FOOD AND NUTRITION

QUESTIONNAIRE

Dear sir/Madam,
Dear respondents i hope you are in good health. I’m a student of
Central High and i’m pursing SBA. As part of my course study, I am
obligated to conduct a research on “Stomach Cancer”, This
Questionnaire contains 10 questions also last for about 5 minutes.
Your identity and answers will be kept confidential strictly and will be
used for academic purposes only.

Thank you for your time.

(1) What gender are you?

A. Female
B. Male
C. Rather not say

(2) Is Stomach Cancer common in your family?

A. Yes
B. No
C. Rather not say

(3) Do you have or know someone who is Diagnose with

Stomach Cancer?
 (A) Yes
(B) No
(C) Rather not say

(4) How much do you think the following factors influence the risk of
developing Stomach Cancer? (0% to 100%)

(A) Age
(B) Sex
(C) Family history of stomach cancer
(D) Salty diet
(E) Spicy diet
(F) Stress
(G) Smoking

(5) How much do you think that Stomach Cancer can be prevented
when the following factors are totally removed? (0% to 100%)

(A) Age
(B) Sex
(C) Family history of stomach cancer
(D) Salty diet
(E) Spicy diet
(F) Stress
(G) Smoking

(6) What do you think of your self-risk of developing stomach cancer?

(A) Very low

(B) Low
(C) Average
(D) High
 (E) Very high

(7) What percentage of Stomach Cancer do you think is gentically

predetermined?
( )%

(8) Do you or anyone you know receive regular screening for stomach
cancer

(A) Yes
(B) No
(C) Rather not say

(9) Do you think you are at risk of stomach cancer?

(A) Yes
(B) No

If no state why:______________________________________

(10) Do you think Stomach Cancer can be treated?

(A) Yes
(B) No
(C) Maybe
(D) I don’t know