Diet and Exercise Amongst 1st Year residents

How old are you?

Are you male or female?

Male

Female

During the past month, how often did you eat hot or cold cereals? (Mark one answer only)

During the past month, what kind of cereal did you usually eat?

If there was another kind of cereal that you usually ate during the past month, what kind was it? (If none, leave blank)

During the past month, how often did you have any milk (either to drink or on cereal?) Include regular milks, chocolate or other flavored milks, lactose-free milk, buttermilk. Please do not include soy milk or small amounts of milk in coffee or tea.

During the past month, what kind of milk did you usually drink?

Whole or regular milk

2% fat or reduced-fat milk

1%, 1/2%, or low-fat milk

Fat-free, skim or non-fat milk

Soy milk

Other (please specify)

Other

During the past month, how often did you drink regular soda or pop that contains sugar? Do not include diet soda.

During the past month, how often did you drink 100% pure fruit juices such as orange, mango, apple, grape and pineapple juices? Do not include fruit-flavored drinks with added sugar or fruit juice made at home anda dded sugar to.

During the past month, how often did you drink coffee or tea that had sugar or honey added to it? Include coffee and tea you sweetened yourself and pre-sweetened tea and coffee drinks such as Arizona Iced Tea and Frappuccino. Do not include artificially sweetened coffee or diet tea.