Form 2080-0068 Beach Interview

OMB Control Number: 2080-0068

Title: Health Effects of Microbial Pathogens in Recreational Waters; National Epidemiological and Environmental Assessment of Recreational (NEEAR) Water Study

Below are the changes to be made to the questionnaire under OMB control number 2080-0068 for 2007. Per OMB’s request, if any minor modifications are to be made each year to the questionnaire, EPA will submit the modified questionnaire to OMB. Below is a summary of the changes for this year’s questionnaire followed by the entire questionnaire.

Page 2 We are now have marine beaches that have a longer swim season that may extend past Memorial Day.

12. How many times do you usually come to this beach each summer year (Memorial Day to Labor Day)

Page 4 includes additional questions that clarify another exposure route

18.c.1 Did {person} get any sand in their mouth?

18.c.1.a If yes to 18b or 18c… After digging in the sand, or building sand castles…did {person} wash their hands before eating? (washing of hands may include the use of personal water-free hand sanitizer.)

18.d.1 Did {person} get any seaweed or algae in their mouth?

18.d.1 If yes to d18d.1… After playing with seaweed or algae…did {person} wash their hands before eating? (washing of hands may include the use of personal water-free hand sanitizer.)

18.e. Was the sand you dug in or played with dry or wet? (interviewer to read the responses)

1) All dry

2) Mostly dry, some wet

3) Mostly wet, some dry

4) All wet

Page 13 is the addition of a question to clarify Question C8

C8c. Was this sore throat related to allergies?

BEACH INTERVIEW

OMB Control No.: 2080-0068

Expiration Date: 09/30/2007

Site ID ______

Friday _______ Saturday _______ Sunday______ Monday _________

Date:__-__-____

Time: _________

1. Have you been interviewed by the National Beaches Survey in the last 28 days?

2. Would you be willing to participate in a study on illnesses associated with recreation at the beach?

Yes ( give brochure with consent form, inform about 2 follow-up calls)

No (Terminate Interview)

2a. Our survey is primarily for households of one or more persons that live together at the same address; Do you all live at the same address?

3. How many members in your party are at the beach today including yourself?

4. What time did you and your household arrive at the beach today?

5. We are interested in asking about the health of your household during the few weeks following your beach visit. Could you please give me your telephone number so we can get in touch with you in 10-12 days from now?

5a. If “NO” Is it fro one of the following reasons? Too busy, no longer interested, will not be available, specify other reason?

5b. 10-12 days from now which phone number(s) should we call?

5c. Is this your home, vacation, or cell phone number?

6. What are the best times to reach you during week days?

6a. Can I please have your mailing address so that we can send you your $25 Thank you check? We will destroy your identifying information after we mail the check.

7. Please tell me the first name of the members of your household at the beach today, their birth dates, gender, race, ethnicity, and whether they are in diapers.

8. Will (you/all these people with you at the beach today) be living (with you) at the same address during the next two weeks?

9. Have any of these household members at the beach today been ill in the past 3 days with

● Diarrhea or loose bowels

● Urinary tract infection or burning sensation

● Throwing-up or vomiting

● Sore throat or cough

● Earache, ear infection or runny ears

● Eye infection

● Rash or itchy skin

● Sunburn

10. Are there any household members NOT present at the beach today?

10.a Have any household members NOT present at the beach today been ill in the past 3 days with

● Diarrhea or loose bowels

● Urinary tract infection or burning sensation

● Throwing-up or vomiting

● Sore throat or cough

● Earache, ear infection or runny ears

● Eye infection

● Rash or itchy skin

● Sunburn

11. Do you or any household members at the beach today, not including any one that stayed at home, suffer from any of the following chronic, long-term conditions?

● Gastrointestinal problems such as Crohn’s disease or irritable bowel syndrome

● Chronic respiratory diseases such as asthma or emphysema

● Allergies, other than drug allergies

● Skin problems such a psoriasis or eczema

12. How many times do you usually come to this beach each summer year (Memorial Day to Labor Day)

13. How many miles did you travel to the beach today?

14. During the past two weeks, did you (anyone in your household at the beach today) go bathing or swimming anywhere - at this or some other beach, pool or lake?

14a. Did you (anyone in your household at the beach today) go bathing or swimming anywhere in the past one week (Monday through Friday) at this or some other beach, pool or lake?

14b. Did you actually get your head or face wet?

14c. During the past 2 weeks, did you get a sunburn that lasted more that 12 hours?

Please go to the exit station when you leave the beach today, before 5:30 PM, to complete Part B of the Beach Interview and pick-up your beach gift. Thank you for participating n this portion of the study.

PART B– Exit Beach Interview

15. Were you the person that we interview on the beach or earlier today?

16. Did you or anyone in your household wade, swim, or play in the water today?

16a1. Did you immerse your body, not necessarily you head, in the water today? Ask for all persons in household.

16a2. Did you put your face in the water or submerge head in the water today? Ask for all persons in household.

16a3. Did you get water in the mouth today? Ask for all persons in household.

16a.4 Did you swallow the water? Ask for all persons in household.

16b. Were you in the water at the following times today? If “YES” what part of the beach did you swim in? Ask for all persons in household.

● Before 10:00 AM

● 10:00AM – 11:59 AM

● 12:00 PM – 1:59 PM

● 2: 00 PM – 3:59 PM

● 4: 00 PM – 5:30 PM

● Area A, B, or C (show map)

16c. What total time did you stay in the water? We are only interested in time actually in the water, not the total time at the beach? Ask for all persons in household.

16d. Did you engage in any of the following water-related activities while at the beach today? Ask for all persons in household.

Swimming, swimming laps, surfing, body surfing, kite surfing, wind surfing, sailing, paddle-boating, canoeing or kayaking, rafting, floating on air mattress, snorkeling, scuba diving, jet skiing, water skiing, playing in non-circulating pool or tidal pool?

17. What would you estimate your total time in direct sunlight was? This does not include being indoors or under umbrellas, etc.? Ask for all persons in household.

18. Did you engage in any of the following activities while at the beach today? Ask for all persons in household.

a. Collecting sea shells, rocks, feathers, etc?

b Digging in sand or building sand castles?

c Had their body buried in the sand?

d Playing with algae or seaweed?

18.c.1 Did {person} get any sand in their mouth?

18.c.1.a If yes to b or c… After digging in the sand, or building sand castles…did {person} wash their hands before eating? (washing of hands may include the use of personal water-free hand sanitizer.)

18.d.1 Did {person} get any seaweed in their mouth?

18.d.1 If yes to d… After playing with algae…did {person} wash their hands before eating? (washing of hands may include the use of personal water-free hand sanitizer.)

18.e. Was the sand you dug in or played with dry or wet? (interviewer to read the responses)

1) All dry

2) Mostly dry, some wet

3) Mostly wet, some dry

4) All wet

19. Did you cut yourself today or have an open cut when you came to beach today? Ask for all persons in household.

20. Did you wear sunscreen/sunblock today? Ask for all persons in household.

21. What was the SPF rating of the sunscreen/sunblock you used most often today? Ask for all persons in household.

21a. When you used sunscreen/sunblock today, how did you apply it? Only to certain areas of my body? All exposed skin? Ask for all persons in household.

22. Did you reapply at least once today? Ask for all persons in household.

23. Did you wear a hat today? Ask for all persons in household.

23a. Did the hat have a wide brim or another way to shade face, ears, and back of the neck from the sun? Ask for all persons in household.

23a1. Did you use protective equipment such as a canopy, umbrella or other type of sunshade today? Ask for all persons in household.

23b. Did you wear protective clothing, such as a long-sleeved shirt or cover-up? Ask for all persons in household.

24. During the summer, if you go out in the sun repeatedly without sunscreen or protective clothing which one of these things most usually happens to your skin? Ask for all persons in household.

A dark tan

Some tanning

No tan, maybe some freckles

Repeated sunburns

Other (specify)

Never go out in the sun

25. Did you wear insect repellant today? Ask for all persons in household.

26. Did your or any member of your household consume food while at the beach today? Ask for all persons in household.

a. brought from home?

b. purchased from vending machines or a vendor at the beach?

c. purchased fro a vendor outside the beach?

27. Did you or any member of your household consume any drinks while at the beach today?

Was the drink…

a. brought from home?

b. purchased from vending machines or a vendor at the beach?

c. purchased fro a vendor outside the beach?

28. In the last 48 hours has anyone done the following…

a. have you come in contact with any animals?

b. come in contact with someone who has complained of diarrhea, vomiting, or stomach illness?

c. consumed raw shell fish?

d. consumed rare/raw/undercooked or meat that is pink in the center (fish, beef, chicken)?

e. consumed runny or raw eggs?

Thank you for your assistance. You can contact us regarding information about the study at the toll free number in the booklet.

Telephone Interview

Telephone Interview - follow-up (10-12 days)

Is this person (primary respondent from beach interview)?

Yes (continue)

No (reschedule or continue)

Were you at the beach on (give date) with (primary respondent)?

Yes - Continue

I’m going to ask questions about any swimming you’ve done and illnesses you’ve experienced in the last week for the following people:

SECTION A

A1. May I have your first name please?

During your beach visit where you enrolled in this study on __________

A2. Did you wear ear plugs while in the water? Ask for all household members at the beach.

A3. Did you wear nose plugs while in the water? Ask for all household members at the beach.

A4. Did you wear eye goggles while in the water? Ask for all household members at the beach.

A5. During the beach interview, did you have contact with an animal? Ask for all household members at the beach.

A6. Between your beach visit on ______ date and today were you menstruating or pregnant? Ask for all household members at the beach.

We are now going to switch and ask you questions about activities that have occurred since the Beach Interview.

SECTION B

B1. Have you, or any of the people I just mentioned, gone bathing or swimming anywhere since we talked to you at the beach interview on ______? Please include any bathing or swimming such as at a beach, waterpark, public pool, private pool, or wading pool.

B2. Who was it that went bathing or swimming? A2. Ask for all household members at the beach.

Ask B3 through B5 about each person who was marked in B2. Begin with the first person in the list who was marked and continued with all other marked.

B3a. Did you go bathing or swimming at the beach (where the interview was taken) since the beach interview on this date {BEACH INTERVIEW DATE}.

B3b. Did you go bathing or swimming at any other beach since the beach interview on this date {BEACH INTERVIEW DATE}.

B3c. Was this beach at a:

Lake

River

Ocean

Other, specify

B3d. Did you go bathing or swimming at a waterpark?

B3e. Did you go bathing or swimming at a public pool?

B3f. Did you go bathing or swimming at a private pool?

B3g. Did you go bathing or swimming in a wading pool?

B3h. Did you go bathing or swimming any other place?

B3i. Swim location of any other place?

B4. Did you actually get your face wet while bathing or swimming? Ask for all household members at the beach.

B5. On which days did you go bathing or swimming? Ask for all household members at the beach.

B6. Have you or anyone else had a stomachache or abdominal cramping since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B6a. Who had a stomachache or abdominal cramping since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B7. Have you or anyone else had diarrhea or loose bowels since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B7a. Who had diarrhea or loose bowels since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B8. Have you or anyone else had nausea since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B8a. Who had nausea since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B9. Have you or anyone else had throwing-up or vomiting since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B9a. Who had throwing-up or vomiting since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B10. Have you or anyone else had urinary tract infection or burning sensation when urinating since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B10a. Who had urinary tract infection or burning sensation when urinating since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B11. Have you or anyone else had fever since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B11a. Who had fever since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B12. Have you or anyone else had headache lasting more than a few hours since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B12a. Who had headache lasting more than a few hours since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B13. Have you or anyone else had sore throat since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B13a. Who had sore throat since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B14. Have you or anyone else had a bad cough since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B14a. Who had a bad cough since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B15. Have you or anyone else had a cold since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B15a. Who had a cold since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B16. Have you or anyone else had a runny or stuffy nose since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B16a. Who had a runny or stuffy nose since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B17. Have you or anyone else had an earache, ear infection, or runny ears since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B17a. Who had an earache, ear infection, or runny ears since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B18. Have you or anyone else had watery eyes since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B18a. Who had watery eyes since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B19. Have you or anyone else had an eye infection since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B19a. Who had an eye infection since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B20. Have you or anyone else had an infected cut since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B20a. Who had an infected cut since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B21. Have you or anyone else had a rash or itchy skin since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B21a. Who had a rash or itchy skin since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B22. Have you or anyone else had a sunburn since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B22a. Who had a sunburn since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

We will now ask about some activities people may have done since the day of the beach interview on the {BEACH INTERVIEW DATE}

B23a. Since the day of the beach interview, have you or anyone else come in contact with any animals? Ask for all household members at the beach.

B23b. Who came into contact with animals since {BEACH INTERVIEW DATE}? Ask for all household members at the beach.

B23c. ASK FOR EACH PERSON IN A23a. Was this animal or any of these animals unfamiliar to you?

B23d. What kind of animals were they?

Dropdown list

B24a. Since the day of the beach interview has anyone come into contact with someone who has complained of diarrhea, vomiting, or stomach illness?

B24b. Who had contact with someone complaining of diarrhea, vomiting, or stomach illness since {BEACH INTERVIEW DATE}?

B25a. Since the day of the beach interview has anyone eaten raw shell fish, such as oysters, clams, mussels, crabs?

B25b. Who has eaten raw shell fish, such as oysters, clams, mussels, crabs since {BEACH INTERVIEW DATE}?

B26a. Since the day of the beach interview has anyone rare or raw meat? This includes pink in the center for fish, beef, chicken, and pork.

B26b. Who has eaten rare or raw meat since {BEACH INTERVIEW DATE}? This includes pink in the center for fish, beef, chicken, and pork.

B27a. Since the day of the beach interview has anyone eaten raw or runny eggs?

B27b. Who has eaten raw or runny eggs since {BEACH INTERVIEW DATE}?

SECTION C

This section is for all persons that experience symptoms.

C1. On what day did your stomachache or abdominal cramping start?

C1a. Do you still have a stomachache or abdominal cramping?

C1b. (For persons that still have symptom) For how many days did you have a stomachache or abdominal cramping?

C2. On what day did your diarrhea or loose bowels start?

C2a. Do you still have a diarrhea or loose bowels cramping?

C2b. (For persons that still have symptom) For how many days did you have a diarrhea or loose bowels cramping?

C2c. What was the maximum number of bouts or episodes of diarrhea experienced in a 24-hour period? Ask for each person with symptom.

C3. On what day did your nausea start?

C3a. Do you still have a nausea?

C3b. (For persons that still have symptom) For how many days did you have a nausea?

C4. On what day did your throwing-up or vomiting start?

C4a. Do you still have throwing-up or vomiting ?

C4b. (For persons that still have symptom) For how many days did you have throwing-up or vomiting?

C4c. What was the maximum number of bouts or episodes of throwing-up or vomiting experienced in a 24-hour period? Ask for each person with symptom.

C5. On what day did your urinary tract infection or burning sensation start?

C5a. Do you still have a urinary tract infection or burning sensation?

C5b. (For persons that still have symptom) For how many days did you have urinary tract infection or burning sensation?

C6. On what day did your fever start?

C6a. Do you still have a fever?

C6b. (For persons that still have symptom) For how many days did you have a fever?

C6c. Was your temperature taken using a thermometer?

C6a. What is the highest temperature that you had since your beach interview on {BEACH INTERVIEW DATE}?

C7. On what day did your headache start?

C7a. Do you still have a headache?

C7b. (For persons that still have symptom) For how many days did you have headache?

C8. On what day did your sore throat start?

C8a. Do you still have a sore throat?

C8b. (For persons that still have symptom) For how many days did you have sore throat ?

C8c. Was this sore throat related to allergies?

C9. On what day did your bad cough start?

C9a. Do you still have a bad cough?

C9b. (For persons that still have symptom) For how many days did you have a bad cough?

C9c. Was this bad cough related to allergies?

C10. On what day did your cold start?

C10a. Do you still have a cold?

C10b. (For persons that still have symptom) For how many days did you have a cold?

C10c. Was this cold related to allergies?

C11. On what day did your runny or stuffy nose start?

C11a. Do you still have a runny or stuffy nose?

C11b. (For persons that still have symptom) For how many days did you have a runny or stuffy nose?

C11c. Was this runny or stuffy nose related to allergies?

C12. On what day did your earache, ear infection or runny ears start?

C12a. Do you still have a earache, ear infection or runny ears?

C12b. (For persons that still have symptom) For how many days did you have a earache, ear infection or runny ears?

C12c. Was this earache, ear infection or runny ears related to allergies?

C13. On what day did your watery eyes start?

C13a. Do you still have watery eyes?

C13b. (For persons that still have symptom) For how many days did you have watery eyes?

C13c. Was this watery eyes related to allergies?

C14. On what day did your eye infection start?

C14a. Do you still have eye infection?

C14b. (For persons that still have symptom) For how many days did you have eye infection?

C15. On what day did your cut first get infected?

C15a. Do you still have an infected cut?

C15b. (For persons that still have symptom) For how many days did you have an infected cut?

C15c. Where were you cut? Mark all that apply

Drop down list

C16. On what day did your rash, itchy skin, or skin infection start?

C16a. Do you still have a rash, itchy skin, or skin infection?

C16b. (For persons that still have symptom) For how many days did you have a rash, itchy skin, or skin infection?

C16c. Where did you have a rash, itchy skin, or skin infection? Mark all that apply

Drop down list

C17. On which parts of the body were you sunburned? Mark all that apply

Drop down list

SECTION D

Ask only once for each person reporting symptoms

D1. When your condition began, were you working for pay either inside or outside the home? Please include jobs for which you were self-employed.

D2. During your illness, did you miss any time from work, for example because you called in sick or took time off to see a doctor?

D3. How many days?

D4. Did this illness prevent you from performing daily activities such as school, recreation, or vacation activities, or work around the home?

D5. How many days?

D6. Did this illness cause other household members to lose time at work?

D7. How many days?

D8a. Did you consult a healthcare provider over the phone about this illness/condition?

D8b. Did you visit a healthcare provider?

D8c. How many times?

D8d. What illness did the healthcare provider say you had?

D8e. Did you visit an emergency room?

D8f. How many times?

D8g. Were you admitted to a hospital?

D8h. How many days were you hospitalized?

D8i. Were you given intravenous fluids?

D9a. Did you receive a prescription for an antibiotic or other drug for this illness/condition?

D9b. About how much of your own or your household’s money was spent altogether for these prescription medicines? Amount to nearest dollar.

D10a. Did you use any over-the-counter medications, including things like special drinks, only because of this illness/condition?

D10b. About how much of your own or your household’s money was spent altogether for these over-the-counter medications? Amount to nearest dollar.

SECTION E

E1. Before today, were you aware that people could become ill by swimming at the beach?

E2. After today, will you change the way you use the water at the beach?

SECTION Q

These are questions from beach interview to ensure data collection for important exposures. Ask for all households.

Q1. Did you or anyone in your household wade, swim, or play in the water on {BEACH INTERVIEW DATE}?

Q1a.1. Did you immerse your body, not necessarily your head in the water {BEACH INTERVIEW DATE}?

Q1a.2. Did you put your face in the water or submerge head in the water on {BEACH INTERVIEW DATE}?

Q1a.3. Did you get water in your mouth on {BEACH INTERVIEW DATE}?

Q1a.4. Did you gag or cough after getting water in your mouth on {BEACH INTERVIEW DATE}?

Q1a.5. Did you swallow the water on {BEACH INTERVIEW DATE}?

Q2. What total time did {person}stay in the water? We are only interested in time actually in the water, not the total time at the beach.

This completes our telephone interview and your participation. I’d like to verify your address so we can mail a check for $25 to {BEACH RESPONDENT}. (VERIFY ADDRESS ON CALL SHEET.) You will receive your check in 30 days and thank you for your participation in this study. You can find information about the results of this study by calling the toll-free number or using the e-mail address listed in the brochure that we gave you. Thank you for taking the time to talk with me. Goodbye.

IF RESP DOESN’T HAVE BROCHURE:

You can call 1-888-422-3072, from 8 am to 4:30 pm, Monday through Friday, Eastern time; mention you are calling about the NEEAR study. You can also e-mail [email protected].