11.6 Survey

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

3MonthQuestionnaireBIOMom

3-Month Interview

OMB: 0925-0593

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OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

3M Questionnaire - Biological Mother, Phase 2g

OMB Specification


3M Questionnaire - Biological Mother


Event Category:

Time-Based

Event:

3M

Administration:

N/A

Instrument Target:

Biological Mother

Instrument Respondent:

Biological Mother

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:

2 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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3M Questionnaire - Biological Mother



TABLE OF CONTENTS





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3M Questionnaire - Biological Mother



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.





MOTHER BIRTH CONDITIONS AND EXPERIENCES


(TIME_STAMP_MBC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD PARTICIPANT ID (P_ID) AND RESPONDENT ID (R_P_ID) FOR ADULT CAREGIVER.

  • PRELOAD MULT_CHILD, CHILD_NUM (IF MULT_CHILD = 1), AND CHILD_QNUM  FROM THE PARTICIPANT VERIFICATION, SCHEDULING & TRACING QUESTIONNAIRE.

  • PRELOAD FIRST NAME OF CHILD (C_FNAME) FROM  PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE AND DISPLAY APPROPRIATE NAME IN “C_FNAME” THROUGHOUT THE INSTRUMENT.

  • OTHERWISE, IF C_FNAME FROM  PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE = -1 OR -2, DISPLAY “the child” IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT.

  • IF CHILD_SEX IN PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE = 1, DISPLAY “his”, “he”, OR “himself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

  • IF CHILD_SEX IN PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE = 2, DISPLAY “her”, “she”, OR “herself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

  • IF MULT_CHILD = 1, LOOP THROUGH ITEMS MBC01000, CHILD_SEX, MBC03000, MBC04000, MBC06000, TRANS_DEPT_BIRTH, AND TRANS_DEPT_BIRTH_OTH (IF TRANS_DEPT_BIRTH = 1) FOR EACH CHILD_QNUM UNTIL NUMBER OF LOOPS = CHILD_NUM BEFORE PROCEEDING TO DELIVER_CES.

  • INCREMENT CHILD_QNUM BY ONE FOR EACH LOOP.


MBC01000. Now I’d like to ask a few questions about {C_FNAME/the child}’s birth.


MBC02000/(CHILD_SEX). Is your child a boy or a girl?


Label

Code

Go To

BOY

1


GIRL

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


MBC03000. How much did {C_FNAME/the child} weigh when he/she was born?


INTERVIEWER INSTRUCTIONS

  • RECORD CHILD'S WEIGHT IN POUNDS AND OUNCES.


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


(BIRTH_WEIGHT_LBS) |___|___|

POUNDS 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF ANSWER < 0 OR > 20 LBS.

  • DISPLAY SOFT EDIT IF ANSWER < 3 OR > 13 LBS.


(BIRTH_WEIGHT_OZ) |___|___|

OUNCES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



MBC04000/(BIRTH_LENGTH_IN). How many inches was {C_FNAME/the child} when he/she was born?

 

|___|___|

INCHES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


PROGRAMMER INSTRUCTIONS

  • DISPLAY SOFT EDIT IF RESPONSE < 6 OR > 30.

  • IF CHILD_QNUM = 1 AND FIRST LOOP OR MULT_CHILD = 2, GO TO DELIVER_WEEK.

  • OTHERWISE, GO TO MBC06000.


MBC05000/(DELIVER_WEEK). In which week of your pregnancy did you give birth?

 

|___|___|

WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


PROGRAMMER INSTRUCTIONS

  • DISPLAY SOFT EDIT IF RESPONSE ≤ 0 OR > 44.


MBC06000. How long was your child in the hospital after the birth?


INTERVIEWER INSTRUCTIONS

  • ENTER VALUE AND SELECT WHETHER DAYS OR WEEKS.

  • IF RESPONDENT REPORTS THE CHILD WAS IN THE HOSPITAL FOR LESS THAN 1 DAY, ENTER "1."


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


(LENGTH_HOSP_TIME) |___|___| 


Label

Code

Go To

CHILD STILL IN HOSPITAL

0


CHILD NOT BORN IN HOSPITAL

-7


REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF LENGTH_HOSP_TIME = -7, AND

    • IF MULT_CHILD = 2 OR IF NUMBER OF LOOPS = CHILD_NUM, GO TO PREG_COMP.

    • OTHERWISE, GO TO TIME_STAMP_MCS_ST AND BEGIN SUBSEQUENT LOOP.

  • IF LENGTH_HOSP_TIME = 0, -7, OR -2, GO TO TRANS_DEPT_BIRTH.


(LENGTH_HOSP_BIRTH_UNIT)


Label

Code

Go To

DAYS

1


WEEKS

2



MBC07000/(TRANS_DEPT_BIRTH). Was your child transferred to another department or hospital after the birth?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


PROGRAMMER INSTRUCTIONS

  • IF TRANS_DEPT_BIRTH = 1, GO TO TRANS_DEPT_BIRTH_OTH.

  • IF TRANS_DEPT_BIRTH = 2, -1, OR -2, AND

    • IF MULT_CHILD = 2 OR IF NUMBER OF LOOPS = CHILD_NUM, GO TO DELIVER_CES.

    • OTHERWISE, GO TO TIME_STAMP_MCS_ST AND BEGIN SUBSEQUENT LOOP.


MBC08000/(TRANS_DEPT_BIRTH_OTH). SPECIFY: ________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


PROGRAMMER INSTRUCTIONS

  • IF MULT_CHILD = 2 OR IF NUMBER OF LOOPS = CHILD_NUM, GO TO DELIVER_CES.

  • OTHERWISE, GO TO TIME_STAMP_MCS_ST AND BEGIN SUBSEQUENT LOOP.


MBC09000/(DELIVER_CES). Was your child delivered by caesarean section?


Label

Code

Go To

YES

1


NO

2

PREG_COMP

REFUSED

-1

PREG_COMP

DON'T KNOW

-2

PREG_COMP


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


MBC10000/(CES_PLAN). Was the caesarean section planned?


Label

Code

Go To

YES

1


NO

2

PREG_COMP

REFUSED

-1

PREG_COMP

DON'T KNOW

-2

PREG_COMP


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


MBC11000/(CES_PLAN_REASON). Why?


Label

Code

Go To

Breech presentation

1

PREG_COMP

Previous cesarean

2

PREG_COMP

Pregnancy complication or mother taken ill

3

PREG_COMP

Poor growth or other factor relating to the fetus

4

PREG_COMP

Own preference

5

PREG_COMP

OTHER

-5


REFUSED

-1

PREG_COMP

DON'T KNOW

-2

PREG_COMP


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


MBC12000/(CES_PLAN_REASON_OTH). SPECIFY: ________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


MBC13000/(PREG_COMP). Were there any complications during the pregnancy?


Label

Code

Go To

YES

1


NO

2

PREG_COMP_HOSP

REFUSED

-1

PREG_COMP_HOSP

DON'T KNOW

-2

PREG_COMP_HOSP


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


MBC14000/(PREG_COMP_OTH). SPECIFY: ___________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


MBC15000/(PREG_COMP_HOSP). Either before or after your baby's birth, were you admitted or transferred to another department or hospital due to complications in connection with the birth? 


Label

Code

Go To

YES

1


NO

2

FAMILY_PRESENT_BIRTH

REFUSED

-1

FAMILY_PRESENT_BIRTH

DON'T KNOW

-2

FAMILY_PRESENT_BIRTH


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire (modified)


MBC16000. Where?


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


(PREG_COMP_HOSP_DEPT) DEPARTMENT: ______________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREG_COMP_HOSP_NAME) HOSPITAL: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



MBC17000. How many days were you in the hospital in connection with the birth?


INTERVIEWER INSTRUCTIONS

  • PROBE TO DETERMINE NUMBER OF DAYS IN HOSPITAL BEFORE CHILD'S BIRTH AND NUMBER OF DAYS IN HOSPITAL AFTER CHILD'S BIRTH.


SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


(PREG_COMP_HOSP_TIME_PRIOR) BEFORE THE BIRTH: |___|___| NUMBER OF DAYS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREG_COMP_HOSP_TIME_AFTER) AFTER THE BIRTH: |___|___| NUMBER OF DAYS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



MBC18000/(FAMILY_PRESENT_BIRTH). Was anyone from your close family present at the birth?


Label

Code

Go To

Yes, child's father

1


Yes, someone else

2


No

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

Norwegian Mother and Child Cohort Study, 6-Month Questionnaire


(TIME_STAMP_MBC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 2 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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