5.2 Survey

Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months and Sibling Birth Enrollment

PV2QuestionnnaireHousehold

Pregnancy Visit 2 Interview

OMB: 0925-0593

Document [docx]
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OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Pregnancy Visit 2 Questionnaire - Household, Phase 2g

OMB Specification


Pregnancy Visit 2 Questionnaire - Household


Event Category:

Trigger-Based

Event:

PV2

Administration:

N/A

Instrument Target:

Pregnant Woman's Residence

Instrument Respondent:

Pregnant Woman

Domain:

Questionnaire

Document Category:

Questionnaire

Method:

Data Collector Administered

Mode (for this instrument*):

In-Person, CAI;
Phone, CAI

OMB Approved Modes:

In-Person, CAI;
Phone, CAI;
Web-Based, CAI

Estimated Administration Time:

5 minutes

Multiple Child/Sibling Consideration:

Per Event

Special Considerations:

N/A

Version:

1.0

MDES Release:

4.0


*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.


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Pregnancy Visit 2 Questionnaire - Household



TABLE OF CONTENTS





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Pregnancy Visit 2 Questionnaire - Household



GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:


DATA ELEMENT FIELDS

MAXIMUM CHARACTERS PERMITTED

DATA TYPE

PROGRAMMER INSTRUCTIONS

ADDRESS AND EMAIL FIELDS

100

CHARACTER


UNIT AND PHONE FIELDS

10

CHARACTER


_OTH AND COMMENT FIELDS

255

CHARACTER

  • Limit text to 255 characters

FIRST NAME AND LAST NAME

30

CHARACTER

  • Limit text to 30 characters

ALL ID FIELDS

36

CHARACTER


ZIP CODE

5

NUMERIC


ZIP CODE LAST FOUR

4

NUMERIC


CITY

50

CHARACTER


DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)

10

NUMERIC


CHARACTER



  • DISPLAY AS MM/DD/YYYY

  • STORE AS YYYY-MM-DD

  • HARD EDITS:

MM MUST EQUAL 01 TO 12

DD MUST EQUAL 01 TO 31

YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.

TIME VARIABLES

TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION

NUMERIC

  • HARD EDITS:

HOURS MUST BE BETWEEN 00 AND 12;

MINUTES MUST BE BETWEEN 00 AND 59


Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).


POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.



A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.





HOUSING CHARACTERISTICS


(TIME_STAMP_HC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD PREGNANT WOMAN'S HOUSEHOLD ID (HH_ID) ​AND RESPONDENT ID (R_P_ID) FOR PREGNANT WOMAN.


HC01000. Now I’d like to find out more about your home and the area in which you live.


HC02000/(RECENT_MOVE). Have you moved or changed your housing situation since we last spoke with you?


Label

Code

Go To

YES

1


NO

2

HC07000

REFUSED

-1

HC07000

DON'T KNOW

-2

HC07000


SOURCE

National Children's Study, Legacy Phase (P1 Mother, T1 Mother)


HC03000/(OWN_HOME). Is your home . . .


Label

Code

Go To

Owned or being bought by you or someone in your household

1

AGE_HOME

Rented by you or someone in your household

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


SOURCE

Survey of Income and Program Participation


HC04000/(OWN_HOME_OTH). SPECIFY:  ___________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Survey of Income and Program Participation


HC05000/(AGE_HOME). Which of these categories best describes when your home or building was built?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

2001 OR LATER

1


1981 TO 2000

2


1961 TO 1980

3


1941 TO 1960

4


1940 OR BEFORE

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Survey of Lead and Allergens in Housing (modified)


HC06000. How long have you lived in this home?


SOURCE

National Survey of Lead and Allergens in Housing


(LENGTH_RESIDE) |_____|_____|

NUMBER


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(LENGTH_RESIDE_UNIT)


Label

Code

Go To

WEEKS

1


MONTHS

2


YEARS

3



HC07000. Now I’m going to ask about how your home is heated and cooled.


HC08000/(MAIN_HEAT). Which of these types of heat sources best describes the main heating fuel source for your home?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

ELECTRIC

1

HEAT2

GAS - PROPANE OR LP

2

HEAT2

OIL

3

HEAT2

WOOD

4

HEAT2

KEROSENE OR DIESEL

5

HEAT2

COAL OR COKE

6

HEAT2

SOLAR ENERGY

7

HEAT2

HEAT PUMP

8

HEAT2

NO HEATING SOURCE

9

COOLING

OTHER

-5


REFUSED

-1

COOLING

DON'T KNOW

-2

COOLING


SOURCE

American Healthy Homes Survey


HC09000/(MAIN_HEAT_OTH). SPECIFY:  ____________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey


HC10000/(HEAT2). Are there any other types of heat you use regularly during the heating season to heat your home?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • PROBE:  Do you have any space heaters, or any secondary method for heating your home?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

ELECTRIC

1


GAS - PROPANE OR LP

2


OIL

3


WOOD

4


KEROSENE OR DIESEL

5


COAL OR COKE

6


SOLAR ENERGY

7


HEAT PUMP

8


NO OTHER HEATING SOURCE

9


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey


PROGRAMMER INSTRUCTIONS

  • IF HEAT2 = ANY COMBINATION OF VALUES 1 - 8, GO TO COOLING.

  • IF HEAT2 = -5, OR ANY COMBINATION OF VALUES 1 - 8 AND -5, GO TO HEAT2_OTH.

  • IF HEAT2 = 9, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO COOLING.


HC11000/(HEAT2_OTH). SPECIFY:  ____________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey


HC12000/(COOLING). Does your home have any type of cooling or air conditioning besides fans?


Label

Code

Go To

YES

1


NO

2

HC15000

REFUSED

-1

HC15000

DON'T KNOW

-2

HC15000


SOURCE

National Children's Study, Legacy Phase (T1 Mother)


HC13000/(COOL). Not including fans, which of the following kinds of cooling systems do you regularly use?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.


Label

Code

Go To

Window or wall air conditioners

1


Central air conditioning

2


Evaporative cooler, also called swamp cooler

3


NO COOLING OR AIR CONDITIONING REGULARLY USED

4


Some other cooling system

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Survey of Lead and Allergens in Housing and American Healthy Homes Survey


PROGRAMMER INSTRUCTIONS

  • IF COOL = ANY COMBINATION OF VALUES 1-3, GO TO HC15000

  • IF COOL = -5, OR ANY COMBINATION OF VALUES 1-3 AND -5, GO TO COOL_OTH.

  • IF COOL = 4, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO HC15000.


HC14000/(COOL_OTH). SPECIFY:  ___________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Survey of Lead and Allergens in Housing and American Healthy Homes Survey


HC15000. Now I’d like to ask about the water in your home.


HC16000/(WATER_DRINK). What water source in your home do you use most of the time for drinking?


Label

Code

Go To

Tap water

1

WATER_COOK

Filtered tap water

2

WATER_COOK

Bottled water

3

WATER_COOK

Some other source

-5


REFUSED

-1

WATER_COOK

DON'T KNOW

-2

WATER_COOK


SOURCE

National Human Exposure Assessment Survey


HC17000/(WATER_DRINK_OTH). SPECIFY:  ___________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Human Exposure Assessment Survey


HC18000/(WATER_COOK). What water source in your home is used most of the time for cooking? 


Label

Code

Go To

Tap water

1

HC20000

Filtered tap water

2

HC20000

Bottled water

3

HC20000

Some other source

-5


REFUSED

-1

HC20000

DON'T KNOW

-2

HC20000


SOURCE

National Human Exposure Assessment Survey


HC19000/(WATER_COOK_OTH). SPECIFY:  ____________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Human Exposure Assessment Survey


HC20000. Water damage is a common problem that occurs inside of many homes. Water damage includes water stains on the ceiling or walls, rotting wood, and flaking sheetrock or plaster. This damage may be from broken pipes, a leaky roof, or floods.


HC21000/(WATER). Since we last spoke with you, have you seen any water damage inside your home?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey (modified)


HC22000/(MOLD). Since we last spoke with you, have you seen any mold or mildew on walls or other surfaces other than the shower or bathtub, inside your home?


Label

Code

Go To

YES

1


NO

2

HC25000

REFUSED

-1

HC25000

DON'T KNOW

-2

HC25000


SOURCE

American Healthy Homes Survey (modified)


HC23000/(ROOM_MOLD). In which rooms have you seen the mold or mildew?


INTERVIEWER INSTRUCTIONS

  • PROBE:  Any other rooms?

  • SELECT ALL THAT APPLY


Label

Code

Go To

KITCHEN

1


LIVING ROOM

2


HALL OR LANDING

3


PARTICIPANT'S BEDROOM

4


OTHER BEDROOM

5


BATHROOM/TOILET

6


BASEMENT

7


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children's Study, Legacy Phase (T1 Mother) (modified)


PROGRAMMER INSTRUCTIONS

  • IF ROOM_MOLD = ANY COMBINATION OF VALUES 1-7, GO TO HC25000.

  • IF ROOM_MOLD = -5, OR ANY COMBINATION OF VALUES 1-7 AND -5, GO TO ROOM_MOLD_OTH.

  • IF ROOM_MOLD = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO HC25000.


HC24000/(ROOM_MOLD_OTH). SPECIFY:  ___________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children's Study, Legacy Phase (T1 Mother)


HC25000. The next few questions ask about any recent additions or renovations to your home.  


HC26000/(PRENOVATE2). Since our last contact, have any additions or renovations been done to your home? Include only major projects that made your home larger or involved construction. Do not count smaller projects such as painting or wallpapering, carpeting, or refinishing floors."


Label

Code

Go To

YES

1


NO

2

PDECORATE2

REFUSED

-1

PDECORATE2

DON'T KNOW

-2

PDECORATE2


SOURCE

American Healthy Homes Survey and National Survey of Lead and Allergens in Housing (modified)


HC27000/(PRENOVATE2_ROOM). Which rooms were renovated?


INTERVIEWER INSTRUCTIONS

  • PROBE:   Any others?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

KITCHEN

1


LIVING ROOM

2


HALL OR LANDING

3


PARTICIPANT'S BEDROOM

4


OTHER BEDROOM

5


BATHROOM/TOILET

6


BASEMENT

7


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey and National Survey of Lead and Allergens in Housing (modified)


PROGRAMMER INSTRUCTIONS

  • IF PRENOVATE2_ROOM = ANY COMBINATION OF VALUES 1-7, GO TO PDECORATE2.

  • IF PRENOVATE2_ROOM = -5, OR ANY COMBINATION OF VALUES 1-7 AND -5,  GO TO PRENOVATE2_ROOM_OTH

  • IF PRENOVATE2_ROOM = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO PDECORATE_2.


HC28000/(PRENOVATE2_ROOM_OTH). SPECIFY:  ___________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey and National Survey of Lead and Allergens in Housing (modified)


HC29000/(PDECORATE2). Since we last spoke with you, were any smaller projects done in your home, such as painting, wallpapering, refinishing floors, or installing new carpet?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_HC_ET

REFUSED

-1

TIME_STAMP_HC_ET

DON'T KNOW

-2

TIME_STAMP_HC_ET


SOURCE

Avon Longitudinal Study of Parents and Children


HC30000/(PDECORATE2_ROOM). In which rooms were these smaller projects done?


INTERVIEWER INSTRUCTIONS

  • PROBE:  Any others?

  • SELECT ALL THAT APPLY


Label

Code

Go To

KITCHEN

1


LIVING ROOM

2


HALL OR LANDING

3


PARTICIPANT'S BEDROOM

4


OTHER BEDROOM

5


BATHROOM/TOILET

6


BASEMENT

7


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children (modified)


PROGRAMMER INSTRUCTIONS

  • IF PDECORATE2_ROOM = ANY COMBINATION OF VALUES 1 - 7, GO TO TIME_STAMP_HC_ET.

  • IF PDECORATE2_ROOM = -5, OR ANY COMBINATION OF VALUES 1 - 7 AND -5, GO TO PDECORATE2_ROOM_OTH.

  • IF PDECORATE2_ROOM = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO TIME_STAMP_HC_ET.


HC31000/(PDECORATE2_ROOM_OTH). SPECIFY:  ____________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children


(TIME_STAMP_HC_ET).


PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 5 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.

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