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The Fit for Delivery team 001. Participant number breast milk, with the regular milk in addition (please write clearly): possible exception of to or instead of breast vitamins)? milk? I never breastfed never/less than ______exclusively once a week ______ 1-3 times/week 002. What is your date of weeks birth? 4-6 times/week ______ once a day ______months twice a day _ 3 times/day 007. How long have you 4 times/day 003. How many months breastfed the baby 5 times/day or have gone since your (either exclusively or in more delivery? addition to formula, porridge, etc.)? ______010. How often does months I never breastfed your child usually drink ______water in addition to or weeks instead of breast milk? 004. What is your primary never/less than activity? ______once a week Working outside months 1-3 times/week the home 4-6 times/week Student once a day Unemployed twice a day Prolonged sick We would like to ask you a leave/disabled little about what your 3 times/day Homemaker child drinks in addition to 4 times/day Maternity leave or instead of breast milk. 5 times/day or more Part-time employment 008. How often does combined with part- your child usually drink time maternity leave formula in addition to or instead of breast milk? 005. Are you currently never/less than 011. How often does your breastfeeding? once a week child usually drink soft No 1-3 times/week drinks/soda in addition to Yes, exclusively 4-6 times/week or instead of breast milk? breastfeeding once a day never/less than Yes, breastfeeding twice a day once a week in addition to other 3 times/day 1-3 times/week food 4 times/day 4-6 times/week 5 times/day or once a day 006. How long did you more twice a day breastfeed EXCLUSIVELY 3 times/day (the baby did not get 4 times/day anything other than 009. How often does your child usually drink 5 times/day or ______more _ 014. Do you smoke? Never smoked ______012. How often does Smoked before I _ your child usually drink became pregnant, fruit juice/nectar in but have stopped addition to or instead of completely breast milk? Smoke 1-4 cigs / 019. Do you use any vitamins or supplements never/less than day daily? once a week Smoke 5-9 cigs / 1-3 times/week day No 4-6 times/week Smoke 10-20 cigs / Yes once a day day twice a day Smoke > 20 cigs / 020. If yes, which (name 3 times/day day of supplement- iron, 4 times/day folate, etc.)? 5 times/day or ______more 015. Do you use snuff? _ Have never used snuff ______ Used snuff _ 013. Does your occasionally before I child receive Vitamin became pregnant, D (for example, D but have stopped vitamin drops or cod completely liver oil/tran) or Used snuff 021. Have you ever used other dietary regularly before I any form of supplements? became pregnant, drugs/narcotics? but have stopped Yes completely Never tried No, but the child Use snuff Used drugs has received Vitamin occasionally regularly before I D/dietary became pregnant, supplements earlier Use snuff daily, about but have stopped No, the child has completely never received 016. _____ doses per Have tried drugs in Vitamin D/dietary day the past, but have supplements stopped completely Use drugs 017. Do you use any occasionally medication daily? Use drugs on a weekly basis No Yes 022. If yes, which? (name of drug/ narcotic): 018. If yes, which? (Name ______of medication): _ Yes No Physical ______activity _ 026. If yes, how long have We active activit you had sick leave? would you ies (choose the answer that now believ you 023. How would you fits best): like to e have describe your own health? ask yourse perfor 1-2 weeks, partial (choose one): you lf to med sick leave about be. over (1) Very good 1-2 weeks, the Think the complete sick leave Good physic of last 7 2-3 weeks, partial al activit days. Neither good nor sick leave activit ies Vigoro bad 2-3 weeks, ies you do us Poor complete sick leave you at physic Very poor 3-4 weeks, partial do. work, al sick leave We as activit 024. To what extent does 3-4 weeks, are part ies your health limit your intere of refer complete sick leave activities of daily life? sted your to (choose one): 4+ weeks, partial in house activit sick leave To a large extent inform and ies 4+ weeks, ation yard that
To some extent complete sick leave about work, take Very little differ to get hard Not at all ent from physic kinds place al of to effort physic place, and al and in make activit your you y that spare breath are time e part (for much of recrea harder wome tion, than n’s exerci norma daily se or l. lives. sport) Includ Please . e only answe those r all Think activit questi of all ies 025. If you are employed ons, vigoro that outside the home, have regard us last you had more than 1 week less of physic for at of sick leave during the how al least past month ? 10 ti over 029. minut vi 0 4 7 9 1 the During es at a ti . . . . 1 last 7 the last time. e D 4 1 1 . days. 7 days, s: o 0 h h 1 Moder on how 027. G n m o o h ate many During o ’t i u u o physic days the last t k n r r u al did you 7 days, o n u a a r activit do on how q o t n n a ies are modera many u w e d d n activit te days e s 1 3 d ies physica did you s 1 0 0 5 that l do t . 5 m m 0 take activiti vigorou i 1 . i i m moder es like s o 0 5 n n i ate carryin physica n m 0 u u n physic g light l 2 i m t t u al loads, activiti 9 n i e e t effort bicyclin es like . u n s s e and g at a heavy t u s make regular lifting, e t 8 1 you pace, digging, s e . 0 1 breath or light aerobic 028. s 1 . 2 e jogging? How some Do not s or fast 2 h 1 . much what include biking? . 6 o h 2 time harder walking 2 . u o h did you than . _ 0 1 r u o usually norma ____ m h a r u spend l. _ days i o n a r on one Includ ____ n u d n s of e only days u r 2 d o those those N t 0 4 r days activit o e m 0 m doing ies vi s i m o N that g vigorou n i r o last o s u n e m 3 for at r physica t u o . least o l e t d 3 10 u activiti s e Think e 0 minut s es? s of all r m es at a p moder a i time. t h n ate y physic e u p si t al c activit h e y a s ies l you si a have c c done a l time walk for a 0 4 7 9 1 you at least 1 c . . . . 1 have 10 . ti D 4 1 1 . spent minutes 1 vi o 0 h h 1 walkin at a 0 ti n m o o h g time? m e ’ i u u o during _____ i s: t n r r u the days n G k u a a r last 7 u o n t n n a days. t t o e d d n This Didn’t e o w s 1 3 d includ walk: s q 0 0 5 es Go to u 1 5 m m 0 walkin questio 2 e . . i i m g at n 33. . s 1 5 n n i work 2 t 0 0 u u n and at 0 i m m t t u home, m o i i e e t walkin i n n n s s e g to 032. n 3 u u s travel How u 1 t t 8 1 from much t . e e . 0 1 place time in e s s 1 . 2 to total s h 1 . place, did you 2 6 o h 2 and usually 3 . . u o h any spend . 2 1 r u o other walking 3 0 h a r u walkin on one 0 m o n a r g that of 030. m i u d n s you those How i n r 2 d o did days? much n u 0 4 r solely time u t m 0 m for 0 did you t e i m o recrea . usually e s n i r tion, D spend s u n e sport, o on one exerci 3 t u n 4 of se or . e t ’ . those leisure 3 s e t 4 days s . k doing 0 0 m n m modera 031. o te i i n During w n physica the last l u u t 7 days, t activiti on how es? e e s Think many s about days did the you at or 5 8 1 1 work, lying . . 0 2 at down 5 1 . . home, to 0 h 1 2 while watch m o h h doing televis i u o o course ion. n r u u work u a r r and t n a s during 033. e d n o leisur During s 2 d r e the last 0 4 m time. 7 days, 6 m 0 o This how . i m r includ much 1 n i e es time in h u n time total o t u The spent did you u e t next sitting usually r s e questi at a spend s on is desk, sitting 7 9 about visitin on a . . 1 the g week 1 1 1 time friend day? h h . you s, o o 1 spent readin A u u h sitting g, nswer: r r o on traveli ______a a u weekd ng on hours n n r ays a bus d d a while or 1 3 n sitting 0 0 d m m 5 i i 0 n n m u u i t t n e e u s s t e s How do you usually get to work/school?
(044): Walk Bike Public transportation (bus, train, etc.) Car Motorcycle, scooter or moped Not applicable (not working, going to school)
Below you will find a list of reasons for NOT doing physical activities. Please mark one or more boxes for the reason(s) that are most important for you:
(065) Don’t have the time (066) Can’t afford it (067) Transportation problems (068) Negative experiences (069) Problems with mobility (070) Don’t think I can do it (071) Don’t have the energy (072) Afraid to get hurt (to fall, get a sprain) (073) Would rather use my time on other things (074) Because of my physical health (075) Don’t have anyone to do physical activities with me (076) Schedules don’t fit for me (077) Don’t know of anything available to me (078) Afraid to go out (079) Nothing available in my area of interest (081) Fear of urinary incontinence (083) Pelvic pain (085) Other reasons
If you have other reasons, please explain:
085. ______
What do you usually eat?
When you answer these dinner? 5 times a week questions, think about what 6 times a week you usually eat. Consider Never Every day what you eat at home, at Less than once a Several times work, and in your spare time. week each day Mark the box that you feel Once a week best fits for you. Twice a week 3 times a week 4 times a week (097). How often do you 087. How often do you eat 5 times a week drink whole milk? breakfast? 6 times a week Never Every day Less than once a Never week Less than once a Once a week week Twice a week Once a week (093). How often do you eat a 3 times a week Twice a week late supper (kveldsmat)? 4 times a week 3 times a week 5 times a week 4 times a week Never 6 times a week 5 times a week Less than once a Every day 6 times a week week Several times Every day Once a week each day Twice a week 3 times a week (089). How often do you eat 4 times a week (099). How often do you lunch? 5 times a week drink low-fat milk? 6 times a week Never Never Every day Less than once a Less than once a week week Once a week Once a week (095). How often do you eat Twice a week Twice a week snacks? 3 times a week 3 times a week 4 times a week 4 times a week Never 5 times a week 5 times a week Less than once a 6 times a week 6 times a week week Every day Every day Once a week Several times Twice a week each day 3 times a week (091). How often do you eat 4 times a week (101). How often do you drink skimmed milk? Several times Twice a week Never each day 3 times a week Less than once a 4 times a week week 5 times a week Once a week 6 times a week Twice a week (107). How often do you Every day 3 times a week drink soda/soft drinks – with Several times 4 times a week sugar? each day 5 times a week Never 6 times a week (113). How often do you Less than once a Every day drink tap water? week Several times Never Once a week each day Twice a week Less than once a 3 times a week week 4 times a week Once a week 5 times a week Twice a week 6 times a week 3 times a week Every day 4 times a week 5 times a week Several times (103). How often do you 6 times a week each day drink juice? Every day Several times Never (109). How often do you each day Less than once a drink soda/soft drinks— week without sugar? Once a week Twice a week Never (115). How often do you 3 times a week Less than once a drink bottled water (without 4 times a week week carbonation or flavor added)? 5 times a week Once a week 6 times a week Twice a week Never Every day 3 times a week Less than once a Several times 4 times a week week each day 5 times a week Once a week 6 times a week Twice a week Every day 3 times a week Several times 4 times a week (105). How often do you each day 5 times a week drink fruit nectar? 6 times a week Never Every day Less than once a Several times week each day Once a week (111). How often do you Twice a week drink beverages that contain 3 times a week alcohol? (117). How often do you 4 times a week drink bottled water with 5 times a week Never carbonation or flavor added? 6 times a week Less than once a Every day week Never Once a week Less than once a Several times week each day Never Once a week Less than once a Twice a week week 3 times a week (123). How often do you eat Once a week 4 times a week vegetables at dinner? Twice a week 5 times a week 3 times a week 6 times a week Never 4 times a week Every day 5 times a week Less than once a Several times 6 times a week week each day Every day Once a week Twice a week Several times 3 times a week each day 4 times a week 5 times a week 6 times a week (129). How often do you eat Every day apples, oranges, pears or bananas?
(119). How often do you (125). How often do you eat Never drink coffee? vegetables on your sandwich? Less than once a week Never Never Once a week Less than once a Less than once a Twice a week week week 3 times a week Once a week Once a week 4 times a week Twice a week Twice a week 5 times a week 3 times a week 3 times a week 6 times a week 4 times a week 4 times a week Every day 5 times a week 5 times a week Several times 6 times a week 6 times a week each day Every day Every day Several times Several times each day each day (131). How often do you eat other fruits or berries (fruits or berries other than apples, (121). How often do you eat oranges, pears or bananas)? potatoes? Never Never Less than once a Less than once a week week Once a week Once a week Twice a week Twice a week 3 times a week 3 times a week 4 times a week 4 times a week (127). How often do you eat 5 times a week 5 times a week other vegetables (for 6 times a week 6 times a week example, carrots at Every day Every day lunchtime)? Several times 3 times a week Never each day 4 times a week Less than once a 5 times a week week 6 times a week (133). How often do you eat Once a week Every day fruits or vegetables as snacks? Twice a week Several times 3 times a week each day Never 4 times a week 5 times a week Less than once a 6 times a week week Every day Once a week Twice a week (139). How often do you eat Several times 3 times a week cake, muffins, etc.? each day 4 times a week Never 5 times a week (145). How often do you eat 6 times a week Less than once a plain yogurt (yogurt without Every day week added sugar)? Several times Once a week Twice a week each day Never 3 times a week Less than once a 4 times a week week 5 times a week Once a week 6 times a week Twice a week Every day (135). How often do you eat 3 times a week Several times cookies or crackers? 4 times a week each day 5 times a week Never 6 times a week Less than once a Every day week (141). How often do you eat Several times Once a week cereal without added sugar? each day Twice a week 3 times a week Never 4 times a week Less than once a 5 times a week week (147). How often do you eat 6 times a week Once a week yogurt with added sugar? Every day Twice a week Several times 3 times a week Never each day 4 times a week Less than once a 5 times a week week 6 times a week Once a week Every day Twice a week 3 times a week (137). How often do you eat Several times 4 times a week sweet buns (sweet rolls, each day 5 times a week “boller”, etc)? 6 times a week Every day Never Several times Less than once a each day week (143). How often do you eat Once a week cereal containing sugar? Twice a week (149). How often do you eat 3 times a week (159). How often do you add instant noodles (for example, 4 times a week sugar to the food you eat? Mr. Lee)? 5 times a week 6 times a week Never Never Every day Less than once a Less than once a Several times week week each day Once a week Once a week Twice a week Twice a week 3 times a week 3 times a week (155). How often do you eat 4 times a week 4 times a week hot dogs/ sausages from a gas 5 times a week 5 times a week station or kiosk? 6 times a week 6 times a week Every day Every day Never Several times Several times Less than once a each day each day week Once a week (161). How often do you add Twice a week salt to the food you eat? 3 times a week 4 times a week Never 5 times a week Less than once a 6 times a week week Every day Once a week (151). How often do you eat Several times Twice a week potato chips/other salty each day 3 times a week snacks? 4 times a week 5 times a week Never (157). How often do you eat 6 times a week french fries from a fast-food Less than once a Every day week chain? Several times Once a week each day Twice a week Never 3 times a week Less than once a 4 times a week week 5 times a week Once a week (163). How often do you eat 6 times a week Twice a week industrially processed food Every day 3 times a week for dinner? (freeze-dried Several times 4 times a week instant food, or pre-cooked each day 5 times a week meals) 6 times a week Every day Never Several times Less than once a (153). How often do you eat each day week chocolate/ other sweets? Once a week Twice a week Never 3 times a week Less than once a 4 times a week week 5 times a week Once a week 6 times a week Twice a week Every day groceries, how often do you check the ingredient list? (165). How often do you eat (167). How often do you eat so much that you are more candy, salty snacks or other Never than full (feel that you have unhealthy food even if you Once in a while eaten too much)? don’t think it tastes very Usually good? Always Never Less than once a Never week Less than once a Once a week week Twice a week Once a week Which size do you usually 3 times a week Twice a week choose when you buy: 4 times a week 3 times a week 5 times a week 4 times a week 6 times a week 5 times a week Every day 6 times a week Large Small Several times Every day (171) Potato chips 350g each day Several times 150g each day (173) chocolate ≥80g <80g (175) Soda 1,5l 0,5l (169). When you buy In this last section, we would like you to mark what you ate and drank yesterday: Yes No 176. Breakfast 188. Beverages containing alcohol 177. Lunch 178. Dinner 189. Tap water 179. Late supper 190. Bottled water, plain 180. Snack 191. Bottled water with carbonation 181. Whole milk or added flavor 182. Low-fat milk 192. Potatoes 183. Skimmed milk 193. Vegetables at dinner 184. Juice 194. Vegetables on a sandwich 185. Fruit nectar 186. Soda/punch with sugar 195. Other vegetables (for example, carrots at lunch) 187. Soda/punch without sugar 196. Apple, orange, 211. Did you add SALT to your pear or banana food yesterday? 197. Other fruits or berries (other than apple, orange, pear or banana) 198. Sweet buns (sweet rolls, Did you buy the following “boller”, etc) yesterday? (Make a mark for each food item) 199. Cake, muffins, etc. Yes No (212) Potato chips 200. Cereal without added sugar (213) Chocolate (214) Soda 201. Cereal containing sugar If you answered “yes”, which size did you buy? 202. Plain yogurt/yogurt without added sugar Large Small (215) Potato chips 203. Yogurt with added sugar (216) Chocolate 204. Instant noodles (217) Soda (for example, Mr. Lee) (218) Which day of the week was it 205. Potato chips/other salty snacks yesterday? 206. Chocolate/other sweets Monday 207. Hot dog from kiosk/gas Tuesday station Wednesday 208. French fries from fast-food chain Thursday Friday Saturday 209. Industrially processed food, liked Sunday freeze-dried or pre-cooked food? (219) Was yesterday a completely normal weekday? 210. Did you add SUGAR to your food yesterday? Yes No