12.6 Survey

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

6MonthQuestionnaireAdult

6-Month Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

6M Questionnaire – Adult, Phase 2g

OMB Specification


6M Questionnaire - Adult


Event Category:

Time-Based

Event:

6M

Administration:

N/A

Instrument Target:

Primary Caregiver

Instrument Respondent:

Primary Caregiver

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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6M Questionnaire - Adult



TABLE OF CONTENTS





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6M Questionnaire - Adult



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.





ADULT CAREGIVER EMPLOYMENT AND MATERNITY LEAVE


(TIME_STAMP_PEA_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

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

  • PRELOAD MULT_CHILD AND C_FNAME FROM PARTICIPANT VERIFICATION, SCHEDULING & TRACING QUESTIONNAIRE. 

  • IF MULT_CHILD = 1, DISPLAY "the children" AS APPROPRIATE THROUGHOUT THE INSTRUMENT.

  • IF MULT_CHILD ≠ 1, AND 

    • IF C_FNAME IN PARTICIPANT VERIFICATION, SCHEDULING & TRACING QUESTIONNAIRE ≠ -1, -2, OR -4, DISPLAY CHILD'S FIRST NAME IN "C_FNAME" THROUGHOUT THE INSTRUMENT.

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


PEA01000. Next, I’d like to ask some questions about work. People’s work situations sometimes change after having a baby.


PEA02000/(WORK_PREG). Just before {C_FNAME/the child/the children}'s birth, were you employed at a job or business? 


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_PEA_ET

REFUSED

-1

TIME_STAMP_PEA_ET

DON'T KNOW

-2

TIME_STAMP_PEA_ET


SOURCE

National Children’s Study, Vanguard Phase (6M) (modified)


PEA03000/(WORK_NOW). Have you returned to work, or are you currently on maternity leave from this job? Please tell me which category best describes your work situation.


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

RETURNED TO WORK

1

PEA05000

UNPAID LEAVE

2

TIME_STAMP_PEA_ET

PAID LEAVE

3

TIME_STAMP_PEA_ET

LEFT THE POSITION

4

TIME_STAMP_PEA_ET

LOOKING FOR WORK

5

TIME_STAMP_PEA_ET

OTHER

-5


REFUSED

-1

TIME_STAMP_PEA_ET

DON’T KNOW

-2

TIME_STAMP_PEA_ET


SOURCE

National Children’s Study, Vanguard Phase (6M)


PEA04000/(WORK_NOW_OTH). SPECIFY

__________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (6M)


PEA05000. How much leave did you take after the birth? 


SOURCE

Norwegian Mother and Child Cohort Study (MoBa), 18 Months


(LEAVE_BIRTH_NUM) |___|___|


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF LEAVE_BIRTH_NUM = 0, -1 OR -2, GO TO PEA07000.

  • OTHERWISE, GO TO LEAVE_BIRTH_UNIT.


(LEAVE_BIRTH_UNIT)


Label

Code

Go To

WEEKS

1


MONTHS

2


REFUSED

-1


DON'T KNOW

-2



PEA06000/(LEAVE_BIRTH_PAID). Was this leave paid or unpaid?


Label

Code

Go To

PAID

1


UNPAID

2


SOME WAS PAID, SOME WAS UNPAID

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

New


PEA07000. How much leave did your partner take after the birth? 


SOURCE

New


(LEAVE_FATHER_NUM) |___|___|


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF LEAVE_FATHER_NUM = 0, -1, OR -2, GO TO TIME_STAMP_PEA_ET.

  • OTHERWISE, GO TO ?LEAVE_FATHER_UNIT.


(LEAVE_FATHER_UNIT)


Label

Code

Go To

WEEKS

1


MONTHS

2


REFUSED

-1


DON'T KNOW

-2



PEA08000/(LEAVE_FATHER_PAID). Was this leave paid or unpaid?


Label

Code

Go To

PAID

1


UNPAID

2


SOME WAS PAID, SOME WAS UNPAID

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

New


(TIME_STAMP_PEA_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


MATERNAL ANXIETY


(TIME_STAMP_MA_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


MA01000. Over the past 2 weeks, how often have you been bothered by the following problems?


SOURCE

Generalized Anxiety Disorder – 7 item (GAD-7), Spitzer, Kroenke, Williams, & Lo’we, 2006.


MA02000/(BOTHER_ANX). Feeling nervous, anxious or on edge


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

NOT AT ALL

1


SEVERAL DAYS

2


MORE THAN HALF THE DAYS

3


NEARLY EVERY DAY

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Generalized Anxiety Disorder – 7 item (GAD-7), Spitzer, Kroenke, Williams, & Lo’we, 2006


MA03000/(BOTHER_STOP_WORRY). Not being able to stop or control worrying


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

NOT AT ALL

1


SEVERAL DAYS

2


MORE THAN HALF THE DAYS

3


NEARLY EVERY DAY

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Generalized Anxiety Disorder – 7 item (GAD-7), Spitzer, Kroenke, Williams, & Lo’we, 2006.


MA04000/(BOTHER_DIF_WORRY). Worrying too much about different things


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

NOT AT ALL

1


SEVERAL DAYS

2


MORE THAN HALF THE DAYS

3


NEARLY EVERY DAY

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Generalized Anxiety Disorder – 7 item (GAD-7), Spitzer, Kroenke, Williams, & Lo’we, 2006.


MA05000/(BOTHER_RELAX). Trouble relaxing


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

NOT AT ALL

1


SEVERAL DAYS

2


MORE THAN HALF THE DAYS

3


NEARLY EVERY DAY

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Generalized Anxiety Disorder – 7 item (GAD-7), Spitzer, Kroenke, Williams, & Lo’we, 2006.


MA06000/(BOTHER_RESTLESS). Feeling so restless that it is hard to sit still


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

NOT AT ALL

1


SEVERAL DAYS

2


MORE THAN HALF THE DAYS

3


NEARLY EVERY DAY

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Generalized Anxiety Disorder – 7 item (GAD-7), Spitzer, Kroenke, Williams, & Lo’we, 2006.


MA07000/(BOTHER_IRRITABLE). Becoming easily annoyed or irritable


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

NOT AT ALL

1


SEVERAL DAYS

2


MORE THAN HALF THE DAYS

3


NEARLY EVERY DAY

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Generalized Anxiety Disorder – 7 item (GAD-7), Spitzer, Kroenke, Williams, & Lo’we, 2006.


MA08000/(BOTHER_AWFUL). Feeling as if something awful might happen


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

NOT AT ALL

1


SEVERAL DAYS

2


MORE THAN HALF THE DAYS

3


NEARLY EVERY DAY

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Generalized Anxiety Disorder – 7 item (GAD-7), Spitzer, Kroenke, Williams, & Lo’we, 2006.


(TIME_STAMP_MA_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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