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pdfAppendix A.2
1998-99 Spring Kindergarten Parent Interview
*The following items were fielded as part of the ECLS-K: 1998-99 Spring Kindergarten Parent Interview.
A-89
PARENT’S INVOLVEMENT WITH CHILD’S SCHOOL - PIQ
PIQ110
Now I'd like to ask you about your family's involvement with (CHILD)'s school.
During this school year, have you or another adult in your household taken it upon yourself to contact {CHILD}'s
teacher or school for any reason having to do with {CHILD}?
1 YES
2 NO
(PIQ120)
(PIQ125BX)
PIQ120
Why did you contact {CHILD}'s teacher or school?
PROBE: Any other reason?
1 TO REPORT AN ABSENCE OR TARDINESS
2 TO DISCUSS PROBLEMS THE CHILD IS HAVING AT SCHOOL
3 TO REQUEST SPECIAL PLACEMENT OR SERVICES
4 TO REQUEST EVALUATION BY A SPECIALIST
5 TO REQUEST A SPECIFIC TEACHER
6 TO CHECK ON {CHILD}’S PROGRESS
7 TO ASK ABOUT HOMEWORK PROBLEMS
91 OTHER (SPECIFY)
Code All That Apply
Other Specify Allowed
DK Allowed
Refusal Allowed
PIQ126a
We’re also interested in times the school contacted you without your having contacted them first. During this school year, have any of
(CHILD)’s teachers or (his/her) school…
Sent your family notes or E-mails specifically about (CHILD)?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ126b
[We’re also interested in times the school contacted you without your having contacted them first. During this school year, have any of
(CHILD)’s teachers or (his/her) school[
Provided newsletters, memos or notices addressed to all parents?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ126c
[We’re also interested in times the school contacted you without your having contacted them first. During this school year, have any of
(CHILD)’s teachers or (his/her) school]
Called you on the phone?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-90
PIQ.127
Since (the beginning of this school year/September), how many times have any of (CHILD)’s teachers or (his/her) school contacted (you/any
adult in your household) about any behavior problems (he/she) is having in (school)?
DK Allowed
Refusal Allowed
PIQ.128
How about any problems (he/she) is having with school work?
DK Allowed
Refusal Allowed
PIQ.129
How about anything (CHILD) is doing particularly well or better in (school/preschool)?
DK Allowed
Refusal Allowed
PIQ130
Since the beginning of this school year, have you or the other adults in your household…
Attended an open house or a back-to-school night?
1 YES
2 NO
DK Allowed (PIQ140)
Refusal Allowed (PIQ140)
(PIQ132)
(PIQ140)
PIQ132
Who did this, was it {CHILD}'s mother, father, both of them, or neither of them?
1 MOTHER
2 FATHER
3 BOTH
4 NEITHER
DK Allowed
Refusal Allowed
PIQ136
How many times (have/has) ({CHILD}'s (mother/father/both of them/{you or} other adults in your household) attended
an open house or a back-to-school night [since the beginning of this school year]?
Range:1 to 99
DK Allowed
Refusal Allowed
PIQ140
[Since the beginning of this school year, have you or the other adults in your household…]
Attended a meeting of a PTA, PTO, or Parent-Teacher Organization?
1 YES
2 NO
DK Allowed (PIQ145)
Refusal Allowed (PIQ145)
(PIQ142)
(PIQ145)
A-91
PIQ142
Who did this, was it {CHILD}'s mother, father, both of them, or neither of them?
1 MOTHER
2 FATHER
3 BOTH
4 NEITHER
DK Allowed
Refusal Allowed
PIQ144
How many times (have/has) ({CHILD}'s (mother/father/both of them/{you or} other adults in your household) attended
a meeting of PTA, PTO, or Parent-Teacher Student Organization [since the beginning of this school year]?
Range:1 to 99
DK Allowed
Refusal Allowed
PIQ145
[Since the beginning of this school year, have you or the other adults in your household…]
Gone to a meeting of a parent advisory group or policy council?
1 YES
2 NO
DK Allowed (PIQ150)
Refusal Allowed (PIQ150)
(PIQ147)
(PIQ150)
PIQ147
Who did this, was it {CHILD}'s mother, father, both of them, or neither of them?
1 MOTHER
2 FATHER
3 BOTH
4 NEITHER
DK Allowed
Refusal Allowed
PIQ149
How many times (have/has) ({CHILD}'s (mother/father/both of them/{you or} other adults in your household) gone to a
meeting of a parent advisory group or policy council [since the beginning of this school year]?
Range:1 to 99
DK Allowed
Refusal Allowed
PIQ150
[Since the beginning of this school year, have you or the other adults in your household…]
Gone to a regularly-scheduled parent-teacher conference with {CHILD}'s teacher or meeting with {CHILD}'s teacher?
1 YES
2 NO
DK Allowed (PIQ160)
Refusal Allowed (PIQ160)
(PIQ152)
(PIQ160)
A-92
PIQ152
Who did this, was it {CHILD}'s mother, father, both of them, or neither of them?
1 MOTHER
2 FATHER
3 BOTH
4 NEITHER
DK Allowed
Refusal Allowed
PIQ156
How many times (have/has) ({CHILD}'s (mother/father/both of them/{you or} other adults in your household) gone to a
regularly-scheduled parent-teacher conference with {CHILD}'s teacher or meeting with {CHILD}'s teacher [since the
beginning of this school year]?
Range:1 to 99
DK Allowed
Refusal Allowed
PIQ160
[Since the beginning of this school year, have you or the other adults in your household…]
Attended a school or class event, such as a play, sports event, or science fair?
1 YES
2 NO
DK Allowed (PIQ170)
Refusal Allowed (PIQ170)
(PIQ162)
(PIQ170)
PIQ162
Who did this, was it {CHILD}'s mother, father, both of them, or neither of them?
1 MOTHER
2 FATHER
3 BOTH
4 NEITHER
DK Allowed
Refusal Allowed
PIQ166
How many times (have/has) ({CHILD}'s (mother/father/both of them/{you or} other adults in your household) attended
a school or class event [since the beginning of this school year]?
Range:1 to 99
DK Allowed
Refusal Allowed
A-93
PIQ170
[Since the beginning of this school year, have you or the other adults in your household…]
Volunteered at the school or served on a committee?
1 YES
2 NO
(PIQ172)
(PIQ175)
DK Allowed (PIQ175)
Refusal Allowed (PIQ175)
PIQ172
Who did this, was it {CHILD}'s mother, father, both of them, or neither of them?
1 MOTHER
2 FATHER
3 BOTH
4 NEITHER
DK Allowed
Refusal Allowed
PIQ174
How many times (have/has) ({CHILD}'s (mother/father/both of them/{you or} other adults in your household) acted as
a volunteer at the school or served on a committee [since the beginning of this school year]?
Range:1 to 99
DK Allowed
Refusal Allowed
PIQ175
[Since the beginning of this school year, have you or the other adults in your household…]
Participated in fundraising for (CHILD)'s school?
1 YES
2 NO
(PIQ177)
(PIQ190)
DK Allowed (PIQ190)
Refusal Allowed (PIQ190)
PIQ177
Who did this, was it {CHILD}'s mother, father, both of them, or neither of them?
1 MOTHER
2 FATHER
3 BOTH
4 NEITHER
DK Allowed
Refusal Allowed
A-94
PIQ179
How many times (have/has) ({CHILD}'s (mother/father/both of them/{you or} other adults in your household)
participated in fundraising for {CHILD}'s school [since the beginning of this school year]?
Range:1 to 99
DK Allowed
Refusal Allowed
PIQ180
[Since the beginning of this school year, have you or the other adults in your household…]
Met with a guidance counselor in person?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ190
For each of the following statements, please tell me how well {CHILD}'s school has done with each activity during
this school year.
The school lets you know between report cards how {CHILD} is doing in school.
Would you say {CHILD}'s school…
1 Does this very well,
2 Just O.K., or
3 Doesn't do this at all?
DK Allowed
Refusal Allowed
PIQ200
[For each of the following statements, please tell me how well {CHILD}'s school has done with each activity during
this school year.]
The school helps you understand what children at {CHILD}'s age are like.
Would you say {CHILD}'s school…
1 Does this very well,
2 Just O.K., or
3 Doesn't do this at all?
DK Allowed
Refusal Allowed
A-95
PIQ210
[For each of the following statements, please tell me how well {CHILD}'s school has done with each activity during
this school year.]
The school makes you aware of chances to volunteer at the school.
Would you say {CHILD}'s school…
1 Does this very well,
2 Just O.K., or
3 Doesn't do this at all?
DK Allowed
Refusal Allowed
PIQ220
[For each of the following statements, please tell me how well {CHILD}'s school has done with each activity during
this school year.]
The school provides workshops, materials, or advice about how to help {CHILD} learn at home.
Would you say {CHILD}'s school…
1 Does this very well,
2 Just O.K., or
3 Doesn't do this at all?
DK Allowed
Refusal Allowed
PIQ230
[For each of the following statements, please tell me how well {CHILD}'s school has done with each activity during
this school year.]
The school provides information on community services to help {CHILD} or your family.
Would you say {CHILD}'s school…
1 Does this very well,
2 Just O.K., or
3 Doesn't do this at all?
DK Allowed
Refusal Allowed
PIQ280
About how far would you say it is from your home to the school {CHILD} attends?
Would you say…
1 Less than 1/8th mile (Less than 3 blocks),
2 1/8th mile to 1/4 miles (3-5 blocks),
3 More than 1/4 mile, but less than 1/2 mile (6-9 blocks),
4 1/2 mile to less than 1 mile (10-19 blocks),
5 One mile to 2.5 miles (less than 5 minute drive),
6 2.6 miles to 5 miles (between 5-10 minute drive),
7 5.1 miles to 7.5 miles (between 11 and 15 minute drive),
8 7.6 miles to 10 miles (between 16 and 20 minute drive), or
9 11 miles or more (more than 20 minute drive)?
Other Specify Allowed
DK Allowed
Refusal Allowed
A-96
PIQ290
How often in the past month, has {CHILD}'s teacher sent home ideas for things to do with {CHILD} at home? Would
you say…
THIS INCLUDES HOMEWORK.
1 Never,
2 One or two times, or
3 Three or more times?
DK Allowed
Refusal Allowed
PIQ300
About how many parents of children in {CHILD}'s class do you talk with regularly, either in person or on
the phone?
Range:0 to 40
DK Allowed
Refusal Allowed
PIQ305
Does {CHILD} have any older brothers or sisters who attend or attended the same school?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ310
How does {CHILD} usually get to school in the morning?
1
2
3
4
5
SCHOOL BUS
PARENT DRIVES (HIM/HER)
CARPOOL
WALK
OTHER (SPECIFY)
Other Specify Allowed
DK Allowed
Refusal Allowed
PIQ400
Last time we spoke to you, you said that (ENGLISH/NON-ENGLISH LANGUAGE/a language other than English) is spoken in your home.
When (CHILD)'s teacher sends home notes or newsletters, are these in (ENGLISH/NON-ENGLISH LANGUAGE/a language other than
English)?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-97
PIQ410
This year, have the following reasons made it harder for you to participate in activities at (CHILD)'s school?
Inconvenient meeting times? Has that made it harder for you to participate in activities at {CHILD}'s school?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ420
[This year, have the following reasons made it harder for you to participate in activities at (CHILD)'s school?]
No child care keeps your family from going to school meetings or events? Has that made it harder for you to
participate in activities at {CHILD}'s school?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ430
[This year, have the following reasons made it harder for you to participate in activities at (CHILD)'s school?]
Family members can't get time off from work? Has that made it harder for you to
participate in activities at {CHILD}'s school?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ440
[This year, have the following reasons made it harder for you to participate in activities at (CHILD)'s school?]
Problems with safety going to the school? Has that made it harder for you to
participate in activities at {CHILD}'s school?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ450
[This year, have the following reasons made it harder for you to participate in activities at (CHILD)'s school?]
The school does not make your family feel welcome? Has that made it harder for you to
participate in activities at {CHILD}'s school?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-98
PIQ460
[This year, have the following reasons made it harder for you to participate in activities at (CHILD)'s school?]
Problems with transportation to the school? Has that made it harder for you to
participate in activities at {CHILD}'s school?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ470
[This year, have the following reasons made it harder for you to participate in activities at (CHILD)'s school?]
Problems because you or members of your family speak a language other than English and meetings are conducted
only in English? Has that made it harder for you to participate in activities at {CHILD}'s school?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ480
[This year, have the following reasons made it harder for you to participate in activities at {CHILD}'s school?]
You don't hear about things going on at school that you might want to be involved in? Has that made it harder for you to
participate in activities at {CHILD}'s school?
1 YES
2 NO
DK Allowed
Refusal Allowed
PIQ490
Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied . . .
With the school (CHILD) attends this year?
PIQ500
[Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied . . .]
With the teachers (CHILD) has this year?
PIQ510
[Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied . . .]
With the academic standards of the school?
PIQ520
[Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied . . .]
With the order and discipline at the school?
A-99
PIQ530
[Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied . . .]
With the way that school staff interacts with parents?
PIQ540
Strongly
agree
Agree
Neither
agree
nor
disagr
ee
Disagree
I feel my contribution to my child's
education is valuable.
I know how to help my child with
his schoolwork.
My child's teacher expects me to
help with homework.
I feel welcome when I enter my
child's school.
My calls to school staff are
answered promptly.
My work schedule interferes with
my ability to help my child with
schoolwork.
PIQ550
Yes
Has {CHILD}'s teacher suggested specific ways you can help {CHILD}
with his schoolwork?
Has {CHILD} asked you to help him with homework?
Do you look at {CHILD}'s homework?
Have you been invited to observe or help in {CHILD}'s classroom?
Have you been invited to a meeting for Title I parents?
Have you been invited by school staff to participate in planning, such
as the school improvement plan, the Title I plan, or the parent
involvement policy?
Have you received a copy of the school-parent compact?
A-100
No
Strongly
disagre
e
FAMILY STRUCTURE - FSQ
Now I have a few questions about your household. We have listed that (READ NAMES FROM MATRIX) lived in this
household at the time of our last interview.
As I read each person's name again, please tell me if he or she still lives in this household.
Does {NAME} still live in this household?
1 YES
2 NO
(FSQ.015)
FSQ015
Why is {NAME} no longer living in this household?
1 SEPARATION OR DIVORCE
2 ATTENDING COLLEGE OR BOARDING SCHOOL
3 LIVING ELSEWHERE FOR EMPLOYMENT- RELATED REASONS
4 DECEASED
5 MOVED ON
6 ROSTER ERROR
7 MOVED BACK WITH PARENTS
91 SOME OTHER REASON (SPECIFY)
Code All That Apply
Other Specify Allowed
DK Allowed
Refusal Allowed
FSQ017
Other than the people I just asked about, is there anyone else currently living in this household?
For example, anyone who has moved in or any babies born since our last interview and who also still lives here?
Please do not include anyone staying here temporarily who usually lives somewhere else.
1 YES
2 NO
DK Allowed (FSQ070)
Refusal Allowed (FSQ070)
(FSQ020)
(FSQ070)
A-101
FSQ020
{Now I have a few questions about your household. We have noted that you and {CHILD} currently live in this household.} {Please tell me the
names and ages of all the other people who normally live here. Please do not
include anyone staying here temporarily who usually lives somewhere else.}
First Name
R
C
Last Name
Age
Respondent
Child
Enter Name,
person 3 through
25
A-102
Gender
Relationship to
child
HOME ENVIRONMENT, ACTIVITIES, AND COGNITIVE STIMULATION - HEQ
HEQ100
In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following things with {CHILD}?
Visited a library?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ130
[In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following things with {CHILD}?]
Gone to a play, concert, or other live show?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ140
[In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following things with {CHILD}?]
Visited an art gallery, museum, or historical site?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ150
[In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following things with {CHILD}?]
Visited a zoo, aquarium, or petting farm?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ180
"[In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following things with
{CHILD}?]"
Attended an athletic or sporting event in which {CHILD} is not a player?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-103
HEQ200
In the past week, how often did {CHILD} look at picture books outside of school?
Would you say …
1 Never,
2 Once or twice a week,
3 3 to 6 times a week, or
4 Every day?
DK Allowed
Refusal Allowed
HEQ210
In the past week, how often did {CHILD} read to (himself/herself) or to others outside of school?
Would you say …
1 Never,
2 Once or twice a week,
3 3 to 6 times a week, or
4 Every day?
DK Allowed
Refusal Allowed
HEQ220
Do you have a home computer that {CHILD} uses?
1 YES
2 NO
DK Allowed (HEQ300)
Refusal Allowed (HEQ300)
(HEQ230)
(HEQ300)
HEQ230
In a average week, how often does {CHILD} use the computer?
Would you say …
1
2
3
4
Never,
Once or twice a week,
3 to 6 times a week, or
Every day?
DK Allowed
Refusal Allowed
HEQ240
Does {CHILD} use the computer …
To play with programs that teach (him/her) something, like math or reading skills?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-104
HEQ250
[Does {CHILD} use the computer …]
To play with drawing or art programs?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ260
Does {CHILD} use the computer at home to get on the Internet?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ300
Outside of school hours, has {CHILD} ever participated in:
Dance lessons?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ310
[Outside of school hours, has {CHILD} ever participated in:]
Organized athletic activities, like basketball, soccer, baseball, or gymnastics?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ320
[Outside of school hours, has {CHILD} ever participated in:]
Organized clubs or recreational programs, like scouts?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ330
[Outside of school hours, has {CHILD} ever participated in:]
Music lessons, for example, piano, instrumental music or singing lessons?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-105
HEQ340
[Outside of school hours, has {CHILD} ever participated in:]
Drama classes?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ350
[Outside of school hours, has {CHILD} ever participated in:]
Art classes or lessons, for example, painting, drawing, sculpturing?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ370
[Outside of school hours, has{CHILD} ever participated in:]
Organized performing arts programs, such as children's choirs, dance programs, or theater performances?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ380
[Outside of school hours, has {CHILD} ever participated in:]
Crafts classes or lessons?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ390
[Outside of school hours, has {CHILD} ever participated in:]
Non-English language instruction?
1 YES
2 NO
DK Allowed
Refusal Allowed
HEQ400
Now, I have some questions about your neighborhood. How safe is it for children to play outside during the day in
your neighborhood?
Would you say it's …
1 Not at all safe,
2 Somewhat safe, or
3 Very safe?
DK Allowed
Refusal Allowed
A-106
HEQ410
How much of a problem are the following in the block or area around your house or apartment? What about …
Garbage, litter, or broken glass in the street or road, on the sidewalks, or in yards?
Would you say they are a…
1 Big problem,
2 Somewhat of a problem, or
3 No problem?
DK Allowed
Refusal Allowed
HEQ420
[How much of a problem are the following in the block or area around your house or apartment? What about …]
Selling or using drugs or excessive
drinking in public?
Would you say they are a…
1 Big problem,
2 Somewhat of a problem, or
3 No problem?
DK Allowed
Refusal Allowed
HEQ430
[How much of a problem are the following in the block or area around your house or apartment? What about …]
Burglary or robbery?
Would you say they are a…
1 Big problem,
2 Somewhat of a problem, or
3 No problem?
DK Allowed
Refusal Allowed
HEQ440
[How much of a problem are the following in the block or area around your house or apartment? What about …]
Violent crimes like drive-by shootings?
Would you say they are a…
1 Big problem,
2 Somewhat of a problem, or
3 No problem?
DK Allowed
Refusal Allowed
A-107
HEQ450
[How much of a problem are the following in the block or area around your house or apartment? What about …]
Vacant houses and buildings?
Would you say they are a…
1 Big problem,
2 Somewhat of a problem, or
3 No problem?
DK Allowed
Refusal Allowed
HEQ500
{I'm going to read some statements about things that may occur in your family.} {Now I have some questions about meals and other
routines.} In a typical week, please tell me the number of days …
At least some of the family eats breakfast together.
Range:0 to 7
DK Allowed
Refusal Allowed
HEQ510
[{I'm going to read some statements about things that may occur in your family.} {Now I have some questions about meals and
other routines.} In a typical week, please tell me the number of days ... ]
{CHILD} has breakfast at a regular time.
HEQ520
[{I'm going to read some statements about things that may occur in your family.} {Now I have some questions about meals and
other routines.} In a typical week, please tell me the number of days ... ]
Your family eats the evening meal together.
HEQ530
[{I'm going to read some statements about things that may occur in your family.} {Now I have some questions about meals and
other routines.} In a typical week, please tell me the
number of days ... ]
The evening meal is served at a regular time.
HEQ550
On weeknights during the school year, does {CHILD} usually go to bed at about the same time each night, or does
(his/her) bedtime vary a lot from night to night?
1 HAS USUAL BEDTIME
2 BEDTIME VARIES
(HEQ560)
(HEQ570)
A-108
HEQ560
About what time does {CHILD}) usually go to bed?
ENTER HOUR THEN MINUTE.
HEQ565
[About what time does {CHILD} usually go to bed?]
SELECT A.M. OR P.M.
1 A.M.
2 P.M.
HEQ570
What is the latest time that {CHILD} goes to bed on weekdays?
ENTER HOUR THEN MINUTE.
HEQ575
[What is the latest time that {CHILD} goes to bed on weekdays?]
SELECT A.M. OR P.M.
1 A.M.
2 P.M.
HEQ580
How often does someone in your family talk with {CHILD} about (his/her) ethnic or racial heritage?
Would you say …
1 Never,
2 Almost never,
3 Several times a year,
4 Several times a month, or
5 Several times a week or more?
DK Allowed
Refusal Allowed
HEQ590
How often does someone in your family talk with {CHILD} about your family's religious beliefs or traditions?
Would you say …
1
2
3
4
5
Never,
Almost never,
Several times a year,
Several times a month, or
Several times a week or more?
DK Allowed
Refusal Allowed
A-109
HEQ600
How often does someone in your family participate in special cultural events or traditions connected with your racial
or ethnic background?
Would you say …
1
2
3
4
5
Never,
Almost never,
Several times a year,
Several times a month, or
Several times a week or more?
DK Allowed
Refusal Allowed
A-110
CRITICAL FAMILY PROCESSES - CFQ
CFQ100
Now, I'd like to ask some questions about your relationship with {NAME OF CURRENT PARTNER}.
Would you say that your relationship is…
1 Very happy,
2 Fairly happy, or
3 Not too happy?
DK Allowed
Refusal Allowed
CFQ106
About how often do you and {NAME OF CURRENT PARTNER} do the following things?
Tell each other about troubles after a bad day?
Would you say almost everyday, once or twice a week, once or twice a month, or less often?
1 ALMOST EVERYDAY
2 ONCE OR TWICE A WEEK
3 ONCE TO TWICE A MONTH
4 LESS OFTEN
DK Allowed
Refusal Allowed
CFQ108
[About how often do you and {NAME OF CURRENT PARTNER} do the following things?]
Laugh together?
[PROBE: Would you say almost everyday, once or twice a week, once or twice a month, or less often?]
1
2
3
4
ALMOST EVERYDAY
ONCE OR TWICE A WEEK
ONCE TO TWICE A MONTH
LESS OFTEN
DK Allowed
Refusal Allowed
CFQ110
[About how often do you and {NAME OF CURRENT PARTNER} do the following things?]
Calmly discuss something?
[PROBE: Would you say almost everyday, once or twice a week, once or twice a month, or less often?]
1
2
3
4
ALMOST EVERYDAY
ONCE OR TWICE A WEEK
ONCE TO TWICE A MONTH
LESS OFTEN
DK Allowed
Refusal Allowed
A-111
CFQ112
[About how often do you and {NAME OF CURRENT PARTNER} do the following things?]
Work together on a project?
[PROBE: Would you say almost everyday, once or twice a week, once or twice a month, or less often?]
1
2
3
4
ALMOST EVERYDAY
ONCE OR TWICE A WEEK
ONCE TO TWICE A MONTH
LESS OFTEN
DK Allowed
Refusal Allowed
CFQ114
[About how often do you and {NAME OF CURRENT PARTNER} do the following things?]
Have a stimulating exchange of ideas?
[PROBE: Would you say almost everyday, once or twice a week, once or twice a month, or less often?]
1
2
3
4
ALMOST EVERYDAY
ONCE OR TWICE A WEEK
ONCE TO TWICE A MONTH
LESS OFTEN
DK Allowed
Refusal Allowed
CFQ140
Do you and {(NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about...
Chores and responsibilities?
1 OFTEN
2 SOMETIMES
3 HARDLY EVER
4 NEVER
DK Allowed
Refusal Allowed
CFQ150
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
Your {child/children}?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
A-112
CFQ160
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
Money?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ170
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
Not showing love and affection?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ180
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
Being too tired for sex?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ190
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
Religion?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
A-113
CFQ200
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
Leisure time?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ210
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
Drinking?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ220
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
Other women or men?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ230
[Do you and {NAME OF CURRENT PARTNER} often, sometimes, hardly ever, or never have arguments about…]
In-laws?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
A-114
CFQ240
There are various ways that couples deal with serious disagreements. When you have a serious disagreement with
{NAME OF CURRENT PARTNER}, how often do you:
Just keep your opinions to yourself?
PROBE: Would you say often, sometimes, hardly ever, or never?
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ250
[There are various ways that couples deal with serious disagreements. When you have a serious disagreement with
{NAME OF CURRENT PARTNER}, how often do you:]
Discuss your disagreements calmly?
[PROBE: Would you say often, sometimes, hardly ever, or never?]
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ260
[There are various ways that couples deal with serious disagreements. When you have a serious disagreement with
{NAME OF CURRENT PARTNER}, how often do you:]
Argue heatedly or shout at each other?
[PROBE: Would you say often, sometimes, hardly ever, or never?]
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
A-115
CFQ270
[There are various ways that couples deal with serious disagreements. When you have a serious disagreement with
{NAME OF CURRENT PARTNER}, how often do you:]
End up hitting or throwing things at each other?
[PROBE: Would you say often, sometimes, hardly ever, or never?]
1
2
3
4
OFTEN
SOMETIMES
HARDLY EVER
NEVER
DK Allowed
Refusal Allowed
CFQ300
How much time (do you/does {NAME}) or another adult male in your home spend playing with {CHILD} on a typical
school day?
0 NO TIME
1 LESS THAN 5 MINUTES
2 5 - 9 MINUTES
3 10 - 15 MINUTES
4 16 - 30 MINUTES
5 31 - 45 MINUTES
6 46 MINUTES TO ONE HOUR
7 MORE THAN ONE HOUR, BUT LESS THAN 2 HOURS
8 TWO HOURS - BUT LESS THAN THREE HOURS
9 THREE HOURS OR MORE
DK Allowed
Refusal Allowed
CFQ310
How about on a typical weekend day?
DK Allowed
Refusal Allowed
A-116
NON-RESIDENT PARENTS - NRQ
NRQ100
The next questions are about {CHILD}'s contact with (his/her) (biological/adoptive) (father/mother).
[We understand that some of these questions may be difficult {for adoptive parents} to answer, however, these are
standard questions we ask when a child does not live with (his/her) biological parents Any information you can
provide will be helpful.]
How long has it been since {CHILD} last had a visit, a phone call, or received a card or letter from (his/her)
(biological/adoptive) (father/mother)? Would you say …
1 Less than one month,
2 More than a month but less than a year,
3 More than a year, or
4 No contact since birth?
5 PARENT IS DECEASED
6 NO CONTACT SINCE ADOPTION
7 NO ADOPTIVE (MOTHER/FATHER)
DK Allowed (NRQ260BX)
Refusal Allowed (NRQ260BX)
(NRQ110)
(NRQ260BX)
(NRQ260BX)
(NRQ260BX)
(NRQ260BX)
NRQ110
How many days has {CHILD} seen (his/her) (biological/adoptive) (father/mother) in the past 4 weeks?
Range:0 to 28
DK Allowed
Refusal Allowed
NRQ120
How many days was {CHILD} scheduled to see (his/her) (biological/adoptive) (father/mother) in the past 4 weeks?
Range:0 to 28
DK Allowed
Refusal Allowed
NRQ121
How many nights did {CHILD} and (his/her) (biological/adoptive) (father/mother) sleep in the same house in the past
four weeks?
Range:0 to 28
DK Allowed
Refusal Allowed
NRQ122
Did {CHILD}'s (biological/adoptive) (father/mother) miss any scheduled visits with {CHILD} in the past four weeks?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-117
NRQ123
How many times have {CHILD} and (his/her) (biological/adoptive) (father/ mother) talked on the telephone to each
other in the past 4 weeks?
Range:0 to 28
DK Allowed
Refusal Allowed
NRQ130
Since the beginning of this school year, has {CHILD}'s (biological/adoptive) (mother/father)...
Attended an open house or a back-to-school night?
1 YES
2 NO
DK Allowed
Refusal Allowed
NRQ135
[Since the beginning of this school year, has {CHILD}'s (biological/adoptive) (mother/father)…]
Gone to a regularly-scheduled parent-teacher conference with {CHILD}'s teacher or meeting with {CHILD}'s teacher?
1 YES
2 NO
DK Allowed
Refusal Allowed
NRQ140
[Since the beginning of this school year, has {CHILD}'s (biological/adoptive) (mother/father)…]
Attended a school or class event, such as a play or sports event or science fair?
1 YES
2 NO
DK Allowed
Refusal Allowed
NRQ145
[Since the beginning of this school year, has {CHILD}'s (biological/adoptive) (mother/father)…]
Volunteered at the school or served on a committee?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-118
NRQ200
Did {CHILD}'s biological father ever sign the application for {CHILD}'s birth certificate or sign a statement that legally
says he is {CHILD}'s biological father?
1 YES
2 NO
DK Allowed (NRQ210)
Refusal Allowed (NRQ210)
(NRQ250)
(NRQ210)
NRQ210
Did you or someone in your family go to court to establish that he was {CHILD}'s legal biological father?
1 YES
2 NO
DK Allowed
Refusal Allowed
NRQ250
How many minutes does {CHILD}'s (biological/adoptive) (mother/father) live from (him/her)?
1 10 MINUTES OR LESS
2 11-30 MINUTES
3 31-59 MINUTES
4 1-2 HOURS
5 MORE THAN 2 HOURS
DK Allowed
Refusal Allowed
NRQ251
Does {CHILD}'s (biological/adoptive) (mother/father) live in the same state or a different state than {CHILD}?
1 SAME STATE
2 DIFFERENT STATE
DK Allowed
Refusal Allowed
NRQ261
CODE ALL THAT APPLY. CODE 5 CANNOT BE CODED WITH ANY OTHER.
Next, I'd like to ask some questions about child support. Have child support payments for {CHILD} ever been awarded
by a court or a judge, agreed to in writing, agreed to informally, or do you not have an agreement of any kind?
1 YES, AWARDED BY A COURT
2 YES, AGREED TO IN WRITING
3 YES, AGREED TO INFORMALLY
4 YES, AWARD PENDING
5 NO AGREEMENT
Code All That Apply
Other Specify Allowed (NRQ262)
DK Allowed (NRQ270BX)
Refusal Allowed (NRQ270BX)
(NRQ263BX)
(NRQ263BX)
(NRQ263BX)
(NRQ263BX)
(NRQ270BX)
A-119
NRQ262
What kind of agreement do you have?
DK NOT Allowed
Refusal NOT Allowed
NRQ264
What parent do you have this agreement with?
PROBE: Any other parent?
1 {CHILD}'s BIOLOGICAL FATHER
2 {CHILD}'S BIOLOGICAL MOTHER
3 {CHILD}'S ADOPTIVE FATHER
4 {CHILD}'S ADOPTIVE MOTHER
Code All That Apply
NRQ265
In the past year were you supposed to receive any child support payments for {CHILD}?
1 YES
2 NO
DK Allowed (NRQ270BX)
Refusal Allowed (NRQ270BX)
(NRQ270BX)
NRQ266
During the last year, have you received this money regularly, so that you could almost always count on getting the money?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-120
DISCIPLINE, WARMTH, AND EMOTIONAL SUPPORTIVENESS - DWQ
DWQ010
Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.
{CHILD} and I often have warm, close times together.
PROBE: Is it completely true, mostly true, somewhat true or not at all true?
1 COMPLETELY TRUE
2 MOSTLY TRUE
3 SOMEWHAT TRUE
4 NOT AT ALL TRUE
DK Allowed
Refusal Allowed
DWQ015
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
Most of the times I feel that {CHILD} likes me and wants to be near me.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
DWQ020
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
I am usually too busy to joke and play around with {CHILD}.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
A-121
DWQ025
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
Even when I'm in a bad mood, I show {CHILD} a lot of love.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
DWQ030
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
By the end of a long day, I find it hard to be warm and loving toward {CHILD}.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
DWQ035
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
I express affection by hugging, kissing, and praising {CHILD}.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
A-122
DWQ040
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
Being a parent is harder than I thought it would be.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
DWQ045
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
{CHILD} does things that really bother me.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
DWQ050
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
I find myself giving up more of my life to meet {CHILD}'s needs than I ever expected.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
A-123
DWQ055
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
I feel trapped by my responsibilities as a parent.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
WQ060
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
I often feel angry with {CHILD}.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
DWQ065
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
{CHILD} seems harder to care for than most.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
A-124
DWQ070
[Now, I'm going to read some statements. Please tell me whether each statement is completely true, mostly true,
somewhat true, or not at all true.]
I find taking care of a young child more work than pleasure.
[PROBE: Is it completely true, mostly true, somewhat true or not at all true?]
1
2
3
4
COMPLETELY TRUE
MOSTLY TRUE
SOMEWHAT TRUE
NOT AT ALL TRUE
DK Allowed
Refusal Allowed
DWQ071
Now I’d like to ask some questions about {CHILD}’s television viewing. We are interested in {his/her} television viewing only in your
home. We want you to include television shows, videotapes, and DVDs, but not games like NINTENDO.
Do you have a television at home?
1
2
YES (DWQ.080)
NO (DWQ.100)
DK Allowed (DWQ.100)
Refusal Allowed (DWQ.100)
DWQ080
On any given weekday, how many hours of television, videotapes, or DVDs on average does {CHILD} watch at home? How
about…
a.
Before 8:00am?
b.
Between 3:00pm and dinner time?
c.
After dinner time?
HOURS
MINUTES
Before 8:00 am
Between 3:00 p.m. and dinner time
After dinner time
DWQ082
How about on Saturday and Sunday? How many hours does {CHILD} watch television, videotapes, or DVDs at home on…
a.
Saturdays?
b.
Sundays?
HOURS
Saturdays
Sundays
A-125
MINUTES
DWQ084
Are there family rules for {CHILD} about any of the following…
What programs {CHILD} can watch?
1 YES
2 NO
DK Allowed
Refusal Allowed
DWQ086
[Are there family rules for {CHILD} about any of the following…]
How many hours {CHILD} may watch television?
1 YES
2 NO
DK Allowed
Refusal Allowed
DWQ088
[Are there family rules for {CHILD} about any of the following…]
How early or late {CHILD} may watch television?
1 YES
2 NO
DK Allowed
Refusal Allowed
DWQ100
Sometimes kids mind pretty well and sometimes they don't. About how many times, if any, have you spanked {CHILD}
in the past week?
ENTER -1 IF RESPONDENT VOLUNTEERS THAT {CHILD} IS NEVER SPANKED.
-1 DO NOT SPANK CHILD
SOFT RANGE CHECK: -1 to 15 spankings. HARD RANGE CHECK -1 to 95.
DK Allowed
Refusal Allowed
A-126
DWQ110
Most children get angry with their parents from time to time. If {CHILD} got so angry that (he/she) hit you, what would
you do? Would you…
1
2
3
4
5
6
7
8
9
10
11
91
Spank (him/her),
Have (him/her) take a time out,
Hit (him/her) back,
Talk to (him/her) about what (he/she) did wrong,
Ignore it,
Make (him/her) do some work around the house,
Make fun of (him/her),
Make (him/her) apologize,
Take away a privilege,
Give a warning,
Yell at {CHILD} or threaten (him/her)?
Something else? (SPECIFY)
Code All That Apply
Other Specify Allowed
DK Allowed
Refusal Allowed
A-127
CHILD’S HEALTH AND WELL-BEING - CHQ
CHQ100
How long has it been since {CHILD}'s last visit to a dentist or dental hygenist for dental care?
1 NEVER
2 LESS THAN 6 MONTHS
3 6 MONTHS TO ONE YEAR
4 1 YEAR TO 2 YEARS
5 MORE THAN 2 YEARS
DK Allowed
Refusal Allowed
CHQ110
How long has it been since {CHILD}'s last visit to a clinic, health center, hospital, doctor's office, or other place for
routine health care?
PROBE: Routine health care may include check-ups, or immunization appointments.
1 NEVER
2 LESS THAN 6 MONTHS
3 6 MONTHS TO ONE YEAR
4 1 YEAR TO 2 YEARS
5 MORE THAN 2 YEARS
DK Allowed
Refusal Allowed
CHQ120
Is {CHILD} now covered by a health insurance plan which would pay any part of a hospital, doctor's, or surgeon's
bill?
PROBE: This includes {Medicaid/ {or STATE NAME FOR MEDICAID}}.
1 YES
2 NO
DK Allowed
Refusal Allowed
CHQ130
DISPLAY “”children,” “{CHILD},” and “{CHILD}’s”.
Now I want to ask you about {CHILD}'s physical activities.
Compared to other (boys/girls/children) (his/her/{CHILD}’s) age, how physically active is {CHILD} during structured activities like
sports or activities at day care or school? Is (he/she/{CHILD})…
1 More physically active than other (boys/girls/children),
2 Less physically active than other (boys/girls/children), or
3 About the same as other (boys/girls/children)?
DK Allowed
Refusal Allowed
A-128
CHQ131
How about during free time?
PROBE: Is (he/she{CHILD}) more physically active, less physically active, or about the same as other (boys/girls/children)?
1 More physically active than other (boys/girls/children),
2 Less physically active than other (boys/girls/children), or
3 About the same as other (boys/girls/children)?
DK Allowed
Refusal Allowed
CHQ137
Aerobic exercise makes the heart work very hard and makes people break out in a sweat. Compared to other
(boys/girls/children) (his/her/{CHILD}’s) age, how much aerobic exercise does (CHILD) get on a consistent basis?
Would you say …
1 More than other (boys/girls/children),
2 Less than other (boys/girls/children), or
3 About the same as other (boys/girls/children)?
DK Allowed
Refusal Allowed
CHQ140
In a typical week, on how many days does (CHILD) get exercise that causes rapid breathing, perspiration, and a
rapid heartbeat for 20 continuous minutes or more?
Range:0 to 7
DK Allowed
Refusal Allowed
CHQ145A
In the last 12 months, did {CHILD} regularly get exercise through any of the following organizations?
A public park or recreation center?
1 YES
2 NO
DK Allowed
Refusal Allowed
CHQ145B
[In the last 12 months, did {CHILD} regularly get exercise through any of the following organizations?]
A church or other place of worship?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-129
CHQ145C
[In the last 12 months, did {CHILD} regularly get exercise through any of the following organizations?]
A sports team or league not affiliated with churches?
1 YES
2 NO
DK Allowed
Refusal Allowed
CHQ145D
[In the last 12 months, did {CHILD} regularly get exercise through any of the following organizations?]
YMCA, YWCA, or other similar organizations?
1 YES
2 NO
DK Allowed
Refusal Allowed
CHQ145E
[In the last 12 months, did {CHILD} regularly get exercise through any of the following organizations?]
A health club or private spa?
1 YES
2 NO
DK Allowed
Refusal Allowed
CHQ145F
[In the last 12 months, did {CHILD} regularly get exercise through any of the following organizations?]
Cub Scouts, {Daisies/Brownies}, or other scouts?
1 YES
2 NO
DK Allowed
Refusal Allowed
CHQ145G
[In the last 12 months, did {CHILD} regularly get exercise through any of the following organizations?]
4-H or other farm clubs?
1 YES
2 NO
DK Allowed
Refusal Allowed
CHQ150
What types of exercise or physical activity did {CHILD} get at the places you just mentioned? [yes/no]
a.
b.
c.
d.
e.
f.
Group sports?
Individual sports?
Dance?
Recreational Sports or outdoor activities?
Martial Arts?
Playground activities?
A-130
g.
h.
Calisthenics or General exercising?
Anything else?
CHQ155
Child A prefers to spend his/her free time reading, playing video games, or watching TV. Child B prefers to spend
his/her free time riding a bike, swimming, and playing sports. Is your child…
1 More like Child A,
2 more like Child B, or
3 similar to both Child A and Child B?
DK Allowed
Refusal Allowed
CHQ740
{In an earlier year of the study, someone in your household told us that {CHILD} has attention deficit disorder, ADHD, or
hyperactivity.} Is {CHILD} now taking any prescription medicine for the condition related to {his/her] ADD, ADHD, or hyperactivity?
YES.........................................................................
NO...........................................................................
REFUSED...............................................................
DON'T KNOW .........................................................
1
2 (CHQ.770)
7 (CHQ.770)
9 (CHQ.770)
CHQ.750
Is {he/she} taking….
a.
b.
c.
d.
e.
f.
g.
Ritalin (METHYLPHENIDATE)?................................
Adderall (AMPHETAMINE)?......................................
Dexedrine (DEXTRO-AMPHETAMINE)? ..................
Metadate (METHYLPHENIDATE)? ...........................
Concerta (METHYLPHENIDATE)? ...........................
Straterra (ATOMOXETINE)? .....................................
Something else? (SPECIFY) .....................................
YES
1
1
1
1
1
1
1
CHQ.760
How long has {CHILD} taken such prescription medicine for this condition, in total?
1
2
3
4
5
Less than one month,
Less than a year,
1 to 2 years,
3 to 4 years, or
5 years or more?
A-131
NO
2
2
2
2
2
2
2
REF
7
7
7
7
7
7
7
DK
9
9
9
9
9
9
9
CHQ160
During this school year, did (CHILD) receive any services for children with special needs such as speech therapy or
did (he/she) participate in a special education program?
1 YES
2 NO
DK Allowed (CHQ180BX)
Refusal Allowed (CHQ180BX)
(CHQ170)
(CHQ180BX)
CHQ170
Overall, how satisfied are you with the special services or special education program that {CHILD} has received this
school year? Are you:
1
2
3
4
5
Completely satisfied,
very satisfied,
fairly satisfied,
somewhat dissatisfied, or
very dissatisfied?
DK Allowed
Refusal Allowed
A-132
PARENT’S PSYCHOLOGICAL WELL-BEING AND HEALTH - PPQ
PPQ100
I'm going to read some statements that may relate to how you have felt about yourself and your life during the past
week. For each statement I read, please indicate how often in the past week you felt or behaved this way. There
are no right or wrong answers.
How often during the past week have you felt that you were bothered by things that don't usually bother you? Would
you say never, some of the time, a moderate amount of the time, or most of the time?
1 NEVER
2 SOME OF THE TIME
3 A MODERATE AMOUNT OF THE TIME
4 MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ110
How often during the past week have you felt that you did not feel like eating, that your appetite was poor?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ120
How often during the past week have you felt that you could not shake off the blues even with help from your family
or friends?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ130
How often during the past week have you felt that you had trouble keeping your mind on what you were doing?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
A-133
PPQ140
How often during the past week have you felt depressed?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ150
How often during the past week have you felt that everything you did was an effort?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ160
How often during the past week have you felt fearful?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ170
How often during the past week have you felt that your sleep was restless?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
A-134
PPQ180
How often during the past week have you felt that you talked less than usual?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ190
How often during the past week have you felt lonely?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ200
How often during the past week have you felt sad?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
PPQ210
How often during the past week have you felt that you could not get going?
[PROBE: Would you say never, some of the time, a moderate amount of the time, or most of the time?]
1
2
3
4
NEVER
SOME OF THE TIME
A MODERATE AMOUNT OF THE TIME
MOST OF THE TIME
DK Allowed
Refusal Allowed
A-135
PPQ220
Now, I would like to ask you about your health. In general, would you say that your health is…
1 Excellent,
2 Very good,
3 Good,
4 Fair, or
5 Poor?
DK Allowed
Refusal Allowed
PPQ230
Does any impairment or health problem now keep you from working at a job or business?
1 YES
2 NO
DK Allowed
Refusal Allowed
PPQ240
Are you limited in the kind or amount of work you can do because of any impairment or health problem?
1 YES
2 NO
DK Allowed
Refusal Allowed
PPQ250
During the past 12 months, have you felt or has anyone suggested that you needed professional help for any
emotional problem or for drug or alcohol use?
1 YES
2 NO
DK Allowed (PPQ265BX)
Refusal Allowed (PPQ265BX)
(PPQ260)
(PPQ265BX)
PPQ260
Did you get help for your problem?
1 YES
2 NO
DK Allowed
Refusal Allowed
PPQ261
About how tall are you without shoes?
ENTER FEET AND INCHES
Range for feet: 4 to 7
Range for inches: 0-11
DK Allowed
Refusal Allowed
A-136
PPQ262
About how much do you weigh without shoes?
ENTER POUNDS
Range: 95-300
DK Allowed
Refusal Allowed
PPQ270
During the past 12 months, has {CHILD}'s biological father felt or has anyone suggested that he needed professional
help for any emotional problem or for drug or alcohol use?
1 YES
2 NO
DK Allowed (PPQ285BX)
Refusal Allowed (PPQ285BX)
(PPQ280)
(PPQ285BX)
PPQ280
Did he get help for his problem?
1 YES
2 NO
DK Allowed
Refusal Allowed
PPQ290
During the past 12 months, has {CHILD}'s stepfather felt or has anyone suggested that he needed professional help
for any emotional problem or for drug or alcohol use?
1 YES
2 NO
DK Allowed (PPQ310BX)
Refusal Allowed (PPQ310BX)
(PPQ300)
(PPQ310BX)
PPQ300
Did he get help for his problem?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-137
FOOD SECURITY – FDQ
*Note. Food Security was fielded as part of the ECLS-K, however the items are re-ordered to follow current guidelines as fielded on
the 2007 Current Population Survey: Food Security Supplement (2007 CPS-FSS).
FDQ.130a
These next questions are about whether your family is able to afford the food that you need. I am going to read you several
statements that people have made about their food situation. For these statements, please tell me whether the statement was often
true, sometimes true, or never true for {you/your household} in the last 12 months, that is, since last {current month}, 2009.
PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?
The first statement is: {I/We} worried whether {my/our} food would run out before {I/we} got money to buy more. Was that often true,
sometimes true, or never true for {you/your household} in the last 12 months?
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE
DK Allowed
Refusal Allowed
FDQ.130a1
Did this happen in the last 30 days?
1
2
YES
NO
DK Allowed
Refusal Allowed
FDQ.130b
[These next questions are about whether your family is able to afford the food that you need. I am going to read you several
statements that people have made about their food situation. For these statements, please tell me whether the statement was often
true, sometimes true, or never true for {you/your household} in the last 12 months, that is, since last {current month}, 2009.]
[PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?]
The food that {I/we} bought just didn’t last, and {I/we} didn’t have money to get more. Was that often true, sometimes true, or never
true for {you/your household} in the last 12 months?
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE
DK Allowed
Refusal Allowed
A-138
FDQ.130b1
Did this ever happen in the last 30 days?
3
4
YES
NO
DK Allowed
Refusal Allowed
FDQ.130c
[These next questions are about whether your family is able to afford the food that you need. I am going to read you several
statements that people have made about their food situation. For these statements, please tell me whether the statement was often
true, sometimes true, or never true for {you/your household} in the last 12 months, that is, since last {current month}, 2009.]
[PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?]
{I/We} couldn’t afford to eat balanced meals.
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE
DK Allowed
Refusal Allowed
FDQ.130d
[These next questions are about whether your family is able to afford the food that you need. I am going to read you several
statements that people have made about their food situation. For these statements, please tell me whether the statement was often
true, sometimes true, or never true for {you/your household} in the last 12 months, that is, since last {current month}, 2009.]
[PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?]
{I/We} couldn’t afford to eat nutritious meals.
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE
DK Allowed
Refusal Allowed
A-139
FDQ.130e
[These next questions are about whether your family is able to afford the food that you need. I am going to read you several
statements that people have made about their food situation. For these statements, please tell me whether the statement was often
true, sometimes true, or never true for {you/your household} in the last 12 months, that is, since last {current month}, 2009.]
[PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?]
{We/I} couldn’t afford to eat the quality and variety of foods that {I/we} should.
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE
DK Allowed
Refusal Allowed
FDQ.140
In the last 12 months, did {you/you or other adults in your household} ever cut the size of your meals or skip meals because there
wasn't enough money for food?
1 YES (FDQ.150)
2 NO (FDQ.160)
DK Allowed (FDQ.160)
Refusal Allowed (FDQ.160)
FDQ.150
How often did this happen? Would you say…
1 Almost every month,
2 Some months, but not every month, or
3 In only 1 or 2 months?
DK Allowed
Refusal Allowed
FDQ.151
Now think about the last 30 days? During that time did (you/you or other adults in your household) ever cut the size of your meals
or skip meals because there wasn’t enough money for food?
1
2
YES
NO
DK Allowed
Refusal Allowed
A-140
FDQ.152
How many days did this happen in the last 30 days?
DK Allowed
Refusal Allowed
FDQ.160
In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money to buy food?
1 YES
2 NO (FDQ.170)
DK Allowed (FDQ.170)
Refusal Allowed (FDQ.170)
FDQ.165
How often did this happen? Would you say…
1 Almost every month,
2 Some months, but not every month, or
3 In only 1 or 2 months?
DK Allowed
Refusal Allowed
FDQ.166
In the last 30 days, how many days did you eat less than you felt you should because there wasn’t enough money for food?
ENTER NUMBER OF DAYS
DK Allowed
Refusal Allowed
FDQ.170
In the last 12 months, were you ever hungry but didn't eat because there wasn't enough money to buy food?
1 YES
2 NO (FDQ.180)
DK Allowed (FDQ.180)
Refusal Allowed (FDQ.180)
A-141
FDQ.175
How often did this happen? Would you say…
1 Almost every month,
2 Some months, but not every month, or
3 In only 1 or 2 months?
DK Allowed
Refusal Allowed
FDQ.176
In the last 30 days, how many days were you hungry but didn’t eat because there wasn’t enough money for food?
ENTER NUMBER OF DAYS
DK Allowed
Refusal Allowed
FDQ.180
In the last 12 months, did you lose weight because there wasn't enough money to buy food?
1 YES
2 NO (FDQ.180)
DK Allowed (FDQ.180)
Refusal Allowed (FDQ.180)
FDQ.185
How often did this happen? Would you say…
1 Almost every month,
2 Some months, but not every month, or
3 In only 1 or 2 months?
DK Allowed
Refusal Allowed
FDQ.190
In the last 12 months, did {you/you or other adults in your household} ever not eat for a whole day because there wasn't enough
money for food?
1 YES
2 NO (FDQ.180)
DK Allowed (FDQ.180)
Refusal Allowed (FDQ.180)
FDQ.191
How often did this happen? Would you say…
1 Almost every month,
2 Some months, but not every month, or
3 In only 1 or 2 months?
DK Allowed
Refusal Allowed
A-142
FDQ.191a
Now think about the last 30 days. During that time did (you/ you or other adults in your household) ever not eat for a whole day
because there wasn't enough money for food?
1 YES
2 NO
DK Allowed
Refusal Allowed
FDQ.191a
How many times did this happen in the last 30 days?
ENTER TIMES
DK Allowed
Refusal Allowed
FDQ.192
Now I am going to read you several statements that people have made about the food situation of their children. For these
statements, please tell me whether the statement was often true, sometimes true, or never true in the last 12 months, that is, since
last {current month}, 2009, for {your child/children living in the household who are under 18 years old}.
{I/We} relied on only a few kinds of low-cost food to feed {{CHILD}/the children} because {I was/we were} running out of money to
buy food. Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?
PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE
DK Allowed
Refusal Allowed
FDQ.193
[Now I am going to read you several statements that people have made about the food situation of their children. For these
statements, please tell me whether the statement was often true, sometimes true, or never true in the last 12 months, that is, since
last {current month}, 2009, for {your child/children living in the household who are under 18 years old}.]
{I/We} couldn't feed {{CHILD}/the children} a balanced meal because {I/we} couldn't afford that. Was that often true, sometimes true,
or never true for {you/your household} in the last 12 months?
[PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?]
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE (FDQ.196)
DK Allowed (FDQ.196)
Refusal Allowed (FDQ.196)
A-143
FDQ.194
[Now I am going to read you several statements that people have made about the food situation of their children. For these
statements, please tell me whether the statement was often true, sometimes true, or never true in the last 12 months, that is, since
last {current month}, 2009, for {your child/children living in the household who are under 18 years old}.]
{I/We} couldn't feed {{CHILD}/the children} a nutritious meal because {I/we} couldn't afford that.
[PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?]
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE
DK Allowed
Refusal Allowed
FDQ.195
[Now I am going to read you several statements that people have made about the food situation of their children. For these
statements, please tell me whether the statement was often true, sometimes true, or never true in the last 12 months, that is, since
last {current month}, 2009, for {your child/children living in the household who are under 18 years old}.]
{I/We} couldn't feed {{CHILD}/the children} the quality and variety of food that we should, because {I/we} couldn't afford that.
[PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?]
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE (FDQ.196)
DK Allowed (FDQ.196)
Refusal Allowed (FDQ.196)
FDQ.196
[Now I am going to read you several statements that people have made about the food situation of their children. For these
statements, please tell me whether the statement was often true, sometimes true, or never true in the last 12 months, that is, since
last {current month}, 2009, for {your child/children living in the household who are under 18 years old}.]
{{CHILD} was/The children were} not eating enough because {I/we} just couldn't afford enough food.
[PROBE: Was that often true, sometimes true, or never true for {you/your household} in the last 12 months?]
1 OFTEN TRUE
2 SOMETIMES TRUE
3 NEVER TRUE
DK Allowed
Refusal Allowed
A-144
FDQ.210
In the last 12 months, since {CURRENT MONTH OF LAST YEAR}, 2009 did you ever cut the size of {{CHILD}'s/any of the
children's} meals because there wasn't enough money for food?
1 YES
2 NO (FDQ.240)
DK Allowed (FDQ.240)
Refusal Allowed (FDQ.240)
FDQ.211
How often did this happen? Would you say…
1 Almost every month,
2 Some months, but not every month, or
3 In only 1 or 2 months?
DK Allowed
Refusal Allowed
FDQ.212
In the last 30 days, how many days did you cut the size of (your child’s/the children’s) meals because there wasn't enough money
for food?
ENTER NUMBER OF DAYS
DK Allowed
Refusal Allowed
FDQ.240
In the last 12 months, {was {CHILD}/were any of the children} ever hungry but you just couldn't afford more food?
1 YES
2 NO (FDQ.242)
DK Allowed (FDQ.242)
Refusal Allowed (FDQ.242)
FDQ.241
How often did this happen? Would you say…
1 Almost every month,
2 Some months, but not every month, or
3 In only 1 or 2 months?
DK Allowed
Refusal Allowed
FDQ.241b
In the last 30 days, how many days (was your child/were the children) but you just couldn’t afford more food?
ENTER NUMBER OF DAYS
DK Allowed
Refusal Allowed
A-145
FDQ.242
In the last 12 months, did {{CHILD}/any of the children} ever skip a meal because there wasn't enough money for food?
1 YES
2 NO (FDQ.250)
DK Allowed (FDQ.250)
Refusal Allowed (FDQ.250)
FDQ.243
How often did this happen? Would you say…
1 Almost every month,
2 Some months, but not every month, or
3 In only 1 or 2 months?
DK Allowed
Refusal Allowed
FDQ.244
Now think about the last 30 days. Did (your child/the children) ever skip a meal because there wasn’t enough money for food?
1
2
YES
NO
DK Allowed
Refusal Allowed
FDQ.250
In the last 12 months, did {{CHILD}/any of the children} ever not eat for a whole day because there wasn't enough money for food?
1 YES
2 NO
DK Allowed
Refusal Allowed
A-146
WELFARE AND OTHER PUBLIC TRANSFERS - WPQ
WPQ100
(Since {DATE OF LAST INTERVIEW})/In the past 12 months), have you or anyone in your household received
Temporary Assistance for Needy Families, sometimes called TANF {or {STATE TANF PROGRAM NAME}}?
PROBE: TANF was formally known as Aids to Families with Dependent Children, or AFDC.
1 YES
2 NO
DK Allowed
Refusal Allowed
(WPQ110)
WPQ105
(Since {DATE OF LAST INTERVIEW}/During those 12 months), how many months did your household
receive TANF {or {STATE TANF PROGRAM NAME}}?
ENTER NUMBER OF MONTH(S).
Range:1 to 12
DK Allowed
Refusal Allowed
WPQ110
(Since {DATE OF LAST INTERVIEW}/In the past 12 months), have you or anyone in your household received food
stamps?
1 YES
2 NO
DK Allowed (WPQ150)
Refusal Allowed (WPQ150)
(WPQ120)
(WPQ150)
WPQ120
(Since {DATE OF LAST INTERVIEW}/During those 12 months), how many months did your household
receive food stamps?
ENTER NUMBER OF MONTH(S).
Range:1 to 12
DK Allowed
Refusal Allowed
WPQ150
Does {CHILD}'s school offer lunch for its students?
1 YES
2 NO
DK Allowed (WPQ200)
Refusal Allowed (WPQ200)
(WPQ160)
(WPQ200)
A-147
WPQ160
Does {CHILD} usually receive a complete lunch offered at school?
PROBE: By complete school lunch, I mean a complete meal such as a salad, soup, a sandwich, or a hot meal that is
offered each day at a fixed price, not just milk, snacks, ice cream, or a lunch (he/she) brought from home.
1 YES
2 NO
DK Allowed (WPQ200)
Refusal Allowed (WPQ200)
(WPQ170)
(WPQ200)
WPQ170
Does {Child} receive free or reduced price lunches at school?
1 YES
2 NO
DK Allowed (WPQ200)
Refusal Allowed (WPQ200)
(WPQ180)
(WPQ200)
WPQ180
Are these lunches free or reduced price?
1 FREE
2 REDUCED PRICE
DK Allowed (WPQ200)
Refusal Allowed (WPQ200)
(WPQ190)
(WPQ200)
WPQ190
During the last five days {CHILD} was in school, how many complete school lunches did (he/she) receive?
Range:0 to 5
DK Allowed
Refusal Allowed
WPQ200
Does {CHILD}'s school offer breakfast for its students?
1 YES
2 NO
DK Allowed (WPQ230)
Refusal Allowed (WPQ230)
(WPQ210)
(WPQ230)
WPQ210
Does {CHILD} usually receive a breakfast provided by the school?
1 YES
2 NO
DK Allowed (WPQ230)
Refusal Allowed (WPQ230)
(WPQ220)
(WPQ230)
A-148
WPQ215
Does {CHILD} receive free or reduced price breakfasts at school?
1
2
YES (WPQ216)
NO (WPQ230)
DK Allowed (WPQ230)
Refusal Allowed (WPQ230)
WPQ216
Are these breakfasts free or reduced price?
1
2
FREE
REDUCED PRICE
DK Allowed
Refusal Allowed
WPQ220
During the last five days {CHILD} was in school, how many school breakfasts did (he/she) receive?
Range:0 to 5
DK Allowed
Refusal Allowed
WPQ230
Does {CHILD} attend a day care center or a before or after school program, or receive child care in someone else's
home?
1 YES
2 NO
DK Allowed (WPQ250BX)
Refusal Allowed (WPQ250BX)
(WPQ240)
(WPQ250BX)
WPQ240
How many meals or snacks per day does {CHILD} receive in total at all the day care centers or the before or after school
programs (he/she) attends?
Range:0 to 5
DK Allowed
Refusal Allowed
A-149
PARENT INCOME AND ASSETS - PAQ
PAQ100
[In studies like this, households are sometimes grouped according to income. What was the total income of all persons in your
household over the past
year, including salaries or other earnings, interest, retirement, and so on for all household members?]
Was it…
1 $25,000 or less, or
2 more than $25,000?
DK Allowed
Refusal Allowed
PAQ110
Was it…
[SET 1]
1
2
3
4
5
$5,000 or less,
$5,001 to $10,000,
$10,001 to $15,000,
$15,001 to $20,000, or
$20,001 to $25,000?
[SET 2]
6 $25,000 to $30,000,
7 $30,001 to $35,000,
8 $35,001 to $40,000,
9 $40,001 to $50,000,
10 $50,001 to $75,000, or
11 over $75,000?
DK Allowed
Refusal Allowed )
BOX 3
IF HOUSEHOLD IS AT 200 PERCENT OF POVERTY OR BELOW, GO TO PAQ.120. ELSE, GO TO PAQ.135.
PAQ120
What was your total household income last year, to the nearest thousand?
|___|___|___|,|___|___|___|,|___|___|___|.
TOTAL INCOME
DK Allowed
Refusal Allowed
PAQ135
Is tuition paid for {CHILD}'s education?
1 YES
2 NO
DK Allowed (PAQ140BX)
Refusal Allowed (PAQ140BX)
(PAQ137)
(PAQ140BX)
A-150
PAQ137
Approximately, how much does {CHILD}'s family pay in tuition per year?
$ |___|___| , |___|___|___|
ENTER AMOUNT OF TUITION
Soft Range: 1 to 33000
DK Allowed
Refusal Allowed
A-151
Items from CMQ, spring-K, that weren’t in OMB
CMQ100
Just to make sure I can reach you for the next interview, which will take place next spring, I'd like to ask a few
questions about how to find you.
I have recorded {PHONE NUMBER} as a second phone number where you can sometimes be reached? Is this the
right number?
1 YES
2 NO
DK Allowed
Refusal Allowed
CMQ200
I have recorded that {NAME OF RELATIVE/FRIEND}
at {PHONE NUMBER}
on
{STREET ADDRESS, LINE 1}
{STREET ADDRESS, LINE 2}
{CITY}
{STATE}
{ZIP CODE}
will always know where you are if you move. Is this still true?
IF NECESSARY SAY: I will only contact this person if I cannot locate you for the next interview.
1 YES --- NO CORRECTION NEEDED
2 YES --- MINOR CORRECTIONS NEEDED
3 NO
DK Allowed
Refusal Allowed
CMQ300
I have also recorded that {NAME OF RELATIVE/FRIEND}
at {PHONE NUMBER}
on
{STREET ADDRESS, LINE 1}
{STREET ADDRESS, LINE 2}
{CITY}
{STATE}
{ZIP CODE}
will always know where you are if you move. Is this still true?
IF NECESSARY SAY: I will only contact this person if I cannot locate you for the next interview.
1 YES --- NO CORRECTION NEEDED
2 YES --- MINOR CORRECTIONS NEEDED
3 NO
DK Allowed
Refusal Allowed
A-152
CMQ395
I have recorded {NAME OF NONRESIDENTIAL PARENT} at {PHONE NUMBER}
on
{STREET ADDRESS, LINE 1}
{STREET ADDRESS, LINE 2}
{CITY}
{STATE}
{ZIP CODE}
is {CHILD}'s {RELATIONSHIP AT CMQ170}.
Is this information still correct?
IF NECESSARY SAY: I will only contact this person if I cannot locate you for the next interview.
1
2
3
4
YES --- NO CORRECTIONS NEEDED
YES --- MINOR CORRECTIONS NEEDED
NO
INFORMATION ALREADY PROVIDED IN PREVIOUS ITEMS
DK Allowed
Refusal Allowed
CMQ600
My records indicate that {CHILD} currently attends {NAME OF SCHOOL}. Will {he/she} be attending this school next
year?
IF NO SCHOOL NAME APPEARS ON SCREEN, ENTER 2 FOR “NO”.
1 YES
2 NO
DK Allowed
Refusal Allowed
CMQ610
What is the name, address, and telephone number of the school {CHILD} will attend for first grade?
ENTER SCHOOL NAME.
CMQ620
[What is the name, address, and telephone number of the school {CHILD} will attend for first grade?]
ENTER STREET ADDRESS, LINE 1.
DK Allowed
Refusal Allowed
CMQ630
[What is the name, address, and telephone number of the school {CHILD} will attend for first grade?]
ENTER STREET ADDRESS, LINE 2.
DK Allowed
A-153
Refusal Allowed
CMQ640
[What is the name, address, and telephone number of the school {CHILD} will attend for first grade?]
ENTER CITY.
DK Allowed
Refusal Allowed
A-154
CMQ650
[What is the name, address, and telephone number of the school {CHILD} will attend for first grade?]
ENTER STATE.
Range:0 to 0
DK Allowed
Refusal Allowed
CMQ660
[What is the name, address, and telephone number of the school {CHILD} will attend for first grade?]
ENTER ZIP CODE.
DK Allowed
Refusal Allowed
CMQ670
[What is the name, address, and telephone number of the school {CHILD} will attend for first grade?]
DK Allowed
Refusal Allowed
CMQ671
Is it a public or private school?
1 PUBLIC
2 PRIVATE
DK Allowed
Refusal Allowed
CMQ672
What is the name of the district this school is located in?
DK Allowed )
Refusal Allowed
A-155
CMQ673
What type of private school is it?
PROBE: Is it Catholic, another type of religious affiliation, or is it non-religious?
1 CATHOLIC
2 ANOTHER TYPE OF RELIGIOUS AFFILIATION
3 NON-RELIGIOUS
DK Allowed
Refusal Allowed
CMQ674
What is the name of the diocese?
DK Allowed (CMQ675BX)
Refusal Allowed (CMQ675BX
CMQ690
WAS THIS INTERVIEW CONDUCTED IN ENGLISH, SPANISH, OR ANOTHER LANGUAGE?
1 ENGLISH
2 SPANISH
91 ANOTHER LANGUAGE (SPECIFY)
CMQ690OS
[WAS THIS INTERVIEW CONDUCTED IN ENGLISH, SPANISH, OR ANOTHER LANGUAGE?]
SPECIFY OTHER LANGUAGE.
CMQ.695
WHERE WAS THIS INTERVIEW CONDUCTED?
1
2
3
CHILD’S HOME
CHILD’S SCHOOL
SOMEWHERE ELSE
A-156
| File Type | application/pdf |
| File Title | Microsoft Word - Appendix A-2.DOC |
| Author | tomasino-rosales_l |
| File Modified | 2009-01-05 |
| File Created | 2009-01-05 |