3 Month Phone Call - abbreviated _201012222_cleancopy

Visit Type: 3 Month

Target: Mother

OMB Control Number: 0925-0593

OMB Expiration Date: July 13, 2013

Recruitment Strategy Substudy

Event Name(s):

3-Month Mother Phone Interview (EH, PB, HI)

Instrument Name(s) and Versions:

3-Month Mother Phone Interview (EH, PB, HI) – 1.0

Recruitment Groups:

Enhanced Household, Provider-Based, High Intensity

Date	Version	Document History
11/01/2010	3 Month Phone Call – abbreviated – 11-01-10.kcs.docx	Ken created 3 Month Phone questionnaire
11/02/2010	3 Month Phone Call – abbreviated – 11-01-10.docx	Nolen formatted, added variable names, and provided sources and numbers for OMB
11/4/10	3 Month Phone Call – abbreviated_20101104.docx	Slutsman revisions on behalf of HSP/IRB Team
11/5/10	3 Month Phone Call – abbreviated_20101105.docx	Paymon changed coding for REF/DK from 9-97 and 9-98 to -1 and -2. Added TOC, page numbers. Re-numbered variables. Highlighted apparent inaccurate skips.
11/15/2010	3 Month Phone Call – abbreviated_20101115	Nolen added some additional source information and made a few corrections per Jen Park, including skip
11/19/2010	3 Month Phone Call – abbreviated_20101115.kcs	Ken addressed comments from earlier reviews
11/19/2010	3 Month Phone Call – abbreviated_20101119	Nolen incorporated comments from Ken
11/29/10	3 Month Phone Call – abbreviated_20101129	Ruth Brenner reviewed instrument
12/2/10	3 Month Phone Call – abbreviated_20101129	Jessica Graber reviewed instrument; please review my comments.
12/6/10	3 Month Phone Call – abbreviated_20101206	Ruth Brenner reviewed instrument with Lisa Haney incorporating the following changes: Revised Interviewer Script (IN003) paragraph IN005 and IN006 revised language from “mother” to “household” DM011 and DM012 moved to after Demographic time stamp to capture data on language that has not been previously captured and avoid being skipped during the pattern (Numbering may need to be adjusted) DM019 responses modified to include a shorter list as provided by the CATI pregnancy screener Hi/Lo (May need to modify source) Child Development and Parenting Instructions modified to include referencing age of child if not 3 months old SL006 changed from “their” to his/her Insertion of IN018
12/8/10	3 Month Phone Call – abbreviated_20101207	Nolen incorporated changes per Jen: OMB numbering and sourcing additions
12/14/10	3 Month Phone Call – abbreviated_20101214_cleancopy	Nolen highlighted skip pattern for demographics, per conversation with OMB on 12/13/2010
12/15/10	3 Month Phone Call – abbreviated_20101214_cleancopy	Jen added note to OMB on highlighted area re: demographics.
12/21/10	3 Month Phone Call – abbreviated_20101221_cleancopy	Copy edited version received from Circle
12/22/10	3 Month Phone Call – abbreviated_20101222_cleancopy	Reviewed copy edits and made changes to DM003 (EDUC) responses. Changed from “for example” to “FOR EXAMPLE”
12/22/10	3 Month Phone Call – abbreviated_20101222_cleancopy	Jen DM003: Converted “Master’s and Doctoral” to uppercase. DMOO7: Added value number to Native Hawaiian (had been missing).

TABLE OF CONTENTS

IN INTERVIEW INTRODUCTION 4

PV participant verification 5

DM DEMOGRAPHICS 7

SL Sleep 10

CP CRYING PATTERNS 11

CDP Child development and parenting 12

CC Child care arrangements 16

HC HEALTH care 18

Interview Introduction

IN001 (TIME_STAMP_1) PROGRAMMER INSTRUCTION: INSERT DATE/TIME STAMP

IN003 Hello. I’m [INTERVIEWER NAME] calling from the National Children’s Study. I’m calling today to ask you some questions about you and your baby. We realize that you are busy, and this call should take only about 20 minutes. I will ask you questions about your baby’s health and behavior and your household. Your answers are very important to us. There are no right or wrong answers. You can skip over any question or stop the interview at any time. We will keep everything that you tell us confidential.

INTERVIEWER COMPLETED QUESTIONS

IN005 (MULT_CHILD) IS THERE MORE THAN ONE CHILD IN THIS HOUSEHOLD ELIGIBLE FOR THE 3-MONTH CALL TODAY?

YES	…………………………………………………….	1
NO	…………………………………………………….	2

IN006 (CHILD_NUM) HOW MANY CHILDREN OF THIS IN THIS HOUSEHOLD ARE ELIGIBLE FOR THE 3-MONTH CALL TODAY?

|___|___|

NUMBER OF CHILDREN

PROGRAMMER INSTRUCTION: IF MULT_CHILD = 1, THEN CHILD_NUM = 1; COMPLETE QUESTIONNAIRE FOR EACH ELIGIBLE CHILD RECORDED IN CHILD_NUM

IN011 (CHILD_QNUM) WHICH NUMBER CHILD IS THIS QUESTIONNAIRE FOR?

|___|___|

PROGRAMMER INSTRUCTION: CHILD_QNUM CANNOT BE GREATER THAN CHILD_NUM

IN017 (CHILD_SEX) IS {CHILD_QNUM} A BOY OR GIRL?

BOY	…………………………………………………….	1
GIRL	…………………………………………………….	2

PROGRAMMER INSTRUCTION: USE CHILD_SEX TO CODE {his/her} AND {he/she} FIELDS AS APPROPRIATE THROUGHOUT INSTRUMENT

IN018 (RESP_REL) WHAT IS THE RELATIONSHIP OF RESPONDENT TO CHILD?

MOTHER	…………………………………………………….	1
FATHER	…………………………………………………….	2

Participant Verification

First, we’d like to make sure we have your child’s correct name and birth date.

PV001 (CNAME_CONFIRM). Is your baby’s name _____[INSERT NAME]___________?

YES	…………………………………	1	(CDOB_CONFIRM)
NO	…………………………………	2	(C_FNAME)(C_LNAME)
REFUSED	…………………………………	-1	(C_FNAME)(C_LNAME)
DON’T KNOW	…………………………………	-2	(C_FNAME)(C_LNAME)

PROGRAMMER INSTRUCTION: INSERT CHILD’S NAME IF KNOWN

PV004 (C_FNAME) (C_LNAME) What is your baby’s full name?

_________________________ _________________________

FIRST NAME LAST NAME

(C_FNAME) (CHILD_LNAME)

REFUSED	…………………………………	-1	(CDOB_CONFIRM)
DON’T KNOW	…………………………………	-2	(CDOB_CONFIRM)

INTERVIEWER INSTRUCTIONS:

• IF RESPONDENT REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS, ASK FOR INITIALS OR SOME OTHER NAME SHE WOULD LIKE HER CHILD TO BE CALLED

• CONFIRM SPELLING OF FIRST NAME IF NOT PREVIOUSLY COLLECTED AND OF LAST NAME FOR ALL CHILDREN.

PV007 (CDOB_CONFIRM). Is {C_FNAME}’S birth date [INSERT CHILD’S DATE OF BIRTH]?

YES	…………………………………	1	(TIME_STAMP2)
NO	…………………………………	2	(CHILD_DOB)
REFUSED	…………………………………	-1	(CHILD_DOB)
DON’T KNOW	…………………………………	-2	(CHILD_DOB)

PROGRAMMER INSTRUCTIONS:

• PRELOAD CHILD’S DOB IF KNOWN AS MM/DD/YYYY

• IF RESPONSE = YES, SET CHILD_DOB TO KNOWN VALUE

INTERVIEWER INSTRUCTION: IF RESPONDENT REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS AND THAT DOB HELPS DETERMINE ELIGIBILITY

PV011 (CHILD_DOB). What is {C_FNAME}’s date of birth?

MONTH: |___|___|

M M

DAY: |___|___|

D D

YEAR: |___|___|___|___|

Y Y Y Y

REFUSED	…………………………………	-1	(TIME_STAMP2)
DON’T KNOW	…………………………………	-2	(TIME_STAMP2)

INTERVIEWER INSTRUCTIONS:

• IF RESPONDENT REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS AND THAT DOB IS HELPS DETERMINE ELIGIBILITY

• ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND A FOUR-DIGIT YEAR

• IF RESPONSE WAS DETERMINED TO BE INVALID, ASK QUESTION AGAIN AND PROBE FOR VALID RESPONSE

PROGRAMMER INSTRUCTIONS:

• INCLUDE A SOFT EDIT/WARNING IF CALCULATED AGE IS LESS THAN 2 MONTHS OR GREATER THAN 5 MONTHS

• FORMAT CHILD_DOB AS YYYYMMDD

PV013 (TIME_STAMP_2) PROGRAMMER INSTRUCTION: INSERT DATE/TIME STAMP

PROGRAMMER INSTRUCTIONS:

• IF CHILD_NUM = 1 AND IF ((NO PRIOR MATERNAL QUESTIONNAIRES WERE COMPLETED) OR (THE MOTHER WAS FIRST IDENTIFIED AT THE BIRTH VISIT)), GO TO MARISTAT

• IF MOTHER WAS ENROLLED PRIOR TO OR DURING PREGNANCY AND HAS COMPLETED AT LEAST ONE QUESTIONNAIRE BEFORE BIRTH, GO TO TIME_STAMP_3

• IF CHILD_NUM >1, GO TO TIME_STAMP_31

Demographics

DE004 (MARISTAT) I’d like to ask about your marital status. Are you:

Married, 1 (EDUC)/(DE003)

Not married but living together with a partner 2 (EDUC)

Never been married, 3 (EDUC) Divorced, 4 (EDUC)

Separated, or 5 (EDUC)

Widowed? 6 (EDUC)

REFUSED -1 (EDUC)

DON’T KNOW -2 (EDUC)

INTERVIEWER INSTRUCTION: RECORD THE RESPONDENT’S CURRENT MARITAL STATUS

DM003 (EDUC) What is the highest degree or level of school you have completed?

LESS THAN A HIGH SCHOOL DIPLOMA OR GED 1 (ETHNICITY)

HIGH SCHOOL DIPLOMA OR GED 2 (ETHNICITY)

SOME COLLEGE BUT NO DEGREE 3 (ETHNICITY)

ASSOCIATE DEGREE 4 (ETHNICITY)

BACHELOR’S DEGREE (FOR EXAMPLE, BA, BS) 5 (ETHNICITY)

POST GRADUATE DEGREE (FOR EXAMPLE, MASTERS OR DOCTORAL) 6 (ETHNICITY)

REFUSED -1 (ETHNICITY)

DON’T KNOW -2 (ETHNICITY)

DE006 (ETHNICITY) Do you consider yourself to be Hispanic, or Latina?

YES 1 (RACE)

NO 2 (RACE)

REFUSED -1 (RACE)

DON’T KNOW -2 (RACE)

DE007 (RACE) What race do you consider yourself to be? You may select one or more.

PROBE: Anything else?

SELECT ALL THAT APPLY.

White, 1 (HH_PRIMARY_LANG)

Black or African American, 2 (HH_PRIMARY_LANG)

American Indian or Alaska Native, 3 (HH_PRIMARY_LANG)

Asian, or 4 (HH_PRIMARY_LANG)

Native Hawaiian or Other Pacific Islander? 5 (HH_PRIMARY_LANG)

SOME OTHER RACE? -5 RACE_OTH)

REFUSED -1 (HH_PRIMARY_LANG)

DON’T KNOW -2 (HH_PRIMARY_LANG)

INTERVIEWER INSTRUCTION: CODE “OTHER” ONLY IF VOLUNTEERED.

DE007A (RACE_OTH)

SPECIFY _____________________________ (HH_PRIMARY_LANG)

REFUSED -1 (HH_PRIMARY_LANG)

DON’T KNOW -2 (HH_PRIMARY_LANG)

Now I’m going to ask a few questions about your income. Family income is important in understanding the information we collect and is often used in scientific studies to compare groups of people who are similar. Please remember that all the information you share with us is confidential.

Please think about your total combined family income during [CURRENT YEAR – 1] for all members of the family.

DE010 (HH_MEMBERS) How many household members are supported by your total combined family income?

|___|___| (NUM_CHILD)

NUMBER

REFUSED -1 INCOME)

DON’T KNOW -2 INCOME)

PROGRAMMER INSTRUCTION: RESPONSE MUST BE > 0; INCLUDE A SOFT EDIT IF RESPONSE IS > 15

DM016 (NUM_CHILD) How many of those people are children? Please include anyone under 18 years or anyone older than 18 years and in high school.

|___|___|

NUMBER (INCOME)

REFUSED -1 (INCOME)

DON’T KNOW -2 (INCOME)

PROGRAMMER INSTRUCTIONS:

• INCLUDE HARD EDIT IF RESPONSE > HH_MEMBERS

• INCLUDE SOFT EDIT IF RESPONSE > 10

DM019 (INCOME) Of these income groups, which category best represents your total combined family income during the last calendar year?

Less than $30,000 1 (TR001)/(TIME_STAMP_10)

$30,000 - $49,000 2 (TR001)/(TIME_STAMP_10)

$50,000 - $99,999 3 (TR001)/(TIME_STAMP_10)

$100,000 or more 4 (TR001)/(TIME_STAMP_10)

REFUSED -1 (TIME_STAMP_3) DON’T KNOW -2 (TIME_STAMP_3)

DM020 (TIME_STAMP_3) PROGRAMMER INSTRUCTION: INSERT DATE/TIME STAMP

DM021 (HH_PRIMARY_LANG) What is the primary language spoken in your home?

ENGLISH 1

SPANISH 2

ARABIC 3

CHINESE 4

FRENCH 5

FRENCH CREOLE 6

GERMAN 7

ITALIAN 8

KOREAN 9

POLISH 10

RUSSIAN 11

TAGALOG 12

VIETNAMESE 13

URDU 14

PUNJABI 15

BENGALI 16

FARSI 17

OTHER -5 (PERSON_LANG_OTH)

REFUSED -1

DON’T KNOW -2

DM022 (PERSON_LANG_OTH)

SPECIFY _____________________________

REFUSED -1

DON’T KNOW -2

Sleep

I’ll begin by asking you about {C_FNAME}’s sleeping habits.

SL001 (SLEEP_PLACE_1) Does your baby usually sleep in your bedroom or in a different room at night?

IN RESPONDENT’S ROOM 1

IN A DIFFERENT ROOM 2

BOTH IN RESPONDENT’S ROOM AND A

DIFFERENT ROOM 3

REFUSED -1

DON’T KNOW -2

SL003 (SLEEP_PLACE_2) What does {C_FNAME} sleep in at night?

A bassinette, 1

A crib, 2

A co-sleeper, 3

In the bed or other place with you, or 4

In something else? (SLEEP_PLACE_2_OTH) 5

REFUSED -1

DON’T KNOW -2

SL004 (SLEEP_PLACE_2_OTH) OTHER SPECIFY

SL006 (SLEEP_POSITION_NIGHT) In what position do you most often lay {C_FNAME} down to sleep at night? On his/her.

Side, 1

Stomach, or 2

Back? 3

REFUSED -1

DON’T KNOW -2

SL008 (SLEEP_HRS_DAY) Approximately how many hours does {C_FNAME} sleep during the day?

|___|___|

HOURS

REFUSED -1

DON’T KNOW -2

SL010 (SLEEP_HRS_NIGHT) Approximately how many hours does {C_FNAME} sleep at night?

|___|___|

HOURS

REFUSED -1

DON’T KNOW -2

SL012 (SLEEP_DIFFICULT) How often is your baby difficult when {he/she} is put to bed?

Most of the time, 1

Often, 2

Sometimes, 3

Rarely, or 4

Never? 5

REFUSED -1

DON’T KNOW -2

Crying Patterns

All babies fuss and cry sometimes. I’m now going to ask you some questions to get a better idea of your baby’s crying patterns.

CP001 (CRY_MORE) Compared to other babies, do you think {C_FNAME} cries more, the same or less?

MORE 1

THE SAME 2

LESS 3

REFUSED -1

DON’T KNOW -2

CP003 (CRY_CONSOLE) Can you usually calm or console {C_FNAME} when {he/she} cries?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

CP005 (CRY_COLIC) Does {C_FNAME} have episodes of colic, or times when {he/she} cries and can’t be calmed or consoled?

YES 1

NO (CRY_PROBLEM/CP009)

REFUSED -1 ( CRY_PROBLEM)

DON’T KNOW -2 ( CRY_PROBLEM)

CP007 (COLIC_FREQ) How often does {C_FNAME} have episodes of colic, or times when {he/she} cries and can’t be calmed or consoled:

Every day, 1

Most days, 2

Sometimes, or 3

Rarely? 4

REFUSED -1

DON’T KNOW -2

CP009 (CRY_PROBLEM) Are you finding {C_FNAME}’s crying to be a problem or upsetting?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

Child Development and Parenting

Even though {C_FNAME} is only [INSERT AGE OF CHILD IN MONTHS] months old, {he/she} may show emotions or other actions. Overall, would you describe your baby as:

PROGRAMMER INSTRUCTION: USING CHILD_DOB CALCULATE CHILD’S AGE TO THE NEAREST MONTH AND PREFIL INTRODUCTORY STATEMENT ABOVE

CDP003 (CALM) Calm?

YES	…………………………………	1
NO	…………………………………	2
REFUSED	…………………………………	-1
DON’T KNOW	…………………………………	-2

CDP004 (WORRIED) Worried?

YES	…………………………………………………..	1
NO	…………………………………	2
REFUSED	…………………………………	-1
DON’T KNOW	…………………………………	-2

CDP005 (SOCIAL) Sociable or outgoing?

YES	…………………………………………………..	1
NO	…………………………………	2
REFUSED	…………………………………	-1
DON’T KNOW	…………………………………	-2

CDP006 (ANGRY) Angry?

YES	…………………………………………………..	1
NO	…………………………………	2
REFUSED	…………………………………	-1
DON’T KNOW	…………………………………	-2

CDP007 (SHY) Shy or quiet?

YES	…………………………………………………..	1
NO	…………………………………	2
REFUSED	…………………………………	-1
DON’T KNOW	…………………………………	-2

CDP008 (STUBBORN) Stubborn?

YES	…………………………………………………..	1
NO	…………………………………	2
REFUSED	…………………………………	-1
DON’T KNOW	…………………………………	-2

CDP009 (HAPPY) Happy?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

I’d like to ask about {C_FNAME} and you. I will read you a list of things {C_FNAME} may already do or may start doing when {he/she} gets older. Does {C_FNAME}:

CDP011 (EYES_FOLLOW) Follow you with {his/her} eyes?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP012 (SMILE) Smile when you smile at {him/her}?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP013 (REACH_1) Try to get a toy that is out of reach?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP014 (FEED) Feed {him/herself} a cracker or cereal?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP015 (WAVE) Wave goodbye?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP016 (REACH_2) Reach for toys or food held to {him/her}?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP017 (GRAB) Grab an object like a block or rattle from you?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP018 (SWITCH_HANDS) Move a toy or block from one hand to the other?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP020 (PICKUP) Pick up a small object like a Cheerio or raisin?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP021 (HOLD) Hold two toys or blocks at a time, one in each hand?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP022 (SOUND_2) Turn towards a sound?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP023 (SOUND_3) Turn toward someone when they’re speaking?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP024 (SPEAK_1) Make sounds as though {he/she} is trying to speak?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP025 (SPEAK_2) Say mama or dada?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP026 (HEADUP) Keep head steady when sitting or held up?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP027 (ROLL_1) Roll over from stomach to back?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP028 (ROLL_2) Roll from back to stomach?

YES	…………………………………………………..	1
NO	…………………………………………………..	2
REFUSED	…………………………………………………..	-1
DON’T KNOW	…………………………………………………..	-2

CDP028 (TIME_STAMP_4) PROGRAMMER INSTRUCTION: INSERT DATE/TIME STAMP

Child Care Arrangements

CC001 Next, I’d like to ask you about different types of child care {C_FNAME} may receive from someone other than parents or guardians. This includes regularly scheduled care arrangements with relatives and non-relatives, and day care or early childhood programs, whether or not there is a charge or fee, but not occasional baby-sitting.

(CHILDCARE) Does {C_FNAME} currently receive any regularly scheduled care from someone other than a parent or guardian. For example, from relatives, non-relatives, or a child care center or program?

YES 1

NO 2 (TIME_STAMP_5)

REFUSED -1 (TIME_STAMP_5)

DON’T KNOW -2 (TIME_STAMP_5)

CC003 (FAMILY_CARE_HRS) I’d like you to think about all the care {C_FNAME} receives from relatives. For example, from grandparents, brothers or sisters, or any other relatives. (This includes all regularly scheduled care arrangements with relatives that happen at least weekly, but does not include occasional baby-sitting.)

Including all of these regular arrangements, how many total hours each week does {C_FNAME} receive care from relatives?

|___|___|___|

HOURS

REFUSED -1

DON’T KNOW -2

CC005 (HOMECARE_HRS) I’d like you to think about all the regularly scheduled care your child receives on a weekly basis from non-relatives in a home setting. (This includes all regularly scheduled care arrangements with non-relatives that happen at least weekly, including home child care providers, regularly scheduled sitter arrangements, or neighbors. This does not include day care centers, early childhood programs, or occasional babysitting.)

Including all of these arrangements, how many total hours each week does {C_FNAME} receive care from non-relatives in a home setting?

|___|___|___|

HOURS

REFUSED -1

DON’T KNOW -2

CC007 (DAYCARE_HRS) I’d like you to think about all the care your child receives from child care centers. For example, day care centers, early learning centers, nursery schools, and preschools. (This includes all regularly scheduled care arrangements in child care centers that happen at least weekly.)

Including all of these arrangements, how many total hours each week does {C_FNAME} receive care at child care centers?

|___|___|___|

HOURS

REFUSED -1

DON’T KNOW -2

CC009 (TIME_STAMP_5) PROGRAMMER INSTRUCTION: INSERT DATE/TIME STAMP

Health Care

HC001 (C_HEALTH) Since {C_FNAME} was born, would you say {his/her} health has been poor, fair, good, excellent?

POOR 1

FAIR 2

GOOD 3

EXCELLENT 4

REFUSED -1

DON’T KNOW -2

The next questions are about where {C_FNAME} goes for health care.

HC003 (R_HCARE) First, what kind of place does {C_FNAME} usually go to when {he/she} needs routine or well-child care, such as a check-up or well-baby shots (immunizations)?

Clinic or health center	………………………	1
Doctor's office or Health Maintenance Organization (HMO)	………………………	2
Hospital emergency room	………………………	3
Hospital outpatient department	………………………	4
Some other place	………………………	5
DOESN'T GO TO ONE PLACE MOST OFTEN	………………………	6
DOESN'T GET WELL-CHILD CARE ANYWHERE	………………………	7	(HCARE_SICK)
REFUSED	………………………	-1	(HCARE_SICK)
DON’T KNOW	………………………	-2	(HCARE_SICK)

HC005 (LAST_VISIT) What was the date of {C_FNAME}’s most recent well-child visit or check-up?

MONTH: |___|___|

M M

DAY: |___|___|

D D

YEAR: |___|___|___|___|

Y Y Y Y

HAS NOT HAD A VISIT	………………………………	1	(SAME_CARE)
REFUSED	………………………………	-1	(SAME_CARE)
DON’T KNOW	………………………………	-2	(SAME_CARE)

HC007 (VISIT_WT) What was {C_FNAME}’s weight at that visit?

|___|___|

Pounds

REFUSED	………………………………	-1
DON’T KNOW	………………………………	-2

PROGRAMMER INSTRUCTION: INCLUDE A SOFT EDIT IF WEIGHT < 8 OR > 21 POUNDS

HC009 (SAME_CARE) If {C_FNAME} is sick or if you have concerns about {his/her} health, does {he/she} go to the same place as for well-child visits?

YES	………………………………	1	(HOSPITAL)
NO	………………………………	2
HAS NOT BEEN SICK	………………………………	3	(HOSPITAL)
REFUSED	………………………………	-1
DON’T KNOW	………………………………	-2

HC011 (HCARE_SICK) What kind of place does {C_FNAME} usually go to when {he/she} is sick, doesn’t feel well, or if you have concerns about {his/her} health?

Clinic or health center	………………………	1
Doctor's office or Health Maintenance Organization (HMO)	………………………	2
Hospital emergency room	………………………	3
Hospital outpatient department	………………………	4
Some other place	………………………	5
DOESN'T GO TO ONE PLACE MOST OFTEN	………………………	6
HAS NOT BEEN SICK	………………………	7
REFUSED	………………………	-1
DON’T KNOW	………………………	-2

HC013 (HOSPITAL) After coming home from the hospital the first time, has your child spent at least one night in the hospital?

YES 1

NO 2 (TIME_STAMP_6)

REFUSED -1 (TIME_STAMP_6)

DON’T KNOW 2 (TIME_STAMP_6)

HC015 (DIAGNOSIS) Did a doctor or other health care provider give your child a diagnosis?

YES 1

NO 2 (TIME_STAMP_6)

REFUSED -1 (TIME_STAMP_6)

DON’T KNOW -2 (TIME_STAMP_6)

HC017 (DIAGNOSIS_SPECIFY) What was the diagnosis?

INTERVIEWER INSTRUCTION: ENTER ALL DIAGNOSES IN FIELD SEPARATED BY COMMAS OR AN “AND”.

________________________________

DIAGNOSES

REFUSED -1

DON’T KNOW -2

HC019 (TIME_STAMP_6) PROGRAMMER INSTRUCTION: INSERT DATE/TIME STAMP

Thank you for your time and for being a part of this important research Study. This is the end of our interview.

LOCATION-SPECIFIC CLOSE-OUT AND SCHEDULING TEXT – include information about next contact (6 month home visit) and verification of contact information.

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