OMB
Approval No. 0584-XXXX Approval
Expires: XX/XX/20XX
APPENDIX J.1
WIC ITFPS-2 Participant Interview
1 Month - ENGLISH
SOCIODEMOGRAPHICS AND BACKGROUND
I’d like to start today by asking you some background questions about your baby and yourself. Let’s start with some questions about your baby.
Child Sex
Enrollment or if recruited prenatal, 1 mo
SD8. Is your baby a boy or a girl? [Source: WIC IFPS-1]
Boy 01
Girl 02
Single or Multiple Birth
Enrollment or if recruited prenatal, 1 mo
SD7. Did you have twins, or more than one baby? [Source: FDA IFPS-2]
Yes 01
No 02
If yes, need to sample one child for study
Child Name
Enrollment or if recruited prenatal, 1 mo
SD9. What is your baby's full name? Please spell that for me. [Source: New Development]
Record full name:
First________________________________________________
Middle______________________________________________
Last ________________________________________________
a. Is there a nickname you use for {CHILD} that you would like me to use while talking with you?
(If yes) Nickname _____________________________________
Infant DOB
Enrollment if postnatal or if recruited prenatal, 1 mo
SD5. {EN: Thinking of the child you enrolled in WIC today,}What month was {EN: this child/ 1 mo: CHILD} born? [Source: WIC IFPS-1]
Month [January – December]
SD6. {EN: Thinking of the child you enrolled in WIC today/ 1 mo: And } what day of the month was {CHILD} born?
Day [1-31]
{Year – autofill for last occurrence of the month}
Don't know 98
Refused 99
Birth
Weight
1
HF28. What was {CHILD’S} weight at birth? [Source: WIC IFPS-1]
Pounds [number]
Ounces [0-15]
Gestational Age (birth <37 weeks)
1
HF29. Was {CHILD} born more than 3 weeks before (his/her) due date? [Source: PHFE WIC Postpartum Questionnaire 2010]
Yes 01
No 02
Don’t know 98
HF30. (If yes) How many weeks pregnant were you when {CHILD} was born? [Source: PHFE WIC Postpartum Questionnaire 2010]
Weeks [22-37]
Child Ethnicity
Enrollment or if recruited prenatal, 1 mo
SD10. Is {CHILD} Latino or Hispanic?
Hispanic or Latino 01
Not Hispanic or Latino 02
Don’t know 98
Refused 99
Child Race
Enrollment or if recruited prenatal, 1 mo
SD11. What is {CHILD’S} race? (choose all that apply) [Source: OMB Standard Categories]
American Indian or Alaska Native 01
Asian 02
Black or African American 03
Native Hawaiian or Other Pacific Islander 04
White 05
Other (specify____________________________________) 06
Don't know 98
Refused 99
Respondent still Caregiver?
1, 3, 5, 7, 9, 11, 13, 15, 18, 24
SD12. (1 mo.: Before we go any further/ All other: Before we begin today), I need to ask whether you are still {CHILD's} caregiver. [Source: New Development]
Yes 01
No 02
(If no, go to a)
a. Does {CHILD} still live with you?
Yes 01
No 02
b. (If a is Yes): Can you please tell me who in your household is now {CHILD's} caregiver? Can I speak with that person?
Name of New Caregiver______________________________________________
c. (If a is No): Can you please tell me who is caring for {CHILD} now, and how I could reach that person?
Name of New Caregiver______________________________________________
Phone of New Caregiver______________________________________________
Address of New Caregiver____________________________________________
Relation of New Caregiver to Child_____________________________________
Now I’m going to ask some questions about you.
Continuation/discontinuation of WIC participation (timing, reasons, location)
1, 3, 5, 7, 9, 11, 13, 15, 18, 24
SD31. Are you currently getting WIC food or checks for yourself or {CHILD}? [Source: FDA IFPS-2; modified]
Yes 01
No 02
(if no for the first time go to #SD 34)
SD32. The last time we talked with you, you were going to WIC at [fill in location]. Do you still go there, or do you go to a new location? [Source: FDA IFPS-2 modified]
Yes, still that location 01
No, new location 02
SD33. (If SD32 is no) Please tell me where you go now
Record location _______________________________________
Ask SD34 and SD35 only if SD31 is 'no'
SD34. How old was {CHILD} when you stopped going to WIC? [Source: LA WIC Survey; modified]
Age [weeks/months]
SD35. I'm going to read some reasons why you might have stopped going to WIC. Please tell me if each one is a reason you stopped going to WIC: [Source: LA WIC Survey; modified]
You no longer qualify for WIC 01
It was inconvenient for you 02
You no longer need WIC 03
Other reason (record response) 04
Employment status during pregnancy
1
SD28. Some women work for pay during pregnancy and some do not. How many months did you work for pay while you were pregnant with {CHILD}? [Source: New Development]
Months [0 to 9]
HOSPITAL EXPERIENCES AND FEEDING PRACTICES
Next I’d like to ask you some questions about your experience in the hospital when {CHILD} was born.
NICU Feeding Module
1, *3 for last question
HF1. Did {CHILD} spend any time in the NICU (If needed: The NICU is the Neonatal Intensive Care Unit, a special hospital unit for newborn babies who are premature or who have special medical problems)?[Source: New Development]
Yes 01
No (if no, skip to HF7) 02
HF2. (If yes) What was the reason? [Source: New Development]
Premature delivery 01
Other health problem (specify ______________________) 02
HF3. How long was she/he in the NICU? [Source: New Development]
Time [days/weeks]
Still there 96
HF4. While she/he was in the NICU, did you feed him/her breastmilk directly from your breast, pump breastmilk for him/her, both feed from your breast and pump, or did you not feed your baby breastmilk at all? (If still there, change to present tense - are you feeding him/her directly from your breast, pumping breastmilk for him/her, both feeding from your breast and pumping, or are you not feeding your baby breastmilk?) [Source: New Development]
Feeding directly from breast 01
Pumping breastmilk 02
Both from breast and pumping 03
Not feeding breastmilk 04
Mode of delivery
1
HF7. How was your baby delivered? [Source: FDA Project First]
vaginally and not induced 01
vaginally and induced 02
a planned caesarean/c-section 03
an unplanned or emergency caesarean/c-section 04
Rooming arrangement in hospital
1
HF8. While you were in the hospital, did {CHILD} stay in the same room with you, or in a nursery? Do not include time your child was out of your room briefly for things such as medical procedures, bathing, or weighing. [Source: WIC IFPS-1; modified]
Only in my room 01
Only in the nursery 02
Both 03
In NICU, never in my room or in the nursery 04
In NICU, then nursery 05
In NICU, then my room 06
In NICU, then both my room and the nursery 07
First Feeding/Initiation of breastfeeding
1
HF9. What was the very first thing that {CHILD} was fed after birth? Was it formula, your breastmilk, sugar water, plain water, or something else? [Source: WIC IFPS-1]
Formula 01
Breastmilk 02
Sugar water 03
Plain water 04
Other 05
Don’t know 98
If baby was in NICU and mother indicated in HF4 she was feeding breast milk, skip to HF11
HF10. (If first thing fed was other than breastmilk) Did you start to breastfeed your baby while still in the hospital? [Source: New Development]
Yes 01
No 02
HF11. (If first fed was breastmilk or started breastfeeding in hospital) Did you start breastfeeding in the first hour after birth or later? [Source: WIC IFPS-1; modified]
First hour 01
Later 02
Don’t remember 98
Initial bf problems/barriers to initiating bf.
1
HF12. (If started to breastfeed in hospital) Did you have any problems with breastfeeding while you were in the hospital? [Source: WIC IFPS-1]
Yes 01
No 02
If no to HF12, skip toHF18
HF13. Did you have problems with your breasts being so full that milk wouldn’t come out or your baby had trouble latching on? [Source: WIC IFPS-1]
Yes 01
No 02
HF14. Did you have problems with breast or nipple pain? [Source: WIC IFPS-1, modified]
Yes 01
No 02
HF15. Did you have problems with thinking the baby was not getting enough milk? [Source: WIC IFPS-1]
Yes 01
No 02
HF16. Did you have problems with it taking too long for your milk to come in? [Source: WIC IFPS-1]
Yes 01
No 02
HF17. Did any of the people working at the hospital assist you with any of these problems? [Source: WIC IFPS-1]
Yes 01
No 02
Receipt of gift package from hospital? Contents?
1
HF18. When you left the hospital, were you given a gift pack? [Source: WIC IFPS-1]
Yes 01
No 02
HF19. (If yes) Which of the following things were in the gift pack? [Source: WIC IFPS-1, modified]
a. Formula
Yes 01
No 02
b. Coupons for formula or discounts on formula
Yes 01
No 02
c. A pacifier
Yes 01
No 02
d. An empty bottle
Yes 01
No 02
Breastfeeding on set schedule or on demand?
1
Ask only if breastfeeding in the hospital
HF20. While you were in the hospital, did you feed your baby breastmilk, either from your breast or from a bottle, on a set schedule or whenever [HE/SHE] cried or seemed hungry? [Source: WIC IFPS -1]
Schedule 01
Cried or seemed hungry 02
Both on a schedule and when baby cried or seemed hungry 03
Pump breasts in hospital
1
HF21. While you were in the hospital, did you pump milk or try to pump milk from your breasts? [Source: WIC IFPS-1]
Yes 01
No 02
Encouragement of bf in hospital
1
HF22. While you were in the hospital, did your doctor, the nurses or other hospital staff encourage you to breastfeed your baby? [Source: New Development]
Yes 01
No 02
Availability of bf support in hospital
1
HF23. Was there someone in the hospital whose job it was to help you with breastfeeding, like a lactation consultant or another trained specialist? [Source: WIC IFPS-1; modified]
Yes 01
No 02
Don’t know 98
Breastfeeding-related
hospital support services used
1
HF24. While you were in the hospital, did you use any of the following support services, information, or equipment for breastfeeding? [Source: New Development]
a. Did you use brochures, pamphlets, or TV classes
Yes 01
No 02
b. Did you use a lactation consultant
Yes 01
No 02
c. Did you use another trained specialist who helped with breastfeeding
Yes 01
No 02
d. While you were in the hospital did you use breastfeeding support groups or classes
Yes 01
No 02
e. Did you use equipment for breastfeeding support such as pumps, breast shields, or other equipment
Yes 01
No 02
f. Did you use counseling that you asked for
Yes 01
No 02
g. Did you use counseling offered when you hadn’t asked
Yes 01
No 02
h. Did you use a hotline or number in the hospital to call for breastfeeding questions
Yes 01
No 02
i. Did you use the name and number of a specific hospital staff member to call for questions
Yes 01
No 02
j While you were in the hospital did you use any other services, information, or equipment not mentioned
Yes (specify ____________________________) 01
No 02
Feeding type at hospital discharge (human milk, formula, both)
1
HF25. When you left the hospital, were you feeding your baby only breastmilk, only formula, or both breastmilk and formula? [Source: WIC IFPS-1]
only breastmilk 01
only formula 02
both breastmilk and formula 03
Length of hospital stay for mother
1
HF26. How many nights did you stay in the hospital after {CHILD’s} birth? [Source: FDA Project First; modified]
Nights [number]
Length of hospital stay for infant
1
HF27. How many nights did {CHILD} stay in the hospital after birth? [Source: FDA Project First; modified]
Nights [number]
Don’t remember 98
CURRENT FEEDING PRACTICES
AMPM Module (Asking child’s food intake in past 24 hours)
24-HR Recall for Food Intake
1, 3, 5, 7, 9, 11, 13, 15, 18, 24
Nutrition intake
Number of breastmilk/formula feedings per day
Type of formula used
Adherence to formula dilution instructions
Use/timing of supplemental formula for breastfeeding mothers
Addition of anything other than human milk/formula to child’s bottle
Specific food item intake
Use of jarred baby foods
Meal and snack pattern
Eating locations (eating on the go)
Use of dietary supplements for infants (direct administration)
Now I’m going to ask you some questions about things you might be doing to feed your baby.
Current feeding choice
1, 3, 5, 7, 9, 11, 13
CF1. Are you currently feeding {CHILD} breastmilk either from your breast or from a bottle, formula, (1-5 months: or both) (7-13 months: both, or neither)? [Source: New Development]
Only breastmilk 01
Only formula 02
Both breastmilk and formula 03
Neither breastmilk nor formula 04
First postnatal interview (1 or 3), if mother indicates formula feeding only in CF1, and if 1 month answered no to HF10 breastfeeding initiated in hospital, ask:
CF29. Did you ever feed your baby breastmilk, either from your breast or from a bottle? [Source: FDA IFPS-2, modified]
Yes 01
No 02
IF CF1 = 02, SKIP TO CF19
Breastfeeding Module (Asked only if mother currently feeding breastmilk, based on CF1)
Questions CF2 – CF18
Frequency and nature of breastfeeding problems
Resolution of breastfeeding problems
1, 3, 5
You said that you are currently feeding {CHILD} breastmilk. I’d like to ask you some questions about that now.
CF2. I would like to ask you about some of the problems you might have had with breastfeeding during the past month. During the past month, have you had any of the following problems:
Ask items (a/b) only at 1 month, then drop at 3 and 5.
a. In the past month, did your baby have trouble latching on?
Yes 01
No 02
b. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)
Turned to someone for advice 01
Bottle fed baby with formula 02
Pumped breastmilk to be fed to baby with bottle 03
Nothing, just continued breastfeeding 04
Other (specify ____________________________________) 05
Ask at 1, 3, 5
c. In the past month did your baby have problems with choking?
Yes 01
No 02
d. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)
Turned to someone for advice 01
Bottle fed baby with formula 02
Pumped breastmilk to be fed to baby with bottle 03
Nothing, just continued breastfeeding 04
Other (specify ____________________________________) 05
e. In the past month did you have sore or cracked nipples?
Yes 01
No 02
f. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)
Turned to someone for advice 01
Took medications or used creams 02
Bottle fed baby with formula 03
Pumped breastmilk to be fed to baby with bottle 04
Nothing, just continued breastfeeding 05
Other (specify ____________________________________) 06
g. In the past month did you have a breast infection?
Yes 01
No 02
h. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)
Turned to someone for advice 01
Took medications or used creams 02
Bottle fed baby with formula 03
Pumped breastmilk to be fed to baby with bottle 04
Nothing, just continued breastfeeding 05
Other (specify ____________________________________) 06
i. In the past month were your breasts too full?
Yes 01
No 02
j. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)
Turned to someone for advice 01
Bottle fed baby with formula 02
Pumped breastmilk to be fed to baby with bottle 03
Pumped or expressed breastmilk to relieve fullness 04
Nothing, just continued breastfeeding 05
Other (specify ____________________________________) 06
k. In the past month did you not have enough milk to satisfy the baby?
Yes 01
No 02
l. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)
Turned to someone for advice 01
Changed what I ate 02
Bottle fed baby with formula 03
Pumped breastmilk to be fed to baby with bottle 04
Nothing 05
Other (specify ____________________________________) 06
m. In the past month did you have any other problems breastfeeding? (specify___________________________________)
Yes 01
No 02
n. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)
Turned to someone for advice 01
Took antibiotics/medications 02
Bottle fed baby with formula 03
Pumped breastmilk to be fed to baby with bottle 04
Nothing, just continued breastfeeding 05
Other (specify ____________________________________) 06
Support received for breastfeeding problem
1, 3, 5
CF3. (If yes to any problem in CF2) When you have encountered problems with breastfeeding have any of the following people given you advice about what to do? [Source: IFPS-1, modified]
a. People who work at your WIC office or clinic
Yes 01
No 02
b. Doctors or nurses
Yes 01
No 02
c. Friends or relatives
Yes 01
No 02
d. Breastfeeding support people outside of WIC such as La Leche League or a lactation counselor
Yes 01
No 02
e. Anyone else?
Yes 01
No 02
Frequency and nature of breastfeeding barriers
Best solutions to identified barriers
1, 3, 5
CF4. I’m going to read you some statements about things that might make it hard to breastfeed or keep you from breastfeeding. For each one, please tell me if this has happened to you in the past month: [FDA IFPS-2, modified]
a. I had to return to work or school and I could not or did not want to pump or breastfeed there. Did this happen to you in the past month?
Yes 01
No 02
b. Breastfeeding took too much out of me. Did this happen to you in the past month?
Yes 01
No 02
c. I did not have time to breastfeed. Did this happen to you in the past month?
Yes 01
No 02
d. I felt tied down by breastfeeding. Did this happen to you in the past month?
Yes 01
No 02
e. My husband or boyfriend was against it. Did this happen to you in the past month?
Yes 01
No 02
CF5. (If yes to any barriers in CF4) What do you think is the best way to deal with this/these things that made it hard to breastfeed? (Interviewer allow open-ended and check all responses offered) [Source: New Development]
Seek support from a friend or relative to help you
to continue breastfeeding 01
Seek support from a health professional to help you
to continue breastfeeding 02
Make arrangements with work or school to continue
breastfeeding or pumping during the day 03
Stop breastfeeding and switch to formula feeding 04
Mix breastfeeding with formula feeding 05
Nothing, just continue breastfeeding 06
Other (specify_____________________________) 07
Use of breast pump
1, 3, 5, 7, 9, 11, 13
CF6. Some mothers are able to pump breastmilk and others are not. Are you currently pumping breastmilk?
Interviewer: code yes if mother is pumping at all, even if infrequently.
Yes 01
No 02
Refused 99
If CF6 is NO, skip to CF18
From where mom received pump
1, 3 (ask at 1 month, or at 3 if mother indicates pumping for the first time at 3 months)
Ask only if currently pumping breastmilk in CF6
CF7. What are you using most often to pump breastmilk, is it an electric pump, a manual pump, pumping by hand, or something else? [Source: New Development]
An electric pump 01
A manual pump 02
Pumping by hand 03
Other 04
CF10. (Do not ask if CF7 pumping by hand) How did you get the breast pump that you use most often? (Interviewer read options)[Source: FDA IFPS-2, modified]
WIC loaned it to you or paid for it 01
You bought it or rented it 02
You borrowed it from a friend or relative 03
It was given to you as a gift 04
You use one provided by a hospital,
your place of work, or someplace else 05
Time of day of pumping
1, 3, 5, 7, 9, 11, 13
Ask only if currently pumping breastmilk in CF6
CF12. Now I’d like to ask you about the times of day when you usually pump. [Source: New Development]
a. When you pump, how often do you pump in the morning, before noon? Would you say usually, sometimes, or never?
Usually 01
Sometimes 02
Never 03
Don’t know 98
Refused 99
b. When you pump, how often do you pump mid-day, from noon to 5pm? Would you say usually, sometimes, or never?
Usually 01
Sometimes 02
Never 03
Don’t know 98
Refused 99
c. When you pump, how often to you pump in the evening or night time, after 5pm? Would you say usually, sometimes, or never?
Usually 01
Sometimes 02
Never 03
Don’t know 98
Refused 99
Frequency of pumping
1, 3, 5, 7, 9, 11, 13
Ask only if currently pumping breastmilk in CF6
CF11. Thinking about the past two weeks, how many times did you pump milk? (Interviewer allow open-ended, calculate numbers for response if needed, and confirm with respondent)[Source: FDA IFPS-2, modified]
Times pumped [times]
Amount of milk pumped
1
Ask only if currently pumping breastmilk in CF6
CF13. During the past 24 hours, about how many ounces of breastmilk did you pump, that is since (time) yesterday? ([Prompt:] Your best estimate or guess is fine. Think about the bottle or bottles you filled with pumped breastmilk and about the size of the bottles.) [Source: New Development]
Interviewer note: If the mother didn’t pump in the past 24 hours, enter 0.
Ounces [number]
What mom did with pumped milk
1
Ask only if currently pumping breastmilk in CF6
If CF13 = 0, skip to CF15.
CF14. What did you do with the breastmilk that you pumped in the past 24 hours? Did you… [Source: New Development]
a. Feed any of it to {CHILD} immediately
Yes 01
No 02
b. Store any of it for later use
Yes 01
No 02
c. Throw any of it away
Yes 01
No 02
Reasons for pumping
1, 3, 5, 7
Ask only if currently pumping breastmilk in CF6
CF15. I’m going to read you some reasons why you might have pumped breastmilk in the past month. For each one, tell me if this was a reason you pumped breastmilk. (CATI to randomize order of sub-items) [Source: FDA IFPS-2, modified]
a. To relieve engorgement or swelling
Yes 01
No 02
b. To keep your milk supply up when your baby could not nurse, such as while you were away from your baby or when your baby was too sick to nurse
Yes 01
No 02
c. To mix with cereal or other food
Yes 01
No 02
d. To increase your milk supply
Yes 01
No 02
e. To have an emergency supply of milk
Yes 01
No 02
f. To get milk so that someone else can feed your baby
Yes 01
No 02
g. Any other reason you have pumped breastmilk in the past month?
Yes (specify_________________________________) 01
No 02
Storage practices for pumped/expressed human milk
1, 3, 5, 7, 9, 11, 13
Ask only if currently pumping breastmilk in CF6
CF16. In the last month, how long was your pumped milk usually stored in the refrigerator? [Source: FDA IFPS-2, modified]
I do not store milk in a refrigerator 01
1 day or less 02
2 to 3 days 03
4 to 5 days 04
6 to 8 days 05
More than 8 days 06
CF17. How long is your frozen milk usually stored? [Source: FDA IFPS-2]
Only include 4 months or more after the 5 month interview
I do not freeze my milk 01
Less than 1 week 02
1 to 4 weeks 03
1 to 3 months 04
4 months or more 05
How is breastmilk feeding schedule determined (time schedule, child seems hungry, mixed)
1, 3, 5, 7, 9, 11, 13
CF18. Do you breastfeed or feed {CHILD} breastmilk from a bottle on a regular schedule, or when [HE/SHE] cries or seems hungry? [Source: IFPS-1, modified]
Schedule 01
Cries or seems hungry 02
Both on a schedule and when baby cries or seems hungry 03
IF CF1 = 01 SKIP TO CF52
Formula Feeding Module (Asked only if mother currently formula feeding)
Questions CF19 – CF27
Who provided formula
1, 3, 5, 7, 9, 11, 13
You said that you are currently feeding {CHILD} formula. I’d like to ask you some questions about that.
CF19. Where do you get the formula that you use to feed {CHILD}? Do you get it from WIC, from somewhere else, or both WIC and somewhere else? [Source: New Development]
WIC 01
Somewhere else 02
Both WIC and somewhere else 03
If CF19 = 02, skip to CF21.
CF20. (If indicated in CF19 getting formula from WIC) Is the amount of formula that you get from WIC to help feed {CHILD} more than you usually need, less than you usually need, or about right? [Source: PHFE WIC Survey 2010, modified]
More 01
Less 02
About right 03
Don’t know 98
Refused 99
Reasons for formula use
1, 3, 5, 7, 9, 11, 13 (ask for the last time at the interview where mom indicates she has completely stopped breastfeeding)
CF21. There are many reasons for using formula. Please tell me if any of the following are reasons why you feed your baby formula? [Source: FDA IFPS-2, modified]
If not currently breastfeeding at all (CF1) and never tried to breastfeed (HF10, CF29), skip to h.
Ask (a) only in months 1, 3, 5
a. My baby had trouble sucking or latching on to the breast
Yes 01
No 02
b. My baby lost interest in nursing or began to stop nursing by him or herself
Yes 01
No 02
c. Breastmilk alone did not satisfy my baby
Yes 01
No 02
d. I thought that my baby was not gaining enough weight
Yes 01
No 02
e. I didn’t have enough breastmilk
Yes 01
No 02
f. Breastfeeding was too painful
Yes 01
No 02
g. I wanted my baby to have both formula and breastmilk.
Yes 01
No 02
Ask h-n if mother is either exclusively formula feeding or feeding both breastmilk and formula
h. I chose not to breastfeed
Yes 01
No 02
i. My baby was sick and could not breastfeed
Yes 01
No 02
j. I was sick or had to take medicine
Yes 01
No 02
k. Breastfeeding seemed too inconvenient
Yes 01
No 02
l. I could not or did not want to pump
Yes 01
No 02
m. I wanted or needed someone else to feed my baby
Yes 01
No 02
n. For another reason
Yes (specify______________________________________) 01
No 02
If not adhering to formula dilution instructions, why? Prescribed by Dr., nutritionist?
1, 3, 5, 7, 9, 11, 13
CF22. In the past month, did you ever mix the formula with extra water to make it last longer? [Source: IFPS-1]
Yes 01
No 02
If CF22 = NO, skip to CF24.
CF23. (If yes to CF22) Who told you to prepare the formula this way? [Source: New Development]
Doctor 01
Someone who works at the WIC office or clinic 02
Another health care provider 03
Friend 04
Family member 05
Other 06
No one told me 07
CF24. In the past month, did you ever mix the formula with less water than directed in order to concentrate it or make it stronger? [Source: IFPS-1, modified]
Yes 01
No 02
Not applicable – use ready-to-feed 03
If CF24 = NO, skip to CF27.
CF25. (If yes to CF24) Who told you to prepare the formula this way? [Source: New Development]
Doctor 01
Someone who works at the WIC office or clinic 02
Another health care provider 03
Friend 04
Family member 05
Other 06
No one told me 07
How is formula feeding schedule determined (set, on demand, mixed)
1, 3, 5, 7, 9, 11, 13
CF27. Do you feed {CHILD} formula on a regular schedule or when [HE/SHE] cries or seems hungry? [Source: IFPS-1]
Schedule 01
Cries or seems hungry 02
Both on a schedule and when baby cries or seems hungry 03
Move to Partial Breastfeeding
Timing of move to partial breastfeeding
(any time 1-13)
Ask of all women who indicated fully BF in CF1. Once answered affirmatively, drop from subsequent interviews.
CF52. Has {CHILD} ever been fed infant formula, even just one time? Do not count while you were in the hospital after {CHILD’s} birth.
Yes 01 (go to CF53)
No 02 (go to CF32)
Don’t know 03
Refused 04
Ask of fully BF women who answered yes to CF52, partially BF women (based on CF1), and fully formula feeding women (based in CF1) who indicated that they ever breastfed in CF29 or HF10. Ask once, first time formula feeding indicated in CF1 or CF52, then drop from subsequent interviews.
CF53. How old was {CHILD} the first time he/she was fed infant formula? Do not count while you were in the hospital after {CHILD’S} birth.
Age [days/weeks/months]
Don’t know 98
Refused 99
Asked of all partially BF women and all fully formula feeding women who ever breastfed based on CF29 or HF10. Ask until an age, don’t know, or refused is given in response, then drop from subsequent interviews.
CF28. How old was {CHILD} when (he/she) was first fed formula every day? [Source: FITS 2002, modified]
Age [days/weeks/months]
Child is not fed formula every day 97
Don’t Know 98
Refused 99
Breastfeeding Cessation Module: (asked once first time mother indicates not currently feeding breastmilk in CF1)
Questions CF30 – CF31
Timing of cessation of breastfeeding
(any time 1-13)
Ask at first interview when mother says she is not feeding breastmilk, if she indicated feeding breastmilk in CF1 on previous interviews or if she answered ‘yes’ to ever breastfed or tried to breastfeed in CF29
CF30. How old was {CHILD} when you completely stopped breastfeeding or feeding [HIM/HER] breastmilk from a bottle? [Source: IFPS-1, modified]
Age [days/weeks/months]
Reasons for cessation of breastfeeding
(any time 1-13)
CF31. There are many reasons mothers stop breastfeeding. Please tell me if any of the following reasons helped you to decide to stop breastfeeding {CHILD}? [Source: FDA IFPS-2, modified]
Do not ask (a) if interview is 5 months or later
a. My baby had trouble sucking or latching on
Yes 01
No 02
b. My baby began to bite
Yes 01
No 02
c. My baby lost interest in nursing or began to stop nursing by him or herself
Yes 01
No 02
d. Breastmilk alone did not satisfy my baby
Yes 01
No 02
e. I thought that my baby was not gaining enough weight
Yes 01
No 02
f. I didn’t have enough milk
Yes 01
No 02
g. Breastfeeding was too painful
Yes 01
No 02
h. I was sick or had to take medicine
Yes 01
No 02
i. Breastfeeding was too inconvenient
Yes 01
No 02
j. I wanted or needed someone else to feed my baby
Yes 01
No 02
k. I did not want to breastfeed in public
Yes 01
No 02
l. Another reason (specify ________________________________)
Yes 01
No 02
Supplemental Foods Initiation (asked all interviews 1-24 until all endorsed)
Fed other than breastmilk or formula
1, 3, 5, 7, 9, 11, 13, 15, 18, 24
Ask CF32 at every interview until mother answers yes, then drop from later interviews and go straight to CF33.
CF32. Has {CHILD} been given anything to eat or drink besides formula or breastmilk? [Source: WIC IFPS-1, modified]
Yes 01
No 02
Were foods other than breastmilk or formula fed by bottle? If so, why?
1, 3, 5, 7
CF36. Now I’m going to ask you some questions about things you might have added to your baby’s bottle of infant formula or pumped breastmilk.: [Source: FDA IFPS-2, modified; New Development for reasons]
a In the past two weeks, how often have you added baby cereal to your baby’s bottle?
Every feeding 01
At most feedings 02
About once a day 03
Every few days 04
Rarely 05
Never 06
b. (If anything other than never) Why did you add baby cereal to your baby’s bottle?
To make him/her full 01
To make him/her drink more milk 02
To give him/her a special treat 03
As a remedy 04
A doctor or other health professional told me to 05
A friend or relative told me to 06
Other 07
c. In the past two weeks, how often have you added sweetener to your baby’s bottle?
Every feeding 01
At most feedings 02
About once a day 03
Every few days 04
Rarely 05
Never 06
d. (If anything other than never) Why did you add sweetener to your baby’s bottle?
To make him/her full 01
To make him/her drink more milk 02
To give him/her a special treat 03
As a remedy 04
A doctor or other health professional told me to 05
A friend or relative told me to 06
Other 07
e. Have you added anything else?(Specify OTHER)_____________________) In the past two weeks, how often have you added [OTHER] to your baby’s bottle?
Every feeding 01
At most feedings 02
About once a day 03
Every few days 04
Rarely 05
Never 06
f. (If anything other than never) Why did you add [OTHER] to your baby’s bottle?
To make him/her full 01
To make him/her drink more milk 02
To give him/her a special treat 03
As a remedy 04
A doctor or other health professional told me to 05
A friend or relative told me to 06
Other 07
If CF32 = NO, skip to MH3.
Time to introduction of supplemental foods
1, 3, 5, 7, 9, 11, 13, 15, 18, 24
Only ask CF33 if CF32 = YES
Next I’m going to ask you some questions about when you first started feeding {CHILD} different types of foods.
Ask each food until answer is affirmative, then stop asking that food in subsequent interviews
CF33. For each of the following, please tell me if {CHILD} has been given this food or drink, and if so, how old {CHILD} was when he/she first had that food. [Sources: FITS 2008; IFPS-1; WHO Toolkit 1996]
a. Has [HE/SHE] been given plain bottled or tap water?
Yes 01
No 02
b. (If yes) How old was {CHILD} when [HE/SHE] was first fed plain bottled or tap water?
Age [weeks/months]
Don’t know 98
Refused 99
c. Has [HE/SHE] been given soda or soft drinks?
Yes 01
No 02
d. (If yes) How old was {CHILD} when [HE/SHE] was first fed soda or soft drinks?
Age [weeks/months]
Don’t know 98
Refused 99
e. Has [HE/SHE] been given other sweetened beverages (such as Kool Aid, Hi-C, Fruit Punch, sweetened juice, sweetened or flavored water, Gatorade, or sweet tea)?
Yes 01
No 02
f. (If yes) How old was {CHILD} when [HE/SHE] was first fed other sweetened beverages?
Age [weeks/months]
Don’t know 98
Refused 99
g. Has [HE/SHE] been given 100% fruit juice such as apple juice, orange juice, or other types of 100% juice. Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to?
Yes 01
No 02
h. (If yes) How old was {CHILD} when [HE/SHE] was first fed 100% fruit juice?
Age [weeks/months]
Don’t know 98
Refused 99
i. Has [HE/SHE] been given other drinks and liquids, including teas and broths?
Yes 01
No 02
j. (If yes) How old was {CHILD} when [HE/SHE] was first fed Other drinks and liquids, including teas and broths?
Age [weeks/months]
Don’t know 98
Refused 99
k. Has [HE/SHE] been given Cow’s milk, including whole milk, 2%, 1%, or skim? Please include milk you add to other foods such as cereal.
Yes 01
No 02
l. (If yes) How old was {CHILD} when [HE/SHE] was first fed cow’s milk?
Age [weeks/months]
Don’t know 98
Refused 99
m. Has [HE/SHE] been given dairy products other than cow’s milk including cheese, yogurt, or goat’s milk? Please include any dairy products other than cow’s milk that you add to other foods.
Yes 01
No 02
n. (If yes) How old was {CHILD} when [HE/SHE] was first fed dairy products other than cow’s milk?
Age [weeks/months]
Don’t know 98
Refused 99
o. Has [HE/SHE] been given baby cereal, either with a spoon or by adding it to a bottle of breastmilk or formula?
Yes 01
No 02
p. (If yes) How old was {CHILD} when [HE/SHE] was first fed baby cereal?
Age [weeks/months]
Don’t know 98
Refused 99
q. Has [HE/SHE] been given other cereal besides baby cereal?
Yes 01
No 02
r. (If yes) How old was {CHILD} when [HE/SHE] was first fed other cereal besides baby cereal?
Age [weeks/months]
Don’t know 98
Refused 99
s. Has [HE/SHE] been given eggs?
Yes 01
No 02
t. (If yes) How old was {CHILD} when [HE/SHE] was first fed eggs?
Age [weeks/months]
Don’t know 98
Refused 99
u. Has [HE/SHE] been given fruit, including baby food or regular fruit?
Yes 01
No 02
v. (If yes) How old was {CHILD} when [HE/SHE] was first fed fruit?
Age [weeks/months]
Don’t know 98
Refused 99
w. Has [HE/SHE] been given vegetables, including baby food or regular vegetables?
Yes 01
No 02
x. (If yes) How old was {CHILD} when [HE/SHE] was first fed vegetables?
Age [weeks/months]
Don’t know 98
Refused 99
y. Has [HE/SHE] been given beans, such as black beans, pinto beans, or chick peas?
Yes 01
No 02
z. (If yes) How old was {CHILD} when [HE/SHE] was first fed beans?
Age [weeks/months]
Don’t know 98
Refused 99
aa. Has [HE/SHE] been given peanut butter
Yes 01
No 02
bb. (If yes) How old was {CHILD} when [HE/SHE] was first fed peanut butter?
Age [weeks/months]
Don’t know 98
Refused 99
cc. Has [HE/SHE] been given meats,, chicken, or fish, including baby food and baby food combination dinners containing these foods?
Yes 01
No 02
dd. (If yes) How old was {CHILD} when [HE/SHE] was first fed meat, chicken, or fish?
Age [weeks/months]
Don’t know 98
Refused 99
ee. Has [HE/SHE] been given salty snacks, such as chips, pretzels, crackers, or other snack foods including baby snacks?
Yes 01
No 02
ff. (If yes) How old was {CHILD} when [HE/SHE] was first fed salty snacks?
Age [weeks/months]
Don’t know 98
Refused 99
gg. Has [HE/SHE] been given sweets, such as cake, cookies, candy, or jam
Yes 01
No 02
hh. (If yes) How old was {CHILD} when [HE/SHE] was first fed sweets?
Age [weeks/months]
Don’t know 98
Refused 99
MATERNAL HEALTH AND LIFESTYLE
Next I’m going to ask you some questions about your health.
Pregnancy weight gain
1
MH3. At the end of your pregnancy and right before you delivered {CHILD}, about how much did you weigh, without shoes? [Source: PHFE WIC Postpartum Questionnaire 2010]
Weight [pounds]
a. Based on what you told us before, this means that you gained about [CATI calculates difference between pre-pregnancy weight (MH2 from screening) and post-pregnancy weight (MH3)] during your pregnancy with {CHILD}. Is that about right?
Yes 01
No (ask for correction to weights) 02
Maternal weight
1, 3, 13, 24
MH13. Right now, about how much do you weigh, without shoes? [Source: PHFE WIC Postpartum Questionnaire 2010]
Pounds [number]
Health problems during pregnancy
1
MH4. Did you have any of the following health problems during your pregnancy? [Source: WIC IFPS-1]
a. Diabetes, which is high sugar
Yes 01
No 02
Don’t know 98
Refused 99
b. High blood pressure while you were pregnant
Yes 01
No 02
Don’t know 98
Refused 99
c. Swelling at the wrists or ankles while you were pregnant
Yes 01
No 02
Don’t know 98
Refused 99
Actions taken to rectify maternal health problems
1 (put this before the hospitalization question)
MH6. (If yes to any of the health problems in MH4) Did you get treatment from your doctor for your pregnancy health problems? [Source: New Development]
Yes 01
No 02
Don’t know 98
Refused 99
Health problems during pregnancy
1
MH5. Did you have any problems during your pregnancy that required you to stay in the hospital overnight before the time you went in and had your baby? [Source: WIC IFPS-1. modified]
Yes 01
No 02
Don’t know 98
Refused 99
a. (If yes), How many total nights were you in the hospital?
Nights [number]
b. (If > 1 night) Was this during a single hospital stay or at different times during your pregnancy?
Single stay 01
Different times 02
Don’t know 98
Refused 99
Prenatal care receipt
1
MH10. Where did you go for prenatal medical care - a private obstetrician, a private other doctor, a public clinic, a midwife, or somewhere else? [Source: WIC IFPS-1; modified]
Private obstetrician 01
Private other doctor 02
Public clinic 03
Midwife 04
Other 05
Timing of first prenatal OB visit
1
MH11. When you had your first visit for prenatal care with a doctor or healthcare provider, how many weeks or months pregnant were you? [Source: PHFE WIC Postpartum Questionnaire 2010]
Weeks [1-40]
Or Months [1-9]
Health care coverage during pregnancy
1
MH12. During your pregnancy with {CHILD}, were you covered by health insurance or any other kind of health care plan? (if necessary, say:) This includes health insurance obtained through your or a spouse’s employer, a plan you bought independently, or one you got through a plan provided by the government? [Source: PHFE WIC Postpartum Questionnaire 2010]
Yes 01
No 02
Don’t know 98
Refused 99
Maternal physical health post-birth
1
MH14. How would you rate your own overall health today? [Source: Medical Outcomes Study]
Excellent 01
Good 02
Fair 03
Poor 04
Actions taken to rectify any maternal health conditions
1
MH15. (If answer to MH14 is Fair or Poor) What, if anything, are you doing to take care of health problems? (Interviewer: ask open-ended, select all that apply) [Source: New Development]
Going to doctor 01
Dieting 02
Exercising 03
Taking medications 04
Nothing 05
Other (specify _____________________________________) 06
EXPERIENCE, KNOWLEDGE, ADVICE, BELIEFS
Next I’m going to ask you some questions about decisions you’ve made and advice you’ve gotten about how to feed your baby.
How long intend to breastfeed
1
KA20. (If still exclusively breastfeeding at 1 month from CF1) How old do you think your baby will be when you feed him or her something other than breastmilk? [Source: WIC IFPS-1]
Age [weeks/months/years]
KA21. (If still doing any breastfeeding at 1 month from CF1): How old do you think your baby will be when you completely stop giving him or her breastmilk? [Source: WIC IFPS-1]
Age [weeks/months/years]
Influences on decision to breastfeed or formula feed
Prenatal, 1
1 Month Question:
Now I’m going to ask you about talks you might have had with different people about the way you feed your baby.
KA23. Have you talked with any of the following people about the ways you are currently feeding your baby, such as breastfeeding, formula feeding, or feeding solid foods? [Source:WIC IFPS-1, modified]
a. Your husband or boyfriend?
Yes 01
No 02
Don’t know 98
Not applicable 99
(If yes) How important was this talk with your husband/boyfriend in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?
Very important 01
Somewhat important 02
Not important 03
b. Your mother?
Yes 01
No 02
Don’t know 98
Not applicable 99
(If yes) How important was this talk with your mother in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?
Very important 01
Somewhat important 02
Not important 03
c. Other relatives?
Yes 01
No 02
Don’t know 98
Not applicable 99
(If yes) How important was this talk with your relatives in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?
Very important 01
Somewhat important 02
Not important 03
d. Friends?
Yes 01
No 02
Don’t know 98
Not applicable 99
(If yes) How important was this talk with your friends in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?
Very important 01
Somewhat important 02
Not important 03
e. People who work at your WIC office or clinic?
Yes 01
No 02
Don’t know 98
Not applicable 99
(If yes) How important was this talk with people who work at your WIC office or clinic in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?
Very important 01
Somewhat important 02
Not important 03
f. Your child’s doctor or another health professional?
Yes 01
No 02
Don’t know 98
Not applicable 99
(If yes) How important was this talk with your child’s doctor or another health professional in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?
Very important 01
Somewhat important 02
Not important 03
Receipt of advice about breastfeeding
1
KA31. Mothers often get advice from family about breastfeeding. I’m going to ask you some questions about advice you might have gotten. [Source: New Development]
a. Has your husband or boyfriend encouraged you to breastfeed {CHILD}, discouraged you from breastfeeding {CHILD}, given mixed advice, or has he not given you advice about this?
Encourage 01
Discourage 02
Mixed advice 03
No advice 04
Not applicable 97
b. Has your mother encouraged you to breastfeed {CHILD}, discouraged you from breastfeeding {CHILD}, given mixed advice, or has she not given you advice about this ?
Encourage 01
Discourage 02
Mixed advice 03
No advice 04
Not applicable 97
c. Have other relatives encouraged you to breastfeed {CHILD}, discouraged you from breastfeeding {CHILD}, given you mixed advice, or have you not gotten advice about this from other relatives?
Encourage 01
Discourage 02
Mixed advice 03
No advice 04
Not applicable 97
KA32. Now I’d like to ask you some questions about information you may have gotten about feeding {CHILD}. Since {CHILD} was born did you get any information about breastfeeding from the following people or groups, not including people who work at your WIC office or clinic? [Source: WIC IFPS-1, modified]
a. Did a doctor or nurse give you information about breastfeeding?
Yes 01
No 02
Don’t know 98
Not applicable 99
b. Did a childbirth education class give you information about breastfeeding?
Yes 01
No 02
Don’t know 98
Not applicable 99
c. Did a lactation specialist give you information about breastfeeding?
Yes 01
No 02
Don’t know 98
Not applicable 99
KA33. Which of the following best describes the kind of advice that people who work at your WIC office or clinic gave you about feeding {CHILD}: Did they say breastfeeding only is better, formula feeding only is better, or that there is no difference between breastfeeding and formula feeding? [Sources: IFPS-1, PHFE WIC Survey 2010, modified]
Breastfeeding is better 01
Formula feeding is better 02
No difference between breastfeeding and formula feeding 03
Didn’t give advice about feeding 04
Don’t know 98
KA34. Does your baby’s doctor recommend breastfeeding only, formula feeding only, or that both are equally ok? [Source: WIC IFPS-1, modified]
Breastfeeding 01
Formula feeding 02
Both are equally OK 03
Didn’t give advice about feeding 04
Don’t know 98
Receipt of counseling about infant feeding and care (sources - physician, WIC, other)
Any advice from physician specific to premature birth status
1
KA35. Now I’d like to ask you about who has given you counseling or education about how to feed and care for {CHILD} more generally. [Source: New Development]
a. Did the people who work at your WIC office or clinic give you counseling or education about how to feed and care for {CHILD}?
Yes 01
No 02
Don’t know 98
Not applicable 99
b. Did a dietitian at a hospital give you counseling or education about how to feed and care for {CHILD}?
Yes 01
No 02
Don’t know 98
Not applicable 99
c. Did a doctor or nurse give you counseling or education about how to feed and care for {CHILD}?
Yes 01
No 02
Don’t know 98
Not applicable 99
d. (If baby born before 37 weeks) Did a doctor or nurse give you any advice about feeding a premature infant?
Yes 01
No 02
Don’t know 98
Not applicable 99
CHILD HEALTH, BEHAVIOR, AND CHILD REARING
Health status/conditions
1, 3, 5, 7, 9, 11, 13, 15, 18, 24
Finally I’m going to ask you about your child’s health.
CH2. Has the doctor told you that {CHILD} has any long-term medical problems or conditions that may affect what or how (he/she) eats? [Source: FITS 2008, modified]
(Interviewer, if necessary add) These medical problems or conditions may be things like food allergies, diabetes, metabolic disorders such as PKU or galactosemia, gastrointestinal problems such as gastric reflux, other problems like cleft palate or other mouth or facial conditions – any long-term problems that affect the baby’s ability to eat and swallow.
Yes 01
No 02
Don’t Know 98
(If yes) What medical problem or condition does {CHILD} have?
Specify ______________________________________________
CH3. (If yes to health status/conditions in CH2): What are you currently doing to treat this medical problem? [Source: New Development] (Open-ended, Interviewer check all that apply)
Taking her/him to the doctor for treatment 01
Treating him/her at home with medicine 02
Treating him/her at home with something other than
medicine (such as herbal remedies, special teas, or other
forms of treatment) 03
Changing his/her diet 04
Other 05
Don’t Know 98
Refused 99
PARTICIPANT CONTACT INFORMATION UPDATE
Thank you for taking the time to speak with me today. Because we’ll be calling you again for your next interview (EN: in a couple of weeks / all other times: when your child is {AGE – next interview}), I’d like to be sure we have all the right ways to contact you.
CM1. Is your full name still {NAME}?
Yes 01
No 02
(If no, go to a)
a. Can you please tell me what your full legal name is now?
_____________________________________________
Ask only if still on WIC:
CM2. {If have WIC ID on file: We have your WIC ID as {FILL}, is that correct?/If don’t have WIC ID on file: Do you know what your current WIC ID is?}
WIC ID is the same (fill below) 01
New WIC ID (specify below) 02
Don’t know WIC ID 98
Refused WIC ID 99
WIC ID___________________________________
CM3. I reached you today at {FILL #}. Will that still be the best number to call you at for your next interview?
Yes (if yes, go to b) 01
No (if no, go to a) 02
a. What is the best number to call you at for your next interview?
Number (specify ---/---/----)
NO PHONE (go to CM4) 97
Is that number home, work, cell, or something else?
Home 01
Work 02
Cell 03
Other (specify__________________) 04
b. Is there another number we could try in case we have trouble reaching you?
Number (specify ---/---/----)
Is that number home, work, cell, or something else?
Home 01
Work 02
Cell 03
Other (specify__________________) 04
We’d like to keep in touch with you even if we can’t get you by phone or your phone number changes, so I’m going to ask you about a few additional ways we might be able to contact you.
CM4. If have email on file: We have your email address as {FILL}, is that correct?/If no email: Do you have an email address we could use to contact you if necessary?
Email is the same (fill below) 01
New Email (specify below) 02
Don’t know Email 98
Refused Email 99
Email___________________________________
CM5. If mailing address on file: We have your current mailing address as {FILL}. Is that correct? If no mailing address on file: Can I get a mailing address we could use to contact you if necessary?
Address is the same (fill below) 01
New address (specify below) 02
Don’t know/don’t have address 98
Refused address 99
a. Can you please tell me what your current mailing address is?
Street/Apt#________________________________________
City______________________________________________
State_____________________________________________
ZIP______________________________________________
b. (If CM3a is 97 – no phone): Earlier you indicated that you do not have a phone. Since we need to speak with you by phone we will mail you a study phone. You will receive the phone before your next interview. The package will contain instructions on how to use the phone. Should we mail the phone to the mailing address you just provided?
Address is the same (fill below) 01
New address (specify below) 02
Don’t know/don’t have address 98
Refused address 99
Can you please provide the address where the phone should be mailed?
Street/Apt#________________________________________
City______________________________________________
State_____________________________________________
ZIP______________________________________________
CM6. [Social Media – will develop question when procedure is finalized]
CM7. (If contacts on file: Earlier you provided the names and contact information for two people who would always know how to find you. Can I read that information back to you and check that it’s still up to date?/If no contacts on file: Just in case we can’t get in touch with you using the information you just gave me, I’d like to ask you for the names and contact information for two people who would always know how to find you.
Person #1 (If contacts on file, read fill info and correct as needed)
Name
Who is this person to you?
Phone
Address
Person #2 (If contacts on file, read fill info and correct as needed)
Name
Who is this person to you?
Phone
Address
Ask only if core sample, at the 1st interview after the child is born:
CM8. As we mentioned when you first joined the study, we’d like to get information from the hospital where {CHILD} was born, and you gave us permission to do that. Can I please have the name of the hospital, the phone number if you have it, and the city and state where you gave birth to {CHILD}?
Hospital name
Location
Phone
Child not born in a hospital 97
Don’t know 98
Refused 99
According
to the Paperwork Reduction Act of 1995, no persons are required to
respond to a collection of information unless it displays a valid
OMB number. The valid OMB control number for this information
collection is 0584-XXXX. The time required to complete this
information collection is estimated to average 27 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.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Nancy Weinfield |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |