Cauliflower Eggplant/Brinjal Which of the following items do you Gourd e.g. bitter, bottle, wax, wintermelon 125 consume at least once a month? Ladies fingers/okra Mushrooms Capsicum/paprika None of these (You can choose more than one) How often do you consume 1 scoop of:

126 Daily Weekly Monthly Cabbage, white 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

127 Daily Weekly Monthly Beansprouts 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

128 Daily Weekly Monthly Cauliflower 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

129 Daily Weekly Monthly Eggplant/Brinjal 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

How often do you consume 1 scoop of:

130 Daily Weekly Monthly Gourd 4+ times 4 - 6 times 2 - 3 times e.g. bitter, bottle, wax, wintermelon 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time

How often do you consume 1 scoop of:

131 Daily Weekly Monthly Celery 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

132 Daily Weekly Monthly Ladies fingers/okra 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

133 Daily Weekly Monthly Mushrooms 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

134 Daily Weekly Monthly Capsicum/paprika 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often are the Vegetable dishes: Always Mostly In curry with coconut, e.g: lemak, kurma, Half the time Sometimes Never/Rarely 1 Always Mostly In curry without coconut Half the time Sometimes Never/Rarely Always Mostly Stir-fried/pan-fried Half the time Sometimes Never/Rarely Always Mostly 135 Deep-fried Half the time Sometimes Never/Rarely Always Mostly Stewed/braised Half the time Sometimes Never/Rarely Always Mostly Roasted/grilled/baked Half the time Sometimes Never/Rarely Always Mostly Boiled/steamed/in soup Half the time Sometimes Never/Rarely SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume Vegetable dishes: Always Mostly Containing pork Half the time Sometimes 1 Never/Rarely Always Mostly Containing chicken Half the time Sometimes Never/Rarely Always 136 Mostly Containing fish/seafood Half the time Sometimes Never/Rarely Always Mostly Containing beancurd Half the time Sometimes Never/Rarely Always Mostly Containing other vegetables Half the time Sometimes Never/Rarely How often are the Vegetable dishes: Always Mostly Prepared at home Half the time Sometimes 137 Never/Rarely Always Mostly Prepared by food outlet Half the time Sometimes Never/Rarely OTHER VEGETABLES

Fried e.g. onion rings, onion Seaweed e.g. in soup, in Korean/Japanese dishes, as a Lettuce, e.g. in salad Which of the following items do you 138 Coleslaw consume at least once a month? (yoghurt with cucumber/onion/carrot) Cucumber (excluding in raita) Tomato, raw Preserved vegetables e.g. kimchi, dong cai, pickled cucumber None of these (You can choose more than one) SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

How often do you consume 1 piece of:

139 Daily Weekly Monthly Fried onion 4+ times 4 - 6 times 2 - 3 times e.g. onion rings, onion bhaji 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time How often do you consume 3 strips OR 1 dessertspoon of:

140 Seaweed Daily Weekly Monthly e.g. in soup, in Korean/Japanese dishes, 4+ times 4 - 6 times 2 - 3 times as a snack 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 4 medium leaves of:

141 Daily Weekly Monthly Lettuce, e.g. in salad 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 2 dessertspoons of:

142 Daily Weekly Monthly Raita (yoghurt with 4+ times 4 - 6 times 2 - 3 times cucumber/onion/carrot) 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 dessertspoon of:

143 Daily Weekly Monthly Coleslaw 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 3 slices of:

144 Daily Weekly Monthly Cucumber (excluding in raita) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume half a medium tomato OR 5 cherry tomatoes of:

145 Daily Weekly Monthly Tomato, raw 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 dessertspoon of:

146 Daily Weekly Monthly Preserved vegetables 4+ times 4 - 6 times 2 - 3 times e.g. kimchi, dong cai, pickled cucumber 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time SALAD DRESSINGS Salad dressing, cream-based, low fat e.g. thousand island, salad cream, Which of the following items do you Salad dressing, cream-based, NOT low fat e.g. thousand 147 consume at least once a month? island, salad cream, mayonnaise Salad dressing, oil-based e.g. vinaigrette, None of these (You can choose more than one) How often do you consume 2 dessertspoons of:

148 Salad dressing, cream-based, low fat Daily Weekly Monthly e.g. thousand island, salad cream, 4+ times 4 - 6 times 2 - 3 times mayonnaise 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 2 dessertspoons of: Salad dressing, cream-based, NOT low 149 Daily Weekly Monthly fat 4+ times 4 - 6 times 2 - 3 times e.g. thousand island, salad cream, 2 - 3 times 2 - 3 times 1 time mayonnaise 1 time 1 time How often do you consume 2 dessertspoons of:

150 Daily Weekly Monthly Salad dressing, oil-based 4+ times 4 - 6 times 2 - 3 times e.g. vinaigrette, olive oil 2 - 3 times 2 - 3 times 1 time 1 time 1 time SOUP ( and tomato clear soup) Which of the following items do you Other clear soup e.g. miso, kimchi soup, broth, stock 151 consume at least once a month? Cream soup e.g. cream of mushroom, cream of tomato None of these (You can choose more than one) How often do you consume 1 medium bowl of:

152 Daily Weekly Monthly Rasam (tamarind and tomato clear soup) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 medium bowl of:

153 Daily Weekly Monthly Other clear soup 4+ times 4 - 6 times 2 - 3 times e.g. miso, kimchi soup, broth, stock 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time How often do you consume 1 medium bowl of:

154 Cream soup Daily Weekly Monthly e.g. cream of mushroom, cream of 4+ times 4 - 6 times 2 - 3 times tomato 2 - 3 times 2 - 3 times 1 time 1 time 1 time FRUIT Apple Avocado Banana Blueberries Dragonfruit Grape Guava Kiwi Which of the following items do you 155 Mango consume at least once a month? Melon e.g. honeydew, watermelon, rock melon Orange Papaya Pear Strawberries Dried fruit e.g. raisins, dates, prunes apricots, figs, cranberries (excluding in bread/breakfast cereal) None of these (You can choose more than one) How often do you consume 1 small:

Daily Weekly Monthly 156 Apple 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume half a fruit of:

157 Daily Weekly Monthly Avocado 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 medium:

158 Daily Weekly Monthly Banana 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 handful OR 25 blueberries of:

159 Daily Weekly Monthly Blueberries 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time

How often do you consume half a fruit of:

160 Daily Weekly Monthly Dragonfruit 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 seed of:

161 Daily Weekly Monthly Durian 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 handful OR 15 grapes of:

162 Daily Weekly Monthly Grape 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume half a fruit of:

163 Daily Weekly Monthly Guava 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 whole:

Daily Weekly Monthly 164 Kiwi 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 slice OR ½ a fruit of:

165 Daily Weekly Monthly Mango 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

How often do you consume 1 slice of:

166 Daily Weekly Monthly Melon 4+ times 4 - 6 times 2 - 3 times e.g. honeydew, watermelon, rock melon 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time How often do you consume 1 small:

Daily Weekly Monthly 167 Orange 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 slice of:

168 Daily Weekly Monthly Papaya 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 small:

Daily Weekly Monthly 169 Pear 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 slice of:

170 Daily Weekly Monthly Pineapple 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 5 strawberries of:

171 Daily Weekly Monthly Strawberries 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 dessertspoon of: Dried fruit 172 Daily Weekly Monthly e.g. raisins, dates, prunes, apricots, figs, 4+ times 4 - 6 times 2 - 3 times cranberries (excluding in bread/breakfast 2 - 3 times 2 - 3 times 1 time cereal) 1 time 1 time HOT / COLD BEVERAGES Coffee (inc. home-made, coffee shop, gourmet e.g. cappuccino) Which of the following items do you 173 Tea (inc. home-made, coffee shop) consume at least once a month ? Malted e.g. Milo®, Ovaltine® None of these (You can choose more than one) SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 cup (200ml) of:

174 Coffee Daily Weekly Monthly (inc. home-made, coffee shop, gourmet 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 e.g. cappuccino) 1 time 1 time Sweetened condensed milk Evaporated milk Whole milk / powder Low fat milk / powder What type of milk do you usually add to Skimmed milk/powder 175 coffee ? Milk is already added (I drink 2-in-1) Soya milk Milk is already added (I drink 3-in-1) Creamer/whitener Do not add milk (You can choose one answer only) 5 or more teaspoons OR Ask for more sugar 3-4 teaspoons OR Ask for regular sugar How much sugar do you usually add to 1-2 teaspoons OR Ask for less sugar 176 coffee ? Less than 1 teaspoon No sugar added (You can choose one answer only) How often do you consume 1 cup (200ml) of:

177 Daily Weekly Monthly Tea (inc. home-made, coffee shop) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time What type of tea do you usually consume ? / Oolong tea 178 (You can choose one answer only) English tea/Black tea Sweetened condensed milk Evaporated milk Whole milk / powder Low fat milk / powder What type of milk do you usually add to Skimmed milk/powder 179 tea? Milk is already added (I drink 2-in-1) Soya milk Milk is already added (I drink 3-in-1) Creamer/whitener Do not add milk (You can choose one answer only) 5 or more teaspoons OR Ask for more sugar 3-4 teaspoons OR Ask for regular sugar How much sugar do you usually add to 1-2 teaspoons OR Ask for less sugar 180 tea? Less than 1 teaspoon No sugar added (You can choose one answer only) SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 cup/can/pack of:

181 Daily Weekly Monthly Malted drink 4+ times 4 - 6 times 2 - 3 times e.g. Milo®, Ovaltine® 2 - 3 times 2 - 3 times 1 time 1 1 time 1 time Sweetened condensed milk Evaporated milk Whole milk / powder Low fat milk / powder What type of milk do you usually add to Skimmed milk/powder 182 malted ? Milk is already added (I drink 2-in-1) Soya milk Milk is already added (I drink 3-in-1) Creamer/whitener Do not add milk (You can choose one answer only) 5 or more teaspoons OR Ask for more sugar 3-4 teaspoons OR Ask for regular sugar How much sugar do you usually add to 1-2 teaspoons OR Ask for less sugar 183 malted drinks? Less than 1 teaspoon No sugar added (You can choose one answer only) OTHER BEVERAGES

Fruit or vegetable juice (100% juice, no added sugar) including freshly squeezed or pack Fruit or vegetable juice drink, not 100% juice (including syrups/cordials with water added) e.g. Ribena, Minute Maid Canned/bottled tea e.g. lemon/peach tea, milk tea, tea, jasmine green tea Canned/bottled coffee e.g. latte, mocha Other non-carbonated sweetened drinks e.g. sugarcane juice, , waterchestnut drink, barley drink Sports drinks e.g. 100 PLUS®, H-Two-O® Which of the following items do you Carbonated soft drinks, sugar free e.g. Coke Zero® 184 consume at least once a month? Carbonated soft drinks, regular e.g. regular cola, Fanta® Soya milk, low sugar/no sugar added, including flavoured e.g. chocolate, fruit, red bean Soya milk, regular, including flavoured e.g. chocolate, fruit, red bean Milkshake e.g. chocolate, strawberry, banana, avocado Yoghurt drink e.g. lassi, Yakult®, Vitagen® Powdered nutrition drink e.g. whey protein shake, Ensure®, Herbalife® Alcoholic beverages Water, plain (including bottled) None of these (You can choose more than one) SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 glass OR 1 bottle OR 1 pack of:

185 Fruit or vegetable juice (100% juice, no Daily Weekly Monthly added sugar) including freshly squeezed 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 or pack 1 time 1 time How often do you consume 1 glass OR 1 bottle OR 1 pack of:

Fruit or vegetable juice drink, not 100% Daily Weekly Monthly 186 juice (including syrups/cordials with 4+ times 4 - 6 times 2 - 3 times water added) 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. Ribena, Minute Maid How often do you consume 1 glass OR 1 bottle OR 1 pack of:

Daily Weekly Monthly Canned/bottled tea 4+ times 4 - 6 times 2 - 3 times 187 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. lemon/peach tea, milk tea, , jasmine green tea How often do you consume 1 bottle OR 1 can of:

Daily Weekly Monthly 188 Canned/bottled coffee 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. latte, mocha How often do you consume 1 glass OR 1 bottle OR 1 pack of:

Daily Weekly Monthly 189 Other non-carbonated sweetened drinks 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. sugarcane juice, bandung, waterchestnut drink, barley drink How often do you consume 1 glass OR 1 bottle OR 1 pack of:

Daily Weekly Monthly 190 Sports drinks 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. 100 PLUS®, H-Two-O® SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 glass OR 1 bottle OR 1 pack of:

Daily Weekly Monthly 191 Carbonated soft drinks, sugar free 4+ times 4 - 6 times 2 - 3 times 1 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. Coke Zero® How often do you consume 1 glass OR 1 bottle OR 1 pack of:

Daily Weekly Monthly 192 Carbonated soft drinks, regular 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. regular cola, Fanta® How often do you consume 1 glass OR 1 bottle OR 1 pack of:

Daily Weekly Monthly 193 Soya milk, low sugar/no sugar added, 4+ times 4 - 6 times 2 - 3 times including flavoured 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. chocolate, fruit, red bean How often do you consume 1 glass OR 1 bottle OR 1 pack of:

Daily Weekly Monthly 194 Soya milk, regular, including flavoured 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. chocolate, fruit, red bean How often do you consume 1 glass of:

Daily Weekly Monthly 195 Milkshake 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. chocolate, strawberry, banana How often do you consume 1 bottle OR 1 glass of:

Daily Weekly Monthly 196 Yoghurt drink 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. lassi, Yakult®, Vitagen® SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 glass OR 1 pack of:

Daily Weekly Monthly 197 Powdered nutrition drink 4+ times 4 - 6 times 2 - 3 times 1 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. whey protein shake, Ensure®, Herbalife® How often do you consume 1 bottle beer OR 1 glass wine OR 25ml liqueur of:

198 Daily Weekly Monthly Alcoholic beverages 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 glass OR 1 bottle of:

199 Daily Weekly Monthly Water, plain (including bottled) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time DAIRY PRODUCTS Milk, non-fat (including on cereal but not in tea/coffee) Milk, low fat (including on cereal but not in tea/coffee) including flavoured e.g. chocolate, strawberry Milk, whole (including on cereal but not in tea/coffee) including Which of the following items do you flavoured e.g. chocolate, strawberry 200 consume at least once a month? Yoghurt/frozen yoghurt including flavoured e.g. greek, chocolate, strawberry Cheese (including cheese spread) None of these (You can choose more than one) How often do you consume 1 glass of:

201 Daily Weekly Monthly Milk, non-fat (including on cereal but not 4+ times 4 - 6 times 2 - 3 times in tea/coffee) 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 glass of:

Daily Weekly Monthly 202 Milk, low fat (including on cereal but not 4+ times 4 - 6 times 2 - 3 times in tea/coffee) including flavoured 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. chocolate, strawberry SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 pot OR 1 pack of:

Daily Weekly Monthly Yoghurt/frozen yoghurt including 4+ times 4 - 6 times 2 - 3 times 203 flavoured 1 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. greek, chocolate, strawberry Yes Is the yoghurt usually reduced fat? No How often do you consume 1 slice OR 1 dessertspoon of:

Daily Weekly Monthly 204 Cheese (including cheese spread) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time Yes Is the cheese usually reduced fat? No AND Savoury e.g. cream cracker, rice cracker, Sweet biscuits (no filling) e.g. digestive, marie , biscuits Biscuits/cookies, with filling or with chocolate e.g. Oreo®, bourbon, Tim Tam® e.g. egg , , red/green bean pastry, croissant, danish, custard puff, cream puff Which of the following items do you Sweet snack, deep-fried e.g. , doughnut, you 205 consume at least once a month? tiao, ham ching peng Sweet desserts and kueh e.g. kueh sarlat, kueh talam, kueh ko swee, coconut burfi, putu mayam, ubi kayu, kesari, jelly/ agar, lapis Sweet desserts in soup e.g. , pulut hitam, chendol, green bean soup, ice kacang, chng tng, payasam (), None of these (You can choose more than one) How often do you consume 2 pieces of:

Daily Weekly Monthly 206 Savoury biscuits 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. cream cracker, rice cracker, pretzel

How often do you consume 2 pieces of:

Daily Weekly Monthly 207 Sweet biscuits (no filling) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. digestive, marie biscuit, ginger biscuits SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

How often do you consume 2 pieces of:

Daily Weekly Monthly 208 Biscuits/cookies, with filling or with 4+ times 4 - 6 times 2 - 3 times chocolate 1 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. Oreo®, bourbon, Tim Tam® How often do you consume 1 piece of:

Daily Weekly Monthly Pastry 4+ times 4 - 6 times 2 - 3 times 209 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. , pineapple tart, red/green bean pastry, croissant, danish, custard puff, cream puff How often do you consume 1 piece of:

Daily Weekly Monthly 210 Sweet snack, deep-fried 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. pisang goreng, doughnut, you tiao, ham ching peng How often do you consume 2 pieces of:

Daily Weekly Monthly Sweet desserts and kueh 4+ times 4 - 6 times 2 - 3 times 211 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. kueh sarlat, kueh talam, kueh ko swee, coconut burfi, putu mayam, ubi kayu, kesari, jelly/agar agar, kuih lapis

How often do you consume 1 bowl of:

Daily Weekly Monthly Sweet desserts in soup 4+ times 4 - 6 times 2 - 3 times 212 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. bubur cha cha, pulut hitam, chendol, green bean soup, ice kacang, chng tng, payasam (kheer), grass jelly How often are the Sweet desserts: Always Mostly 213 With coconut/coconut milk Half the time Sometimes Never/Rarely SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number OTHER SNACKS AND DESSERTS

Beancurd e.g. tau huay, soya Pancake/hotecake/waffle (including ) Ice cream 1 Cake e.g. plain butter, sponge, fruit, cream cake Chocolate Which of the following items do you 214 Seeds e.g. sunflower seeds, sesame seeds consume at least once a month? Nuts e.g. , cashews, almonds Puffs and pies e.g. , chicken pie Dumpling e.g. siew mai, wanton, , gyoza Fried chips and crackers, savoury e.g. potato chips, prawn crackers, papadum, muruku, keropok, , tortilla chips None of these (You can choose more than one) How often do you consume 1 medium bowl of:

Daily Weekly Monthly 215 Beancurd dessert 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. tau huay, soya pudding How often do you consume 1 piece of:

216 Daily Weekly Monthly Pancake/hotcake/waffle (including 4+ times 4 - 6 times 2 - 3 times appam) 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

217 Daily Weekly Monthly Ice cream 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 slice of:

Daily Weekly Monthly 218 Cake 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. plain butter, sponge, fruit, cream cake How often do you consume 1 bar (50g) of:

219 Daily Weekly Monthly Chocolate 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you consume 1 dessertspoon of:

Daily Weekly Monthly 220 Seeds 4+ times 4 - 6 times 2 - 3 times 1 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. sunflower seeds, sesame seeds How often do you consume 1 dessertspoon of:

Daily Weekly Monthly 221 Nuts 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. peanuts, cashews, almonds How often do you consume 1 piece of:

Daily Weekly Monthly 222 Puffs and pies 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. curry puff, chicken pie How often do you consume 1 piece of:

Daily Weekly Monthly 223 Dumpling 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. siew mai, wanton, har gow, gyoza

How often do you consume 1 handful of:

Daily Weekly Monthly Fried chips and crackers, savoury 4+ times 4 - 6 times 2 - 3 times 224 2 - 3 times 2 - 3 times 1 time 1 time 1 time e.g. potato chips, prawn crackers, , muruku, keropok, rempeyek, tortilla chips EATING OUT centres, food courts or coffee shops Workplace or school canteens At which of the following places do you Western fast food outlets, quick-service restaurants, or 225 consume food at least once a month? convenience stores Other restaurants None of these (You can choose more than one) SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number How often do you eat at

Daily Weekly Monthly 226 Hawker centres, food courts or coffee 4+ times 4 - 6 times 2 - 3 times shops 2 - 3 times 2 - 3 times 1 time 1 time 1 time 1 How often do you eat at

Daily Weekly Monthly 227 Workplace or school canteens 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you eat at

Daily Weekly Monthly 228 Western fast food outlets, quick-service 4+ times 4 - 6 times 2 - 3 times restaurants, or convenience stores 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you eat at

Daily Weekly Monthly 229 Other restaurants 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time How often do you consume 1 serving (e.g. 1 apple, 1 banana, 1 papaya wedge) of: 230 Daily Weekly Monthly Fruit (excluding juices) 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time

How often do you consume 1 scoop of:

231 Daily Weekly Monthly Vegetables 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 1 time 1 time SALT AND SAUCES Always Mostly At the table, how often do you add salt or Half the time 232 sauces to your food? Sometimes Never/Rarely e.g. , braised gravy SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number Butter, dripping, , lard or any other animal fat Peanut or ground nut oil Canola oil Rice bran oil Canola/olive oil blend 1 Canola/sunflower oil blend Soft margarine Coconut oil What type of COOKING OIL do you Soya bean oil 233 usually consume? Corn oil Sunflower oil Grapeseed oil Vanaspati (vegetable ghee) Hard margarine Vegetable oil/blended oil Olive oil Others Palm oil I don’t usually eat home-cooked food (You can choose one answer only) VITAMINS AND SUPPLEMENTS Yes 234 Do you take vitamins or supplements? No Vitamins and supplements Fish oil Evening primrose oil Vitamin A Any B vitamin Vitamin C Which of the following items do you 235 Vitamin D consume at least once a month? Calcium Iron Glucosamine Herbal supplements Other supplements (You can choose more than one)

Daily Weekly Monthly How often do you take: Fish oil 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 236 1 time 1 time Less than 1 year How long have you taken : Fish oil Between 1 and 5 years More than 5 years

Daily Weekly Monthly How often do you take: Evening primrose 4+ times 4 - 6 times 2 - 3 times oil 2 - 3 times 2 - 3 times 1 time 237 1 time 1 time Less than 1 year How long have you taken : Evening Between 1 and 5 years primrose oil More than 5 years SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

Daily Weekly Monthly How often do you take: Vitamin A 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 238 1 time 1 time Less than 1 year 1 How long have you taken : Vitamin A Between 1 and 5 years More than 5 years

Daily Weekly Monthly How often do you take: Any B vitamin 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 239 1 time 1 time Less than 1 year How long have you taken : Any B vitamin Between 1 and 5 years More than 5 years

Daily Weekly Monthly How often do you take: Vitamin C 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 240 1 time 1 time Less than 1 year How long have you taken : Vitamin C Between 1 and 5 years More than 5 years

Daily Weekly Monthly How often do you take: Vitamin D 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 241 1 time 1 time Less than 1 year How long have you taken : Vitamin D Between 1 and 5 years More than 5 years

Daily Weekly Monthly How often do you take: Calcium 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 242 1 time 1 time Less than 1 year How long have you taken : Calcium Between 1 and 5 years More than 5 years

Daily Weekly Monthly How often do you take: Iron 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 243 1 time 1 time Less than 1 year How long have you taken : Iron Between 1 and 5 years More than 5 years SPHS - MEC3 ONLINE NUTRITION SURVEY

Page Questions Answer options Number

Daily Weekly Monthly How often do you take: Glucosamine 4+ times 4 - 6 times 2 - 3 times 2 - 3 times 2 - 3 times 1 time 244 1 time 1 time Less than 1 year 1 How long have you taken : Glucosamine Between 1 and 5 years More than 5 years

Daily Weekly Monthly How often do you take: Herbal 4+ times 4 - 6 times 2 - 3 times supplements 2 - 3 times 2 - 3 times 1 time 245 1 time 1 time Less than 1 year How long have you taken : Herbal Between 1 and 5 years supplements More than 5 years

Daily Weekly Monthly How often do you take: Other 4+ times 4 - 6 times 2 - 3 times supplements 2 - 3 times 2 - 3 times 1 time 246 1 time 1 time Less than 1 year How long have you taken : Other Between 1 and 5 years supplements More than 5 years Thank you for completing this 247 questionnaire. We very much appreciate your time and effort. SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Last Interview Date : ______Study ID: Current Interview Date : ______

Interviewer’s Name : ______

Interview Language : ______

SECTION A – DIET SCREENER QUESTIONNAIRE 饮食频率问卷 [This Section applies only to participants who are not able to do the Online Nutrition Survey]

DIET SCREENER 饮食筛选 A diet screener is a short dietary assessment method for estimating your usual dietary pattern and nutrient intake over a period of time. Please describe your routine habits of eating over the past year, on average, by choosing one of the options to indicate how often you ate the foods listed in the food items. Please take a moment to recall your usual food intake habits instead of recent food consumption.

For each food item, choose the frequency that most appropriately reflects your usual consumption on average over the whole year. If your answer falls between two categories, please select the one frequency that best describes how often you eat the food item. Only select ‘Never/Rarely’ when you do not eat the food at all or when the food is consumed less than once a month.

“饮食筛选” 是一项用来估计您，在平常的一段时间里的饮食习惯和营养摄取量的短版膳食评价方法。请 从以下所列出的食物选项中，填写您在过去一年中，平均多常吃各项食物，以形容您平常的饮食习惯。 请您用一些时间，来回顾一下您平时的饮食习惯，而不是最近的食品消费。

请从每一种食品项目中，选择最适合反映您在过去一年中，平时饮食习惯的次数。如果您的答案介于两 个类别之间，请选择最能够形容您平时饮食习惯的那个次数。如果您完全不吃该项食物或每月只吃少过 一次，请选择“从不/很少”。

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Frequency / 次数 Never Once Once 2-3 a 2-3 a 4-6 a Once 2-3 a 4-5 a 6+ a One serving How often do you consume one serving of: or a a month week week a day day day day means / 您多常吃一份: rarely month week 从不 1 个月 1 个月 1 星期 1 星期 1 星期 1 天 1 天 1 天 1 天 一份代表： /很少 1 次 2-3 次 1 次 2-3 次 4-6 次 1 次 2-3 次 4-5 次 6+次 Item 1 glass, 1 玻璃杯, EXAMPLE: 1 bottle, 1 瓶, no. 1 3 4 5 6 7 8 9 10 例如：豆奶 2 1 pack, 1 包, 项目 1 cup 1 杯,

Red or brown rice (including porridge) 1 饭碗 / 1 1 2 3 4 5 6 7 8 9 10 1 rice bowl 红米或糙米（包括粥类） / 1 plate 1 碟 White rice (including glutinous rice, briyani, 1 饭碗 / basmati and porridge) 1 rice bowl 2 1 2 3 4 5 6 7 8 9 10 / 1 plate 1 碟 白米（包括糯米、印度香饭、印度香米和粥） Wholemeal noodles/pasta e.g. brown rice beehoon, wholemeal pasta 1 medium 1 中型碗 3 全麦面食/意大利面食 1 2 3 4 5 6 7 8 9 10 bowl 例如：糙米米粉、全麦意大利面食 Noodles/pasta (not wholemeal) e.g. white rice noodles, wheat noodles 1 medium 1 中型碗 4 面食/意大利面食（非全麦） 1 2 3 4 5 6 7 8 9 10 bowl 例如：白米面条，麦面条 Wholemeal bread (including chapati) 5 1 2 3 4 5 6 7 8 9 10 2 slices 2 片 全麦面包（包括印度麦饼） White bread (including roti prata) 6 1 2 3 4 5 6 7 8 9 10 2 slices 2 片 白面包（包括印度煎饼） Breakfast cereal Please state brand and name of type usually consumed: 早餐谷类食品 1 medium 1 中型碗 7 1 2 3 4 5 6 7 8 9 10 bowl 请注明您常吃的品牌和种类名称：

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Frequency / 次数 Never Once Once 2-3 a 2-3 a 4-6 a Once 2-3 a 4-5 a 6+ a One serving How often do you consume one serving of: or a a month week week a day day day day means / 您多常吃一份: rarely month week 从不 1 个月 1 个月 1 星期 1 星期 1 星期 1 天 1 天 1 天 1 天 一份代表： /很少 1 次 2-3 次 1 次 2-3 次 4-6 次 1 次 2-3 次 4-5 次 6+次 Oily/fatty fish (solid texture, darker colour) e.g. mackerel, kembong, batang, selar/kuning, sardine, salmon, tuna 1 palm- 1 个手掌 sized 8 油性鱼类/多脂鱼类（肉质扎实、颜色较暗） 1 2 3 4 5 6 7 8 9 10 大小 piece 例如：鲭鱼、甘望鱼、马鲛鱼、色拉鱼/君冷 鱼、沙丁鱼、三文鱼、金枪鱼 White fish (dry and flaky) e.g. pomfret, bream, catfish, dory, grouper 1 palm- 1 个手掌 sized 9 1 2 3 4 5 6 7 8 9 10 大小 白肉鱼类（肉质干燥、薄片状） piece 例如：鲳鱼、鲷鱼、鲶鱼、多利魚、石斑鱼 Other seafood e.g. prawns, sotong 4 只 10 1 2 3 4 5 6 7 8 9 10 4 medium 其他海鲜 prawns 中型虾 例如：虾、苏东/乌贼 Red meat e.g. beef, mutton, lamb, pork 1 palm- 1 个手掌 sized 11 红肉 1 2 3 4 5 6 7 8 9 10 大小 piece 例如：牛肉、羊肉、羔羊肉、猪肉 Processed meat e.g. bacon, , lap cheong, sausage 1 sausage, 1 条, 12 加工肉类 1 2 3 4 5 6 7 8 9 10 1 piece 1 片 例如：煙肉/培根、肉干、腊肠、香肠 Poultry e.g. chicken, duck 1 palm- 1 个手掌 sized 13 家禽类 1 2 3 4 5 6 7 8 9 10 大小 piece 例如：鸡肉、鸭肉

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Frequency / 次数 Never Once Once 2-3 a 2-3 a 4-6 a Once 2-3 a 4-5 a 6+ a One serving How often do you consume one serving of: or a a month week week a day day day day means / 您多常吃一份: rarely month week 从不 1 个月 1 个月 1 星期 1 星期 1 星期 1 天 1 天 1 天 1 天 一份代表： /很少 1 次 2-3 次 1 次 2-3 次 4-6 次 1 次 2-3 次 4-5 次 6+次 Western fast food 1 个汉堡 1 regular 包,1 普通 e.g. french fries, burger, french 装炸薯 14 西式快餐 1 2 3 4 5 6 7 8 9 10 fries, 1 burger 条, 例如：炸薯条、汉堡包、炸鸡 Other deep fried food/snacks e.g. chicken, curry puff, goreng pisang, potato chips, prawn crackers, papadum, , keropok, rempeyek, tortilla chips 1 块, 15 其他煎炸食品/小吃 1 2 3 4 5 6 7 8 9 10 1 piece 例如：炸鸡肉、咖哩角、炸香蕉、薯片、 1 片 炸虾饼、印度脆饼、印度圈圈饼、 马来炸鱼饼、马来花生江鱼仔脆饼、墨西哥脆 饼 Stir-fried food e.g. meat, fish, vegetables 16 翻炒食物 1 2 3 4 5 6 7 8 9 10 1 scoop 1 勺子 例如：肉类、鱼类、蔬菜 Gravies containing coconut milk (added on top rice or as part of a main dish, e.g. curry 17 chicken) 1 2 3 4 5 6 7 8 9 10 1 scoop 1 勺子 含椰奶的肉汁（淋在饭上或作为部分主食，例 如：咖哩鸡）

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Frequency / 次数 Never Once Once 2-3 a 2-3 a 4-6 a Once 2-3 a 4-5 a 6+ a One serving How often do you consume one serving of: or a a month week week a day day day day means / 您多常吃一份: rarely month week 从不 1 个月 1 个月 1 星期 1 星期 1 星期 1 天 1 天 1 天 1 天 一份代表： /很少 1 次 2-3 次 1 次 2-3 次 4-6 次 1 次 2-3 次 4-5 次 6+次 Green leafy vegetables e.g. kailan, kang kong, cabbage, spinach 18 绿叶蔬菜 1 2 3 4 5 6 7 8 9 10 1 scoop 1 勺子 例如：芥蓝菜、空心菜、包菜、菠菜 Carrots 1 scoop 1 勺子 19 红萝卜 1 2 3 4 5 6 7 8 9 10 Legumes e.g. long beans, peas, lentils/dhal/sambhar 20 豆类 1 2 3 4 5 6 7 8 9 10 1 scoop 1 勺子 例如：长豆、豌豆、扁豆/木豆/南印度桑巴

Other vegetables e.g. tomato, mushrooms, brinjal, capsicum, 21 ladies fingers 1 2 3 4 5 6 7 8 9 10 1 scoop 1 勺子 其他蔬菜 例如：番茄、菇类、茄子、灯笼椒、羊角豆 Soy products (excluding soy milk) e.g. beancurd/tofu, taukwa, taupok, tempeh, tau huay 2 small 2 小块 22 1 2 3 4 5 6 7 8 9 10 blocks 豆类食品（豆浆以外） 例如：豆腐、豆干、豆卜、马来豆酵饼、豆花

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Frequency / 次数 Never Once Once 2-3 a 2-3 a 4-6 a Once 2-3 a 4-5 a 6+ a One serving How often do you consume one serving of: or a a month week week a day day day day means / 您多常吃一份: rarely month week 从不 1 个月 1 个月 1 星期 1 星期 1 星期 1 天 1 天 1 天 1 天 一份代表： /很少 1 次 2-3 次 1 次 2-3 次 4-6 次 1 次 2-3 次 4-5 次 6+次 Sweet , desserts, confectionery 1 , e.g. kueh-kueh, chendol, cheng tng, 1 piece, 块 23 chocolate, candy 1 2 3 4 5 6 7 8 9 10 1 bowl, 1 碗, 1 pack 蛋糕、甜品、糕饼 1 包 例如：马来糕点、浆罗、清汤、巧克力、糖果 Nuts/seeds e.g. cashew, peanuts, sesame seeds 24 坚果/籽 1 2 3 4 5 6 7 8 9 10 1 tablespoon 1 汤匙 例如：腰果、花生、芝麻 Citrus fruit (excluding juices) e.g. orange, pomelo 1 orange, 25 柑橘类水果（果汁以外） 1 2 3 4 5 6 7 8 9 10 1 tangerine, 1 粒 1 pomelo 例如：橙、柚子 1 apple, 1 粒苹果, 1 条 1 banana, 香蕉, Other fresh fruit (excluding juices) 1 wedge 26 1 2 3 4 5 6 7 8 9 10 papaya/ 1 块木瓜/西瓜/ 其他新鲜水果（果汁以外） watermelon/ ,10 pineapple, 黄梨 粒葡 10 grapes 萄 1 glass milk, 1 玻璃杯牛奶, Low fat dairy (milk, yoghurt or cheese) 1 pot 27 1 2 3 4 5 6 7 8 9 10 yoghurt, 1 罐酸乳, 1 片 低脂奶类食品（牛奶、酸乳或乳酪） 1 slice

cheese 乳酪 1 glass milk, 1 玻璃杯牛奶, Full fat dairy (milk, yoghurt or cheese) 1 pot 28 1 2 3 4 5 6 7 8 9 10 yoghurt, 1 罐酸乳, 1 片 全脂奶类食品（牛奶、酸乳或乳酪） 1 slice

cheese 乳酪 1 glass, Soy milk (including fresh and flavoured) 1 玻璃杯, 1 瓶 29 1 2 3 4 5 6 7 8 9 10 1 bottle, 豆浆（包括现做和加味的豆浆） 1 pack, 1 包, 1 杯, 1 cup

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Frequency / 次数 Never Once Once 2-3 a 2-3 a 4-6 a Once 2-3 a 4-5 a 6+ a One serving How often do you consume one serving of: or a a month week week a day day day day means / 您多常吃一份: rarely month week 从不 1 个月 1 个月 1 星期 1 星期 1 星期 1 天 1 天 1 天 1 天 一份代表: /很少 1 次 2-3 次 1 次 2-3 次 4-6 次 1 次 2-3 次 4-5 次 6+次 Malted drink/ e.g. Milo®, Ovaltine® 1 cup, 1 can, 1 , 1 , 1 30 麦芽饮料/热巧克力 1 2 3 4 5 6 7 8 9 10 1 pack 杯 罐 包 例如：美禄®、阿华田® Fruit juice, 100%, no added sugar e.g. watermelon juice, orange juice 1 glass, 1 1 , 1 31 果汁，100%，无加糖 1 2 3 4 5 6 7 8 9 10 cup 玻璃杯 杯 例如：西瓜汁、柳橙汁 Sugar-free sweetened beverages e.g. 1 can, CokeZero® 1 , 1 32 1 2 3 4 5 6 7 8 9 10 1 bottle 罐 瓶 无糖份甜饮料 例如：CokeZero® Sweetened beverages, including fruit juice drinks with added sugar E.g. cola, , ribena, water chestnut 1 can, 33 drinks, sweetened ice tea,. 1 2 3 4 5 6 7 8 9 10 1 罐, 1 瓶 甜饮料，包括果汁及加糖饮料 1 bottle 例如：可乐、泡泡茶、利宾纳、马蹄水、加糖 冰茶 Tea 34 e.g. Chinese/oolong tea, black tea, green tea 1 2 3 4 5 6 7 8 9 10 1 cup 1 杯 茶 例如：中国茶/乌龙茶、红茶、绿茶 Coffee 35 e.g. brewed, instant, cappuccino 1 2 3 4 5 6 7 8 9 10 1 cup, 1 can 1 杯, 1 罐 咖啡 例如：沖煮咖啡、即溶咖啡、卡布奇诺 1 bottle 1 瓶啤酒, Alcohol beer, e.g. beer, wine, spirits 1 glass 1 杯葡萄酒, 36 1 2 3 4 5 6 7 8 9 10 wine, 1 酒精类 例如：啤酒、葡萄酒、烈酒 1 measure 份量烈酒 (25ml) spirit (25ml) Water 37 1 2 3 4 5 6 7 8 9 10 1 glass 1 玻璃杯 白开水

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Dietary Practices Questions Never or Once a 2-3 a Once a 2-3 a 4-6 a Once a 2-3 a 4-5 a 6+ a rarely month month week week week day day day day 从不 1 个月 1 个月 1 星期 1 星期 1 星期 1 天 1 天 1 天 1 天 /很少 1 次 2-3 次 1 次 2-3 次 4-6 次 1 次 2-3 次 4-5 次 6+次 DP1 How often do you eat at hawker centres, foods courts or coffee shops? 1 2 3 4 5 6 7 8 9 10 您多常在熟食中心、食阁或咖啡店吃饭？ DP2 How often do you eat at workplace or school canteens? 1 2 3 4 5 6 7 8 9 10 您多常在工作场所或学校食堂吃饭？ DP3 How often do you eat at western fast food outlets or quick-service restaurants? 1 2 3 4 5 6 7 8 9 10 您多常在西式快餐厅或快速服务餐厅吃饭？ DP4 How often do you eat at other restaurants? 您多常在其他餐厅吃饭？ 1 2 3 4 5 6 7 8 9 10

DP5) How often do you consume chicken with skin? 您多常食用带皮的鸡肉？

1) Never 1) 从来不吃 2) Sometimes 2) 偶尔 3) Always 3) 经常 4) Do not eat chicken 4) 我不吃鸡肉

DP6) How often do you consume meat with visible fat? 您多常食用肉块上面可看见脂肪的肉类?

1) Never 1) 从来不吃 2) Sometimes 2) 偶尔 3) Always 3) 经常 4) Do not eat meat 4) 我不吃肉

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

DP7 What type of fat or oil is usually used for cooking at home? (Select ONE ONLY) 您在家里做饭时，最常使用哪一类的脂肪或食用油？（请只选其中一项）

1) Butter, dripping, ghee, lard or any other animal fat 1) 牛油、油滴、印度液体奶油、猪油或其他动物脂肪 2) Canola oil 2) 芥花籽油 3) Canola/olive oil blend 3) 芥花籽油/橄榄混合油 4) Canola/sunflower oil blend 4) 芥花籽油/向日葵花籽混合油 5) Coconut oil 5) 椰油 6) Corn oil 6) 玉米油 7) Grapeseed oil 7) 葡萄籽油 8) Hard margarine 8) 硬性人造黄油 9) Olive oil 9) 橄榄油 10) Palm oil 10) 棕榈油 11) Peanut oil 11) 花生油 12) Rice bran oil 12) 米糠油 13) Sesame oil 13) 芝麻油 14) Soft margarine 14) 软性人造黄油 15) Soya bean oil 15) 黄豆油 16) Sunflower oil 16) 葵花籽油 17) Sunflower/olive oil blend 17) 葵花籽油/橄榄混合油 18) Vanaspati (vegetable ghee) 18) 印度人造黄油（用植物油脂制成） 19) Vegetable oil/blended oil 19) 菜油/混合油 20) Others, Please specify: ______20) 其他, 请注明：______21) Do not eat food cooked at home 21) 不吃家里煮的饭菜

DP8 At the table, how often do you add salt or sauces to your food? e.g. soy sauce, braised gravy 您在用餐时，多常在食物加入盐或酱汁？（例如：酱油、卤汁）

1) Never 1) 从来不会 2) Sometimes 2) 偶尔 3) Always 3) 经常

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

DP9) What type of milk do you usually add to your coffee? (CHOOSE ONE ONLY) 您通常会在咖啡里加入哪一类的牛奶？（请只选其中一项）

1) Do not drink coffee (go to DP10) 1) 我不喝咖啡（请到第 10 题） 2) Milk is already added (I drink 3-in-1) 2) 已经加入牛奶（我喝三合一即溶咖啡） 3) Milk is already added (I drink 2-in-1) 3) 已经加入牛奶（我喝二合一即溶咖啡） 4) Sweetened condensed milk 4) 甜炼奶 5) Evaporated milk 5) 淡炼奶 6) Whole milk/powder 6) 全脂牛奶 / 奶粉 7) Low-fat milk/powder 7) 低脂牛奶 / 奶粉 8) Skimmed milk/powder 8) 脱脂牛奶 / 奶粉 9) Soya milk 9) 豆奶 10) Creamer/whitener 10) 奶精 / 人造稀奶油 11) Do not add milk (I drink black coffee) 11) 不加牛奶（我只喝黑咖啡.）

DP9a) When you make or buy your coffee, how much sugar do you usually add to your coffee? 当你冲泡或买咖啡的时候,您通常会在咖啡内加入多少糖分?

1) Do not add sugar 1) 不加糖 2) Less than 1 teaspoon 2) 少过 1 茶匙糖 3) 1 – 2 teaspoon / Ask for less 3) 1 – 2 茶匙 / 要求少糖 4) 3 – 4 teaspoon / Ask for regular 4) 3 – 4 茶匙 / 不要求加或少糖 5) 5+ teaspoon / Ask for more 5) 5 茶匙或以上 / 要求加糖

DP9b) When buying your coffee, how often do you ask for coffee with ‘less sugar’? 您在买咖啡 的时侯，多常会要求 “少糖”？

1) Always 1) 经常 2) Most of the time 2) 大多时候 3) Sometimes 3) 偶尔 4) Never 4) 从来不会 777) Not applicable 777) 不适用

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

DP10) What type of milk do you usually add to your tea? (CHOOSE ONE ONLY) 您通常会在茶内加入哪一类的牛奶?（请只选其中一项）

1) Do not drink tea (go to DP11) 1) 我不喝茶（请到第 11 题） 2) Milk is already added (I drink 3-in-1) 2) 已经加入牛奶（我喝三合一即溶奶茶） 3) Milk is already added (I drink 2-in-1) 3) 已经加入牛奶（我喝二合一即溶奶茶） 4) Sweetened condensed milk 4) 甜炼奶 5) Evaporated milk 5) 淡炼奶 6) Whole milk/powder 6) 全脂牛奶 / 奶粉 7) Low-fat milk/powder 7) 低脂牛奶 / 奶粉 8) Skimmed milk/powder 8) 脱脂牛奶 / 奶粉 9) Soya milk 9) 豆奶 10) Creamer/whitener 10) 奶精 / 人造稀奶油 11) Do not add milk (I drink tea without milk) 11) 不加牛奶

DP10a) When you make or buy your tea, how much sugar do you usually add to your tea? 当你冲泡或买茶的时候,您通常会在茶内加入多少糖分?

1) Do not add sugar 1) 不加糖 2) Less than 1 teaspoon 2) 少过 1 茶匙糖 3) 1 – 2 teaspoon / Ask for less 3) 1–2 茶匙 / 要求少糖 4) 3 – 4 teaspoon / Ask for regular 4) 3–4 茶匙 / 不要求加或少糖 5) 5+ teaspoon / Ask for more 5) 5 茶匙或以上 / 要求加糖

DP10b) When buying your tea, how often do you ask for tea with ‘less sugar’? 您在买茶的 时侯，多常会要求 “少糖”？

1) Always 1) 经常 2) Most of the time 2) 大多时候 3) Sometimes 3) 偶尔 4) Never 4) 从来不会 777) Not applicable 777) 不适用

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

DP11) What type of milk do you usually add to your malted beverages? (e.g. hot chocolate, Horlicks®, Milo, Ovaltine®)? (CHOOSE ONE ONLY) 您通常会在麦芽饮料内加入哪一类的牛奶（例如：热巧克力，好立克®，美禄，阿华田®）？（请只选其中一项）

1) Do not drink malted beverages (go to DP12) 1) 我不喝麦芽饮料（请到第 12 题） 2) Milk is already added (I drink 3-in-1) 2) 已经加入牛奶（我喝三合一即溶麦芽饮料） 3) Milk is already added (I drink 2-in-1) 3) 已经加入牛奶（我喝二合一即溶麦芽饮料） 4) Sweetened condensed milk 4) 甜炼奶 5) Evaporated milk 5) 淡炼奶 6) Whole milk/powder 6) 全脂牛奶 / 奶粉 7) Low-fat milk/powder 7) 低脂牛奶 / 奶粉 8) Skimmed milk/powder 8) 脱脂牛奶 / 奶粉 9) Soya milk 9) 豆奶 10) Creamer/whitener 10) 奶精 / 人造稀奶油 11) Do not add milk 11) 不加牛奶

DP11a) When you make or buy your malted beverages, how much sugar do you usually add to your malted beverages? 当你冲泡或买麦芽饮料的时候,您通常会在麦芽饮料内加入多少糖分?

1) Do not add sugar 1) 不加糖 2) Less than 1 teaspoon 2) 少过 1 茶匙糖 3) 1 – 2 teaspoon / Ask for less 3) 1–2 茶匙 / 要求少糖 4) 3 – 4 teaspoon / Ask for regular 4) 3–4 茶匙 / 不要求加或少糖 5) 5+ teaspoon / Ask for more 5) 5 茶匙或以上 / 要求加糖

DP11b) When buying your malted beverages, how often do you ask for malted beverages with ‘less sugar’? 您在买麦芽饮料的 时侯，多常会要求 “少糖”？

1) Always 1) 经常 2) Most of the time 2) 大多时候 3) Sometimes 3) 偶尔 4) Never 4) 从来不会 777) Not applicable 777) 不适用

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

DP12) Do you take vitamins or supplements? 您有在服用维生素或保健食品吗？

1) Yes 1) 有 2) No (Go to B1) 2) 没有 (请前进到第 B1)

DP12a) If yes, please state the name, brand, number, frequency and duration below. 如果有在服用维生素或保健食品，请注明名称、品牌、数量、次数和您持续服用了多长时间。

Strength Length of time taking supplement Frequency / 次数 Type per dose 持续服用了多久 e.g. Vitamin C, multivitamin Brand name e.g. 500mg (if Number of At least Less than Less known) pills/ once a once a More than than 1 每剂量浓 Capsules Every week week Between 5 years 数量 day year 1 – 5 years 名称 度 e.g. 至少 少过 多过 品牌 每天 少过 1 – 5 年 例如：维生素 C，复合维生素 例如： （颗/胶囊） 1 星期 1 星期 年 年 5 500mg 1 1 次 1 次 (若有注明)

1 1 2 3 1 2 3

2 1 2 3 1 2 3

3 1 2 3 1 2 3

4 1 2 3 1 2 3

5 1 2 3 1 2 3

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

SECTION B – LIFESTYLE FACTORS 生活方式

Self-reported Height and Weight 自我报道身高和体重

B1 How tall are you without shoes? 您不穿鞋子时有多高？

cm 公分

888) Refuse to answer 拒绝回答

999) Do not know 不知道

B2 How much do you weigh? 您的体重是多少？

kg 公斤

888) Refuse to answer 拒绝回答

999) Do not know 不知道

B3 What was your weight at age 21? If you are not sure, please give your best estimation. 您 21 岁时的体重是多少？ 如果不能确定, 请给以最准确的估计。

kg (nearest kg) 公斤(最接近的公斤)

Eating Pattern 饮食模式

B4 How many times per day do you eat? Include meals and snacks, but not beverages. 您每天进食多少次？答案包括正餐和小吃，但不包括饮料。

1) 1 or 2 times per day 1) 一天一到两次 2) 3/day 2) 一天三次 3) 4/day 3) 一天四次 4) 5/day 4) 一天五次 5) 6/day 5) 一天六次 6) 7/day 6) 一天七次 7) 8/day 7) 一天八次 8) 9 or more times per day 8) 一天九次以上

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

B5 In a typical week, on how many days do you eat breakfast? 在平常的一个星期里，您有多少天会吃早餐？

1) Zero (0) 1) 没有(零) 2) 1 Day 2) 一天 3) 2 Days 3) 两天 4) 3 Days 4) 三天 5) 4 Days 5) 四天 6) 5 Days 6) 五天 7) 6 Days 7) 六天 8) 7 Days 8) 七天

B6 How fast is your rate of eating? 您吃东西的速度如何？

1) Very slow 1) 非常慢 2) Relatively slow 2) 较慢 3) Medium 3) 中度 4) Relatively fast 4) 较快 5) Very fast 5) 非常快

Drinking 喝酒

Guide : 1 alcohol serving: 2/3 of 1 mug/can of beer (220ml), 1 glass of wine (about 100ml), 1 measure of hard liquor (20-30ml) 指南 : 1份酒: 3分之 2 杯/罐啤酒 (220ml), 1杯葡萄酒 (大约100ml), 1份烈酒 (20-30ml) B7 For Women 女性:

Did you have 4 or more servings of alcohol at a single drinking session in the past month? 您在过去三十天中是否曾经一次喝了 4 份份或超过 4 份的酒？

1) Yes 1) 是 2) No 2) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

For Men 男性:

Did you have 5 or more servings of alcohol at a single drinking session in the past month? 您在过去三十天中是否曾经一次喝了 5 份或超过 5 份的酒？

1) Yes 1) 是 2) No 2) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Smoking 吸烟

B8.1 Have you ever smoked at least 100 cigarettes (about 5 packs) in your lifetime? 从您出生到现在,您是否曾经吸过至少 100 支香烟（大约 5 包）?

[Guide: Captures exposure to all forms of tobacco , except Shisha]

1) Yes 1) 有 2) No (Go to B8.7) 2) 没有 (跳到 B8.7) 888) Refuse to answer (Go to B8.7) 888) 拒绝回答(跳到 B8.7) 999) Do not know (Go to B8.7) 999) 不知道（跳到 B8.7）

B8.2 Do you smoke cigarettes currently? 您目前是否有吸烟？

[Guide: “Currently” refers to period around time of interview]

1) Yes 1) 有 2) No (Go to B8.5) 2) 没有 (跳到 B8.5) 888) Refuse to answer (Go to B8.5) 888) 拒绝回答 (跳到 B8.5)

B8.3 Do you smoke cigarettes…? 您是否。。。。。吸烟?

1) Everyday 1) 每天 2) Occasionally (Go to B8.5) 2) 偶尔(跳到 B8.5) 888) Refuse to answer (Go to B8.5) 888) 拒绝回答 (跳到 B8.5)

B8.4 When did you start smoking cigarettes daily? 您什么时候开始每天吸烟？

Age when started 开始的年龄 ______

(or 或) Year when started 开始的年份 l___l___l___l___l

(or 或) Years ago 年前 ______(Go to 跳到 B8.6)

888) Refuse to answer 拒绝回答

999) Do not know 不知道

B8.5 When did you last stop smoking cigarettes regularly? 您最后一次停止经常吸烟，是什么时候?

[Guide : Participant might have tried to quit repeatedly. Ask for the last quit year. “Stop smoking” means a total

cessation in smoking]

Age when stopped 停止时的年龄 ______

(or 或) Year when stopped 停止时的年份 l___l___l___l___l

(or 或) years ago 年前 ______

777) Not Applicable 不适用 (Go to 跳到 B8.6) 888) Refuse to answer 拒绝回答 (Go to 跳到 B8.7) 999) Do not know 不知道 (Go to 跳到 B8.7)

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

B8.6 Please describe your cigarette smoking pattern from time you started smoking till present/you stopped. 请您描述从开始吸烟直到您目前的吸烟模式或停止吸烟的模式。

Guide:  Ask participant about the entire period of his life when he/she was smoking cigarettes, starting from earliest to the most recent.  Document the type of cigarettes he/she smoked and the amount smoked per day/week/month.  If participant is a very irregular smoker who is completely unable to gauge his or her usage, put down answer as “1 time per month”.  Also record intermittent period(s) of non-smoking.

Per … 每… From To Type of cigarettes smoke Amount 从 到 smoked Day Week Month 香烟的种类 [MM / YYYY] [MM / YYYY] 吸烟的份量 天 周 月

1) Manufactured cigarettes 制成香烟

2) Hand-rolled cigarettes / tahil / liangs / Ang hun 手卷烟 1 2 3

3) Not smoking in this period 在这期间没吸烟 Sticks 支

1) Manufactured cigarettes 制成香烟

2) Hand-rolled cigarettes / tahil / liangs / Ang hun 手卷烟 1 2 3

3) Not smoking in this period 在这期间没吸烟 Sticks 支

1) Manufactured cigarettes 制成香烟

2) Hand-rolled cigarettes / tahil / liangs / Ang hun 手卷烟 1 2 3

3) Not smoking in this period 在这期间没吸烟 Sticks 支

1) Manufactured cigarettes 制成香烟

2) Hand-rolled cigarettes / tahil / liangs / Ang hun 手卷烟 1 2 3

3) Not smoking in this period 在这期间没吸烟 Sticks 支

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

B8.7 Have you ever smoked any of the following other tobacco products besides cigarettes? [SHOWCARD] 除了香烟以外，您是否曾吸过以下的其他烟草产品？

Yes 是 Have stopped List of other tobacco products using this No

其他烟草产品列表 Daily Occasionally smoked 否 每天 偶尔 tobacco products 已停止吸这 种烟草产品

a Cigars 雪茄 1 2 3 4

b Cigarillos 小雪茄 1 2 3 4

c Shisha (waterpipe) 水烟 1 2 3 4

d Beedis 比迪烟 1 2 3 4

Rolled cigarettes / Ang Hun (loose tobacco) e 1 2 3 4 手卷香烟（散烟草）

Others 其他 f 1 2 3 4 (Please specify 请注明: ______)

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

B9 PHYSICAL ACTIVITY 体能活动

We would like you to think about the physical activities that you do in the last three months. 我们请您回想，您在过去三个月曾经做过的体能活动

Leisure Time Activity 休闲活动

We would like you to think about the things that you do in your free time. 我们请您回想，您在休闲时候做的活动。

On average 平均次数,

B9.1 How much time do you usually spend watching TV/ DVDs/ videos on a typical weekday? 在平常的周日里，您通常花多少时间观看电视/ DVD/影片？

______hours 小时 or 或 ______minutes 分钟

B9.2 How much time do you usually spend watching TV/ DVDs/ videos on a typical weekend day? 在平常的周末日里，您通常花多少时间观看电视/ DVD/影片？

______hours 小时 or 或 ______minutes 分钟

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

B9.3 Which of the following do you do in your spare time (outside working hours)? [SHOWCARD] 您在空余时间（工作时间以外）会进行下列哪项活动？[SHOWCARD]

On average, How how long do How many you do this Activities 活动 many times activity times per each time? per week month (duration in minutes) 每周 每月 您平均每次做 有几次 有几次 这个活动 多久？ （持续时间以 分钟为单位） Walking and Miscellaneous 步行和其他

1. Walking for pleasure or walking 为了休闲或锻炼身体而散步 for exercise (如带孩子或宠物散步，不包 (e.g. walking with children or pets 括从一个地方步行到另一个地 - DO NOT include walking to get 方) from one place to another)

2. Bicycling for pleasure 为了休闲而骑脚车 3. Dancing-ballroom, square, line 跳舞: 标准舞、土风舞、排舞

and / or disco 和/或迪斯科 4. Dancing-aerobic, ballet 跳舞: 有氧舞蹈、芭蕾舞 Conditioning Exercise 运动训练 9. Home exercise 家中运动（如仰卧起坐、俯卧

(e.g. sit-ups, push-ups) 撑） 10. Health club exercise classes 健身俱乐部健身课程（如健身

(e.g. aerobics) 操） 11. Jog/walk combinations 慢跑/散步 12. Balance exercises: Taiqi, 平衡性运动：太极、气功、呼

Qigong, breathing exercises 吸练习 13. Running 跑步 14. Weight lifting 举重 Water Activities 水上运动 18. Canoeing or rowing for pleasure 为了休闲，划独木舟或划船 19. Canoeing or rowing for 为了比赛，划独木舟或划船 competition 20. Swimming (at least 50 m in a 游泳（在泳池游至少 50 米） pool) 21. Swimming at the beach 在海边游泳 Sports Activities 体育运动 24. Bowling 保龄球

26. Table tennis 乒乓球 27. Tennis-singles 网球单打 28. Tennis- 网球双打 32. Badminton 羽毛球

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

On average, How how long do How many you do this Activities 活动 many times activity times per each time? per week month (duration in minutes) 每周 每月 您平均每次做 几次 几次 这个活动 多久？ （持续时间以 分钟为单位） Sports Activities 体育运动 33. Basketball/netball - non score 篮球/英式篮球-非比赛性的,

game i.e. not keeping score 不记分数 34. Basketball/netball - game play 篮球/英式篮球-比赛性的,计

(keeping score) 分数 37. Soccer (football) 足球 42.1 Golf: riding a powerkart /buggy 高尔夫球：乘坐电动车/球车 42.2 Golf: walking and pulling clubs 高尔夫球：步行并用手推车拉

on cart 球杆 42.3 Golf: walking and carrying 高尔夫球：步行并背着球杆 clubs 43 Do not do any of the above activities (Go to B9.4) 没有进行以上任何活动（跳到 B9.4）

B9.4 Do you do any other leisure time activities regularly that have not been included in the list? 您是否有定期进行其他不被包括在列表中的休闲活动？

1) Yes 1) 是 2) No (Go to B10) 2) 否（跳到 B10）

B9.4.a Please list any other leisure time activities that How How On average, how long do you do regularly that have not been included many many in the list. you do this activity each times times time? 请列出您定期进行而不被包括在列表中的其他休 per per (duration in minutes) 闲活动。 week month

每周 每月 您平均每次做这个 几次 几次 活动多久？ （持续时间以分钟为单位）

B9.4.a.1

B9.4.a.2

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

B10 Occupational Physical Activity 职业体能活动

B10.1 In the last 3 months, did you hold any job that last for more than 1 month? 在过去 3 个月，您有没有持续做任何工作超过 1 个月？

1) Yes 1) 是 2) No (Go to B11) 2) 否 （跳到 B11） 888) Refuse to answer (Go to B11) 888) 拒绝回答（跳到 B11）

B10.2 We would like you to think about the activities you do at work over the last 3 months. 我们请您回想一下您在过去 3 个月在工作时间所做的活动。

Under Hours of work per day, ask “….on average, how many hours a day do you work?” Then minus the time taken for breaks. If overtime is a regular feature in this participant’s work, include this in the number of hours done in an average day. 在每天工作的时数，问：“...... 平均来说，您每天工作多少小时？然后减去休息的时间。如果参与者的工作需 要常常加班，则将加班时数包括在每天平均的工作时数。

Under Days of work per week, record how many days per week the participant is required to work. This includes overtime, if it is a regular feature of this job. 在每周工作的天数，记录参与者每周需要工作的天数。如果参与者的这项工作需要常常加班，将加班的天数也包 括在每天平均加班工作的天数。

Under Hours spent sitting per day while at work, record the number of hours spent doing his/her job while in a sitting position. 每天在工作中坐下的时间，记录他/她工作时坐着的时数。

Job name should be descriptive enough to give an idea of the kind of intensity of job activity. E.g. document “physical trainer” or “speech trainer”, instead of just “trainer” or name of organization. 工作名称应该是足以描述工作活动的详情。例如记录“体能教练”或“语音教练” ，而不是记录“教练”或机构 名称。

Number of hours spent per day in Number of Hours spent each category below when you are Hours of Days of weeks in the sitting per not sitting

work per work per Job Name last 3 months day while at 当您不坐着时，每天花多少时间在以下 day week

S/N 工作名称 at the job work 的每个类别 [SHOWCARD] 每天工作 每周工作 在过去 3 个月 每天在工作中 时数 天数 Light Moderate Vigorous 的工作周数 坐下的时数 activity activity activity 轻微活动 中度活动 剧烈活动

1

2

3

4

Min 4 Sum total no. of hours = hours of work per day Max 12

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

B11 Transportation 交通

In this context, the sole purpose of walking, cycling or taking motorised transport is to travel from one place to another. It does not refer to walking, cycling or taking motorised transport while on your job. 在这个项目，所指的步行、骑脚车、驾驶或骑/乘坐交通工具的唯一目的，是为了从一个地方去到另一 个地方。这不包括您在工作时需要的步行、骑脚车、驾驶或骑/乘坐交通工具。

B11.1 Do you walk for at least 10 minutes continuously to get to and from places? 您有没有持续步行至少 10 分钟来回一些地方？

1) Yes 1) 是 2) No (Go to B11.5) 2) 否 (跳到 B11.5)

B11.2 In a typical week, how many days do you walk for at least 10 minutes continuously to get to and from places? 在平常的一周里，您有几天持续步行至少 10 分钟来回一些地方？

Days a Week 每周天数

B11.3 On one of those days that you walk for at least 10 minutes continuously, how much time would you typically walk for travel? 在持续步行至少 10 分钟的一天里，您会花多少时间步行来回一些地方？

______hours 小时 or 或 ______minutes 分钟

B11.4 What is the intensity of walking? 您步行的强度是什么？

[Guide : Ask the participant in terms of breathing intensity as described in the parentheses. Do not suggest “Light”, “Moderate”, or “Vigorous” to the participant.]

1) Light (no change in breathing pattern) 1) 轻微（呼吸没有变化） 2) Moderate (make you breathe somewhat harder 2) 中度（呼吸会比平常快） than normal)

3) Vigorous (make you breathe much harder than 3) 剧烈（呼吸比平常更快） normal)

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B11.5 Do you use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places? 您有没有骑一辆脚踏车持续至少 10 分钟来回一些地方？

[Guide: This does not refer to motorized cycles, whether by electric or engine version.]

1) Yes 1) 是 2) No (Go to B11.9) 2) 否 (跳到 B11.9)

B11.6 In a typical week, how many days do you bicycle for at least 10 minutes continuously to get to and from places? 在平常的一周里，您有几天持续骑一辆脚踏车至少 10 分钟来回一些地方？

Days a Week 每周天数

B11.7 On one of those days that you bicycle for at least 10 minutes continuously, how much time would you typically bicycle for travel? 在骑脚踏车持续至少 10 分钟的一天里，您会花多少时间骑踏脚车来回一些地方？

______hours 小时 or 或 ______minutes 分钟

B11.8 What is the intensity of bicycling? 您骑踏脚车的强度是什么？

[Guide: Ask the participant in terms of breathing intensity as described in the parentheses. Do not suggest “Light”, “Moderate”, or “Vigorous” to the participant.]

1) Light (no change in breathing pattern) 1) 轻微（呼吸没有变化）

2) Moderate (make you breathe somewhat harder than 2) 中度（呼吸会比平常快） normal) Vigorous (make you breathe much harder than 3) 3) 剧烈（呼吸比平常更快） normal)

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Shareable Bicycle Use 使用共享脚踏车

B11.9 Do you use shareable bicycles (e.g. ‘oBike’, ‘moBike’, ‘ofo’ bicycles)? 您有没有使用共享脚踏车（例如：'oBike', '摩拜单车', 'ofo' 共享單車)?

1) Yes 1) 是 2) No (Go to B11.15) 2) 否 (跳到 B11.15)

B11.10 Over the past three months, how many times per week have you typically used these bikes? 在过去三个月里，您每星期有几次曾使用共享脚踏车？

On Average, Times Per Week 平均一个星期次数

B11.11 On a day that you use a shareable bicycle, how much time would you typically spend riding the shareable bicycle? 当您使用共享脚踏车的那一天里，您会花多少时间骑共享脚踏车？

______hours 小时 or 或 ______minutes 分钟

B11.12 What is the intensity of bicycling when you ride a shareable bicycle? 当您使用共享脚踏车时，您骑脚踏车的强度是什么？

[Guide: Ask the participant in terms of breathing intensity as described in the parentheses. Do not suggest “Light”,

“Moderate”, or “Vigorous” to the participant.]

1) Light (no change in breathing pattern) 1) 轻微（呼吸没有变化）

2) Moderate (make you breathe somewhat harder than 2) 中度（呼吸会比平常快） normal) Vigorous (make you breathe much harder than 3) 3) 剧烈（呼吸比平常更快） normal)

B11.13 When you use a shareable bicycle, which option best represents the typical purpose of most trips? 当您使用共享脚踏车时，以下哪项最能代表您通常骑脚踏车的目的？

1) Travel to the bus stop or MRT/LRT station. 1) 前往巴士车站或地铁/轻轨列车站 2) Travel from home to your place of work. 2) 从住家前往工作场所 3) Travel from home to your place of study. 3) 从住家前往学习场所 4) Travel to the shops. 4) 前往商店 5) I do not use shareable bicycle for travel for most of 5) 大部分时候我外出时不会使用共享脚踏 the trips. 车

B11.14 Do you use a shareable bicycle for trip purposes other than transport (e.g. for leisure time activity)? 除了用作交通目的之外，您有没有为了其他目的而使用共享脚踏车（例如: 为了休闲活动）？

1) Yes 1) 是 2) No 2) 否

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B11.15 How much time would you spend sitting during motorized transport (e.g. car, bus or MRT) for travel on a day? 在平常的一天里，您会花多少时间乘坐交通工具（例如驾车，搭巴士或地铁）来回一些地 方？

______hours 小时 or 或 ______minutes 分钟

B11.16 In a typical week, how many days do you drive or ride motorized transport to get to and from places? 在平常的一个星期里，您有几天是驾驶或乘坐交通工具来回一些地方？

Days a Week 每周天数

B12 Total Sitting Time 坐下的总时间

B12.1 How much time do you usually spend sitting or reclining on a typical weekday? 在平常的周日里，您通常会花多少时间坐着或躺着？

______hours 小时 or 或 ______minutes 分钟

B12.2 How much time do you usually spend sitting in your free time on a typical weekday? 在平常的周日里，您通常会花多少空闲时间坐着？

______hours 小时 or 或 ______minutes 分钟

B12.3 How much time do you usually spend sitting or reclining on a typical weekend day? 在平常的周末日里，您通常会花多少时间坐着或躺着？

______hours 小时 or 或 ______minutes 分钟

B12.4 How much time do you usually spend sitting in your free time on a typical weekend day? 在平常的周末日里，您通常会花多少空闲时间坐着？

______hours 小时 or 或 ______minutes 分钟

B13 General 一般问题

B13.1 How many flights of stairs (not individual steps) do you climb daily? 您每天会爬几段（不是个别梯级）楼梯？

1) 2 flights or less 1) 两段或更少 2) 3 – 4 2) 三到四 3) 5 – 9 3) 五到九 4) 10 – 14 4) 十到十四 5) 15 or more flights 5) 十五段或更多

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B14 PITTSBURGH SLEEP QUALITY INDEX 匹兹堡睡眠质量指数 University of Pittsburgh (owner) & MAPI Research Trust (for translations)

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SECTION C – PERSONAL AND SOCIAL BACKGROUND 个人与社会背景

C1 Gender 性别:

1) Male 1) 男 2) Female 2) 女

C2 What is your current ethnicity according to your NRIC? 您目前身份证上所写的种族是什么？

1) Chinese 1) 华人 2) Malay 2) 马来人 3) Indian 3) 印度人 Others, please specify 4) 4) 其他, 请列明:______

C3 What is your current marital status? 您目前的婚姻状况是什么？

1) Never married 1) 从未结婚 2) Currently married 2) 已婚 3) Separated but not divorced 3) 分居但没有离婚 4) Divorced 4) 离婚 5) Widowed 5) 丧偶 88 888) Refuse to answer 拒绝回答 8)

C4 Do you have any children? Include those living with you and living in a separate residence. 您有孩子吗？包括那些与您一起居住及住在别处的孩子。

[Guide: Include biological and adopted children]

1) Yes 1) 有 2) No (Go to C5) 2) 没有 (跳到 C5) 888) Refuse to answer (Go to C5) 888) 拒绝回答 (跳到 C5)

C4.1 How many children do you have under 5 years of age? 您有几位 5 岁以下的孩子？

Answer 答案：

C4.2 How many children do you have between 5 and 12 years of age? 您有几位 5 岁至 12 岁之间的孩子？

Answer 答案：

C4.3 How many children do you have between 13 and 20 years of age? 您有几位 13 岁至 20 岁之间的孩子？

Answer 答案：

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C4.4 How many children do you have age 21 years and older? 您有几位 21 岁以上的孩子？

Answer 答案：

C4.5 Do you have any grandchildren? 您有孙子吗？

1) Yes 1) 有 2) No 2) 没有 888) Refuse to answer 888) 拒绝回答

C5 Which of the following best describes your usual work status over the last 12 months? 以下哪一项最可以形容您在过去 12 个月中的一般工作状况？

[Guide: If participant works intermittently and is unable to commit to any of the choices, classify him as working. “Unemployed (able to work)” describes a person who is fit to work but have not yet found employment. “Unemployed (unable to work)” describes a person who is unable to work due to a medical condition. “Others” describe persons such as disabled persons and persons with private means. Prisoners, patients of mental hospitals, inmates of homes for the aged as well as those who are awaiting call-up for National Service are included in this category.]

1) Working 1) 工作 2) Student (full-time) 2) 学生 (全职) 3) Homemaker/Housewife 3) 主妇/家庭主妇 4) Retired 4) 退休 5) Unemployed (able to work) 5) 未被雇用 (有工作能力) 6) Unemployed (unable to work) 6) 未被雇用 (没有工作能力) 7) Others 7) 其他 888) Refuse to answer 888) 拒绝回答

C6 Thinking over the past year, can you tell me what the average earnings of the household have been per month? 在过去的一年,您每月的平均家庭收入是多少？

[Guide: The monthly average of the total income of all members of the household. This does not include tenants’ earnings, but include tenants’ rent payment to the household. Income also includes regular inflow of cash from a welfare organization, a pension and money given by participant’s children or from relatives staying in another household. Circle “less than $2000” if the entire household is not receiving any income and is dependent on savings.]

1) Less than $ 2 000 1) 少于$ 2 000 2) $ 2 000 to $ 3 999 2) $ 2 000 到 $ 3 999 3) $ 4 000 to $ 5 999 3) $ 4 000 到 $ 5 999 4) $ 6 000 to $ 9 999 4) $ 6 000 到 $ 9 999 5) More than $ 10 000 5) 多于 $ 10 000 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

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C7 What type of house do you live in? 您居住于哪一种住宅？

[Guide : If participant is a tenant of a rented property, classify him as “Others” and specify, e.g. “renting 1 room in a 4 room HDB flat”. “Others” may include nursing home, hostel, barracks, workplace etc.]

1) HDB 1–2 room flat 1) HDB 1–2 房式组屋 2) HDB 3-room flat 2) HDB 3 房式组屋 3) HDB 4-room flat 3) HDB 4 房式组屋 4) HDB 5-room or executive flat 4) HDB 5 房式组屋或执行共管公寓 5) Private condominium 5) 私人公寓 6) Private house (landed property) 6) 私人住宅 (有地住宅) 7) Others, please specify: ______7) 其它, 请注明: ______888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

C8 What is the highest level of education that you have attained? 您接受过的最高等级的教育是什么？

[Guide: This question is designed to find out about the formal education. Probe the response if it seems that the participant’s answer is reporting the highest level of school attended, not necessary completed.]

1) No formal qualifications/lower primary 1) 未接受正规教育/小学教育 2) Primary (PSLE) 2) 小学 (PSLE) 3) Secondary (‘O’/’N’ Level) 3) 中学 (‘O’ / ‘N’ 水准) 4) ITE/NTC 4) ITE / NTC 5) ‘A’ level/Polytechnic/Diploma 5) ‘A’ 水准 / 理工学院文凭 6) University 6) 大学和以上学历 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

C9 What is your religion? 您的宗教信仰是什么？

1) No religion 1) 没有宗教信仰 2) Buddhism 2) 佛教 3) Taoism/Chinese Traditional Beliefs 3) 道教/华人传统信仰 4) Islam 4) 伊斯兰教 5) Hinduism 5) 印度教 6) Sikhism 6) 锡克教 7) Christianity, Roman Catholic 7) 基督教，天主教 8) Christianity, other denomination 8) 基督教，其他派系 9) Other religion 9) 其他宗教

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SECTION D – PERSONAL MEDICAL HISTORY 个人医疗史

D1. Heart Disease 心脏疾病

D1.1 Has a Western-trained doctor ever told you that you have blockage of the arteries to your heart? 西医是否曾经告诉过您、您患有心脏动脉阻塞?

[Guide : Participant must have had an angiogram for this diagnosis. ECG alone cannot be used to diagnose. Heart

Disease in this context does NOT include congenital or ‘born with’ disease/defects.]

1) Yes 1) 是 2) No (Go to D1.2) 2) 否（跳到 D1.2） 888) Refuse to answer (Go to D1.2) 888) 拒绝回答（跳到 D1.2） 999) Do not know (Go to D1.2) 999) 不知道（跳到 D1.2）

D1.1.1 When did it first occur? 请问第一次发生是什么时候？

Age 年龄 (or 或) Year 年份 l___l___l___l___l

(or 或) Years ago 年前 888) Refuse to answer 拒绝回答 999) Do not know 不知道

D1.1.2 Which hospital/clinic? 在哪一家医院、诊所? [Guide: Write the hospital name in full or in common abbreviations e.g. SGH, TTSH, AH and CGH. If it was an overseas hospital/clinic, document the country and name of the hospital/clinic.]

1． 2．

3． 888) Refuse to answer 拒绝回答

999) Do not know 不知道

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D1.2 Have you ever had a heart attack? 您是否曾经心脏病发作过？

[Guide: Heart attack refers to a situation whereby there is loss in heart muscle function due to lack of oxygenation, typically due to restriction in blood flow from blocked arteries.]

1) Yes 1) 是 2) No (Go to D1.3) 2) 否（跳到 D1.3） 888) Refuse to answer (Go to D1.3) 888) 拒绝回答（跳到 D1.3） 999) Do not know (Go to D1.3) 999) 不知道（跳到 D1.3）

[FOR RECRUITER’S USE] D1.2.1 This participant is INELIGIBLE. Please confirm.

□ I have confirmed with the participant that he/she has ever had a heart attack. (End survey)

D1.3 Is your doctor giving you medication for your heart disease currently? 您的医生目前是否有给您治疗心脏病的药物？

1) Yes 1) 是 2) No 2) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

D1.4 Have you ever had an angiogram? 您是否曾经进行过血管造影检查？

[Guide: An angiogram is a diagnostic procedure performed to find out (not to cure) if there is any blockages to the arteries. A small tube is inserted into a big blood vessel to administer a dye into the blood vessels of the desired area. X-rays are then taken to locate the blockages in the blood vessels.]

1) Yes 1) 是 2) No (Go to D1.5) 2) 否（跳到 D1.5） 888) Refuse to answer (Go to D1.5) 888) 拒绝回答（跳到 D1.5） 999) Do not know (Go to D1.5) 999) 不知道（跳到 D1.5）

D1.4.1 If Yes, which year was it first done and at which hospital? 如果‘是’，您是在哪一年和在哪一家医院第一次进行的？

Year 年份 l___l___l___l___l

888) Refuse to answer 拒绝回答

999) Do not know 不知道

D1.4.2 Hospital 医院: 888) Refuse to answer 拒绝回答 999) Do not know 不知道

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D1.5 Have you ever had an angioplasty-ballooning? 您是否曾经进行过心血管扩张手术？

[Guide: An angioplasty-ballooning a procedure that clears the blockages in the blood vessels.]

1) Yes 1) 是 2) No (Go to D1.6) 2) 否（跳到 D1.6） 888) Refuse to answer (Go to D1.6) 888) 拒绝回答（跳到 D1.6） 999) Do not know (Go to D1.6) 999) 不知道（跳到 D1.6）

[FOR RECRUITER’S USE]

D1.5.1 This participant is INELIGIBLE. Please confirm.

I have confirmed with the participant that he/she has ever had an angioplasty-ballooning. (End □ survey)

D1.6 Have you ever had a heart bypass operation? 您是否曾经进行过心脏绕道手术？

[Guide: A heart bypass operation creates a new route to supply blood to the heart by transplanting part of a blood vessel.]

1) Yes 1) 是 2) No (Go to D2.1) 2) 否（跳到 D2.1） 888) Refuse to answer (Go to D2.1) 888) 拒绝回答（跳到 D2.1） 999) Do not know (Go to D2.1) 999) 不知道（跳到 D2.1）

[FOR RECRUITER’S USE] D1.6.1 This participant is INELIGIBLE. Please confirm.

□ I have confirmed with the participant that he/she has ever had a heart bypass operation. (End survey)

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D2. Peripheral Arterial Disease 周边动脉疾病

D2.1 Has a Western-trained doctor ever told you that you have blockage of the arteries in your legs? 西医是否曾经告诉过您,您的腿部动脉阻塞？

1) Yes 1) 是 2) No (Go to D3) 2) 否 (跳到 D3） 888) Refuse to answer (Go to D3) 888) 拒绝回答(跳到 D3） 999) Do not know (Go to D3) 999) 不知道 (跳到 D3）

D2.1.1 When did it first occur? 请问第一次发生是什么时候？

Age 年龄 (or 或) Year 年份 l___l___l___l___l

(or 或) Years ago 年前

888) Refuse to answer 拒绝回答

999) Do not know 不知道

D2.1.2 Which hospital/clinic? 在哪一家医院、诊所?

[Guide : Write the hospital name in full or in common abbreviations e.g. SGH, TTSH, AH and CGH. If it was an overseas hospital/clinic, document the country and name of the hospital/clinic.]

1．

2．

3． 888) Refuse to answer 拒绝回答 999) Do not know 不知道

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D2.2 Have you ever had an angiogram? 您是否曾经进行过血管造影检查？

[Guide : An angiogram is a diagnostic procedure performed to find out (not to cure) if there are any blockages to the arteries. A small tube is inserted into a big blood vessel to administer a dye into the blood vessels of the desired area. X-rays are then taken to locate the blockages in the blood vessels.]

1) Yes 1) 是 2) No (Go to D2.3) 2) 否 (跳到 D2.3) 888) Refuse to answer (Go to D2.3) 888) 拒绝回答 (跳到 D2.3) 999) Do not know (Go to D2.3) 999) 不知道 (跳到 D2.3)

D2.2.1 If Yes, which year was it first done and at which hospital? 如果‘是’，您是在哪一年和在哪一家医院第一次进行的？

Year 年份 l___l___l___l___l

888) Refuse to answer 拒绝回答

999) Do not know 不知道

D2.2.2 Hospital 医院: 888) Refuse to answer 拒绝回答 999) Do not know 不知道

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D2.3 Have you ever had an angioplasty-ballooning? 您是否曾经进行过心血管扩张手术？

[Guide: An angioplasty-ballooning a procedure that clears the blockages in the blood vessels.]

1) Yes 1) 是 2) No (Go to D2.4) 2) 否 (跳到 D2.4) 888) Refuse to answer (Go to D2.4) 888) 拒绝回答 (跳到 D2.4) 999) Do not know (Go to D2.4) 999) 不知道 (跳到 D2.4)

[FOR RECRUITER’S USE]

D2.3.1 This participant is INELIGIBLE. Please confirm.

I have confirmed with the participant that he/she has ever had an angioplasty-ballooning. (End □ survey)

D2.4 Have you ever had a bypass operation? 您是否曾经进行过绕道手术？

[Guide: A bypass operation creates a new route to supply blood to the heart by transplanting part of a blood

vessel.]

1) Yes 1) 是 2) No (Go to D3) 2) 否(跳到 D3) 888) Refuse to answer (Go to D3) 888) 拒绝回答(跳到 D3) 999) Do not know (Go to D3) 999) 不知道(跳到 D3)

[FOR RECRUITER’S USE]

D2.4.1 This participant is INELIGIBLE. Please confirm.

□ I have confirmed with the participant that he/she has ever had a bypass operation. (End survey)

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D3. Stroke 中风

D3.1 Has a Western-trained doctor ever told you that you had a stroke? 西医是否曾经告诉过您,您中风过？

[Guide : Stroke refers to a condition whereby there is a permanent damage to brain function from lack of

oxygenation due to limited blood flow or ruptured blood vessel.]

1) Yes 1) 是 2) No (Go to D3.2) 2) 否 (跳到 D3.2) 888) Refuse to answer (Go to D4) 888) 拒绝回答 (跳到 D4) 999) Do not know (Go to D4) 999) 不知道(跳到 D4)

[FOR RECRUITER’S USE]

D3.1.1 This participant is INELIGIBLE. Please confirm.

□ I have confirmed with the participant that he/she has ever had a stroke. (End survey)

D3.2 Has a Western-trained doctor ever told you that you had a TIA or transient ischemic attack, or a mini stroke? (A mini stroke is a stroke where the symptoms completely disappear after 24 hours and the patient appears to recover fully from the attack.) 西医是否告诉过您、您有短暂性的脑部缺血(TIA) 或是轻微中风? (轻微中风是由于大脑特定 部位的血液供应暂时受到阻碍，致使产生了神经系统的功能障碍。一般持续时间少于 24 小时)

1) Yes 1) 是 2) No (Go to D4) 2) 否 (跳到 D4) 888) Refuse to answer (Go to D4) 888) 拒绝回答 (跳到 D4) 999) Do not know (Go to D4) 999) 不知道 (跳到 D4)

[FOR RECRUITER’S USE]

D3.2.1 This participant is INELIGIBLE. Please confirm.

□ I have confirmed with the participant that he/she has ever had a TIA or mini stroke. (End survey)

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D4. High Blood Pressure (Hypertension) 高血压

D4.1 Has a Western-trained doctor, nurse, or other healthcare professional told you that you have high blood pressure? 西医、护士或是其他医疗工作者是否曾经告诉您、您患有高血压？

1) Yes 1) 是 2) No (Go to D5) 2) 否 (跳到 D5) 888) Refuse to answer (Go to D5) 888) 拒绝回答(跳到 D5) 999) Do not know (go to D5) 999) 不知道(跳到 D5)

D4.2 At what age were you diagnosed to have high blood pressure? 您几岁时被诊断患有高血压？

Age 年龄

(or 或) Year 年份 l___l___l___l___l

(or 或) Years ago 年前

888) Refuse to answer 拒绝回答

999) Do not know 不知道

D4.3 Is your doctor giving you medication for your high blood pressure currently? 您的医生目前是否有给您治疗高血压的药物？

1) Yes 1) 有 2) No 2) 没有

888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

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D5. Diabetes Mellitus 糖尿病

D5.1 When was the last time you had a blood test to check for diabetes? 您最后一次为了检查是否患有糖尿病所进行的血液检验是什么时候？

1) 1 year ago or less 1) 一年前或更少 2) More than 1 year to 2 years 2) 多过一年至两年前 3) More than 2 years to 3 years 3) 多过两年至三年前 4) More than 3 years to 5 years 4) 多过三年至五年前 5) More than 5 years 5) 多过五年前 6) Never been checked 6) 从来没检查

D5.2 Has a Western-trained doctor ever told you that you have diabetes? [If “Yes” and respondent is female, prompt “Was this only when you are pregnant”?] 西医是否曾经告诉过您，您患上糖尿病？

[如果回答“有”且受访者是女性，提示“是当您怀孕的时候吗”？]

1) Yes 1) 是 2) Yes, but only during pregnancy (Go to D6) 2) 是，但只有在怀孕期间(跳到 D6) 3) No (Go to D6) 3) 否(跳到 D6) 888) Refuse to answer (Go to D6) 888) 拒绝回答(跳到 D6) 999) Do not know (Go to D6) 999) 不知道(跳到 D6)

D5.3 How old were you when the doctor first told you had diabetes? 您几岁时第一次被诊断患有糖尿病？

Age 年龄

(or 或) Year 年份 l___l___l___l___l

(or 或) Years ago 年前

888) Refuse to answer 拒绝回答

999) Do not know 不知道

D5.3.1 Which hospital/clinic? 在哪一家医院、诊所?

[Guide : Write the hospital name in full or in common abbreviations e.g. SGH, TTSH, AH and CGH. If it was an overseas hospital/clinic, document the country and name of the hospital/clinic.]

1．

2．

3． 888) Refuse to answer 拒绝回答 999) Do not know 不知道

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D5.3.2 Is your doctor giving you medication for your diabetes currently? 您的医生目前是否有给您治疗糖尿病的药物？

1) Yes, insulin injections 1) 是, 注射胰岛素 2) Yes, tablets 2) 是, 口服降糖药 3) Yes, insulin injections and tablets 3) 是, 注射胰岛素和口服降糖药 4) No 4) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

D5.4 Have you ever been told by a Western-trained doctor that you have diabetic eye disease? 西医是否曾经告诉您、您患上了由糖尿病而引起的眼部疾病？

1) Yes 1) 是 2) No (Go to D5.8) 2) 否 (跳到 D5.8) 888) Refuse to answer (Go to D5.8) 888) 拒绝回答 (跳到 D5.8) 999) Do not know (Go to D5.8) 999) 不知道(跳到 D5.8)

D5.5 When did the doctor first tell you had diabetic eye disease? 您几岁时第一次被诊断患上了由糖尿病而引起的眼部疾病？

Age 年龄

(or 或) Year 年份 l___l___l___l___l (or 或) Years ago 年前

888) Refuse to answer 拒绝回答

999) Do not know 不知道

D5.6 Did you have surgery or laser procedure for your diabetic eye disease? 您是否曾经因由糖尿病而引起的眼部疾病进行过手术或者是激光程疗？

1) Yes 1) 是 2) No (Go to D5.8) 2) 否 (跳到 D5.8) 888) Refuse to answer (Go to D5.8) 888) 拒绝回答(跳到 D5.8) 999) Do not know (Go to D5.8) 999) 不知道(跳到 D5.8)

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D5.7 Do you know if the surgery or laser procedure was for: 您是否知道这个手术或激光程疗是为了治疗。。。。。吗？

Refuse to Do not Yes No answer know 是 否 拒绝回答 不知道 D5.7.1 Retinopathy 视网膜病变 1 2 888 999

D5.7.2 Cataract 白内障 1 2 888 999 2 888 999 D5.7.3 Others 其它 1 (Go to D5.8) (Go to D5.8) (Go to D5.8) D5.7.3.1 Please specify 请说明:

D5.8 Have you ever been told by a Western-trained doctor that you have kidney problems caused by your diabetes (including proteinuria)? 西医是否曾经告知您，您因为糖尿病而引起肾脏问题（包括蛋白尿）？

1) Yes 1) 是 2) No (Go to D5.10) 2) 否 (跳到 D5.10) 888) Refuse to answer (Go to D5.10) 888) 拒绝回答 (跳到 D5.10) 999) Do not know (Go to D5.10) 999) 不知道 (跳到 D5.10)

D5.9 When did the doctor first tell you had kidney problems caused by your diabetes (including proteinuria)? 西医什么时候首次告诉您，您因为糖尿病而引起肾脏问题(包括蛋白尿）？

Age 年龄

(or 或) Year 年份 l___l___l___l___l

(or 或) Years ago 年前

888) Refuse to answer 拒绝回答

999) Do not know 不知道

D5.10 Have you ever been told by a Western-trained doctor that you have nerve problems in your arms or legs caused by your diabetes? 西医是否曾经告知您，您因为糖尿病而导致您的手臂或是腿部神经有问题？

1) Yes 1) 是 2) No (Go to D6) 2) 否 (跳到 D6) 888) Refuse to answer (Go to D6) 888) 拒绝回答(跳到 D6) 999) Do not know (Go to D6) 999) 不知道(跳到 D6)

D5.11 When did the doctor first tell you had nerve problems in your arms or legs caused by your diabetes? 西医什么时候首次告诉您，您因为糖尿病而导致您的手臂或是腿部的神经有问题？

Age 年龄

(or 或) Year 年份 l___l___l___l___l (or 或) Years ago 年前

888) Refuse to answer 拒绝回答 999) Do not know 不知道

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D6. High Cholesterol 高胆固醇

D6.1 Have you ever been told by a Western-trained doctor you have high cholesterol? 西医是否曾经告知您，您患有高胆固醇？

1) Yes 1) 是 2) No (Go to D7) 2) 否 (跳到 D7) 888) Refuse to answer (Go to D7) 888) 拒绝回答(跳到 D7) 999) Do not know (Go to D7) 999) 不知道(跳到 D7)

D6.2 When did the doctor first tell you had high cholesterol? 西医什么时候第一次告诉您，您患有高胆固醇？

Age 年龄

(or 或) Year 年份 l___l___l___l___l (or 或) Years ago 年前

888) Refuse to answer 拒绝回答 999) Do not know 不知道

D6.3 Is your doctor giving you medication for your high cholesterol currently? 您的医生目前是否有给您治疗高胆固醇的药物？

1) Yes 1) 是 2) No 2) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

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D7. Other Chronic Disease 其它慢性疾病

Kidney Disease 肾脏疾病

D7.1 Have you ever been told by a Western-trained doctor that you had weak or failing kidneys? (Do not include kidney stones, bladder infections or incontinence) 西医是否曾经告知您，您患有肾脏衰弱或衰竭？（不要包括肾结石、膀胱受感染或失禁)

1) Yes 1) 是 2) No (Go to D7.2) 2) 否 (跳到 D7.2) 888) Refuse to answer (Go to D7.2) 888) 拒绝回答(跳到 D7.2) 999) Do not know (Go to D7.2) 999) 不知道(跳到 D7.2)

[FOR RECRUITER’S USE]

D7.1.1 This participant is INELIGIBLE. Please confirm.

□ I have confirmed with the participant that he/she has ever had weak or failing kidneys. (End survey)

Lower Back Pain 腰痛

D7.2 In the past 1 month (30 days), have you had low back pain that lasted a whole day or more? 在过去的 1 个月内（30 天），您是否有腰痛长达一整天或更久？

1) Yes 1) 是 2) No (Go to D7.5) 2) 否 (跳到 D7.5) 888) Refuse to answer (Go to D7.5) 888) 拒绝回答(跳到 D7.5) 999) Do not know (Go to D7.5) 999) 不知道(跳到 D7.5)

D7.3 About how many days did you experience this pain in the past 1 month? 在过去的 1 个月，您大约几天有这种疼痛？

Days 天

888) Refuse to answer 拒绝回答 999) Do not know 不知道

D7.4 Were you limited in your usual activities because of low back pain? 您是否会因为腰痛而限制您平时的活动？

1) Yes 1) 是 2) No 2) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

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Asthma 哮喘病

D7.5 Have you ever been told by a Western-trained doctor that you have asthma? 西医是否曾经告诉过您，您患有哮喘病？

1) Yes 1) 是 2) No (Go to D7.11) 2) 否 (跳到 D7.11) 888) Refuse to answer (Go to D7.11) 888) 拒绝回答(跳到 D7.11) 999) Do not know (Go to D7.11) 999) 不知道(跳到 D7.11)

D7.6 How old were you when you were first told you had asthma? 您几岁时，第一次被诊断患有哮喘病？

Years old 岁

888) Refuse to answer 拒绝回答

999) Do not know 不知道

D7.7 Do you still have asthma? 您还有哮喘病吗？

1) Yes 1) 是 2) No (Go to D7.11) 2) 否 (跳到 D7.11) 888) Refuse to answer (Go to D7.11) 888) 拒绝回答(跳到 D7.11) 999) Do not know (Go to D7.11) 999) 不知道(跳到 D7.11)

D7.8 During the last 12 months, have you had an episode of asthma or an asthma attack? 在过去的 12 个月里，您的哮喘病是否有发作过？

1) Yes 1) 是 2) No (Go to D7.11) 2) 否(跳到 D7.11) 888) Refuse to answer (Go to D7.11) 888) 拒绝回答(跳到 D7.11) 999) Do not know (Go to D7.11) 999) 不知道(跳到 D7.11)

D7.9 Over the past 1 month, on average, how many times per week do you need to use your inhaler medication for quick relief of asthma symptoms? 在过去的 1 个月里，您每星期平均几次需要使用吸入性药物以尽快缓解哮喘病症状？

Times per Week 每星期次数 888) Refuse to answer 拒绝回答

999) Do not know 不知道

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D7.10 Are you taking a long term preventive medication for asthma every day? 您是否每天服用预防哮喘病的长期药物？

[Guide : Preventive medication is one taken daily for the purpose of preventing asthma attacks.]

1) Yes 1) 是 2) No 2) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

D7.11 Have you ever been told by a Western-trained doctor that you have the following chronic diseases: 西医是否曾经告知您，您有其它以下的慢性疾病:

If YES, at what Do Not Yes No 慢性疾病 age diagnosed Know Chronic Diseases 是 否 被诊断时的年龄 不知道

Arthritis (rheumatoid / osteoarthritis) D7.11.1 关节炎 (类风湿性/骨关节炎) 1 2 999

D7.11.2 Rheumatism 风湿 1 2 999

Hyper- / hypo-thyroidism D7.11.3 甲状腺功能亢进症/甲状腺功能减退症 1 2 999

D7.11.4 Gastritis 胃炎 1 2 999

D7.11.5 Chronic Bronchitis 慢性支气管炎 1 2 999

D7.11.6 Emphysema 肺气肿 1 2 999

D7.11.7 Gout 痛风 1 2 999

D7.11.8 Cataract 白内障 1 2 999 999 2 D7.11.9 Cancer 癌症 1 (Go to (Go to D7.11.10) D7.11.10)

[FOR RECRUITER’S USE] D7.11.9.1 □ I have confirmed with the participant that he/she has ever had cancer. [End survey]

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If YES, at what Do Not Yes No 慢性疾病 age diagnosed Know Chronic Diseases 是 否 被诊断时的年龄 不知道

D7.11.10 Chronic Kidney Disease 慢性肾脏病 1 2 999

D7.11.14 Liver disease e.g. hepatitis B or C, fatty liver, liver

cirrhosis, liver surgery [USE SHOWCARD] 999 1 2 肝病 (Go to (Go to D7.11.11) 例如 B/乙型肝炎或 C/丙型肝炎，脂肪肝， D7.11.11) 肝硬化，肝脏手术 [USE SHOWCARD]

D7.11.14.1 Please specify 请说明:

D7.11.11 Depression 忧郁症/抑郁症 1 2 999

2 999 D7.11.12 Other 其它 1 (Go to E1) (Go to E1)

D7.11.12.1 Please specify 请说明:

2 999 D7.11.13 Other 其它 1 (Go to E1) (Go to E1) D7.11.13.1 Please specify 请说明:

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SECTION E – FAMILY HISTORY OF HEART DISEASE & CANCER 心脏疾病及癌症家族史

HEART DISEASE 心脏疾病

E1 As far as you know, did your father and mother had heart disease ? 据您所知，您的父母是否患有心脏疾病？

888) Refused to answer 拒绝回答 (Go to 跳到 E2)

a) had heart disease? c) have heart disease before age of ……… ? 患有心脏疾病? 如果“是”心脏疾病是否发生在以下年龄之前? Family Members 55? 65? 家庭成员 Yes No NA DK 是 否 不适用 不知道 Yes No DK Yes No DK 是 否 不知道 是 否 不知道 E1.1 Father 父亲 1 2 777 999 1 2 999

E1.2 Mother 母亲 1 2 777 999 1 2 999

CANCER 癌症

E2 As far as you know, who in your family had cancer? If yes, what are the type(s) of cancer? 据您所知，您的父母是否患有癌症？如果有，是什么癌症？

888) Refused to answer (For Female: Go to Section F / For Male: Go to Section G) 拒绝回答 (女士: 跳到 F 部分 / 男士: 跳到 G 部分)

a) had cancer 患有癌症？ Family Members c) Type(s) of cancer 家庭成员 癌症种类 Yes No NA DK 是 否 不适用 不知道

E2.1 Father 父亲 1 2 777 999

E2.2 Mother 母亲 1 2 777 999

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SECTION F – WOMEN’S HEALTH 女性健康 (FOR MEN, GO TO SECTION G)

F1 Are you currently pregnant? 您现在是否怀孕？

1) Yes (Go to F7) 1) 是(跳到 F7) 2) No 2) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

F2 Have you stopped having your periods? 您的月经是否停止了？

1) Yes 1) 是 2) No (Go to F7) 2) 否(跳到 F7) 888) Refuse to answer (Go to F7) 888) 拒绝回答(跳到 F7) 999) Do not know (Go to F7) 999) 不知道(跳到 F7)

F3 Did your period stop naturally or because of a hysterectomy? 您是自然停经还是因为进行了子宫切除手术？

[Guide: A hysterectomy is an operation done to remove the uterus (womb)]

1) Naturally 1) 自然停经 2) Hysterectomy 2) 子宫切除手术 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

F4 At what age did your periods stop? 您的月经在几岁时停止？

Years Old 岁

888) Refuse to answer 拒绝回答

999) Do not know 不知道

F5 Did you take hormone replacement therapy after your periods stopped? 您停经后, 是否有接受荷尔蒙激素替代疗法？

1) Yes 1) 是 2) No (Go to F7) 2) 否(跳到 F7) 888) Refuse to answer (Go to F7) 888) 拒绝回答(跳到 F7) 999) Do not know (Go to F7) 999) 不知道(跳到 F7)

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F6 Are you still taking hormone replacement therapy? 您目前还在接受荷尔蒙激素替代疗法吗？

1) Yes 1) 是 2) No 2) 否 888) Refuse to answer 888) 拒绝回答 999) Do not know 999) 不知道

F7 Have you given birth to any children? 您有生过孩子吗？

1) Yes 1) 是 2) No (Go to Section G) 2) 否（跳到 G 部分） 888) Refuse to answer (Go to Section G) 888) 拒绝回答（跳到 G 部分） 999) Do not know (Go to Section G) 999) 不知道（跳到 G 部分）

F8 How many children have you given birth to? 您生过几位孩子？+

Children 孩子

888) Refuse to answer 拒绝回答

999) Do not know 不知道

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SECTION G – MEDICATION 药物治疗

G1 Are you currently taking any regular medication? 您目前是否定期服用药物？

Guide: “Regular medications” refer to the medication taken for long term, for health or for chronic conditions such as heart diseases, stroke, high blood pressure,

diabetes, high cholesterol, arthritis etc. This excludes regular health supplements (e.g. vitamins, fish oil).

1) Yes 1) 是 2) No (Go to Section H ) 2) 否 (跳到 H 部分) 888) Refuse to answer (Go to Section H) 888) 拒绝回答 (跳到 H 部分) 999) Do not know (Go to Section H) 999) 不知道 (跳到 H 部分)

G2 Please list all the medication and the dose that you are taking. 请列下您服用的所有药物名称以及份量。

888) Refuse to answer (Go to Section H) 888) 拒绝回答 (跳到 H 部分) 999) Do not know (Go to Section H) 999) 不知道 (跳到 H 部分)

According to latest prescription 根据最新的处方 How long have you been taking this type of medicine? Name of Medicine S/N Frequency of Dose 您服用这种药物有多久？ 药物的名称 剂量频率 Take when-ever needed No. of dose Per Day Per Week Per Month 在需要时服用 No. Year(s) Month(s) Week(s) Day(s) 剂量次数 每天 每周 每月 次数 年 月 周 天 1 1 2 3 4 1 2 3 4 2 1 2 3 4 1 2 3 4 3 1 2 3 4 1 2 3 4 4 1 2 3 4 1 2 3 4 5 1 2 3 4 1 2 3 4 6 1 2 3 4 1 2 3 4 7 1 2 3 4 1 2 3 4 8 1 2 3 4 1 2 3 4 9 1 2 3 4 1 2 3 4 10 1 2 3 4 1 2 3 4

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SECTION H – EQ-5D™ EuroQol Research Foundation

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SECTION I – K6+

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SECTION J – WHO (Five) Well-Being Index 世界卫生组织五项身心健康指标

Please choose the number for each of the five statements which represents the closest to how you have been feeling over the last two weeks. Notice that higher numbers mean better well-being. 请在下面五个语句中选出在过去两个星期里最能接近您的感觉状态的代表数字。请注意数字越高意味 着更好的身心越健康。

Over the last two weeks All of Most More than Less than Some At no 过去两个星期里 the of the half of the half of the of the time time time time time time 所有 大部分 超过一半的 少于一半 有时候 从未 时间 时间 时间 的时间 有过

1 I have felt cheerful and in good spirits 我感觉快乐、心情舒畅 6 5 4 3 2 1

2 I have felt calm and relaxed 我感觉宁静和放松 6 5 4 3 2 1

3 I have felt active and vigorous 我感觉充满活力、精力充沛 6 5 4 3 2 1

4 I woke up feeling fresh and rested 我睡醒时感到清新、得到了足够休息 6 5 4 3 2 1

5 My daily life has been filled with things that interest me 6 5 4 3 2 1 我每天的生活充满了有趣的事情

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

SECTION K – MMSE 40YO AND OLDER ONLY 40 岁或以上的参与者而已 PAR Inc

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

SECTION L – Barthel Index 巴氏指数 65YO AND OLDER ONLY 65 或以上的参与者而已 [SHOWCARD]

1 Bowels 大便控制 First, let me ask about your bowel movement. In the last 7 days, did you ever lost control Interviewers’ Guide and pass motion unexpectedly or do you have constipation so serious that need to inject fluid into your rectum to relieve constipation? In the preceding [IF YES] Did it happen more than once in the last 7 days? week:  If needs enema 首先，让我问您有关排便问题。在过去 7 天里，您是否有失控及意外排便或您有 from nurse, then 非常严重的便秘，以致需要注入液体到直肠内以缓解便秘？ 'incontinent.'  'Occasional' = once [如果是] 在过去的 7 天里，这是否发生超过一次？ a week.

1. Incontinent (or needs to be given enemata – injecting fluid into rectum to help relieve constipation) 无法自己控制（或者需要灌肠 ̶ 注入液体到直肠内以帮助缓解便秘） 2. Occasional accident (once/week) 偶尔出现失控意外（一周一次） 3. Continent 可以自我控制

2 Bladder 小便控制

Do you lose control of passing urine? [IF YES] Was it once a day in the last 7 days? [IF Interviewers’ Guide

NO], Are you on a catheter? [IF YES], Do you change the catheter yourself? In the preceding 您有失去排尿控制吗？ [如果是] 在过去的 7 天内里，这是否每天会发生一次？ week:  'Occasional' = less [如果否]，您是否使用导尿管？ [如果是]，您是自己更换导尿管吗？ than once a day.  A catheterized patient who can 1. Incontinent, or catheterized and unable to manage completely manage 无法自己控制，或者被插入导尿管，并且无法控制 the catheter alone is registered as 2. Occasional accident (max. once per 24 hours) 'continent.' 偶尔出现失控意外（二十四小时最多失控一次） 3. Continent (for over 7 days) 可以自我控制（超过七天）

3 Grooming 个人卫生 Do you need help with taking care of your personal hygiene such as putting on your false Interviewers’ Guide teeth, doing hair, shaving, washing face etc.? 您是否需要别人帮忙照顾您的个人卫生，如装戴假牙，梳洗头发，刮胡子，洗脸 In the preceding 24 - 48 hours: 等？  Refers to personal hygiene: doing teeth, fitting false 1. Needs help with personal care teeth, doing hair, 进行个人护理时需要帮助 shaving, washing face. Implements 2. Independent face/hair/teeth/shaving (implements provided) can be provided by 可以独自洗脸/梳理毛发/清理牙齿/剃须（在提供工具的情况下） helper.

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

4 Toilet use 上厕所

Do you need any help with using the toilet/commode such as: Interviewers’ Guide • Getting to the toilet (getting the commode)  Should be able to • Getting on/off the toilet seat (or commode) reach toilet • Undressing/dressing /commode, undress • Wiping sufficiently, clean [IF YES], Do you need some help or totally dependent on someone? self, dress, and leave. 您在使用厕所/便桶时，是否需要任何帮助,例如：  'With help' = can • 前往厕所（拿取便桶） wipe self and do some other of • 坐上/离开便座（或便桶） above. • 脱/穿衣裤  A commode is a toilet chamber. • 擦拭 [如果是]，您需要一些帮助或完全依赖于他人？

1. Dependent 依赖于他人 2. Needs some help, but can do something alone 需要一些帮助，但是可以独自做一些事情 3. Independent (on and off, dressing, wiping) 可以独自处理（坐上和离开，穿衣，擦拭）

5 Feeding 进食

When taking food, do you need someone to help you to cut your food or spread butter Interviewers’ Guide on bread for you or you can do these without help? [IF NEED HELP] Are you able to  Able to eat any feed yourself or need help with that? normal food (not 当您进食时，您是否需要他人帮您切您的食物或帮您在面包上涂奶油, 或者您不 only soft food). 需要任何帮助？ [如果需要帮助] 您是否能自己进食或者需要帮助？ Food cooked and served by others, but not cut up. 1. Unable  'Help' = food cut up, 无法自理 patient feeds self. 2. Needs help cutting, spreading butter, etc 需要帮助来切割食物、涂抹牛油等等 3. Independent (food provided within reach) 可以自理（在可以拿到的距离内被提供食物）

6 Transfer 移动能力

[IF PARTICIPANT HAS SITTING BALANCE] Do you need help from 1 or 2 people to Interviewers’ Guide physically move you to a chair? [IF NO] Do you need minor help from someone to guide  From bed to chair you verbally and physically, such as holding your arm to guide you to sit down? and back. [如果参与者能平稳坐着]您需要 1 或 2 人帮助把您移动到椅子上吗？ [如果否]  'Dependent' = NO sitting balance 您是否需要他人在口头或行动上给您一些帮助及指导，例如握着您的手臂指导您 (unable to sit); two 坐下？ people to lift.  'Major help' = one 1. Unable – no sitting balance strong/skilled, or two normal people. 无法自理 - 不能平稳坐着 Can sit up. 2. Major help (one or two people, physical), can sit  'Minor help' 需要很多帮助（1 或 2 人，行动上），可以坐着 = one person easily, OR needs any 3. Minor help (verbal or physical) supervision for safety 需要一些帮助（口头或行动上） 4. Independent 可以自理

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

Mobility 行走能力 7 Do you walk with the help of one person guiding you or verbally giving you instructions? Interviewers’ Guide [IF PARTICIPANT SAYS NO, I USE WHEELCHAIR] When using the wheelchair, are  Refers to mobility you able to turn corners or open doors without help? about house or 您是否需要在他人帮助指导或言语的指示下步行？ [如果参加者回答“否”，我 ward, indoors. May use aid. If in 使用轮椅] 当使用轮椅时，您可以在没有任何帮助下，自己转弯或开门吗？ wheelchair, must negotiate corners/ 1. Immobile doors unaided. 无法行动  'Help' = by one untrained person, 2. Wheelchair independent, including corners, etc. including supervision / moral 可独立乘坐轮椅活动，包括在角落位时等等 support. 3. Walks with help of one person (verbal or physical) 在一个人的帮助下行走（口头或行动上） 4. Independent (but may use any aid, e.g., stick) 可以自理（但需要使用任何其他的协助工具，比如：拐杖）

8 Dressing 穿脱衣服 When you are dressing, do you need help from someone to put on your clothes, do your Interviewers’ Guide buttons, zips or laces etc.? [IF YES] Are you able to put on some clothes by yourself?  Should be able to select and put on all 当您穿衣时，您需要别人帮您穿衣服、扣纽扣、拉拉链和系鞋带等吗？ clothes, which may [如果是] 您能自己穿上几件衣服吗？ be adapted.  'Half' = help with 1. Dependent buttons, zips, etc. (check!), but can put 依赖于他人 on some garments alone. 2. Needs help, but can do about half unaided 需要帮助，但是在毫无帮助的情况下可以做一半的事情 3. Independent (including buttons, zips, laces, etc.) 可以自理（包括扣纽扣、拉拉链和系鞋带等等）

9 Stairs 上下楼梯 When you climb up or down the stairs, do you need supervision or physical support from Interviewers’ Guide someone?  Must carry any 当您上下楼梯时，您需要别人监督您或给于您行动上的支持吗？ walking aid used to be independent.

1. Unable 无法自理 2. Needs help (verbal, physical, carrying aid) 需要帮助（口头、行动上和搬运协助） 3. Independent up and down 可以独自上下楼梯

10 Bathing 洗澡 When you bathe or take a shower, do you need help from someone to get in and out of Interviewers’ Guide your shower/bath and with your washing?  Usually the most 当您洗澡或淋浴时，您需要他人出入您的淋浴/浴缸帮助您洗涤吗？ difficult activity.  Must get in and out unsupervised, and 1. Dependent wash self. 依赖于他人  Independent in shower = 'independent' if 2. Independent (or in shower) unsupervised / 可以自理（或者淋浴） unaided.

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

SECTION M – IADL 工具性日常生活活动 65YO AND OLDER ONLY 65 或以上的参与者而已 [SHOWCARD]

1 Ability to Use Telephone 使用电话 Now I am going to ask you about your ability to use the telephone. Do you have a problem with dialing phone numbers to make a call? [IF YES] Can you dial at least a few numbers that you know? [IF NO], Are you able to answer calls? 现在我要问您, 关于您使用电话的能力。您拨打电话号码时有问题吗？ [如果是] 您能拨打几个您 记得的电话号码吗？ [如果否] 您可以接听电话吗？

1. Operates telephone on own initiative; looks up and dials numbers 能够自己主动操作电话，查阅并拨打号码 2. Dials a few well-known numbers 能够拨打几个熟悉的号码 3. Answers telephone, but does not dial 只会接听电话，但是不会拨打电话 4. Does not use telephone at all 完全不使用电话

2 Shopping 购物 Do you always need someone to help you when you shop, buy things, or can you shop without help for small purchases? 您是否经常需要他人在您购物或买东西时帮助您，或者您可独自完成少量的购物？

1. Takes care of all shopping needs independently 独自完成所有的购物需求 2. Shops independently for small purchases 独 自完成少量的购物 3. Needs to be accompanied on any shopping trip 每次购物时都需要有人陪 4. Completely unable to shop 完全不能上街购物

3 Food Preparation 烹调食物 Are you able to cook your own meals? [IF YES] Do you need someone to help bring you the ingredients to make a meal? [IF NO] Can you heat up food or serve food already cooked? 您能自己做饭吗？ [如果是] 您需要有人帮助您拿做饭的材料吗？ [如果否] 您能加热食物或盛已经煮熟的食物吗？

1. Plans, prepares, and serves adequate meals independently 独自计划、烹煮和供应一顿适当的饭菜 2. Prepares adequate meals if supplied with ingredients 如果准备好佐料,能做一顿适当的饭菜 3. Heats and serves prepared meals or prepares meals but does not maintain adequate diet 能将已做好的饭菜加热，或者能够烹煮但不能够维持适当的饮食习惯 4. Needs to have meals prepared and served 需要别人把饭菜煮好、盛好

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

4 Housekeeping 家务维持 Are you able to perform the housekeeping by yourself or you can only do light daily chores such as dishwashing, bed making? [IF participant can only do light daily tasks], ask, do you need some help to do cleaning properly? 您能够自己做家务，或者您只能做轻微的日常家务如洗碗、整理床铺？ [如果参与者只能做轻微的 日常家务]，请问，您需要一些帮助才能将清洁任务完成好吗？

1. Maintains house alone with occasion assistance (heavy work) 在偶尔的协助下，可以独自维持家务（重活） 2. Performs light daily tasks such as dishwashing, bed making 能做较简单的日常家务,例如洗碗和整理床铺 3. Performs light daily tasks, but cannot maintain acceptable level of cleanliness 能做简单的日常家务,但不能维持可以被接受的整洁程度 4. Needs help with all home maintenance tasks 所有的家务都需要別人協助 5. Does not participate in any housekeeping tasks 完全不做家务

5 Laundry 洗衣服 Are you able to do your own personal laundry completely or you are only able to wash small items, rinse socks etc, or you are not able to wash any laundry? 您是否可以自己清洗您所有的个人衣物，或您只能清洗小件衣物，例如洗短袜、长袜等等，或者您 完全不能够洗任何衣物？

1. Does personal laundry completely 自己清洗所有个人衣物 2. Launders small items, rinses socks, stockings, etc 只能清洗小件衣物，例如洗短袜、丝袜等等 3. All laundry must be done by others 完全依赖他人清洗衣物

6 Mode of Transportation 外出活动 If you take public transport to travel to another place, do you need help or someone to go with you? [IF YES], Do you need help when you take the taxi, MRT or bus? 如果您乘坐公共交通工具前往另一个地方，您会需要他人的帮助或跟着您一起去吗？ [如果“是”] 当您搭德士、地铁或公共巴士时，您需要帮忙吗？

1. Travels independently on public transportation or drives own car 能够独自乘搭公共交通工具或自己开车 2. Arranges own travel via taxi, but does not otherwise use public transportation 能够自己搭乘德士但不会乘搭公共交通工具 3. Travels on public transportation when assisted or accompanied by another 当有人陪同时，可搭德士或公共交通工具 4. Travel limited to taxi or automobile with assistance of another 限于在他人协助下，乘坐德士或汽车 5. Does not travel at all 完全不出门

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

7 Responsibility for Own Medications 自己负责服用药物 For your medication, do you remember to take it on time without help from someone to remind you? [IF NO] So you need someone to help you remember when to take your medicine, but are you able to prepare the correct dosages to take without help? 对于您的药物，在没人提醒您的情形下，您会记得准时吃药吗？ [如果不会] 那么您需要别人帮您记住吃药的时间，但是您能够自己准备正确的药物份量吗？

1. Is responsible for taking medication in correct dosages at correct time 能自己负责正确的时间，服用正确的药物 2. Takes responsibility if medication is prepared in advance in separate dosages 如果事先准备好服用的药物份量,可自己服药 3. Is not capable of dispensing own medication 不能自己服用药物

8 Ability to Handle Finances 处理财务能力 About handling finances or money, do you need someone to help you keep track of income or savings and day-to-day purchases? [IF NO] How about banking and keeping track of big purchases or bills, do you need help with that? 关于财务或金钱管理，您需要他人帮您记录收入或储蓄及日常的购买吗？ [如果否] 至于银行账目 往来及记录大型购买或账单，您需要帮助吗？

1. Manages financial matters independently (budgets, writes checks, pays rent and bills, goes to bank); collects and keeps track of income 可以独自处理财务（预算、填写支票、支付租金和账单、前往银行）；领取和记录收入 2. Manages day-to-day purchases, but needs help with banking, major purchases, etc 可以处理日常的购买，但需要别人协助与银行的往来或大型购买，等等 3. Incapable of handling money 无法理财

SECTION N – FALLS HISTORY 跌倒史 65YO AND OLDER ONLY 65 或以上的参与者而已

N1. How many times have you had a fall in the last 12 months? 在过去的 12 个月，您曾跌到多少次？

1) Zero 1) 零

2) 1 in the last 12 months 2) 过去 12 个月里 1 次

3) 2 or more in the last 12 months 3) 过去 12 个月里 2 次或更多

4) 1 or more requiring hospitalization 4) 1 次或更多并需住院

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SPHS-MEC3 & Diet Screener Form Language: English/Mandarin MAIN QUESTIONNAIRE

SECTION O – FRAIL 脆弱点 65YO AND OLDER ONLY 65 岁或以上的参与者而已

Refuse to Yes No Do Not Know Answer 是 否 不知道 拒绝回答 O1. Are you fatigued? 您是否感觉疲倦？ 1 2 888 999

O2. Are you unable to climb one flight of stairs? 您是否无法上下一层楼梯？ 1 2 888 999

O3. Are you unable to walk one block? 您是否无法行走一个街区的距离？ 1 2 888 999

O4. Do you have 5 or more illnesses? 您是否患有 5 种或以上的疾病？ 1 2 888 999

O5. Have you lost 5% (or more) of your weight in the last 6 months to 1 year? 您是否在过去半年到一年内体重减 1 2 888 999 轻了您原本的 5% (或更多)？

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SPHS Annex J F1A / F1B / F1C / F1D / MEC 3 Health Screening Form

Appt Time:

VISIT ID Date Registered:

Time Gender 2nd Ref. No. Registered:

[For females] Are you pregnant?  No  Yes; ask participant to reschedule When was the last time you had food or a drink (not plain water)? Date: _ _/_ _/_ _ _ _ Time: _ _ : _ _ AM / PM [For females] Are you still having menses currently?  No  Yes; do not collect urine Have you taken any painkillers / antibiotics in the last 7 days?  No  Yes; do not collect urine

Do you have these medical conditions? 1 High Cholesterol  No  Yes Staff initial 2 Hypertension  No  Yes 3 Diabetes  No  Yes 4 Kidney failure  No  Yes 5 Heart failure  No  Yes 6 Heart attack  No  Yes 7 Stroke  No  Yes 8 Cancer  No  Yes 9 Irregular heart beat  No  Yes 10 Congenital heart disease  No  Yes 11 Other heart diseases  No  Yes 12 Other medical conditions (please specify)  No  Yes ______

Height and Weight Refuse Unable OOR  NOT DONE Height (m) .   

Weight (kg) .    Staff initial

Waist and Hip  NOT DONE Refuse Unable Waist circumference (cm) .  

Hip circumference (cm) .   Staff initial

Blood Pressure  NOT DONE Refuse Unable    To retake BP before Refuse Unable discharge (Systolic/Diastolic) Systolic Diastolic Staff initial rd st st Take a 3 reading if  Dinamap 1 1   difference between 2 readings is >10mmHg nd systolic or >5mmHg  Digital 2 nd   2 diastolic  Manual 3 rd 3rd  

Visual Acuity [F1-A,F1-C,F1-D and MEC3 participants]  NOT DONE Refuse Unable Do you currently have any eye problems affecting your Right eye Left eye   eyesight? 1 Myopic (short sightedness)   2 Long sightedness   3 Astigmatism   4 Lazy eye   The HS report will be mailed to 5 Floaters   you in 4 weeks. Would you need 6 Dry eye syndrome   explanation on your report? 7 Cataract   8 Glaucoma   Yes 9 Blindness   10 Ptosis (drooping eyelids)   No 11 Other vision / eye problem  

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 Participant does not wear lens / glasses  Participant used lens / glasses for the test  Participant needed lens / glasses but forgot them and did the test without them

Snellen E 3m/10ft R L

Snellen E 3m/10ft with pinhole R L Staff initial

Spirometry exclusion criteria: [F1-A participants ≥35 and ≤80 years old] Yes No

(exclude if yes)

1 <35 or >80 years old  

--- Any heart attack / stroke, eye / abdominal / heart / major surgery done in the last 3 2   months? 3 Any aneurysm / embolism / spontaneous pneumothorax?   4 HIV / Hepatitis / TB   5 Pregnancy   6 Asthma / COPD exacerbation   7 Ear drum infection   8 Uncontrolled hypertension (BP ≥200/120mmHg)  

Not for data entry entry data for Not 9 CA lung  

--- 10 Inguinal hernia  

11 Physical inability to perform spirometry of acceptable quality   Spirometry 1. Not Selected 2.Selected Not done Refuse Unable Ineligible      

1. Do you have any known medical history of respiratory diseases / problems? Yes No Asthma   Childhood asthma   COPD   URTI (cough, runny nose, sore throat)   Sinuses problem   Other lung diseases   2. On doctor follow up for respiratory problem?  

Time of last puff (bronchodilator) for asthma or 3. COPD Date: ______Time: ______(DDMMYYYY) (24hr format)  Not applicable

 Yes Are all the 3 best spirograms  Unable to follow instructions/uncooperative  No, please specify: acceptable?  Refused to continue  Not feeling well

Staff initial

ECG Refuse Unable  Taken  NOT DONE   1) Known heart problems?  No  Yes ECG advice before discharge: 2) Has pacemaker?  No  Yes  No advice 3) Known dextrocardia?  No  Yes  Bring ECG on next F/U visit 4) Experiencing heart-related symptoms?  No  Yes  See Dr within 1 week 5) On doctor follow-up for heart  No  Yes  See Dr within 24hrs problem(s)? 6)  Uncertain diagnosis Uncertain diagnosis?  No  Yes Staff initial

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Foot Assessment [F1-A,F1-C,F1-D participants]  NOT DONE No. of sensory points felt Refuse Unable OOR Monofilament 5.07 R 5   sensory test L 5  

Neurothesiometer Apex 1st R    Reading (Mv) Med Mal. R   

Apex 1st L    Med Mal. L   

Arm used  Left  Right Is this the dominant arm?  Yes  No Refuse Unable OOR Brachial BP (mmHg) 1   (Systolic reading by Doppler) 2  

Ankle BP (mmHg) R1    (Systolic reading by Doppler) R2   

L1    L2    Staff initial

TUG [F1-A, F1-C, F1-D and MEC3 participants ≥40 years old]

Timed Up-and-Go Test:______sec [3-300s]  Refuse  Unable  NOT DONE Staff initial

Hand Grip Strength (kg)  NOT DONE

Refuse Unable Refuse Unable Left .   Right .  

.   .   Staff initial

.   .  

Blood taking  Random  Fasting Urine Micral test (mg/L)

 Taken  NOT DONE Research Refuse Unable  Plain tube (10ml)    Refuse  Unable  EDTA tube (9ml)  

Screening  Neg  50  Plain (5ml)    20  100  EDTA (3ml)    Fluoride (2ml)  

Staff initial

Staff initial

Page 3 of 4 v6, 28 Nov 2018

Fundus Photo [MEC3 participants] 1. Not Selected 2. Selected 3. Not done 4. Refuse 5. Unable 6. Ineligible      

Staff initial

[F1-B participants] Wellbeing survey  Completed  /Unable  Refuse Staff initial

[F1-C participants with previous accelerometer data and F1-B participants]

Community Environment survey  Not Selected  Unable Staff initial

 Completed  Refuse

Discharge

Discharge Time:  Oral health survey and examination

>65 years old [F1-D] Staff initial

Not for DATA Entry

Page 4 of 4 v6, 28 Nov 2018