Appendix_E

S tudy to Explore Early Development

How to Collect Cheek Swab Samples

Thank you for agreeing to give cheek swab samples. This kit has the following items:

• Consent forms (copies for you to keep and copies for you to sign and return).

• Envelope containing brushes (three brushes per person)

• Cheek Swab Sample Record form (one form per person)

• Large pre-stamped, addressed envelope

• Small addressed envelopes

Please read this document before you start collecting the cheek swab samples.

We need samples from each of the family members listed below.

Family Member		Name

Wait at least 1 hour after eating before you collect the samples. For children, a good time to collect the sample might be before tooth brushing.

If more than one person is listed above, please try to do the samples for everyone on the same day.

Please mail completed samples back to us within 24 hours.

Each person named above should follow the steps on the back of this page when collecting the cheek swab samples. You might want to have your child watch you take your sample before you take a sample from him or her. It might be helpful to show your child the brush and tell him or her that it is “like a special toothbrush for the cheeks.” If you can’t get all three samples from your child, please return the ones you can get.

Please read all the directions on the back of this page before you start collecting the cheek swab samples.

E ach adult should read and sign one copy of the enclosed consent forms. Check the title of the form to make sure that you sign the correct form. Put the signed forms into the small, self, addressed envelope and seal the envelope. Please call us if you have any questions.

1. Take out the envelope that is labeled for you. For example, if you are the child’s biological mother, you should use the envelope labeled “Mother.” Inside you will find a sheet titled Cheek Swab Sample Record. Answer the three questions in Section A.

Note: If this envelope is for your child’s sample, the Cheek Swab Sample Record should be green. For the biological mother, the sheet should be yellow. For the biological father, the sheet should be blue.

2. Take out the plastic pouch labeled Brush #1. Slowly tear part of the backing of the pouch; start where it says “peel at arrow” and peel back about an inch. See Figure A. Carefully take the brush out of the pouch. Do NOT touch the brush end.

3. Hold the brush handle in one hand and place the brush end inside your mouth, against your cheek. Place your other hand on the outside of the cheek. Twirl the brush firmly against the inside of the cheek and your cheek’s “gutter” for 30 seconds. The gutter is the area between your gums and cheek. Use the other hand to apply gentle pressure from the outside. See Figures B and C.

If you are collecting your child’s sample, you may want to do the brushing for him or her. Ask your child to open his or her mouth wide. Remember to use your other hand to gently apply pressure from the outside of the cheek.

4. Put the brush back in the pouch, brush end first. Do not re-use the brush. See Figure D.

5. Answer the questions in Section B of the Cheek Swab Sample Record for Brush #1.

6. Repeat steps 3 through 6 with Brush #2. This time use the other side of your cheek and gutter.

7. Repeat steps 3 through 6 with Brush #3. This time twirl the brush for about 15 seconds on both sides of the mouth and gutter.

8. After collecting all three samples, complete Section C of the Cheek Swab Sample Record. Put all three completed cheek samples back into the envelope they came in. Complete Section D of the Cheek Swab Sample Record and put the form inside the envelope with the brushes.

9. All other family members listed on the front of this sheet should follow steps 2–9 using the brushes labeled for them.

10. When everyone has finished collecting all their samples, place all samples in the large, pre-addressed, stamped envelope. Seal the large return envelope and send it to us by U.S. mail. Remember, mail the samples within 24 hours of collecting them. Please place the consent forms in the smaller envelope so that they may be returned to the study staff.

If you have any questions on how to collect these samples, please call us at [phone number]. We will be happy to help in any way!

Version 9-07 SNC Page 2 of 2