









- | |
---|---|
1 - Yes and consulted doctor 2 - Yes but did not consult doctor 3 - No |
|
anxiety or 'nerves' | |
depression | |
headache or migraine | |
epilepsy | |
back pain, sciatica, slipped disc | |
indigestion | |
high blood pressure | |
cough or cold | |
diabetes | |
haemorrhoids/piles | |
schizophrenia | |
influenza | |
alcohol problem | |
wheezing or asthma | |
bronchitis | |
stomach ulcer | |
eczema | |
psoriasis | |
arthritis | |
rheumatism | |
urinary infection | |
problems with your periods | |
problems with a pregnancy | |
syphilis | |
gonorrhoea |

Check Have you included the contraceptive pill, iron tablets, laxatives, skin creams, vitamins, sleeping tablets, aspirin, cough mixture, pain killers, herbal medicine, slimming pills?
What did you take: | About how many days did you take or use it? | How often per day? | |
---|---|---|---|
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many | |
1 | |||
2 | |||
3 | |||
4 | |||
5 | |||
6 | |||
7 | |||
8 | |||
9 | |||
10 |


- | |
---|---|
1 - Almost all the time 2 - Sometimes 3 - Not at all |
|
backache | |
headache or migraine | |
urinary infection | |
nausea | |
vomiting | |
diarrhoea | |
haemorrhoids or piles | |
feeling weepy/tearful | |
feeling irritable | |
feeling exhausted | |
varicose veins | |
passing urine very often | |
problem holding urine when you jump, sneeze etc. | |
indigestion | |
feeling dizzy/fainting | |
flashing lights/spots before eyes | |
shoulder ache | |
tingling in hands/fingers | |
tingling in feet/toes | |
neck ache | |
feeling depressed |







- | |
---|---|
1 - Yes, and saw a doctor 2 - Yes, but did not see a doctor 3 - No, not at all 9 - Do not know |
|
headaches or migraine | |
indigestion | |
epilepsy | |
depression | |
anxiety or nerves | |
haemorrhoids/piles | |
cough or cold | |
influenza | |
bronchitis | |
high blood pressure (hypertension) | |
diabetes | |
schizophrenia | |
drink (alcohol) problem | |
stomach ulcer | |
asthma or wheezing | |
eczema | |
psoriasis | |
arthritis | |
urinary infection | |
rheumatism | |
back pain, sciatica or slipped disc | |
syphilis | |
gonorrhoea |
Below are listed a number of conditions which your husband/partner might have had. Please indicate whether he has had any of these since your study child's 10th birthday. other condition(s) (please tick and describe)
- | |
---|---|
1 - This is always how I feel 2 - This is sometimes how I feel 3 - I never feel this way |
|
He really loves this child | |
He is glad that I had this child when I did | |
I like to watch him play with the child | |
I am afraid to leave the child alone with him because I think he might be violent | |
He seems to feel very close to the child | |
This child gets on his nerves | |
He really cannot bear it when this child cries or whines | |
I think he is interested as he watches the child develop | |
He feels anxious when the child is staying with others | |
He doesn't mind the mess that surrounds children | |
This child makes him very happy |

Which of the following statements about alcohol best applies to your husband/partner:

- | |
---|---|
1 - Very true 2 - Moderately true 3 - Somewhat true 4 - Not at all true |
|
Is very considerate of me | |
Wants me to take his side in an argument | |
Wants to know exactly what I'm doing and where I am | |
Is a good companion | |
Is affectionate to me | |
Is clearly hurt if I don't accept his views | |
Tends to try to change me | |
Confides closely in me | |
Tends to criticise me over small issues | |
Understands my problems and worries | |
Tends to order me about | |
Insists I do exactly as I'm told | |
Is physically gentle and considerate | |
Makes me feel needed | |
Wants me to change in small ways | |
Is very loving to me | |
Seeks to dominate me | |
Is fun to be with | |
Wants to change me in big ways | |
Tends to control everything I do | |
Shows his appreciation of me | |
Is critical of me in private | |
Is gentle and kind to me | |
Speaks to me in a warm and friendly voice |

Medicine, pills, drops, ointment etc for: a-zd | Other condition (please tick & describe) | cs_qD1_a-zd_X | Generic text | cs_Yes | Generic text | cs_Ed_Md_S_Oot | cs_Ed_Md_S_Oot | Generic text | cs_Ed_Md_S_Oot | cs_Ed_Md_S_Oot | Generic text | cs_Yes | cs_Ed_Md_S_Oot | cs_Yes | cs_Ed_Md_S_Oot | Generic text | Generic text | Generic text | cs_Yes | Generic text | cs_Ed_Md_S_Oot | cs_Ed_Md_S_Oot | cs_Ed_Md_S_Oot | Generic text | cs_Yes | Generic text | cs_Ed_Md_S_Oot |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 - Yes |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Yes |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Yes |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Yes |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
1 - Yes |
1 - Every day 2 - Most days 3 - Sometimes 4 - Once or twice |
|||||||||||||
Headache or or migraine | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Headache or or migraine | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Headache or or migraine | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Headache or or migraine | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Headache or or migraine | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Headache or or migraine | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Headache or or migraine | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Headache or or migraine | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Headache or or migraine | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Headache or or migraine | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Headache or or migraine | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Headache or or migraine | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Headache or or migraine | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Headache or or migraine | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Headache or or migraine | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Backache | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Backache | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Backache | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Backache | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Backache | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Backache | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Backache | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Backache | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Backache | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Backache | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Backache | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Backache | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Backache | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Backache | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Backache | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Period pain | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Period pain | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Period pain | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Period pain | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Period pain | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Period pain | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Period pain | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Period pain | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Period pain | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Period pain | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Period pain | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Period pain | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Period pain | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Period pain | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Period pain | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other pain | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Other pain | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other pain | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other pain | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other pain | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other pain | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Other pain | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other pain | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other pain | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other pain | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other pain | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Other pain | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other pain | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other pain | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other pain | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Indigestion | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Indigestion | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Indigestion | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Indigestion | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Indigestion | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Indigestion | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Indigestion | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Indigestion | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Indigestion | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Indigestion | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Indigestion | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Indigestion | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Indigestion | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Indigestion | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Indigestion | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Nausea | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Nausea | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Nausea | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Nausea | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Nausea | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Nausea | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Nausea | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Nausea | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Nausea | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Nausea | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Nausea | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Nausea | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Nausea | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Nausea | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Nausea | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Vomiting | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Vomiting | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Vomiting | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Vomiting | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Vomiting | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Vomiting | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Vomiting | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Vomiting | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Vomiting | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Vomiting | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Vomiting | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Vomiting | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Vomiting | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Vomiting | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Vomiting | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Diarrhoea | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Diarrhoea | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Diarrhoea | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Diarrhoea | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Diarrhoea | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Diarrhoea | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Diarrhoea | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Diarrhoea | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Diarrhoea | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Diarrhoea | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Diarrhoea | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Diarrhoea | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Diarrhoea | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Diarrhoea | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Diarrhoea | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Piles or haemorrhoids | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Piles or haemorrhoids | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Piles or haemorrhoids | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Piles or haemorrhoids | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Piles or haemorrhoids | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Piles or haemorrhoids | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Piles or haemorrhoids | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Piles or haemorrhoids | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Piles or haemorrhoids | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Piles or haemorrhoids | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Piles or haemorrhoids | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Piles or haemorrhoids | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Piles or haemorrhoids | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Piles or haemorrhoids | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Piles or haemorrhoids | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Constipation | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Constipation | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Constipation | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Constipation | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Constipation | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Constipation | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Constipation | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Constipation | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Constipation | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Constipation | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Constipation | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Constipation | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Constipation | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Constipation | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Constipation | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Depression | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Depression | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Depression | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Depression | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Depression | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Depression | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Depression | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Depression | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Depression | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Depression | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Depression | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Depression | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Depression | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Depression | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Depression | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Anxiety or nerves | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Anxiety or nerves | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Anxiety or nerves | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Anxiety or nerves | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Anxiety or nerves | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Anxiety or nerves | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Anxiety or nerves | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Anxiety or nerves | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Anxiety or nerves | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Anxiety or nerves | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Anxiety or nerves | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Anxiety or nerves | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Anxiety or nerves | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Anxiety or nerves | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Anxiety or nerves | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Sleeping | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Sleeping | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Sleeping | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Sleeping | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Sleeping | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Sleeping | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Sleeping | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Sleeping | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Sleeping | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Sleeping | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Sleeping | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Sleeping | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Sleeping | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Sleeping | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Sleeping | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Psoriasis | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Psoriasis | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Psoriasis | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Psoriasis | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Psoriasis | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Psoriasis | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Psoriasis | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Psoriasis | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Psoriasis | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Psoriasis | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Psoriasis | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Psoriasis | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Psoriasis | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Psoriasis | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Psoriasis | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Eczema | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Eczema | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Eczema | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Eczema | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Eczema | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Eczema | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Eczema | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Eczema | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Eczema | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Eczema | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Eczema | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Eczema | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Eczema | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Eczema | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Eczema | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Asthma | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Asthma | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Asthma | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Asthma | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Asthma | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Asthma | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Asthma | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Asthma | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Asthma | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Asthma | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Asthma | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Asthma | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Asthma | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Asthma | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Asthma | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Hay fever | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Hay fever | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Hay fever | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Hay fever | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Hay fever | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Hay fever | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Hay fever | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Hay fever | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Hay fever | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Hay fever | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Hay fever | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Hay fever | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Hay fever | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Hay fever | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Hay fever | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other allergies | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Other allergies | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other allergies | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other allergies | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other allergies | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other allergies | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Other allergies | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other allergies | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other allergies | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other allergies | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other allergies | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Other allergies | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other allergies | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other allergies | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other allergies | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Sore throat | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Sore throat | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Sore throat | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Sore throat | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Sore throat | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Sore throat | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Sore throat | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Sore throat | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Sore throat | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Sore throat | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Sore throat | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Sore throat | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Sore throat | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Sore throat | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Sore throat | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Cough | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Cough | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Cough | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Cough | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Cough | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Cough | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Cough | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Cough | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Cough | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Cough | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Cough | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Cough | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Cough | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Cough | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Cough | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
A cold | 1 | Yes in past 12 months | |||||||||||||||||||||||||
A cold | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
A cold | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
A cold | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
A cold | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
A cold | 2 | Yes in past 12 months | |||||||||||||||||||||||||
A cold | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
A cold | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
A cold | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
A cold | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
A cold | 3 | Yes in past 12 months | |||||||||||||||||||||||||
A cold | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
A cold | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
A cold | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
A cold | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Flu | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Flu | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Flu | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Flu | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Flu | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Flu | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Flu | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Flu | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Flu | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Flu | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Flu | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Flu | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Flu | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Flu | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Flu | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other infection | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Other infection | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other infection | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other infection | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other infection | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other infection | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Other infection | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other infection | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other infection | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other infection | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Other infection | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Other infection | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Other infection | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Other infection | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Other infection | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Thrush | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Thrush | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Thrush | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Thrush | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Thrush | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Thrush | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Thrush | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Thrush | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Thrush | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Thrush | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Thrush | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Thrush | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Thrush | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Thrush | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Thrush | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Cystitis | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Cystitis | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Cystitis | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Cystitis | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Cystitis | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Cystitis | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Cystitis | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Cystitis | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Cystitis | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Cystitis | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Cystitis | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Cystitis | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Cystitis | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Cystitis | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Cystitis | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Diabetes | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Diabetes | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Diabetes | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Diabetes | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Diabetes | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Diabetes | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Diabetes | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Diabetes | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Diabetes | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Diabetes | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Diabetes | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Diabetes | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Diabetes | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Diabetes | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Diabetes | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Epilepsy | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Epilepsy | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Epilepsy | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Epilepsy | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Epilepsy | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Epilepsy | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Epilepsy | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Epilepsy | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Epilepsy | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Epilepsy | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Epilepsy | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Epilepsy | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Epilepsy | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Epilepsy | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Epilepsy | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
High blood pressure | 1 | Yes in past 12 months | |||||||||||||||||||||||||
High blood pressure | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
High blood pressure | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
High blood pressure | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
High blood pressure | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
High blood pressure | 2 | Yes in past 12 months | |||||||||||||||||||||||||
High blood pressure | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
High blood pressure | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
High blood pressure | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
High blood pressure | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
High blood pressure | 3 | Yes in past 12 months | |||||||||||||||||||||||||
High blood pressure | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
High blood pressure | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
High blood pressure | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
High blood pressure | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Oral contraceptive | 1 | Yes in past 12 months | |||||||||||||||||||||||||
Oral contraceptive | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Oral contraceptive | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Oral contraceptive | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Oral contraceptive | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Oral contraceptive | 2 | Yes in past 12 months | |||||||||||||||||||||||||
Oral contraceptive | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Oral contraceptive | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Oral contraceptive | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Oral contraceptive | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
Oral contraceptive | 3 | Yes in past 12 months | |||||||||||||||||||||||||
Oral contraceptive | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
Oral contraceptive | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
Oral contraceptive | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
Oral contraceptive | 3 | How often did you take/use this? 2 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 1 | Yes in past 12 months | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 1 | If yes, give name of substance 1 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 1 | How often did you take/use this? 1 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 1 | If yes, give name of substance 2 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 1 | How often did you take/use this? 2 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 2 | Yes in past 12 months | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 2 | If yes, give name of substance 1 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 2 | How often did you take/use this? 1 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 2 | If yes, give name of substance 2 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 2 | How often did you take/use this? 2 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 3 | Yes in past 12 months | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 3 | If yes, give name of substance 1 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 3 | How often did you take/use this? 1 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 3 | If yes, give name of substance 2 | |||||||||||||||||||||||||
HRT (hormone replacement therapy) | 3 | How often did you take/use this? 2 |

(Please say which vitamins and give brand name)
Vitamins | - | |
---|---|---|
1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text |
1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text |
|
1 | ||
2 | ||
3 |
(Please say which minerals e.g. iron, calcium, and give brand name)
Mineral supplements | - | |
---|---|---|
1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text |
1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text |
|
1 | ||
2 | ||
3 |
(Please say which, e.g. fish oils, Evening Primrose oil, and give brand name)
Oil supplements | - | |
---|---|---|
1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text |
1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text |
|
1 | ||
2 | ||
3 |
(Please say which, e.g. Ginseng, Royal Jelly, and give brand name)
Other supplements | - | |
---|---|---|
1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text |
1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text1 - Every day 2 - Most days 3 - About 1-2 times a week 4 - Less than once a week 5 - Not at all Generic text |
|
1 | ||
2 | ||
3 |










- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than 7 times a week |
|
Meat sausages and burgers | |
Vegetarian sausages, vegeburgers | |
Meat pies/pasties (pork pie, steak/meat pie etc.) | |
Vegetarian pies/pasties (cheese and onion pasty, vegetable samosa, onion bhaji, vegetable grills etc.) | |
Ham, bacon, paté and cold meats (e.g. salami, luncheon meat, garlic sausage etc.) | |
Meat roast, chops, stews and curries, shepherds pie, bolognaise etc. (beef, lamb pork mince) | |
Liver, kidney, heart | |
Chicken/turkey in crispy coating (chicken nuggets, turkey burgers, chicken fingers etc.) | |
Poultry: roast, grilled, fried boiled, stewed (chicken, turkey etc.) | |
Shellfish (prawns, crab, cockles, mussels etc.) | |
White fish in breadcrumbs or batter (fish fingers/shapes, chip shop fish, breaded cod, plaice or haddock etc.). | |
White fish without coating (grilled fish, cod in parsley sauce etc.) | |
Tuna | |
Other fish (pilchards, sardines, mackerel, herrings, kippers, trout, salmon etc.) | |
Eggs, quiche/flans, omelettes etc. | |
Cheese | |
Pizza | |
Oven chips or roast potatoes (cooked in fat or oil) | |
Fried chips, potato waffles and croquettes, Alphabites etc. | |
Boiled, mashed, jacket potatoes | |
Rice (boiled, or fried, not rice pudding) | |
Canned pasta (spaghetti rings, ravioli, macaroni cheese etc.) Pot Noodles, Super Noodles etc. | |
Boiled pasta (e.g. spaghetti fusilli, lasagne), bulgar wheat or cous-cous |
- | |
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1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than 7 times a week |
|
Baked beans | |
Peas, broad beans | |
Sweetcorn | |
Carrots | |
Other root vegetables (turnip, swede, parsnip etc.) | |
Tomatoes (cooked or raw) | |
Salads (lettuce, cucumber, peppers, other raw vegetables) | |
Pulses - and pulse dishes (dahl, lentil soup, falafel, dried peas, beans, chick peas etc.) | |
Soya 'Meat', TVP, Bean curd, (Tofu, Miso etc.), Quorn | |
Peanuts, peanut butter | |
Other nuts (e.g. cashews), nut roast etc. | |
Canned fruit | |
Yoghurt, Fromage Frais | |
Milk puddings (e.g. rice pudding, semolina), mousse Angel Delight etc. | |
Ice cream, choc ice, chocolate ice cream bar etc. | |
Pudding (e.g. fruit pie, crumble, cheesecake, gateaux) | |
Custard, cream, Elmlea, Tip-Top, evaporated milk etc. on puddings | |
Cakes or buns (fruit cake, sponge, teacake, doughnut, flapjack, scone, custard tart, cream cake etc.) | |
Crispbreads (Ryvita, crackerbread etc.) | |
Ketchup/brown sauce etc. | |
Mayonnaise, salad cream or dressing etc. |

- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than 7 times a week |
|
Oat cereals (e.g. porridge Ready Brek, muesli) | |
Wholegrain or bran cereals (e.g. All Bran, Bran Flakes, Weetabix, Wheatflakes, Fruit & Fibre, Shredded Wheat) | |
Sugar/honey coated cereals (e.g. Frosties, Honeynut Loops, Crunchynut cornflakes) | |
Other cereals (e.g. Cornflakes Rice Krispies, Special K) |
- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than 7 times a week |
|
Crisps, corn snacks (e.g. Wotsits, Quavers, tortilla chips etc.) | |
Full-coated chocolate biscuits (e.g. Club, Kit Kat, Penguin, Breakaway etc.) | |
Other biscuits (e.g. Rich tea, shortcakes, digestive and chocolate digestive, Hob Nobs) | |
Chocolate (dairy milk or plain nut, fruit, filled etc.) | |
Sweets (individual, packets or bars, peppermints, boiled sweets, toffees etc.) |
- | |
---|---|
1 - Never or rarely 2 - Once in 2 weeks 3 - 1-3 times a week 4 - 4-7 times a week 5 - More than 7 times a week |
|
Pure fruit juice from a carton or freshly squeezed including tomato juice | |
Squash, fruit drinks | |
Cola drinks (e.g. Coca Cola, Pepsi etc.) | |
Other fizzy drinks (e.g. lemonade, fizzy water) | |
Bottled still water | |
Water from tap | |
Milk on its own | |
Flavoured milk drinks (e.g. Horlicks, cocoa, drinking chocolate, Ovaltine, milkshakes) or yoghurt drinks |
On bread or vegetables | For frying | |
---|---|---|
1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No |
1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No 1 - Yes 2 - No |
|
Butter, ghee, dripping, lard, solid cooking fat | ||
Full-fat polyunsaturated margarine (e.g. Flora, Vitalite, sunflower margarine) | ||
Other full-fat margarine (e.g. Blue Band, Stork, Clover, Golden Crown,Willow, supermarket own brand) | ||
Low-fat polyunsaturated margarine (e.g. Flora Lite, Vitalite Lite, low-fat Sunflower margarine) | ||
Other low-fat spread not polyunsaturated (e.g. Delight, St Ivel Gold) | ||
Sunflower oil, corn oil, soya oil | ||
Olive oil, hazelnut oil, rapeseed oil | ||
Other vegetable oil | ||
Other (please tick & describe) |