Appendix
A A.1.1.a–
Visit Type: Enumeration
Target: Adult Household Member
T1 Father Interview
T1 Dad Visit: Interview Introduction
IN001. Thank you for agreeing to participate in this study. We are about to begin the interview portion of today’s home visit, which will take about 30 minutes to complete. Your answers are important to us. There are no right or wrong answers, just those that help us to understand your situation. There are questions about where you work, your health, and your feelings during this interview and you can always refuse to answer any question or group of questions.
IN002. Are you ready to begin?
YES 1
NO 2 (END interview)
T1 Dad Visit: Demographics Part 1
DE001. I’ll begin by asking some questions about you.
DE002. How old are you?
|___|___|___|
AGE IN YEARS
REFUSED 9--97
DON’T KNOW 9--98
DE003. Now I’d like to ask about your marital status. What is your current marital status? Are you:
Married, 01
Not married but living together with a partner of the opposite sex, 02
Not married but living together with a partner of the same sex, 03
Widowed, 04
Divorced, 05
Separated, or 06
Never been married? 07
REFUSED 9--97
DON’T KNOW 9--98
DE004. Do you consider yourself to be Hispanic, or Latino?
YES 1
NO 2 (DE005)
REFUSED 9--97 (DE005)
DON’T KNOW 9--98 (DE005)
DE005. Please give me the number of the group that represents Hispanic origin or ancestry.
SHOW CARD DE2.
PUERTO RICAN 01
CUBAN/CUBAN AMERICAN 02
DOMINICAN (REPUBLIC) 03
MEXICAN 04
MEXICAN AMERICAN 05
CENTRAL OR SOUTH AMERICAN 06
OTHER 96
REFUSED 9--97
DON’T KNOW 9--98
DE006. What race do you consider yourself to be? You may select one or more.
PROBE: Anything else?
SELECT ALL THAT APPLY.
White, 1
Black or African American, 2
American Indian or Alaska Native, 3
Asian, or 4
Native Hawaiian or Other Pacific Islander? 5
SOME OTHER RACE? (SPECIFY): 6
REFUSED 9--97
DON’T KNOW 9--98
DE007. Please look at the card and tell me what is the highest degree or level of school that you have completed?
SHOW CARD DE3.
NO SCHOOL 01
ELEMENTARY
NURSERY SCHOOL TO 4TH GRADE 02
5TH-6TH GRADE 03
7TH-8TH GRADE 04
HIGH SCHOOL
9TH GRADE 05
10TH GRADE 06
11TH GRADE 07
12TH GRADE (NO DIPLOMA) 08
HIGH SCHOOL DIPLOMA 09
GED OR EQUIVALENT 10
COLLEGE
SOME COLLEGE CREDITS, BUT LESS THAN 1 YEAR 11
1 OR MORE YEARS OF COLLEGE, BUT NO DEGREE 12
ASSOCIATE DEGREE: OCCUPATIONAL, TECHNICAL, OR
VOCATIONAL PROGRAM 13
ASSOCIATE DEGREE: ACADEMIC PROGRAM 14
BACHELOR’S DEGREE (e.g., BA, BS) 15
GRADUATE
MASTER’S DEGREE (e.g., MA, MS, MSW, MEng, MBA) 16
PROFESSIONAL SCHOOL DEGREE (e.g., MD, DDS, DVM, JD) 17
DOCTORAL DEGREE (e.g., Ph.D., Ed.D.) 18
REFUSED 9--97
DON’T KNOW 9--98
T1 Dad Visit: Paternal Medical History
MC001. The next questions are about medical conditions or health problems you have or have had.
MC002. Have you ever been told by a doctor or other health care provider that you had asthma?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC003. (Have you ever been told by a doctor or other health care provider that you had:)
Eczema or atopic dermatitis?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC004. (Have you ever been told by a doctor or other health care provider that you had:)
Seasonal allergies?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC005. (Have you ever been told by a doctor or other health care provider that you had:)
Any other allergies?
YES 1
NO 2 (MC007)
REFUSED 9--97 (MC007)
DON’T KNOW 9--98 (MC007)
MC006. What type of allergy do you have?
SELECT ALL THAT APPLY.
PEANUTS 1
BEE STINGS 2
SHELLFISH 3
CATS 4
DOGS 5
OTHER (SPECIFY): 6
REFUSED 9--97
DON’T KNOW 9--98
MC007. (Have you ever been told by a doctor or other health care provider that you had:)
Hypertension or high blood pressure?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC008. (Have you ever been told by a doctor or other health care provider that you had:)
Diabetes?
YES 1
NO 2 (MC013)
REFUSED 9--97 (MC013)
DON’T KNOW 9--98 (MC013)
MC009. Have you taken any medicine or received other medical treatment for this in the past 12 months?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC010. Have you ever taken insulin?
YES 1
NO 2 (MC013)
REFUSED 9--97 (MC013)
DON’T KNOW 9--98 (MC013)
MC011. Were you taking medication by mouth (for example, pills) for diabetes?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC012. Were you taking Insulin, either by injection or by pump?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC013. (Have you ever been told by a doctor or other health care provider that you had:)
High cholesterol?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC014. (Have you ever been told by a doctor or other health care provider that you had:)
Any type of cancer?
YES 1
NO 2 (MC016)
REFUSED 9--97 (MC016)
DON’T KNOW 9--98 (MC016)
MC015. What type or types of cancer were you diagnosed with?
SELECT ALL THAT APPLY.
BRAIN 1
BREAST 2
CERVICAL (FEMALE ONLY) 3
COLON 4
HODGKIN’S LYMPHOMA 5
LEUKEMIA 6
LIVER 7
LUNG 8
NON-HODGKIN’S LYMPHOMA 9
OVARIAN (FEMALE ONLY) 10
PROSTATE (MALE ONLY) 11
SKIN 12
TESTICULAR (MALE ONLY) 13
THYROID 14
UTERINE (FEMALE ONLY) 15
OTHER (SPECIFY): 96
REFUSED 9--97
DON’T KNOW 9--98
MC016. (Have you ever been told by a doctor or other health care provider that you had:)
Sickle cell anemia or sickle cell trait?
YES 1
NO 2 (MC018)
REFUSED 9--97 (MC018)
DON’T KNOW 9--98 (MC018)
MC017. Which do you have?
SICKLE CELL ANEMIA 1
SICKLE CELL TRAIT 2
REFUSED 9--97
DON’T KNOW 9--98
MC018. (Have you ever been told by a doctor or other health care provider that you had:)
An autoimmune disorder such as rheumatoid arthritis, lupus, or scleroderma?
YES 1
NO 2 (MC020)
REFUSED 9--97 (MC020)
DON’T KNOW 9--98 (MC020)
MC019. What type of autoimmune disorder were you diagnosed with?
RHEUMATOID ARTHRITIS 01
LUPUS 02
SCLERODERMA 03
MULTIPLE SCLEROSIS 04
GRAVES’ DISEASE 05
OTHER (SPECIFY): 96
REFUSED 9--97
DON’T KNOW 9--98
MC020. (Have you ever been told by a doctor or other health care provider that you had:)
Migraines?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC021. (Have you ever been told by a doctor or other health care provider that you had:)
Epilepsy or seizures?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC022. (Have you ever been told by a doctor or other health care provider that you had:)
Sleep apnea?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC023. (Have you ever been told by a doctor or other health care provider that you had:)
Blindness or any severe vision impairment?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC024. (Have you ever been told by a doctor or other health care provider that you had:)
Deafness or any severe hearing impairment?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC025. (Have you ever been told by a doctor or other health care provider that you had:)
Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC026. (Have you ever been told by a doctor or other health care provider that you had:)
Autism, Asperger syndrome, or any other autism spectrum disorder?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC027. (Have you ever been told by a doctor or other health care provider that you had:)
Bipolar disorder?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC028. (Have you ever been told by a doctor or other health care provider that you had:)
Depression, other than bipolar disorder?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC029. (Have you ever been told by a doctor or other health care provider that you had:)
An anxiety disorder, such as generalized anxiety disorder or obsessive compulsive disorder (OCD)?
YES 1
NO 2 (MC031)
REFUSED 9--97 (MC031)
DON’T KNOW 9--98 (MC031)
MC030. What type of anxiety disorder were you diagnosed with?
SELECT ALL THAT APPLY.
GENERALIZED ANXIETY DISORDER 01
OBSESSIVE COMPULSIVE DISORDER 02
SOCIAL PHOBIA 03
SPECIFIC PHOBIA 04
OTHER (SPECIFY): 96
REFUSED 9--97
DON’T KNOW 9--98
MC031. (Have you ever been told by a doctor or other health care provider that you had:)
HIV or AIDS?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC032. (Have you ever been told by a doctor or other health care provider that you had:)
Hepatitis B?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
MC033. (Have you ever been told by a doctor or other health care provider that you had:)
Any other chronic or long lasting conditions?
YES 1
NO 2 (EOS)
REFUSED 9--97 (EOS)
DON’T KNOW 9--98 (EOS)
MC034. What other chronic condition or conditions were you diagnosed with?
(SPECIFY): 96
REFUSED 9--97
DON’T KNOW 9—98
MC035. In general, do you consider yourself to be right-handed, left-handed, or both (ambidextrous)?
RIGHT-HANDED 1
LEFT-HANDED 2
BOTH/AMBIDEXTROUS 3
REFUSED 9--97
DON’T KNOW 9--98
MC036. Now I'd like to ask about your spouse or partner's current pregnancy. Did you feel that she became pregnant sooner than you wanted, later than you wanted or at about the right time?
SOONER 1
LATER 2
AT ABOUT THE RIGHT TIME 3
REFUSED 9--97
DON’T KNOW 9--98
T1 Dad Visit: Occupational/Hobby Exposures
OH001. Now I would like to ask some questions about any schoolwork, jobs, volunteer work, and hobbies that you have done recently. Please only include activities that you do (or have done) for at least four hours a week.
OH002. Are you currently a full- or part-time student? This includes vocational or technical schooling that may not be done in a classroom.
PROBE: Do you go full-time or part-time?
NO, NOT A STUDENT 1 (OH007)
YES, FULL-TIME STUDENT 2
YES, PART-TIME STUDENT 3
REFUSED 9--97 (OH007)
DON’T KNOW 9--98 (OH007)
OH003. What type or types of school are you currently attending?
HIGH SCHOOL 1
TECHNICAL SCHOOL 2
COLLEGE OR UNIVERSITY 3
GRADUATE SCHOOL 4
PROFESSIONAL SCHOOL (E.G., MEDICAL, LAW, DENTAL) 5
OTHER (SPECIFY): 6
REFUSED 9--97
DON’T KNOW 9--98
OH004. Please refer to this card and tell me, what describes the place where you typically go to school?
SHOW CARD OH1.
SELECT ALL THAT APPLY.
CLASSROOM 01
RESIDENCE, SUCH AS YOUR HOME OR SOMEONE ELSE’S HOME 02
LABORATORY 03
GARAGE OR SHOP 04
MOTOR VEHICLE 05
SOME OTHER LOCATION (SPECIFY): 96
REFUSED 9--97
DON’T KNOW 9--98
OH005. Now I would like to ask you about the jobs you have had recently. {In the past 3 months}:
NUMBER RF DK
a. How many full-time jobs have you had? |___|___| 9--97 9--98
b. How many part-time jobs have you had? |___|___| 9--97 9--98
c. How many volunteer jobs have you had (fire department,
humane
society, etc.)? |___|___| 9--97 9--98
BOX OH02
CHECK ITEM:
|
BEGIN LOOP OH01
LOOP:
|
BOX OH03
CHECK ITEM:
|
OH006. {Now I’d like to ask some questions about each one of your paid or volunteer jobs, starting with the job where you work the most hours/Now think about the job where you work the next greatest number of hours}”.
OH007. Are you currently employed at this job?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
OH008. For this job, what {is/was} your job title or occupation?
_____________________________________________________
JOB TITLE
REFUSED 9--97
DON’T KNOW 9--98
OH009. For this job, who {is/was} your employer?
_____________________________________________________
EMPLOYER
REFUSED 9--97
DON’T KNOW 9--98
OH010. What types of activities {do/did} you do most often at this job? For example, teach classes, work on the computer, keep account books, file, photocopy, answer phone, wait tables, help customers, do lab work, or carpentry?
PROBE: Anything else?
_____________________________________________________
ACTIVITY
REFUSED 9--97
DON’T KNOW 9--98
OH011. In what kind of business or industry {is/was} this job? That is, what does this company make or do?
_____________________________________________________
INDUSTRY
REFUSED 9--97
DON’T KNOW 9--98
OH012. On average, how many hours a week {do/did} you usually work at this job?
|___|___|___|
NUMBER OF HOURS
REFUSED 9--97
DON’T KNOW 9--98
OH013. Please look at this card and tell me, what best describes the place where you typically {work/worked} for this job?
SHOW CARD OH2.
SELECT ALL THAT APPLY.
OFFICE AREA 01
STORE 02
CLASSROOM 03
HOTEL OR MOTEL 04
RESTAURANT 05
RESIDENCE, SUCH AS YOUR HOME OR SOMEONE ELSE’S HOME 06
HEALTHCARE FACILITY OR HOSPITAL 07
LABORATORY 08
FACTORY, PLANT, OR PRODUCTION AREA 09
WAREHOUSE 10
GARAGE OR SHOP 11
SALON 12
LOADING DOCK 13
CONSTRUCTION SITE 14
GROUNDS, YARD, OR GARDEN 15
BARNS, FIELD, OR FARMYARDS 16
MOTOR VEHICLE 17
SOME OTHER LOCATION (SPECIFY): 96
REFUSED 9--97
DON’T KNOW 9--98
END LOOP OH01
LOOP:
|
EOS
|
T1 Dad Visit: Paternal Mental Health
PM001. Now, I will read a list of the ways you might have felt or behaved. Please look at this card, and tell me how often you have felt this way during the past week.
SHOW CARD PM1.
PM002. I was bothered by things that usually don’t bother me.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM003. I did not feel like eating; my appetite was poor.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM004. I felt that I could not shake off the blues even with help from my family or friends.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM005. I felt that I was just as good as other people.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM006. I had trouble keeping my mind on what I was doing.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM007. I felt depressed.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM008. I felt that everything I did was an effort.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM009. I felt hopeful about the future.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM010. I thought my life had been a failure.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM011. I felt fearful.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM012. My sleep was restless.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM013. I was happy.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM014. I talked less than usual.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM015. I felt lonely.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM016. People were unfriendly.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM017. I enjoyed life.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM018. I had crying spells.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM019. I felt sad.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM020. I felt that people dislike me.
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
PM021. I could not get “going.”
SHOW CARD PM1.
RARELY OR NONE OF THE TIME (LESS THAN ONE DAY) 1
SOME OR A LITTLE OF THE TIME (1-2 DAYS) 2
OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 DAYS) 3
MOST OR ALL OF THE TIME (5-7 DAYS) 4
REFUSED 9--97
DON’T KNOW 9--98
T1 Dad Visit: Household Composition and Demographics: Part 2
DM001. These next questions are about your background and cultural heritage.
DM002. Were you born in the United States?
YES 1 (DM005)
NO 2
REFUSED 9--97 (DM005)
DON’T KNOW 9--98 (DM005)
DM003. In what country were you born?
INTERVIEWER INSTRUCTION:
SELECT COUNTRY FROM LIST.
(Source: U.S. State Department List, Independent States in the World)
REFUSED 9--97
DON’T KNOW 9--98
DM004. About how long have you lived in the United States?
INTERVIEWER INSTRUCTION:
IF LESS THAN ONE YEAR, ENTER “00”.
|___|___|
YEARS
REFUSED 9--97
DON’T KNOW 9--98
DM005. Was your mother born in the United States?
YES 1 (DM007)
NO 2
REFUSED 9--97 (DM007)
DON’T KNOW 9--98 (DM007)
DM006. In what country was your mother born?
INTERVIEWER INSTRUCTION:
SELECT COUNTRY FROM LIST.
(Source: U.S. State Department List, Independent States in the World)
REFUSED 9--97
DON’T KNOW 9--98
DM007. Was your father born in the United States?
YES 1 (DM009)
NO 2
REFUSED 9--97 (DM009)
DON’T KNOW 9--98 (DM009)
DM008. In what country was your father born?
INTERVIEWER INSTRUCTION:
SELECT COUNTRY FROM LIST.
(Source: U.S. State Department List, Independent States in the World)
REFUSED 9--97
DON’T KNOW 9--98
DM009. These next questions are about the food eaten in your household in the last 12 months, and whether you were able to afford the food you need.
DM010. QUESTION DELETED
DM011. QUESTION DELETED
DM011a. I’m going to read you two statements that people have made about their food situation. Please tell me whether the statement was OFTEN, SOMETIMES, or NEVER true for {you/you and the other members of your household} in the last 12 months.
The first statement is “The food that {I/we} bought just didn’t last, and {I/we} didn’t have money to get more.” Was that often, sometimes, or never true for {you/your household} in the last 12 months?
OFTEN TRUE 1
SOMETIMES TRUE 2
NEVER TRUE 3
REFUSED 9--97
DON'T KNOW 9--98
DM011b. “{I/We} couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true for {you/your household} in the last 12 months?
OFTEN TRUE 1
SOMETIMES TRUE 2
NEVER TRUE 3
REFUSED 9--97
DON'T KNOW 9--98
DM011c. In the last 12 months, did {you/you or the other adults in your household} ever cut the size of your meals or skip meals because there wasn’t enough money for food?
YES 1
NO 2
REFUSED 9--97
DON'T KNOW 9--98
BOX DM01
CHECK ITEM:
|
BOX DM02
CHECK ITEM:
|
DM011d. How often did this happen – almost every month, some months but not every month, or in only 1 or 2 months?
ALMOST EVERY MONTH 1
SOME MONTHS BUT NOT EVERY MONTH 2
ONLY 1 OR 2 MONTHS 3
REFUSED 9--97
DON'T KNOW 9--98
DM011e. In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money to buy food?
YES 1
NO 2
REFUSED 9--97
DON'T KNOW 9--98
DM011f. In the last 12 months, were you ever hungry but didn’t eat because you couldn’t afford enough food?
YES 1
NO 2
REFUSED 9--97
DON'T KNOW 9—98
DM012. Now I’m going to switch the subject and ask about health insurance.
DM013. Do you currently have insurance through a current or former employer or union (of yourself or another family member)?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
DM014. (Do you currently have):
Insurance purchased directly from an insurance company (by yourself or another family member)?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
DM015. (Do you currently have:)
Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
DM016. (Do you currently have:)
TRICARE, VA, or other military health care?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
DM017. (Do you currently have:)
Indian Health Service?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
DM018. (Do you currently have:)
Medicare, for people 65 and older, or people with certain disabilities?
YES 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
DM019. (Do you currently have:)
Any other type of health insurance or health coverage plan?
YES (SPECIFY): 1
NO 2
REFUSED 9--97
DON’T KNOW 9--98
DM020. Lastly, I’d like to find out how you see yourself in relation to other people in the United States.
DM021. Please look at this card. Think of this ladder as representing where people stand in the United States. At the top of the ladder are the people who are the best off – those who have the most money, the most education and the most respected jobs. At the bottom are the people who are the worst off – who have the least money, least education, and the least respected jobs or no job.
Where would you place yourself on this ladder?
Please point to the rung where you think you stand at this time in your life, relative to other people in the United States.
SHOW CARD DM1.
RUNG A 01
RUNG B 02
RUNG C 03
RUNG D 04
RUNG E 05
RUNG F 06
RUNG G 07
RUNG H 08
RUNG I 09
RUNG J 10
REFUSED 9--97
DON’T KNOW 9--98
T1 Dad Interview: Tracing Information
THIS SECTION HAS BEEN DELETED
Revised 7/2/08
| File Type | application/msword |
| File Title | T1 Dad Visit: Interview Introduction |
| File Modified | 2008-09-19 |
| File Created | 2008-09-19 |