Canway Youth focuses on positive youth development and is conducting an anonymous survey to explore the relationship between dietary fiber intake and mood, including anxiety and depression. You can learn more about Canway Youth at canwayyouth.org.

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* 1. Your age in years

Fiber intake questions

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* 2. On average, over the PAST YEAR, how many servings of FRUIT have you consumed?
The following are examples of 1 SERVING OF FRUIT 1 medium piece of fruit- i.e. apple, banana, orange, tomato or pear OR 2 small pieces of fruit- i.e. apricot, kiwifruit or plum OR 1/2 cup fresh, frozen, canned or stewed fruit- i.e. berries or canned peaches OR 1 small handful of dried fruit- i.e. raisins.

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* 3. On average, over the PAST YEAR, how many servings of VEGETABLES have you consumed?
The following are examples of 1 SERVING OF VEGETABLES 1 medium potato, sweet potato, yam, taro or carrot OR 1/2 cup of cooked broccoli, green peas, corn, pumpkin of spinach OR 1 cup of salad

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* 4. On average, over the PAST YEAR, how many servings of BREADS AND CEREALS have you consumed?
The following are examples of 1 SERVING OF BREADS AND CEREALS Wholegrain/wholemeal- 1 slice of bread, 1 small roll or 1 wrap OR White- 2 slices of bread, 2 small rolls or 2 wraps OR Rice/pasta- 1/2 cup of cooked brown rice or wholegrain pasta or 1 cup of cooked white rice or white pasta OR Cereals- 1/2 cup cooked porridge or muesli, 1/3 cup all bran/raisin bran or 2 Weetabix biscuits

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* 5. On average, over the PAST YEAR, how many servings of NUTS AND SEEDS have you consumed?
The following are examples of 1 SERVING OF NUTS AND SEEDS 2 tablespoons of peanut butter OR 1/3 cup (or a small handful) of nuts and seeds (e.g. cashew nuts, almonds, pistachio nuts, brazil nuts, macadamia nuts, hazel nuts, chia seeds, sunflower seeds, pumpkin seeds, sesame seeds)

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* 6. On average, over the PAST YEAR, how many servings of LEGUMES (e.g. BEANS, PEAS, and LENTILS) have you consumed?
The following are examples of 1 SERVING OF LEGUMES (e.g. BEANS, PEAS, and LENTILS) 3/4 cup of tofu OR 3/4 cup cup legumes (e.g. kidney beans, chickpeas, green/brown/red lentils, hummus, baked beans, split peas, canned bean mix, broad beans, white/black beans)

Mood and mental state questions

Please complete BOTH the confidential anxiety and depressive feelings questions (~ 2 minutes each set) presented below.  Note that we do not track your identity and your results are anonymous:

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* 7. Anxiety related questions:  Over the last 2 weeks, how often have you been bothered by the following problems?

  Not at all Several days More than half the days Nearly every day
Feeling nervous, anxious, or on edge:
Not being able to stop or control worrying:
Worrying too much about different things:
Trouble relaxing:
Being so restless that it is hard to sit still:
Becoming easily annoyed or irritable:
Feeling afraid, as if something awful might happen:

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* 8. Depression related questions:  Over the last 2 weeks, how often have you been bothered by the following problems?

  Not at all Several days More than half the days Nearly every day
Little interest or pleasure in doing things:
Feeling down, depressed, or hopeless:
Trouble falling or staying asleep, or sleeping too much:
Feeling tired or having little energy:
Poor appetite or overeating:
Feeling bad about yourself - or that you are a failure or have let yourself or your family down:
Trouble concentrating on things, such as reading the newspaper or watching television:
Moving or speaking so slowly that other people could have noticed:
Thoughts that you would be better off dead, or of hurting yourself

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* 9. If you checked off any problems, how difficult have these problems made it for you at work, home, or with other people?

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