NSCH - screener

Attachment 1: 2011 National Survey of Children’s Health Age Screener

The following public burden estimate statement will be available as a CATI screen:

According to the Paperwork Reduction Act (PRA) of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 0920-0406. The time required to complete this information collection is estimated to average 1 minute per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments about the accuracy of the time estimate(s) or suggestions for improving this form please write to: CDC Reports Clearance Officer, 1600 Clifton Road, MS-D74, Atlanta, GA 30333; call 404-639-4794; or send an email to [email protected].

Data collection conducted under contract to the CDC by XXX.

Form approved

OMB No. 0920-0406

Exp. Date 04/30/11

2011 National Survey of Children’s Health

CATI Instrument - Screener

July 12, 2010

All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

NIS Eligibility, Selection of Sample Child [S.C.], and Informed Consent

INTRO_1 Hello, my name is ________________. I'm calling on behalf of the Centers for Disease Control and Prevention. We're conducting a nationwide immunization study to find out how many children under 4 years of age are receiving all of the recommended vaccinations for childhood diseases. Your telephone number has been selected at random to be included in the study.

S1 Am I speaking to someone who lives in this household who is over 17 years old?

(1) I AM THAT PERSON [SKIP TO S_NUMB]

(0) THIS IS A BUSINESS [TERMINATE]

(3) NEW PERSON COMES TO PHONE [SKIP BACK TO INTRO_1]

(8) DOES NOT LIVE IN HOUSEHOLD [SCHEDULE APPT]

(9) NO PERSON AT HOME WHO IS OVER 17 [SCHEDULE APPT]

(7) REFUSED [TERMINATE]

HELP SCREEN (S1): IF NO, ASK "Is there someone who lives in this household who is over 17 that I may speak with?"

Group Quarters SUCH AS Barracks, dormitories, hospitals, OR schools should be coded as “DOES NOT LIVE IN HOUSEHOLD.”

S_NUMB How many children between the ages of 12 months and 3 years old are living or staying in your household?

ENTER NUMBER OF NIS-ELIGIBLE CHILDREN ____ ____

[Augmentation Sample----------------------

INTRO_AUG IF SAMPLE_USE_CODE = 3, READ INTRO_AUG, ELSE SKIP TO S_UNDR18.

USED ONLY FOR AUGMENTATION SAMPLE (SUC=3)

Hello, my name is _________. I am calling on behalf of the Centers for Disease Control and Prevention. We are doing a nationwide survey about the health of children and teenagers. Your telephone number has been selected at random to be included in the study."

GO TO S_UNDR18

[TIMESTAMP_SCREENER]

S_UNDR18 CATI INSTRUCTION (S_UNDR18): IF S_NUMB > 0, SKIP TO NIS INTERVIEW. AFTER NIS INTERVIEW IS COMPLETE, GO TO AGE_GRID.

IF NIS DONE AND S_NUMB > 0, FILL S_UNDR18 FROM NIS DATA: S_UNDR18 = C1 - C1A. NOTE: C1-C1A CANNOT BE LE 0. IF THAT IS THE CASE, ASK S_UNDR18.

IF SAMPLE_USE_CODE = 4: FILL TIS_UNDER18 TO S_UNDR18

SET ELIGIBILITY DATE AT THIS POINT (ONCE IT IS ASKED OR FILLED)

TODAY_M_NSCH

TODAY_D_NSCH

TODAY_Y_NSCH

How many people less than 18 years old live in this household?

ENTER NUMBER OF CHILDREN ____ ____

IF = 0 [GO TO NOCHILD]

IF > 0 [GO TO AGE_X]

(6) DON'T KNOW [GO TO ASK_ANOTHER]

(7) REFUSED [TERMINATE AND SET AS REFUSAL ((IF INCENTIVE > 0 THEN GO TO ADDRESS COLLECTION), THEN GO TO R1, SET ITS = 23)]

HELP SCREEN (S_UNDER18): A CHILD IS COUNTED AS "LIVING IN THE HOUSEHOLD" IF THE CHILD:

• HAS BEEN STAYING THERE (OR IS EXPECTED TO STAY THERE) FOR AT LEAST TWO MONTHS

• THE LENGTH OF THE CURRENT STAY IS UNKNOWN, BUT THERE IS NO OTHER PLACE WHERE THE CHILD USUALLY STAYS

• USUALLY STAYS IN THE HOUSEHOLD, BUT IS CURRENTLY AWAY FOR LESS THAN TWO MONTHS (WHETHER TRAVELING, IN THE HOSPITAL, OR AWAY FOR ANY OTHER REASON)

• USUALLY STAYS IN THE HOUSEHOLD, BUT IS CURRENTLY AWAY FOR TWO MONTHS OR MORE BECAUSE THEY ARE AT SCHOOL (COLLEGE, BOARDING SCHOOL, MILITARY ACADEMY, PREP SCHOOL, ETC.)

• ONLY LIVES PART-TIME IN THE HOUSEHOLD BECAUSE OF CUSTODY ISSUES, BUT IS STAYING THERE AT THE TIME OF THE CALL

ASK_ANOTHER Is there anyone in your household who knows how many people in this household are less than 18 years old?

(1) NEW PERSON COMES TO PHONE [GO TO S_UNDR18]

(0) NO [GO TO NSCH_TERM]

NSCH_TERM Thank you, we’ll try back another time.

TERMINATE > SET ITS = 61

NOCHILD (IF INCENTIVE > 0 THEN GO TO ADDRESS COLLECTION), THEN READ NOCHILD

Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease Control and Prevention for the time and effort you’ve spent answering these questions.

TERMINATE > SET ITS = 61

AGE_X CATI INSTRUCTION (AGE_GRID): IF S_UNDR18 = 1, FILL “age” AND “child”. ELSE, FILL “ages” AND “children”.

IF S_NUMB = 0, DISPLAY THIS TEXT WHEN ASKING ABOUT FIRST CHILD: “Many of my questions are only for children of certain ages. So, I’ll know which questions to ask, please tell me the [age/ages] of the [child/children] less than 18 years old living in this household.” FOR ALL SUBSEQUENT CHILDREN (LOOP UNTIL # OF CHILDREN=S_UNDR18) DISPLAY: READ IF NECESSARY: (Please tell me the age of the next child who lives in this household.)

ELSE IF (S_NUMB=S_UNDR18 then FILL AGE_1 (and AGE_1Y_X as needed) with age of child and skip to AGE_CONF

ELSE IF S_NUMB > 0 AND S_UNDR18 – S_NUMB > 0, FILL: "You have already given me (FILL NAME OF NIS-ELIGIBLE CHILD OR CHILDREN)'s birth date(s). Now, would you please tell me the [age/ages] of the other [IF S_UNDER18 - S_NUMB = 1, INSERT "child"; IF S_UNDR18 - S_NUMB > 1, INSERT "children"] living in this household.” FOR ALL SUBSEQUENT CHILDREN (LOOP UNTIL # OF CHILDREN=S_UNDR18 - S_NUMB) DISPLAY: READ IF NECESSARY: (Please tell me the age of the next child who lives in this household.)

IF SAMPLE_USE_CODE = 4: FILL AGE ROSTER FROM TEEN ROSTER

FILL AGE_1 (and AGE_1_X ) with age of NSCH SELECTED child taken from TIS_S3AGE_X

[IF 6 GO TO WHEN_CALL,

IF 7 GO TO AGE_REF]

________ ENTER VALUE AGES STORED IN AGE_1 – AGE_9

ENTER 6 FOR DON'T KNOW AND 7 FOR REFUSED

[IF 6 GO TO WHEN_CALL]

[IF 7 GO TO AGE_REF]

HELP SCREEN (age_X): IF AGE IS LESS THAN 1 MONTH OLD, ROUND TO 0 MONTH. A CHILD IS COUNTED AS "LIVING IN THE HOUSEHOLD" IF THE CHILD:

• HAS BEEN STAYING THERE (OR IS EXPECTED TO STAY THERE) FOR AT LEAST TWO MONTHS

• THE LENGTH OF THE CURRENT STAY IS UNKNOWN, BUT THERE IS NO OTHER PLACE WHERE THE CHILD USUALLY STAYS

• USUALLY STAYS IN THE HOUSEHOLD, BUT IS CURRENTLY AWAY FOR LESS THAN TWO MONTHS (WHETHER TRAVELING, IN THE HOSPITAL, OR AWAY FOR ANY OTHER REASON)

• USUALLY STAYS IN THE HOUSEHOLD, BUT IS CURRENTLY AWAY FOR TWO MONTHS OR MORE BECAUSE THEY ARE AT SCHOOL (COLLEGE, BOARDING SCHOOL, MILITARY ACADEMY, PREP SCHOOL, ETC.)

• ONLY LIVES PART-TIME IN THE HOUSEHOLD BECAUSE OF CUSTODY ISSUES, BUT IS STAYING THERE AT THE TIME OF THE CALL

AGE1_X _____(1) MONTHS

_____(0) YEARS

WHEN_CALL What would be a good time to reach a person who knows the child's age?

(1) SET APPOINTMENT FOR CALLBACK [GO TO CB1]

(0) PERSON AVAILABLE [GO TO INTRO_AGE]

AGE_REF The reason we need your child's age is to know which health and health care questions to ask. The information you provide is completely confidential.

(1) YES [GO TO AGE_X]

(0) NO [GO TO AGE_TERM]

AGE_TERM IF INCENTIVE>0 THEN GO TO ADDRESS COLLECTION THEN READ AGE_TERM

Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease Control and Prevention for the time and effort you’ve spent answering these questions.

INTRO_AGE Hello, my name is ________________. I'm calling on behalf of the Centers for Disease Control and Prevention. We are doing a nationwide survey about the health of children and teenagers, and I was told that you were the person to talk with about the health of the (IF S_UNDR18 =1, INSERT "child"; IF S_UNDR18 > 1 INSERT "children") in your household

(1) CONTINUE [RETURN TO AGE_X]

AGE_1Y_1 IF EXACTLY 1 AGE_X=1 YEAR OLD, THEN ASK "Because some of our questions are only for children of certain ages, can you please tell me the age of the 1-year-old child in months? "

ELSE IF > 1 AGE_X = 1 YEAR OLD THEN ASK "Because some of our questions are only for children of certain ages, can you please tell me the age of the first 1-year-old child in months? "

ELSE IF 0 AGE_X = 1 YEAR OLD THEN SKIP TO AGE_CONF

___ ___ MONTHS [RANGE: 0-24]

IF EXACTLY 1 AGE_X = 1 YEAR OLD, GO TO AGE_CONF, ELSE IF > 1 AGE_X = 1 YEAR OLD GO TO AGE_1Y_2-9

AGE_1Y_2- And how about the next 1 year old?

AGE_1Y_9

___ ___ MONTHS [RANGE: 0-24]

CONTINUE TO LOOP FOR ALL REMAINING 1 YEAR OLDS. THEN GO TO AGE_CONF

AGE_CONF So, you have a [FILL WITH AGE IN YEARS FOR ALL CHILDREN 2 YEARS OLD OR OLDER, AND AGE IN MONTHS FOR ALL CHILDREN UNDER 24 MONTHS OLD. INCLUDE AGES FOR ANY NIS-ELIGIBLE CHILDREN] living at this address all or most of the time. Is that correct?

1. (1) YES [SKIP TO MULTIAGE]

(0) NO, WRONG AGES [RETURN TO AGE_X]

(3) NO, WRONG NUMBER OF CHILDREN [RETURN TO S_UNDR18]

(4) NO, NOT ALL CHILDREN LIVING AT THIS ADDRESS ALL OR MOST OF THE TIME

[RETURN TO S_UNDR18]

MULTIAGE CATI INSTRUCTION (MULTIAGE): IF NO CHILDREN ARE THE SAME AGE, SKIP TO NSCH RANDOM SELECTION PROCESS.

ELSE ASK

Since you have more than one child who is [FILL DUPLICATE AGES FROM AGE_CONF], I need a way to refer to each of them during the interview. Could you please tell me their first names or initials?

(1) YES [RECORD NAMES IN NAME_1 – NAME_9]

(0) NO [(IF INCENTIVE > 0 THEN GO TO ADDRESS COLLECTION), THEN TERMINATE, SET ITS=23]

(6) DON'T KNOW [GO TO REFNAME1]

(7) REFUSED [GO TO REFNAME1]

CATI INSTRUCTION: loop for all NAME_X. Then skip to NSCH RANDOM SELECTION PROCESS

NAME_1 -NAME_9

What is the [first, second, third, etc.] child's name or initials?

NAME:

REFNAME1 I would like to assure you that ALL information will be kept in strict confidence and will be summarized for research purposes only. Since you have two or more children of the same age, we must have some way to tell them apart. You could give me a first name, nickname, or their initials.

(1) RESPONDENT WILL GIVE NAMES [RETURN TO NAME_1 THROUGH NAME_9 AND ENTER]

(0) REFUSED [GO TO REFNAME2]

REFNAME2 (IF INCENTIVE > 0 THEN GO TO ADDRESS COLLECTION), THEN READ REFNAME2

Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease Control and Prevention for the time and effort you’ve spent answering these questions.

TERMINATE > SET ITS = 23; POINT OF RETURN SHOULD BE MULTIAGE

NIS_ELIG IF age_x = 19-35 months and S3_3 = NULL, go to NEW_NIS (S3_Intro); else skip to NSCH random selection process. ELSE IF SAMPLE_USE_CODE = 3 OR 4: IGNORE LOGIC ABOVE AND GO TO NSCH RANDOM SELECTION PROCESS.

NSCH RANDOM SELECTION PROCESS

CATI INSTRUCTION: AT THIS POINT, A SAMPLE CHILD MUST BE SELECTED FOR THE REST OF THE INTERVIEW FROM ALL CHILDREN ROSTERED. IF ONLY ONE CHILD UNDER 18 YEARS OLD (AGE_GRID HAS 1 CHILD LISTED), THAT CHILD IS THE SAMPLE CHILD [S.C.] FROM THIS POINT. IF THERE IS MORE THAN ONE CHILD UNDER THE AGE OF 18 (AGE_GRID HAS > 1 CHILD LISTED), ONE OF THESE CHILDREN SHOULD BE RANDOMLY SAMPLED AND THAT CHILD IS THE SAMPLE CHILD [S.C.] FROM THIS POINT.

IF SAMPLE_USE_CODE=4: PERFORM NEW RANDOM SELECTION OF CHILD FROM FULL ROSTER COMPLETELY INDEPENDENT OF TEEN SELECTION

STORE SAMPLED CHILD IN VARIABLE: SC_NSCH (e.g., if 2nd child chosen, SC_NSCH = AGE_2)

AGE_NSCH (in months for SC) AGE_NSCH_Y (in years for SC)

S.C. = "your N month/year old" or name from NAME_1 - NAME_9

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