Form A.1.2.b Survey

Appendix A A.1.1.a–0

Visit Type: Enumeration

Target: Adult Household Member

P1, P2, P4 Month Phone Calls

Preconception Phone Follow-ups (1, 2, & 4 MO)

BOX FV00

CHECK ITEM:

• IF R IN HIGH PPG GROUP AND REPORTED TRYING TO GET PREGNANT AT LAST PPG ASSIGNMENT, GO TO FV003.

• IF R IN HIGH PPG GROUP AND REPORTED NOT TRYING TO BECOME PREGNANT AT LAST PPG ASSIGNMENT, GO TO FV001.

FV001. I’m calling today just to update some information we have for you. Last time we spoke, you weren’t trying to become pregnant, but we know that plans can sometimes change.

FV002. Are you now:

Trying to become pregnant, 1 (BOX FV01)

Not trying to become pregnant, or 2 (FV011)

Currently pregnant? 3 (FV005)

REFUSED 9--97 (FV011)

DON’T KNOW 9--98 (FV011)

FV003. I’m calling to update some information we have for you.

FV004. Since we last spoke with you have you learned that you’re pregnant?

YES 1 (FV005)

NO 2

RECENTLY LOST PREGNANCY 3 (BOX FV006)

REFUSED 7

DON’T KNOW 8

BOX FV01

CHECK ITEM:

• IF R IS A NEW TRYER (FV002 = 1), GO TO BOX FV06.

• IF R IS A PREVIOUS TRYER (FV002 NOT ASKED), GO TO FV008.

FV005. Congratulations. When is your baby due?

|___|___| |___|___| |___|___|___|___|

MM DD YYYY

REFUSED 9--97 (FV006)

DON’T KNOW 9--98 (FV006)

BOX FV02

CHECK ITEM:

• GO TO BOX FV06.

FV006. What was the first day of your last menstrual period?

|___|___| |___|___| |___|___|___|___|

MM DD YYYY

REFUSED 9--97 (FV007)

DON’T KNOW 9--98 (FV007)

BOX FV03

• GO TO BOX FV06.

FV007. How many weeks pregnant are you now? If you’re not sure, please make your best guess.

|___|___|

NUMBER

REFUSED 9--97 (FV007A)

DON’T KNOW 9--98 (FV007A)

FV007A. About how many months pregnant are you? If you’re not sure, please make your best guess.

|___|___|

NUMBER OF MONTHS

REFUSED 9--97 (FV007B)

DON’T KNOW 9--98 (FV007B)

BOX FV04A

PROGRAMMER INSTRUCTION:

• GO TO BOX FV06.

FV007B. Are you currently in your 1^st, 2^nd, or 3^rd trimester?

1^ST Trimester (1 to 3 months pregnant) 1

2^ND Trimester (4 to 6 months pregnant) 2

3^RD Trimester (7 to 9 months pregnant) 3

REFUSED 7

DON’T KNOW 8

BOX FV04B

PROGRAMMER INSTRUCTION:

• GO TO BOX FV06.

BOX FV04

• GO TO BOX FV06.

FV008. Are you currently trying to become pregnant?

YES 1

NO 2 (BOX FV06)

REFUSED 9--97 (BOX FV06)

DON’T KNOW 9--98 (BOX FV06)

BOX FV05

CHECK ITEM:

• GO TO BOX FV06.

FV009. QUESTION DELETED

FV010. QUESTION DELETED

FV011. This next question is about birth control. The last time you had intercourse with a man, did you use any type of birth control or do anything to prevent pregnancy?

YES 1

NO 2 (BOX FV06)

REFUSED 9--97 (BOX FV06)

DON’T KNOW 9--98 (BOX FV06)

FV012. Please listen to the following options and tell me all the types of birth control you used the last time you had intercourse with a man. Did you use:

YES NO RF DK

a. Birth control pills? 1 2 9--97 9--98

b. Condoms? 1 2 9--97 9--98

c. Depo-Provera, or other shots or injections? 1 2 9--97 9--98

d. A diaphragm, cervical cap, or shield? 1 2 9--97 9--98

e. Natural family planning; including rhythm or safe period

by calendar, temperature or cervical mucus? 1 2 9--97 9--98

f. Foam, jelly, cream, suppository or other insert? 1 2 9--97 9--98

g. A female condom, or vaginal pouch? 1 2 9--97 9--98

h. The patch, Nuva ring or the ring? 1 2 9--97 9--98

i. The TODAY sponge? 1 2 9--97 9--98

j. Withdrawal or pulling out? 1 2 9--97 9--98

k. An IUD, Coil or Loop? 1 2 9--97 9--98

l. Plan B or the “Morning After” pill? 1 2 9--97 9--98

m. Norplant? 1 2 9--97 9--98

n. Some other method or did something else? 1 2 9--97 9--98

BOX FV06

PROGRAMMER INSTRUCTION:

RUN ALGORITHM

BOX FV07

CHECK ITEM:

• IF IN PREGNANT ELIGIBLE GROUP, GO TO FV013.

• IF IN HOLDING GROUP AND PREGNANT (FV004 = 1) OR (FV002 = 3), GO TO FV014.

• IF IN HOLDING GROUP AND NOT PREGNANT (FV004 = 3), GO TO FV014A.

• IF IN HIGH TRYER GROUP, GO TO FV016.

• IF IN HIGH NON-TRYER GROUP, GO TO FV019.

• IF IN MODERATE GROUP AND DID NOT REPORT TRYING TO BECOME PREGNANT AT LAST PPG ASSIGNMENT AND NOT CURRENTLY TRYING TO BECOME PREGNANT (FV002 = “1”) AND (FV008) NOT ASKED), GO TO FV015.

• IF IN MODERATE GROUP AND CURRENTLY TRYING TO BECOME PREGNANT (FV008 = “1”), GO TO FV015A.

• IF IN MODERATE GROUP AND REPORTED TRYING TO BECOME PREGNANT AT LAST PPG ASSIGNMENT AND NOT CURRENTLY TRYING TO BECOME PREGNANT (FV002) NOT ASKED AND (FV008 = “1”), GO TO FV017.

• IF IN LOW GROUP, GO TO FV018.

• IF IN NO FOLLOWUP GROUP BECAUSE R RECENTLY LOST BABY (FV004 = “3”) AND, GO TO FV020.

• IF IN NO FOLLOW UP GROUP BECAUSE AGE WILL BE OLDER THAN 49 AT NEXT VISIT ACCORDING TO IMS, GO TO FV021.

• IF IN NO FOLLOWUP GROUP BECAUSE DUE DATE IS AFTER LAST ELIGIBLE DUE DATE, GO TO FV022.

FV013. (Congratulations again on your pregnancy.) Thanks for answering these questions. You have been chosen to be part of this important study because of your due date. The next step for the group you’re in is a home visit. I would like to tell you more about it and give you all the information you need to decide if you would like to be part of the study.

INTERVIEWER INSTRUCTION:

INFORM RESPONDENT OF NEXT STEPS BASED ON CURRENT STUDY PROCEDURES.

BOX FV08

• GO TO EOS.

FV014. (Congratulations again on your pregnancy.) Thanks for answering these questions. You are too far along in your pregnancy to be part of this study now, but we will get in touch with you about six months after your baby is born to update your information. If you become pregnant again, you may be able to be part of the study. Thanks for your time.

BOX FV08A

• GO TO EOS.

FV014A. I’m so sorry to hear that you’ve lost your baby. I know this can be a hard time. We will be in touch again in about six months to see how you’re doing and update your information. Thanks for your time.

BOX FV09

• GO TO EOS.

FV015. Thanks for your time. We’ll call to check in with you and update your information in another month or two.

BOX FV10

• GO TO EOS.

FV015A. Thanks for your time. We’ll call to check in with you and update your information in another month or two.

INTERVIEWER INSTRUCTION:

• USE CURRENT PROCEDURES FOR REQUESTING RESPONDENT TO INFORM STUDY IF SHE BECOMES PREGNANT

BOX FV10A

• GO TO EOS.

FV016. Thanks for your time. We’ll call to check in with you and update your information in another month or two.

• THIS INDIVIDUAL IS IN THE HIGH TRYER GROUP.

BOX FV11

• GO TO EOS.

FV017. Thanks for your time. We understand that plans can change and that you’re not trying to become pregnant right now. We’ll call to check in with you and update your information in another month or two.

BOX FV12

• GO TO EOS.

FV018. Thanks for your time. We’ll call to check in with you and update your information in about six months.

BOX FV13

• GO TO EOS.

FV019. Thanks for your time. We’ll call to check in with you and update your information in another month or two.

• THIS INDIVIDUAL IS IN THE HIGH NON-TRYER GROUP.

BOX FV14

• GO TO EOS.

FV020. I’m so sorry to hear that you’ve lost your baby. I know this can be a hard time. Based on what you’ve told me, we will not ask you to take part in the study. Because your address is part of the study, we may be back in touch at a later time to update your household information. Thank you for your time.

BOX FV15

• GO TO EOS.

FV021. Thank you for answering these questions. Based on what you’ve told me, you are not in one of the groups that we need for this study and we will not ask you to take part in it at this time. Because your address is part of the study, we may be back in touch at a later time to update your household information. Thank you for your time.

BOX FV16

• GO TO EOS.

FV022. (Congratulations again on your pregnancy.) Based on what you’ve told me, your baby will be born too late to take part in this study. At this time we have almost all the people that we need for the study and we will not be calling you again to ask about new pregnancies. Thanks for your time.

EOS

Revised 7/2/08