Form 14.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 07/31/ 2013

Birth Interview (LI), Phase 2e

Birth Interview

Event:	Birth
Participant:	Mother
Domain:	Questionnaire
Type of Document:	Interview
Recruitment Groups: Allowable Mode: Allowable Method: Version: Release:	LI Telephone CATI Vx.x MDES 3.0

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Birth Interview

TABLE OF CONTENTS

INTERVIEWER-COMPLETED QUESTIONS 1

BABY CHARACTERISTICS 3

HOUSING CHARACTERISTICS 8

ENVIRONMENTAL EXPOSURES 10

INFANT FEEDING 13

INFANT SLEEP 14

WELL BABY CARE AND IMMUNIZATIONS 16

WORK AND PLANS FOR CHILDCARE 18

INTERVIEWER-COMPLETED QUESTIONS 24

Birth Interview

INTERVIEWER-COMPLETED QUESTIONS

IC001/(BIRTH_DELIVER). WHERE DID PARTICIPANT DELIVER BABY OR BABIES?

HOSPITAL, 1

BIRTHING CENTER, 2

AT HOME 3

SOME OTHER PLACE -5

PROGRAMMER INSTRUCTION:

• IF BIRTH_DELIVER = 1, DISPLAY “hospital” THROUGHOUT THE INSTRUMENT.

• IF BIRTH_DELIVER = 2, DISPLAY “birthing center” THROUGHOUT THE INSTRUMENT.

• IF BIRTH_DELIVER=3, GO TO PROGRAMMER INSTRUCTIONS AT START OF BABY CHARACTERISTICS SECTION.

• IF BIRTH_DELIVER = -5, DISPLAY “other place” THROUGHOUT THE INSTRUMENT.

IC002/(MULTIPLE). WAS THIS A MULTIPLE BIRTH?

YES 1

NO …. 2

IC004/(MULTIPLE_NUM). HOW MANY BABIES WERE DELIVERED?

|___|___|

NUMBER OF BABIES

PROGRAMMER INSTRUCTIONS:

• IF MULTIPLE=1, DISPLAY “babies”

• IF MULTIPLE=2, DISPLAY “baby”

IC005/(CHILD_DOB). WHAT WAS THE {BABY’S/BABIES’} DATE OF BIRTH?

MONTH: |___|___|

M M

DAY: |___|___|

D D

YEAR: |___|___|___|___|

Y Y Y Y

REFUSED -1

DON’T KNOW -2

IC006/(RELEASE). {HAS BABY}{HAVE BABIES} BEEN RELEASED FROM THE {HOSPITAL/BIRTHING CENTER/OTHER PLACE}?

INTERVIEWER INSTRUCTIONS:

• ASK ONLY IF NEEDED.

• IF MULTIPLE BIRTH AND AT LEAST ONE BABY HAS BEEN RELEASED FROM HOSPITAL, SELECT “1”.

YES 1

NO 2

PROGRAMMER INSTRUCTIONS:

• DISPLAY “HAS BABY” IF MULTIPLE=2

• DISPLAY “HAVE BABIES” IF MULTIPLE=1

Baby Characteristics

BC001/(BABY_FNAME). During this interview, we would like to refer to your {baby/babies} by name. {Let’s start with your first {twin/triplet/higher order} birth.} What name would you like me to use to talk about your {first/next} baby}. {Now let’s talk about your next baby. What name would you like me to use to talk about your next baby?}

NAME PROVIDED 1

NO OFFICIAL NAME SELECTED 3 (BABY_SEX)

REFUSED -1 (BABY_SEX)

DON’T KNOW -2 (BABY_SEX)

PROGRAMMER INSTRUCTIONS:

• LOOP THROUGH QUESTIONS BABY_FNAME THROUGH BABY_RACE_OTH (IF BABY_RACE INCLUDES -5) UNTIL NUMBER OF LOOPS = MULTIPLE_NUM . THEN, GO TO TIME_STAMP_3.

• BASED ON NUMBER OF LOOPS, DISPLAY APPROPRIATE ADJECTIVES (E.G. “first” OR “next”)

• If MULTIPLE = 1 AND MULTIPLE_NUM = 2 AND FIRST LOOP, DISPLAY: “Let’s start with your first twin birth. What name would you like me to use to talk about your first baby?”

• IF MULTIPLE = 1 AND MULTIPLE_NUM = 3 AND FIRST LOOP, DISPLAY: ““Let’s start with your first triplet birth. What name would you like me to use to talk about your first baby?”

• IF MULTIPLE = 1 AND MULTIPLE_NUM = ≥ 4 AND FIRST LOOP, DISPLAY: ““Let’s start with your first higher order birth. What name would you like me to use to talk about your first baby?”

• IF MULTIPLE = 1 AND MULTIPLE_NUM = 2 AND SECOND LOOP, DISPLAY: “Now let’s talk about your next baby. What name would you like me to use to talk about your next baby?”

• IF MULTIPLE = 1 AND MULTIPLE_NUM = ≥ 3 AND SECOND OR HIGHER LOOP, DISPLAY: “Now let’s talk about your next baby. What name would you like me to use to talk about your next baby?”

• IF MULTIPLE =2, DISPLAY: “What name would you like me to use to talk about your baby?”

BC002.

INTERVIEWER INSTRUCTION:

• ENTER NAME AND CONFIRM SPELLING.

_____________________

FIRST NAME

(BABY_FNAME)

REFUSED -1

DON’T KNOW -2

_____________

MIDDLE NAME

(BABY_MNAME)

REFUSED -1

DON’T KNOW -2

___________________

LAST NAME

(BABY_LNAME)

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF MULTIPLE = 1, DISPLAY “your babies” throughout the instrument.

• IF MULTIPLE = 2 AND VALID RESPONSE PROVIDED FOR BABY_FNAME, DISPLAY BABY_FNAME THROUGHOUT THE INSTRUMENT.

• OTHERWISE, IF MULTIPLE = 2 AND VALID RESPOND NOT PROVIDED FOR BABY_FNAME, DISPLAY “your baby” THROUGHOUT THE INSTRUMENT.

BC007/(BABY_SEX). What is the sex of your baby?

MALE 1

FEMALE 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF BABY_SEX=1, DISPLAY “he” AND “him” THROUGHOUT THE INSTRUMENT.

• IF BABY_SEX=2, DISPLAY “she” AND “her” THROUGHOUT THE INSTRUMENT.

• IF BABY_SEX = -1 OR -2, DISPLAY “your baby” THROUGHOUT THE INSTRUMENT.

BC007A/(BABY_BWT_LB)/(BABY_BWT_OZ). How much did {BABY_FNAME/your baby} weigh when {he/she/your baby} was born?

POUNDS: |___|___|

P P

REFUSED -1

DON’T KNOW -2

OUNCES: |___|___|

O O

REFUSED -1

DON’T KNOW -2

BC007B/(BABY_ETHNICITY). Do you consider {BABY_FNAME/your baby} to be of Hispanic, Latino/a or Spanish origin?

INTERVIEWER INSTRUCTIONS:

• SELECT ALL THAT APPLY.

• PROBE: Anything else?

No, the baby is not of Hispanic, Latino/a, or Spanish origin 1

Yes, Mexican, Mexican American, Chicano/a 2

Yes, Puerto Rican 3

Yes, Cuban 4

Yes, Another Hispanic, Latino/a, or Spanish origin 5

REFUSED -1

DON’T KNOW -2

BC007C/(BABY_RACE). What race do you consider {BABY_FNAME/your baby} to be? You may select one or more.

INTERVIEWER INSTRUCTIONS:

• IF USING SHOWCARDS, REFER PARENT/CAREGIVER TO APPROPRIATE SHOWCARD.

• OTHERWISE, READ RESPONSE CATEGORIES TO PARENT/CAREGIVER.

• SELECT ALL THAT APPLY.

• CODE “OTHER” ONLY IF VOLUNTEERED.

• PROBE: Anything else?

WHITE, 1

BLACK OR AFRICAN AMERICAN, 2

AMERICAN INDIAN OR ALASKA NATIVE, 3

ASIAN INDIAN 4

CHINESE 5

FILIPINO 6

JAPANESE 7

KOREAN 8

VIETNAMESE 9

OTHER ASIAN 10

NATIVE HAWAIIAN 11

GUAMANIAN OR CHAMORRO 12

OTHER PACIFIC ISLANDER 13

SAMOAN 14

SOME OTHER RACE -5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF RACE = ANY COMBINATION OF 1 THROUGH 15, GO TO LIVE_MOM.

• IF RACE = ANY COMBINATION OF 1 THROUGH 15, GO TO LIVE_MOM.

• IF RACE = ANY COMBINATION OF 1 THROUGH 15 AND -5, GO TO RACE_OTH.

• IF RACE = -5, GO TO RACE_OTH.

• IF RACE = -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO LIVE_MOM.

BC007D/(RACE_OTH).

SPECIFY _____________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

• IF MULTIPLE_NUM < NUMBER OF LOOPS, LOOP TO BABY_NAME.

• IF MULTIPLE_NUM = NUMBER OF LOOPS, GO TO LIVE_MOM.

BC008/(LIVE_MOM). {Does {BABY_FNAME/your baby}}/{Do your babies} live with you/{When {{BABY_FNAME/your baby} leaves}/{your babies leave} the {hospital/ birthing center/other place} will {he/she/your baby} live with you?

YES 1 (RECENT_MOVE)

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF MULTIPLE = 2 AND VALID RESPONSE PROVIDED FOR BABY_FNAME AND EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “Does BABY_FNAME”.

• IF MULTIPLE = 2 AND VALID RESPONSE NOT PROVIDED FOR BABY_FNAME = AND EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “Does your baby”.

• IF MULTIPLE = 1 AND EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “Do your babies”.

• IF MULTIPLE = 2 AND RELEASE = 2 AND VALID RESPONSE PROVIDED FOR BABY_FNAME, DISPLAY “When BABY_FNAME leaves” .

• IF MULTIPLE = 2 AND RELEASE = 2 AND VALID RESPONSE NOT PROVIDED FOR BABY_FNAME, DISPLAY “When your baby leaves”.

• IF MULTIPLE = 1 AND RELEASE = 2, DISPLAY “your babies leave”.

BC009/(LIVE_OTH). With whom {{does {he/she/your baby}}/{do they}}/ {will {he/she/your baby}} live?

BABY’S FATHER 1

BABY’S GRANDPARENT(S) 2

OTHER FAMILY MEMBER 3

PLACING IN FOSTER CARE 4

PLACING FOR ADOPTION 5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF MULTIPLE = 2 AND BABY_SEX = 1 AND EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “does he”.

• IF MULTIPLE = 2 AND BABY_SEX = 2 AND EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “does she”.

• IF MULTIPLE = 2 AND BABY_SEX = -1 OR -2 AND EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “does your baby”.

• IF MULTIPLE = 1 AND BABY_SEX = -1 OR -2 AND EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “do they”.

• IF MULTIPLE = 2 AND BABY_SEX = 1 AND RELEASE=2, DISPLAY “will he”.

• IF MULTIPLE = 2 AND BABY_SEX = 2 RELEASE=2, DISPLAY “will she”.

• IF MULTIPLE = 1 AND BABY_SEX = 3, -1, OR -2, OR IF MULTIPLE = 2, AND RELEASE=2, DISPLAY “will they”.

(TIME_STAMP_2). PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

HOUSING CHARACTERISTICS

(TIME_STAMP_3) PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

HC001/(RECENT_MOVE). Have you moved or changed your housing situation since we contacted you last?

YES 1

NO 2 (HC009)

REFUSED -1 (HC009)

DON’T KNOW -2 (HC009)

HC004/(OWN_HOME). Is your current home…

Owned or being bought by you or someone in your household 1 (AGE_HOME)

Rented by you or someone in your household, or 2 (AGE_HOME)

Occupied without payment of rent? 3 (AGE_HOME)

SOME OTHER ARRANGEMENT -5

REFUSED -1 (AGE_HOME)

DON’T KNOW -2 (AGE_HOME)

HC005/(OWN_HOME_OTH).

SPECIFY ________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

HC006/(AGE_HOME). Can you tell us when your home or building was built? Was it between…

2001 to present, 1

1981 to 2000, 2

1961 to 1980, 3

1941 to 1960, or 4

1940 or before 5

REFUSED -1

DON’T KNOW -2

HC007/(LENGTH_RESIDE)/(LENGTH_RESIDE_UNIT). How long have you lived in this home?

INTERVIEWER INSTRUCTION:

• ENTER IN NUMERIC VALUE AND SELECT ASSOCIATED UNIT OF TIME

|___|___|

NUMBER

REFUSED -1

DON’T KNOW -2

WEEKS 1

MONTHS 2

YEARS 3

PROGRAMMER INSTRUCTION:

• INCLUDE SOFT EDIT IF VALUE > 18 YEARS

HC009. Now I have a few questions about {C_FNAME/the child}’s primary household.

HC010/(NUM_HH). How many persons are currently living in or staying in this household, not including the child?

|___|___|

NUMBER OF PERSONS

REFUSED -1 (TIME_STAMP_4)

DON’T KNOW -2 (TIME_STAMP_4)

HC012/(MILITARY_HH). Have any household members ever served on active duty in the U.S. Armed Forces, military Reserves, or National Guard? Active duty does not include training for the Reserves or National Guard, but does include activation, for example, for the Persian Gulf War.

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• LOOP THROUGH FNAME_HH, CHILD_RELAT, CHILD_RELAT_OTH_1 (IF CHILD_RELAT = 7), CHILD_RELAT_OTH_2 (IF CHILD_RELAT = 8), HH_MEM_DOB, ACTIVE_DUTY (IF MILITARY_HH = 1 AND EITHER HH_MEM_AGE ≥ 18 YEARS OR HH_MEM_DOB = -1 OR -2), AND BRANCH_SERV (IF ACTIVE_DUTY = 1, 2 OR 3) UNTIL NUMBER OF LOOPS = NUM_HH.

• THEN GO TO TIME_STAMP_4.

HC015/(FNAME_HH). {What are the names of all the persons living or staying in this household? Start with the name of the person, or one of the persons, who owns or rents this home}/{What is the name of the next person living or staying here?}

INTERVIEWER INSTRUCTION:

• CONFIRM SPELLING.

_________________________________

FIRST NAME

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF FIRST LOOP CYCLE, DISPLAY “What are the names of all the persons…”

• IF SUBSEQUENT LOOP CYCLE, DISPLAY “What is the name of the next person…”

HC020/(CHILD_RELAT). How is {F_NAME} related to the child?

MOTHER 1 (HH_MEM_DOB)

FATHER 2 (HH_MEM_DOB)

GRANDMOTHER 3 (HH_MEM_DOB)

GRANDFATHER 4 (HH_MEM_DOB)

SISTER 5 (HH_MEM_DOB)

BROTHER 6 (HH_MEM_DOB)

OTHER RELATIVE 7

OTHER NON-RELATIVE 8 (CHILD_RELAT_OTH_2)

REFUSED -1 (HH_MEM_DOB)

DON’T KNOW -2 (HH_MEM_DOB)

PROGRAMMER INSTRUCTION:

• DISPLAY F_NAME.

HC025/(CHILD_RELAT_OTH_1).

SPECIFY: _____________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• LIMIT TEXT TO 255 CHARACTERS.

• GO TO HH_MEM_DOB.

HC030/(CHILD_RELAT_OTH_2).

SPECIFY: _____________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

HC032/(HH_MEM_DOB). What is {F_NAME}’s date of birth?

INTERVIEWER INSTRUCTIONS:

• IF PARENT/CAREGIVER REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS

• 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.

MONTH: |___|___|

M M

DAY: |___|___|

D D

YEAR: |___|___|___|___|

Y Y Y Y

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• FORMAT HH_MEM_DOB AS YYYYMMDD.

• DISPLAY F_NAME.

• IF MILITARY_HH = 1 AND,

  • IF VALID RESPONSE PROVIDED FOR HH_MEM_DOB, CALCULATE DERIVED VARIABLE, HH_MEM_AGE, BASED ON HH_MEM_DOB AND DATE OF CURRENT INTERVIEW;

    • IF HH_MEM_AGE > 18 YEARS, GO TO ACTIVE_DUTY.

  • IF VALID RESPONSE NOT PROVIDED FOR HH_MEM_DOB, GO TO ACTIVE_DUTY.

• OTHERWISE, COMPLETE LOOP:

  • IF NUMBER OF COMPLETED LOOPS < NUM_HH, GO TO FNAME_HH.

  • IF NUMBER OF COMPLETED LOOPS = NUM_HH, GO TO TIME_STAMP_4.

HC035/(ACTIVE_DUTY). Has {F_NAME} ever served on active duty in the U.S. Armed Forces, military Reserves, or National Guard?

INTERVIEWER INSTRUCTION:

• READ AS NECESSARY: [Active duty does not include training for the Reserves or National Guard, but does include activation, for example, for the Persian Gulf War.]

Yes, they are now on active duty, 1

Yes, they were on active duty during the last 6

months, but not now, 2

Yes, they were on active duty in the past, but not

during the last 6 months, 3

No, they are training for Reserves or National

Guard only, or 4

No, they never served in the military? 5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• DISPLAY F_NAME.

• IF ACTIVE_DUTY = 1, 2, OR 3, GO TO BRANCH_SERV.

• OTHERWISE, IF ACTIVE_DUTY = 4, 5, -1, OR -2, COMPLETE LOOP:

  • IF NUMBER OF COMPLETED LOOPS < NUM_HH, GO TO FNAME_HH.

  • IF NUMBER OF COMPLETED LOOPS = NUM_HH, GO TO TIME_STAMP_4.

HC040/(BRANCH_SERV). What {is/was} {C_FNAME}’s branch of service?

Air Force, 1

Army, 2

Marine Corps, 3

Navy, or 4

Coast Guard? 5

NOT IN U.S. ARMED FORCES -7

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF ACTIVE_DUTY = 1, DISPLAY “is”.

• IF ACTIVE_DUTY = 2 OR 3, DISPLAY “was”.

• IF NUMBER OF COMPLETED LOOPS < NUM_HH, GO TO FNAME_HH TO BEGIN NEXT LOOP.

• IF NUMBER OF COMPLETED LOOPS = NUM_HH, GO TO TIME_STAMP_4.

(TIME_STAMP_4). PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

ENVIRONMENTAL EXPOSURES

EX001. The next few questions ask about any recent additions or renovations to your home.

EX001A/(RENOVATE). Since our last contact, have any additions been built onto your home to make it bigger or renovations or other construction been done in your home? Include only major projects. Do not count smaller projects such as painting or wallpapering, carpeting, or refinishing floors.

YES 1

NO 2 (DECORATE)

REFUSED -1 (DECORATE)

DON’T KNOW -2 (DECORATE)

EX002/(RENOVATE_ROOM). Which rooms were renovated?

INTERVIEWER INSTRUCTION:

• SELECT ALL THAT APPLY.

KITCHEN 1

LIVING ROOM 2

HALL/LANDING 3

BABY’S BEDROOM 4

OTHER BEDROOM 5

BATHROOM/TOILET 6

BASEMENT 7

OTHER -5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF RENOVATE_ROOM=ANY COMBINATION OF 1 THROUGH 7, INCLUDING JUST ONE OF THOSE RESPONSES, GO TO DECORATE.

• IF RENOVATE_ROOM=ANY COMBINATION OF 1 THROUGH 7, AND -5, GO TO RENOVATE_ROOM_OTH.

• IF RENOVATE_ROOM= -5, GO TO RENOVATE_ROOM_OTH.

• IF RENOVATE_ROOM=-1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES, AND GO TO DECORATE.

EX003/(RENOVATE_ROOM_OTH).

SPECIFY ________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

EX004/(DECORATE). Since our last contact, were any smaller projects done in your home, such as painting, wallpapering, refinishing floors, or installing new carpet?

YES 1

NO 2 (SMOKE)

REFUSED -1 (SMOKE)

DON’T KNOW -2 (SMOKE)

EX005/(DECORATE_ROOM). In which rooms were these smaller projects done?

INTERVIEWER INSTRUCTION:

• SELECT ALL THAT APPLY.

KITCHEN 1

LIVING ROOM 2

HALL/LANDING 3

BABY’S BEDROOM 4

OTHER BEDROOM 5

BATHROOM/TOILET 6

BASEMENT 7

OTHER -5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF DECORATE_ROOM =ANY COMBINATION OF 1 THROUGH 7, INCLUDING JUST ONE OF THOSE RESPONSES, GO TO SMOKE.

• IF DECORATE_ROOM =ANY COMBINATION OF 1 THROUGH 7, AND -5, GO TO DECORATE_ROOM_OTH.

• IF RENOVATE_ROOM = -5, GO TO RENOVATE_ROOM_OTH.

• IF DECORATE_ROOM = -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES, AND GO TO SMOKE.

EX006/(DECORATE_ROOM_OTH).

SPECIFY ________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

EX007/(SMOKE). Currently, do you or others in your household smoke cigarettes, cigarillos, cigars, pipes or other tobacco products?

YES 1

NO 2 (TIME_STAMP_5)

REFUSED -1 (TIME_STAMP_5)

DON’T KNOW -2 (TIME_STAMP_5)

EX008/(SMOKE_LOCATE). Do those who smoke usually smoke indoors, outdoors, or both indoors and outdoors?

INDOORS 1

OUTDOORS 2

BOTH 3

REFUSED -1

DON’T KNOW -2

(TIME_STAMP_5). PROGRAMMER INSTRUCTIONS:

• INSERT DATE/TIME STAMP

• IF BIRTH_DELIVER ≠3 AND RELEASE=2 GO TO FED_BABY.

• OTHERWISE, GO TO HOW_FED.

INFANT FEEDING

IF001/(FED_BABY). Have you fed {BABY_FNAME/your baby/your babies} since {his/her/their} birth?

YES 1

NO 2 (PLAN_FEED)

REFUSED -1

DON’T KNOW -2

IF002/(HOW_FED). How have you fed {BABY_FNAME/your baby/your babies} ? Did you breast or bottle feed?

BREAST ONLY 1

BOTTLE ONLY 2

BOTH BREAST AND BOTTLE 3

OTHER -4

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF LIVE_MOM = 2, GO TO TIME_STAMP_10.

• OTHERWISE, GO TO PLAN_FEED.

IF003/(PLAN_FEED). {Have you fed/ Do you plan to feed} the {baby/babies} breast milk, formula or both?

BREAST MILK 1

FORMULA 2

BOTH BREAST MILK AND FORMULA 3

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF FED_BABY = 2, -1, OR -2, DISPLAY “Do you plan to feed”.

• OTHERWISE, DISPLAY “Have you fed”.

(TIME_STAMP_6). PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

• IF BIRTH_DELIVER =3 AND RELEASE=2, GO TO POS_HOSP.

• OTHERWISE, GO TO POS_HOME.

INFANT SLEEP

IS001/(POS_HOSP). Do the nurses here in the {hospital/birthing center/other place} usually put {BABY_FNAME}/your baby/your babies} to sleep on {his/her/your baby} stomach{s}, back{s}, or side{s}?

STOMACH 1

BACK 2

SIDE 3

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF MULTIPLE=1, DISPLAY “their stomachs, backs, or sides”.

• OTHERWISE, DISPLAY “stomach, back, or side”.

IS002/(POS_HOME). In what position do you {usually put {BABY_FNAME}/your baby/your babies} to sleep at home?}/{plan to put {BABY_FNAME/your baby/your babies} to sleep at home?

STOMACH 1

BACK 2

SIDE 3

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF BIRTH_DELIVER = 3 OR RELEASE= 1, DISPLAY “usually put…”.

• OTHERWISE, DISPLAY “plan to put …”.

IS003/(SLEEP_ROOM). {When you go home from the {hospital/birthing center/other place}, do you plan for}/{Do/Does}{BABY_FNAME/your baby/your babies} {to} sleep…

In {his/her/their} own room, 1

In a room with other children, 2

In your bedroom, or 3

Another location? 4

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF RELEASE = 2, DISPLAY “When you go home from… do you plan for” and “to”

• IF BIRTH_DELIVER = 3 OR RELEASE=1, AND IF MULTIPLE=1, DISPLAY “Do your babies sleep…”

• OTHERWISE, IF BIRTH_DELIVER = 3 OR RELEASE=1 AND MULTIPLE = 2, DISPLAY “Does … sleep…”

IS004/(BED). {When you go home from the {hospital/birthing center/other place}, do you plan for}/{Do/Does}{BABY_FNAME/your baby/your babies} {to} sleep in …

A bassinette, 1 (TIME_STAMP_7)

A crib, 2 (TIME_STAMP_7)

A co-sleeper, 3 (TIME_STAMP_7)

An adult bed alone, 4 (TIME_STAMP_7)

An adult bed with you, 5 (TIME_STAMP_7)

An adult bed with another child, or 6 (TIME_STAMP_7)

Something else -5

REFUSED -1 (TIME_STAMP_7)

DON’T KNOW -2 (TIME_STAMP_7)

PROGRAMMER INSTRUCTIONS:

• IF RELEASE = 2, DISPLAY “When you go home from… do you plan for” and “to”

• IF BIRTH_DELIVER = 3 OR RELEASE=1, AND IF MULTIPLE=1, DISPLAY “Do your babies sleep…”

• OTHERWISE, IF BIRTH_DELIVER = 3 OR RELEASE=1 AND MULTIPLE = 2, DISPLAY “Does … sleep…”

IS005/(BED_OTH).

SPECIFY ________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

(TIME_STAMP_7).PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

• IF BIRTH_DELIVER = 3 OR RELEASE = 1, GO TO HCARE_YET.

• OTHERWISE, GO TO HCARE.

WELL BABY CARE AND IMMUNIZATIONS

WB001/(HCARE_YET). Have you taken your new {baby/babies} for any well-baby checkups?

Yes 1

No 2

REFUSED -1

DON’T KNOW -2

WB002/(HCARE). Where {have you taken/do you plan to take} your new {baby/babies} for well-baby checkups?

Hospital clinic 1

Health department clinic 2

Private doctor’s office or Health

Maintenance Department (HMO) 3

Some other Place -5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF HCARE_YET = 1, DISPLAY, “have you taken”.

• IF HCARE_YET = 2,-1 OR -2, DISPLAY, “do you plan to take”.

• IF HCARE = 1, 2, 3, -1, or -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING HCARE_OTH.

• OTHERWISE, GO TO HCARE_OTH.

WB003/(HCARE_OTH).

SPECIFY ________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• LIMIT TEXT TO 255 CHARACTERS.

• IF BIRTH_DELIVER = 3 OR RELEASE = 1, GO TO VACCINE_YET.

• OTHERWISE, GO TO VACCINE.

WB004/(VACCINE_YET). Have you taken your new {baby/babies} to have any well-baby shots or vaccinations?

Yes 1 (TIME_STAMP_8)

No 2

REFUSED -1

DON’T KNOW -2

WB005/(VACCINE). Do you plan for your new {baby/babies} to have well-baby shots or vaccinations?

YES 1

YES, ON A DELAYED SCHEDULE 2

NO 3

REFUSED -1

DON’T KNOW -2

(TIME_STAMP_8). PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

WORK AND PLANS FOR CHILDCARE

WCC001/(EMPLOY2). Are you currently employed?

YES 1

NO 2 (WCC003G)

REFUSED -1

DON’T KNOW -2

WCC002/(RETURN_JOB_YET). {Have you returned/Do you plan to return} to your current job?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF BIRTH_DELIVER = 3 OR RELEASE = 1, display “Have you returned”.

• OTHERWISE, display “Do you plan to return”.

• IF BIRTH_DELIVER = 3 OR RELEASE = 1, AND RETURN_JOB_YET = 1, GO TO (RETURN_JOB_DT_MM)(RETURN_JOB_DT_DD)(RETURN_JOB_DT_YY).

• IF RELEASE = 2 AND RETURN_JOB_YET = 1, GO TO (RETURN_JOB)/(RETURN_JOB_UNIT).

• IF RETURN_JOB_YET = 2, -1, OR -2, GO TO WCC003G.

WCC003/(RETURN_JOB_DT_MM)(RETURN_JOB_DT_DD)(RETURN_JOB_DT_YY). When did you return to your job?

MONTH: |___|___|

M M

REFUSED -1 (WCC003G)

DON’T KNOW -2 (WCC003G)

DAY: |___|___|

D D

REFUSED -1

DON’T KNOW -2

YEAR: |___|___|___|___|

Y Y Y Y

REFUSED -1 (WCC003G)

DON’T KNOW -2 (WCC003G)

WCC003A/(RETURN_JOB). When do you plan to return to your current job?

|___|___|

NUMBER

DOESN’T PLAN TO RETURN TO WORK -7

REFUSED -1

DON’T KNOW -2

WCC003B/(RETURN_JOB_UNIT)

INTERVIEWER INSTRUCTION:

• ENTER IN NUMERIC VALUE AND SELECT ASSOCIATED UNIT OF TIME

DAYS 1

WEEKS 2

MONTHS 3

YEARS 4

PROGRAMMER INSTRUCTION:

• INCLUDE SOFT EDIT IF VALUE > 1 YEAR OR >12 MONTHS OR > 52 WEEKS OR >365 DAYS.

• IF EMPLOY2 = 1, AND WORK_NAME PREVIOUSLY SET TO COMPLETE, AND VALID RESPONSE PROVIDED, GO TO WORK_NAME_CONFIRM.

• IF EMPLOY2 = 1, AND WORK_NAME PREVIOUSLY NOT SET TO COMPLETE, GO TO WORK_NAME.

• OTHERWISE, GO TO WCC003G.

WCC003C/(WORK_NAME_CONFIRM). Let me confirm the name of the place where you work. I have it as {PARTICIPANT’S WORK PLACE NAME}. Is that correct?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF WORK_NAME_CONFIRM = 2 OR -2, GO TO WORK_NAME.

• OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING WORK_NAME.

WCC003D/(WORK_NAME). What is the name of the place where you work?

_____________________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTUCTIONS:

• LIMIT TEXT TO 255 CHARACTERS.

• IF WORK ADDRESS VARIABLES COLLECTED PREVIOUSLY AND VALID WORK ADDRESS PROVIDED, GO TO WORK ADDRESS VARIABLES CONFIRM.

• OTHERWISE, IF WORK ADDRESS VARIABLES NOT COLLECTED PREVIOUSLY OR VALID WORK ADDRESS NOT PROVIDED, GO TO WORK ADDRESS VARIABLES.

WCC003E/(WORK ADDRESS VARIABLES CONFIRM). Let me confirm your work address. I have it as {PARTICIPANT’S WORK ADDRESS}.

INTERVIEWER INSTRUCTION:

• MAKE CORRECTIONS TO WORK ADDRESS AS NEEDED.

__________________________________________________

ADDRESS 1 - STREET/PO BOX (CWORK_ADDRESS_1)

REFUSED -1

DON’T KNOW -2

ADDRESS 2 (CWORK_ADDRESS_2)

REFUSED -1

DON’T KNOW -2

UNIT (CWORK_UNIT)

REFUSED -1

DON’T KNOW -2

CITY (CWORK_CITY)

REFUSED -1

DON’T KNOW -2

|___|___|

STATE (CWORK_STATE)

REFUSED -1

DON’T KNOW -2

|___|___|___|___|___| - |___|___|___|___|

ZIP CODE ZIP+4 (CWORK_ZIP) (CWORK_ZIP4)

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• PRELOAD WORK ADDRESS; ALLOW INTERVIEWER TO MAKE CORRECTIONS.

• IF VALID ADDRESS NOT PROVIDED OR WORK ADDRESS VARIABLES CONFIRM = -1 or -2, GO TO WORK ADDRESS VARIABLES.

• OTHERWISE, GO TO WCC003G.

WCC003F/(WORK ADDRESS VARIABLES). ENTER ADDRESS

INTERVIEWER INSTRUCTION:

• PROBE AND ENTER AS MUCH INFORMATION AS PARTICIPANT KNOWS.

__________________________________________________

ADDRESS 1 - STREET/PO BOX (WORK_ADDRESS_1)

REFUSED -1

DON’T KNOW -2

ADDRESS 2 (WORK_ADDRESS_2)

REFUSED -1

DON’T KNOW -2

UNIT (WORK_UNIT)

REFUSED -1

DON’T KNOW -2

CITY (WORK_CITY)

REFUSED -1

DON’T KNOW -2

|___|___|

STATE (WORK_STATE)

REFUSED -1

DON’T KNOW -2

|___|___|___|___|___| - |___|___|___|___|

ZIP CODE ZIP+4 (WORK_ZIP) (WORK_ZIP4)

REFUSED -1

DON’T KNOW -2

WCC003G. Next I would like to ask you a few questions about your plans for childcare.

WCC004/(CHILDCARE). Will {BABY_FNAME/your baby/your babies} receive regularly scheduled care from someone other than you or the {baby’s/babies’} father?

YES 1

NO 2 (TIME_STAMP_9)

REFUSED -1

DON’T KNOW -2

WCC005/(CCARE_TYPE). Please describe the type of setting in which most of the childcare will occur.

PARTICIPANT’S HOME 1 (CCARE_WHO)

OTHER PRIVATE HOME 2 (CCARE_WHO)

CHILD CARE CENTER 3 (CCARE_WHO)

OTHER -5

REFUSED -1 (CCARE_WHO)

DON’T KNOW -2 (CCARE_WHO)

WCC006/(CCARE_TYPE_OTH).

SPECIFY ________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

WCC007/(CCARE_WHO). Which best describes the person who will be caring for {BABY_FNAME/your baby/your babies}?

INTERVIEWER INSTRUCTION:

• IF USING SHOWCARDS, REFER PARTICIPANT TO APPROPRIATE SHOWCARD. OTHERWISE, READ RESPONSE CATEGORIES TO PARTICIPANT.

YOUR MOTHER 1 (TIME_STAMP_9)

YOUR FATHER 2 (TIME_STAMP_9)

YOUR MOTHER IN-LAW 3 (TIME_STAMP_9)

YOUR FATHER IN-LAW 4 (TIME_STAMP_9)

GUARDIAN 5 (TIME_STAMP_9)

OTHER RELATIVE 6

FRIEND 7 (TIME_STAMP_9)

NANNY 8 (TIME_STAMP_9)

PROFESSIONAL IN HOME DAYCARE 9 (TIME_STAMP_9)

PROFESSIONAL CENTER BASED DAYCARE 10 (TIME_STAMP_9)

OTHER -5 (CCARE_WHO_OTH)

REFUSED -1 (TIME_STAMP_9)

DON’T KNOW -2 (TIME_STAMP_9)

PROGRAMMER INSTRUCTION:

• IF USING SHOWCARDS, DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS. OTHERWISE, DISPLAY RESPONSE CATEGORIES AS MIXED UPPER/LOWER CASE PER BELOW.

WCC008/(REL_CARE_OTH).

SPECIFY ________________________ (TIME_STAMP_9)

REFUSED -1 (TIME_STAMP_9)

DON’T KNOW -2 (TIME_STAMP_9)

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

WCC009/(CCARE_WHO_OTH).

SPECIFY ________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

(TIME_STAMP_9). PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

END. Thank you for participating in the National Children’s Study and for taking the time to answer our questions.

INTERVIEWER-COMPLETED QUESTIONS

(TIME_STAMP_10) PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

IC001/(PARTICIPANT). WAS THE INTERVIEW COMPLETED WITH THE BIRTH MOTHER OR A PROXY?

BIRTH MOTHER 1

PROXY 2

IC003/(CONTACT_TYPE). IN WHAT MODE WAS THE QUESTIONNAIRE ADMINISTERED?

IN-PERSON 1

TELEPHONE 2

MAIL 3

WEB 4

IC004/(ENGLISH). WAS THIS DATA COLLECTION SESSION CONDUCTED IN ENGLISH?

YES 1 (INTERPRET)

NO 2

IC005/(CONTACT_LANG). WHAT OTHER LANGUAGE WAS USED TO CONDUCT THIS SESSION?

SPANISH 1 (INTERPRET)

ARABIC 2 (INTERPRET)

CHINESE 3 (INTERPRET)

FRENCH 4 (INTERPRET)

FRENCH CREOLE 5 (INTERPRET)

GERMAN 6 (INTERPRET)

ITALIAN 7 (INTERPRET)

KOREAN 8 (INTERPRET)

POLISH 9 (INTERPRET)

RUSSIAN 10 (INTERPRET)

TAGALOG 11 (INTERPRET)

VIETNAMESE 12 (INTERPRET)

URDU 13 (INTERPRET)

PUNJABI 14 (INTERPRET)

BENGALI 15 (INTERPRET)

FARSI 16 (INTERPRET)

OTHER -5

IC006/(CONTACT_LANG_OTH).

SPECIFY ________________________

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

IC007/(INTERPRET). WAS AN INTERPRETER USED?

YES 1

NO 2 (TIME_STAMP_11)

IC008/(CONTACT_INTERPRET). WHAT TYPE OF INTERPRETER WAS USED?

BILINGUAL INTERVIEWER 1 (TIME_STAMP_11)

IN-PERSON PROFESSIONAL INTERPRETER 2 (TIME_STAMP_11)

IN-PERSON FAMILY MEMBER INTERPRETER 3 (TIME_STAMP_11)

LANGUAGE-LINE INTERPRETER 4 (TIME_STAMP_11)

VIDEO INTERPRETER 5 (TIME_STAMP_11)

SIGN LANGUAGE INTERPRETER 6 (TIME_STAMP_11)

OTHER -5

IC009/(CONTACT_ INTERPRET_OTH).

SPECIFY ________________________

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS

(TIME_STAMP_11). PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.