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Table 6 Penn Healthy Diet Survey- Goals (PHD-G)

From: Development of the Penn Healthy Diet screener with reference to adult dietary intake data from the National Health and Nutrition Examination Survey

FOODS YOU DRANK OR ATE YESTERDAY

Circle the TIMES YESTERDAY

BEVERAGES

0

1

2

3

4

5 or more

 Water

 Coffee or tea

  Did you add sugar, honey, or flavored creamers to your coffee or tea?

Yes

No

 

  Did you add artificial sweeteners to your coffee or tea?

Yes

No

 

  Did you add half and half or whipped cream to your coffee or tea?

Yes

No

 

 Sugar-sweetened drinks such as soda, iced tea, sports drinks, fruit drink or fruit punch

 Diet soda or artificially-sweetened tea or beverages

 Milk

  Did you use regular or full fat milk or yogurt?

Yes

No

Don’t know

FRUITS AND VEGETABLES

0

1

2

3

4

5 or more

 Fruit juice such as orange or apple juice with no added sugar

 Fruit such as apples, bananas, oranges, tangerines, or berries (not juice)

 Green or leafy vegetables such as spinach, kale, broccoli, cabbage, or salad

 Red or orange vegetables such as carrots, tomatoes, peppers, or squash

BREAD AND GRAINS

0

1

2

3

4

5 or more

 Whole grain bread

 Cooked whole grains such as oats, quinoa, brown rice, or whole wheat pasta

 White bread or rolls, wraps, taco shells, tortillas, burritos, or boxed cereal

 Cooked white rice, dumplings, pasta, noodles, grits, baked or boiled potatoes or sweet potatoes but not French fries

  Did you add butter or gravy to bread, rolls, biscuits, or potatoes?

Yes

No

 

FOODS YOU ATE OR DRANK LAST WEEK

Circle the TIMES LAST WEEK

BEVERAGES

0

1

2

3

4

5 or more

 Beer, wine, spirits, or wine cooler

DAIRY

0

1

2

3

4

5 or more

 Yogurt

 Cheese

PROTEIN FOODS

0

1

2

3

4

5 or more

 Eggs

 Poultry or chicken that is not fried

 Fish or seafood such as shrimp or clams that is not fried

 Plant proteins such as beans, peas, lentils, chickpeas, hummus, or tofu

 Red meat or pork

 Cold cuts, lunchmeats, hot dogs, or kielbasa

 Bacon, sausage, or pork roll

 Fried foods such as fried chicken, shrimp, fish, eggrolls, rice, or French fries

 Fast food meals; Asian takeout; burgers; wings; nachos; or pizza meals

  Did you add salt to your food at the table?

yes

no

 

  Did you add olive oil or vegetable oil (not coconut oil) to foods or use it in cooking?

yes

No

Don’t know

SNACKS

0

1

2

3

4

5 or more

 Nuts, seeds, or nut butter

 Desserts such as cake, pie, or ice cream

 Snacks such as cookies, brownies, donuts, or candy

 Salty snacks such as potato, corn, or nacho chips, pretzels, crackers, or popcorn