Att 10_CEA_Pilot2_Tool

Case Exposure Ascertainment (CEA) – FoodNet
Pilot 2: Proposed Data Collection Tool
July 3, 2012
Table 1: Variable names, components, and sample questions for CEA pilot 2
Question
Variable name
Minimum required
Response
number
exposure components
values
(in the 7 days before
illness)

Question examples
at or below 8th
grade reading
level*
(In the 7 days
before illness,
would you/your
child have…)

Travel
dom_travel

1. domestic travel

1 = Yes
2 = No

…traveled within
the US but outside
of the area where
you live or work?

1. quantify times
ate outside of
home

[number]

1. handle raw
chicken in home
2. anyone in
household
handle raw
chicken
1. quantify times
consumed
chicken or foods
containing
chicken

1 = Yes
2 = No

1. consume
undercooked
chicken
2. consume raw
chicken
1. consume ground
chicken
1. consume whole
or cut chicken
parts

1 = Yes
2 = No

How many times
would you/your
child have eaten out
(deli, fast food, or
other
restaurant)?**
Would you/your
child, or anyone in
your household,
have handled raw
chicken in the
home?
How many times
would you/your
child have eaten
chicken or any foods
containing
chicken?**
…eaten any chicken
that was
undercooked or
raw?

Q1
Foodborne
Out_freq
Q2

Chx_handle
Q3

chicken
Q4

Chx_uncook
Q5

chx_ground

Q6

Chx_whole
Q7

[number]
(If value = 0,
skip to Q13)

1 = Yes
2 = No
1 = Yes
2 = No

…eaten any ground
chicken?
…eaten any whole
or cut chicken parts
(e.g., rotisserie,

Sites’
question(s)
for collecting
min. required
exposure
components
(To be filled
out by sites)

chx_processed

1 = Yes
2 = No

Q8

1. consume
processed
chicken products

1 = Yes
2 = No

Q9

1. consume chicken
prepared away
from home

1. consume chicken
prepared at [a]
home

1 = Yes
2 = No (If value
= No, skip to
Q13)
1 = Yes
2 = No

Chx_outside

Chx_home
Q10
Chx_fresh
Q11
Chx_frozen
Q12
Turkey_handle
Q13

Turkey
Q14
Turkey_uncook
Q15

Turkey_ground

Q16

Turkey_whole
Q17
Turkey_processed
Q18

1. consume chicken
that was bought
fresh
(refrigerated)
1. consume chicken
that was bought
frozen
1. handle raw
turkey
2. anyone in
household
handle raw
turkey
1. consume turkey
2. consume foods
that contained
turkey
1. consume
undercooked
turkey
2. consume raw
turkey
1. consume ground
turkey
1. consume whole
or cut turkey
parts
consume
processed turkey
products

chicken breasts,
wings, etc.)?
…eaten any
processed chicken
(e.g., deli meat,
chicken nuggets,
pre-made dinners,
etc.)?**
…eaten any chicken
made outside of
home (deli, fast
food, take-out, or
restaurant)?**
…eaten any chicken
made at home?

Was the chicken
bought fresh
(refrigerated)?

1 = Yes
2 = No

Was the chicken
bought frozen?

1 = Yes
2 = No

Would you/your
child, or anyone in
your household,
have handled raw
turkey in the home?

1 = Yes
2 = No (If value
= No, skip to
Q21)
1 = Yes
2 = No

…eaten any turkey
or any foods
containing
turkey?**
…eaten any turkey
that was
undercooked or
raw?

1 = Yes
2 = No
1 = Yes
2 = No

…eaten any ground
turkey?
…eaten any whole
or cut turkey parts?

1 = Yes
2 = No

…eaten any
processed turkey
(e.g., deli meat,

Turkey_outside
Q19

Turkey_home
Q20
Other_poultry
Q21

Beef_handle
Q22

Beef
Q23
Beef_uncook
Q24

Beef_ground

Q25

Beef_whole
Q26
Beef_processed
Q27

Beef_outside
Q28

1. consume turkey
prepared outside
of home

1 = Yes
2 = No

1. consume turkey
prepared at [a]
home
1. consume poultry
other than
chicken or turkey

1 = Yes
2 = No

1. handle raw beef
2. anyone in
household
handle raw beef

1 = Yes
2 = No

1. consume beef or
foods containing
beef

1 = Yes
2 = No (If value
= No, skip to
Q32)
1 = Yes
2 = No

1. consume
undercooked
beef
2. consume raw
beef
1. consume ground
beef
1. consume whole
or cut beef parts

1 = Yes
2 = No

1 = Yes
2 = No
1 = Yes
2 = No

1. consume
processed beef
products

1 = Yes
2 = No

1. consume beef
prepared outside
of home

1 = Yes
2 = No

bacon, sausage, premade dinners,
etc.)?**
…eaten any turkey
made outside of
home (deli, fast
food, take-out, or
restaurant)?**
…eaten any turkey
made at home?
…eaten any poultry
other than chicken
or turkey (e.g., duck,
cornish hens, quail,
etc.)?
Would you/your
child, or anyone in
household, have
handled raw beef in
the home?
…eaten beef or any
foods containing
beef?
…eaten any beef
that was
undercooked or
raw?
…eaten any ground
beef?
…eaten any whole
or cut beef parts
(e.g., steaks, roasts,
etc.)?
…eaten any
processed beef
(e.g., deli meat,
sausage, jerky, premade dinners,
etc.)?**
…eaten any beef
made outside of
home (deli, fast
food, take-out, or
restaurant)?**

Beef_home
Q29
Beef_fresh
Q30
Beef_frozen
Q31
Pork_handle
Q32

Pork
Q33
pork_uncook
Q34

pork_whole

1. consume beef
prepared at [a]
home
1. consume beef
that was bought
fresh
(refrigerated)?
1. consume beef
that was bought
frozen?
1. handle raw pork
2. anyone in
household
handle raw pork
1. consume pork or
foods containing
pork
1. consume
undercooked
pork
2. consume raw
pork
1. consume whole
or cut pork parts

1 = Yes
2 = No (If value
= No, skip to
Q32)
1 = Yes
2 = No

…eaten any beef
made at home?

1 = Yes
2 = No

Was the beef
bought frozen?

1 = Yes
2 = No

Would you/your
child, or anyone in
your household,
have handled raw
pork in the home?
…eaten pork or any
foods containing
pork?

1 = Yes
2 = No (If value
= No, skip to
Q37)
1 = Yes
2 = No

1 = Yes
2 = No

Q35

pork_processed
Q36

Lamb

1. consume
processed pork
products

1 = Yes
2 = No

1. consume lamb

1 = Yes
2 = No

1. consume any
non-fish seafood,
including:
2. crustaceans
3. mollusks
1. consume
undercooked
non-fish seafood

1 = Yes
2 = No (If value
= No, skip to
Q40)

Q37
Seafood
Q38

seafood_uncook
Q39

1 = Yes
2 = No

Was the beef
bought fresh
(refrigerated)?

…eaten any
undercooked or raw
pork?

..eaten any whole or
cut pork parts (e.g.,
ham shank, pork
chops, chitlins,
etc.)?
…eaten any
processed pork
(e.g., deli meat [like
ham slices], bacon,
sausage, etc.)?**
…eaten any lamb?

…eaten any non-fish
seafood (e.g., crab,
shrimp, oysters,
clams, etc.) that was
not from a can?
…eaten any non-fish
seafood that was
undercooked or raw

2. raw non-fish
seafood
Fish

Q40

Fish_uncook
Q41
Fish_whole
Q42
eggs
Q43
eggs_outside
Q44

eggs_home
Q45
eggs_uncook

Q46

Dairy

Q47

Queso_fresco

Q48

(e.g., raw oysters,
clams, etc.)?

1. consume any fish
or fish products
that was
processed or
unprocessed
(excluding
canned fish)
1. consume
undercooked fish
2. consume raw fish

1 = Yes
2 = No (If value
= No, skip to
Q43)

…eaten any fish or
fish products
(processed or
unprocessed) that
was not from a can?

1 = Yes
2 = No

1. consume
unprocessed fish
(whole or fish
filets)
1. consume eggs or
foods containing
eggs

1 = Yes
2 = No

…eaten any fish that
was undercooked or
raw (e.g., sushi,
etc.)?
…eaten any whole
fish or fish filets
(unprocessed fish)?

1. consume eggs
prepared outside
of home

1. consume eggs
prepared at [a]
home
1. consume
runny/undercook
ed eggs
2. consume raw
eggs or uncooked
foods made with
raw eggs
1. consume dairy
products

1. consume queso
fresco, queso
blanco
2. consume other
type of soft
Mexican-style

1 = Yes
2 = No (If value
= No, skip to
Q47)
1 = Yes
2 = No

1 = Yes
2 = No

…eaten eggs or any
foods containing
eggs?
…eaten any eggs
made away outside
of home (deli, fast
food, take-out, or
restaurant)?**
…eaten any eggs
made at home?

1 = Yes
2 = No

…eaten any eggs
that were runny or
raw, or uncooked
foods made with
raw eggs?

1 = Yes
2 = No (If value
= No, skip to
Q49)
1 = Yes
2 = No

…eaten or drank any
dairy products (e.g.,
milk, yogurt, cheese,
ice cream, etc.)?
…eaten any queso
fresco, queso
blanco, or other
type of Mexicanstyle soft cheese?**

Dairy_uncook

Q49

Cantaloupe

Q50

Strawberries

Q51

Other_berries

Q52

Watermelon

Q53

Apples

Q54

Honeydew

Q55

Pineapple

Q56

Raw_cider

Q57

Other_fruit

Q58

Nuts_uncook

Q59

Lettuce

Q60

Cabbage

Q61

Spinach

Q62

Broccoli

Q63

cheese
1. consume raw
(unpasteurized)
dairy products

1 = Yes
2 = No

…eaten or drank any
dairy products that
were raw or
unpasteurized (e.g.,
raw milk, or
cheeses, yogurts,
and ice cream made
from raw milk)?**
…eaten any fresh
cantaloupe?**
…eaten any fresh
(unfrozen)
strawberries?**
…eaten any other
fresh (unfrozen)
berries?**
…eaten any fresh
watermelon?**
…eaten any fresh
apples?
…eaten any fresh
honeydew
melon?**
…eaten any fresh
pineapple?**
…drank any
unpasteurized juice
or cider?**
…eaten any other
fruit (fresh or
frozen) or drank
other fruit juices?

1. consume fresh
cantaloupe
1. consume
unfrozen, fresh
strawberries
1. consume other
unfrozen, fresh
berries
1. consume fresh
watermelon
1. consume fresh
apples
1. consume fresh
honeydew melon

1 = Yes
2 = No
1 = Yes
2 = No

1. consume fresh
pineapple
1. consume raw
cider or juice

1 = Yes
2 = No
1 = Yes
2 = No

1. consume other
fruit (fresh or
frozen)
2. consume other
fruit juice
1. consume raw
nuts

1 = Yes
2 = No

1 = Yes
2 = No

…eaten any raw or
uncooked nuts?

1. consume fresh,
raw lettuce
1. consume fresh,
raw cabbage
1. consume fresh
(unfrozen), raw
spinach
1. consume fresh
(unfrozen), raw
broccoli

1 = Yes
2 = No
1 = Yes
2 = No
1 = Yes
2 = No

…eaten any fresh,
raw lettuce?
…eaten any fresh,
raw cabbage?
…eaten any fresh
(unfrozen), raw
spinach?
…eaten any fresh
(unfrozen), raw
broccoli?**

1 = Yes
2 = No
1 = Yes
2 = No
1 = Yes
2 = No
1 = Yes
2 = No

1 = Yes
2 = No

Tomatoes

Q64

Onions

Q65

Carrots

Q66

Sprouts

Q67

Herbs

Q68

Other_veggies

Q69

Infant

Q70

Waterborne
Well_water
Q71
Other_untreated

Q72

swim_unchlor
Q73

1. consume fresh,
raw tomatoes
1. consume fresh
(unfrozen), raw
onions
1. consume fresh
(unfrozen), raw
carrots
1. consume fresh,
raw sprouts
1. consume fresh
herbs
1. consume other
vegetables (fresh
or frozen)
2. consume
vegetable juice
For children under 1 year
old (all that apply):
1. consume breast
milk
2. consume infant
formula
3. consume other
milk

1 = Yes
2 = No
1 = Yes
2 = No

(all that apply)
1 = breast milk
2 = formula
3 = other milk
4 = N/A
(For reporting
purposes, use
the following
for multiple
responses:
5 = #1 & #2
6 = #1 & #3
7 = #2 & #3
8 = #1-3
9 = any combo
that includes #4

If you are answering
for an ill infant aged
1 year or younger,
are they drinking
(select all that
apply):
-breast milk
-infant formula
-other milk
-not applicable

1. Consumed water
from a well

1 = Yes
2 = No

…drank any water
from a well?

1. Consumed any
water from a
natural spring,
lake, pond,
stream, or river

1 = Yes
2 = No

…swallowed or
drank any water
directly from a
natural spring, lake,
pond, stream, or
river?**

1 = Yes
2 = No

…swam in, waded
in, or entered an
ocean, lake, pond,

Contact with a(n):
1. ocean
2. lake

1 = Yes
2 = No
1 = Yes
2 = No
1 = Yes
2 = No
1 = Yes
2 = No

…eaten any fresh,
raw tomatoes?
..eaten any fresh
(unfrozen), raw
onions?
…eaten any fresh
(unfrozen), raw
carrots?
…eaten any fresh,
raw sprouts?
…eaten any fresh
(not dried) herbs?
…eaten any other
vegetables (fresh or
frozen) or drank any
vegetable juices?**

3.
4.
5.
6.
Person-Person
sick_contacts

river, stream, or
natural spring?

1. household
member with
diarrhea
2. close contact
with someone
that had diarrhea
1. contact with dirty
diapers
1. live, work or
volunteer at
residential
facility

1 = Yes
2 = No

Was there a
household member
or a close contact
with diarrhea?**

1 = Yes
2 = No
1 = Yes
2 = No

1. work or
volunteer at a
daycare
2. household
member that
attends daycare

1 = Yes
2 = No

…had contact with
dirty diapers?**
…lived, worked, or
volunteered in a
shared living facility
(e.g., dorm, nursing
home, etc.)?**
Would you/your
child, or anyone in
your house, have
attended, worked,
or volunteered at a
day care?**

Q78

1. pet(s) with
diarrhea

1 = Yes
2 = No
1 = Yes
2 = No

Q79

1. reptile contact
2. amphibian
contact

1. extensive
outdoor activities
like hiking,
camping,
gardening, or
yardwork
1. contact with
animal manure
2. contact with
compost
1. farm
2. ranch
3. petting zoo

1 = Yes
2 = No

Q74

Diaper_contact

pond
river
stream
natural spring

Q75

shared_facility
Q76

Daycare
Q77

Environmental
sick_pet

Reptile_amphib

Outdoors
Q80

manure_compost
Q81
farm_ranch
Q82

1 = Yes
2 = No

1 = Yes
2 = No (If value
= No, survey is

…had any contact
with a pet that had
diarrhea?
…had any contact
with a reptile or
amphibian (e.g.,
frog, snake, turtle,
etc.)?**
…done any hiking,
camping, gardening,
or yard work?

…had any contact
with animal manure,
pet feces, or
compost?**
…visited, worked, or
lived on farm, ranch,
petting zoo, or other

Live_poultry
Q83
Cattle_others
Q84

Other_animals

4. any other setting
with farm
animals

complete)

setting that has
farm animals?**

1. exposure to live
poultry

1 = Yes
2 = No

1. exposure to
cattle
2. exposure to
goats
3. exposure to
sheep
1. exposure to
other farm
animals

1 = Yes
2 = No

Were there any live
poultry (e.g.,
chickens, turkeys,
hens, etc.)?
Were there any
cattle, goats, or
sheep?

1 = Yes
2 = No

Were there any
other farm animals
Q85
(e.g., pigs, horses,
etc.)?
*At or below 8th grade reading level (determined by Flesch-Kincaid readability test) unless otherwise noted
**At reading level above 8th grade