12.7 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

6M Infant Feeding SAQ, Phase 2g

OMB Specification

6M Infant Feeding SAQ

Event Category:	Time-Based
Event:	6M
Administration:	N/A
Instrument Target:	Child
Instrument Respondent:	Primary Caregiver
Domain:	Questionnaire
Document Category:	Questionnaire
Method:	Self-Administered
Mode (for this instrument*):	In-Person, PAPI
OMB Approved Modes:	In-Person, PAPI; Phone, PAPI; Web-Based, CAI
Estimated Administration Time:	7 minutes
Multiple Child/Sibling Consideration:	Per Child
Special Considerations:	N/A
Version:	4.0
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 Infant Feeding SAQ

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

6-MONTH INFANT FEEDING SAQ SPECIFICATION 3

FOR OFFICE USE ONLY: 17

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6M Infant Feeding SAQ

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.

6-MONTH INFANT FEEDING SAQ SPECIFICATION

SIF01000. Thank you for agreeing to participate in the National Children’s Study. This self-administered questionnaire will take about 7 minutes to complete. There are questions about your child’s diet. Your answers are important to us. There are no right or wrong answers. You can skip over any question. We will keep everything that you tell us confidential.

SIF02000/(BREAST_FEED). Did you ever breast feed your baby?

Label	Code	Go To
Yes	1
No	2	PUMPED

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified) 

SIF03000/(BREAST_FEED_NOW). Are you currently breast feeding your baby?

Label	Code	Go To
Yes	1
No	2

SOURCE

Infant Feeding Practices Study II Month 2 Questionnaire (modified)

SIF04000/(PUMPED). Did you ever feed your baby pumped or expressed breast milk?

Label	Code	Go To
Yes	1
No	2

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified) 

PARTICIPANT INSTRUCTIONS

If you answered “No” to both SIF03000 and SIF04000, go to SIF06000.

 

If you answered “Yes” to SIF03000 and “No” to SIF04000, go to SIF06100.

 

Otherwise, go to SIF05000.

SIF05000/(PUMPED_NOW). Are you currently feeding your baby pumped or expressed breast milk?

Label	Code	Go To
Yes	1	SIF06100
No	2

SOURCE

Infant Feeding Practices Study II Month 2 Questionnaire (modified)

SIF06000. How old was your baby when you completely stopped feeding your baby breast milk?

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)  

(BREAST_STOP) |___|___| Number of 

Label	Code	Go To
Never fed breast milk	-7

(BREAST_STOP_UNIT) (circle one) weeks/ months

Label	Code	Go To
Weeks	1
Months	2

SIF06100. Questions SIF07000 through SIF10000 will ask about the milk, formula, and food your child has eaten in the past 7 days. In answering, include feedings by everyone who feeds the baby. Include snacks and night-time feedings. Use these guidelines in choosing how to respond:

• If the baby was fed this item once a day or more, write the number of feedings per day in the boxes and then circle the word “Day” that follows.

• If the baby was fed the item less than once a day, write the number of feedings per week in the boxes and then circle the word “Week” that follows.

• If the baby was not fed the item at all during the past 7 days, write “00” in the boxes.

SIF07000. In the past 7 days, how often was your baby fed breast milk (include breast fed and expressed or pumped breast milk)?

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

(BREAST_MILK) |___|___| Number per

(BREAST_MILK_UNIT) (circle one) day / week

Label	Code	Go To
Day	1
Week	2

SIF08000. In the past 7 days, how often was your baby fed formula?

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

(FORMULA_OFTEN) |___|___| Number per 

(FORMULA_OFTEN_UNIT) (circle one) day / week

Label	Code	Go To
Day	1
Week	2

SIF09000. In the past 7 days, how often was your baby fed cow’s milk?

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified) 

(COW_MILK) |___|___| Number per

(COW_MILK_UNIT) (circle one) day / week

Label	Code	Go To
Day	1
Week	2

SIF10000. In the past 7 days, how often was your baby fed other milk (soy milk, rice milk, goat milk)?

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

(MILK_OTHER) |___|___| Number per

(MILK_OTHER_UNIT) (circle one)  day / week

Label	Code	Go To
Day	1
Week	2

PARTICIPANT INSTRUCTIONS

• If you answered “00” to SIF07000 (if your baby was not fed breast milk in the past 7 days), go to SIF13000.

 

• Otherwise, go to SIF10100.

SIF10100/(PUMPED_3). In the past 7 days, about how often was your baby fed pumped or expressed breast milk? Include feedings by everyone who feeds the baby and include snacks and night-time feedings.

Label	Code	Go To
Never	-7	FORMULA
1 time per week	2
2 to 4 times per week	3
Nearly every day	4
1 to 3 times per day	5
4 or more times per day	6

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF11000/(BREAST_MILK_STORED). In the past 7 days, about how long was your breast milk usually stored in the refrigerator before it was fed to your baby? (Include cooler with cold source such as freezer packs). 

Label	Code	Go To
1 day or less	1
2-3 days	2
4-5 days	3
More than 6 days	4
Did not store breast milk in refrigerator	-7

SOURCE

Infant Feeding Practices Study II Month 2 Questionnaire (modified) 

SIF12000/(BREAST_MILK_TEMP). In the past 7 days, about how long was your breast milk usually kept at room temperature and then fed to your baby?

Label	Code	Go To
Less than 2 hours	1
2-4 hours	2
5-8 hours	3
More than 8 hours	4
Did not keep breast milk at room temperature	-7

SOURCE

Infant Feeding Practices Study II Month 2 Questionnaire (modified) 

SIF13000/(FORMULA). How old was your baby when he or she was first fed formula on a daily basis?

Label	Code	Go To
Less than 1 week	1
7-13 days	2
14-31 days	3
More than 31 days	4
Never fed formula	-7	SIF22000

SOURCE

Infant Feeding Practices Study II Neonatal Questionnaire (modified) 

SIF14000/(FORMULA_IRON). Was the formula fed to your baby within the past 7 days with iron or a low iron formula?

Label	Code	Go To
With iron	1
Low iron	2
Don't know	-2

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF15000/(FORMULA_TYPE). Was the formula fed to your baby within the past 7 days ready-to-feed, liquid concentrate, powder from a can that makes more than one bottle, or powder from single serving packets?

PARTICIPANT INSTRUCTIONS

Select all the answers that apply.

Label	Code	Go To
Ready-to-feed	1
Liquid Concentrate	2
Powder from a can that makes more than one bottle	3
Powder from single serving packets	4
Don't know	-2

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified) 

PARTICIPANT INSTRUCTIONS

If your answer to Question SIF15000 was “Ready-to-feed,” and that was the only answer that applied, go to Question SIF20000.

 

Otherwise, go on to Question SIF16000.

SIF16000/(FORMULA_LABEL). When the formula was mixed, was it made according to the directions on the formula label?

Label	Code	Go To
Yes	1	WATER_1
No	2
Don't know	-2

SOURCE

Infant Feeding Practices Study II Month 2 Questionnaire (modified)

SIF17000. When the formula was mixed, how much formula was used?

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

(FORMULA_AMT) |___|___| Number of 

(FORMULA_UNIT) (select one unit below)

Label	Code	Go To
Tablespoon(s)	1
Teaspoon(s)	2
Ounce(s)	3
Cup(s)	4
Packet(s)	5
Formula can(s)	6
Don't know	-2

SIF18000. When the formula was mixed, how much water was used?

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

(WATER_AMT) |___|___| Number of 

(WATER_UNIT) (select one unit below)

Label	Code	Go To
Tablespoon(s)	1
Teaspoon(s)	2
Ounce(s)	3
Don't know	-2

SIF19000/(WATER_1). During the past 7 days, what types of water have you and others who care for your baby used for mixing your baby’s formula?

PARTICIPANT INSTRUCTIONS

Select all the answers that apply.

Label	Code	Go To
Tap water from the cold faucet	1
Warm tap water from the hot faucet	2
Bottled water	3
No water used	4
Don't know	-2

SOURCE

Infant Feeding Practices Study II Month 9 Questionnaire (modified) 

PROGRAMMER INSTRUCTIONS

If your answer to SIF19000 was "No water used", go to SIF20000.

 

Otherwise, go to SIF19100. 

SIF19100/(WATER_2). In the past 7 days, was the water used to mix the formula ALWAYS boiled?

Label	Code	Go To
Yes	1
No	2
Don't know	-2

SOURCE

Infant Feeding Practices Study II Month 2 Questionnaire (modified) 

SIF20000/(OUNCES). In the past 7 days, on the average, how many ounces of formula did your baby drink at each feeding?

 

|___|___| Ounces

Label	Code	Go To
Don't know	-2

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF21000. Now think about how you cleaned your hands when you were preparing formula. During the past 7 days, did you never, sometimes, most of the time, or always:

SOURCE

Infant Feeding Practices Study II Month 9 Questionnaire (modified)

SIF21100/(CLEAN_HANDS_1). Rinse hands with water only?

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

Infant Feeding Practices Study II Month 9 Questionnaire (modified)

SIF21200/(CLEAN_HANDS_2). Wipe hands only?

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

Infant Feeding Practices Study II Month 9 Questionnaire (modified)

SIF21300/(CLEAN_HANDS_3). Wash hands with soap?

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

Infant Feeding Practices Study II Month 9 Questionnaire (modified) 

SIF21400/(CLEAN_HANDS_4). Use a hand sanitizer (such as gel or wipes)?

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

Infant Feeding Practices Study II Month 9 Questionnaire (modified)

SIF21500/(CLEAN_HANDS_5). Prepare formula without cleaning your hands?

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

Infant Feeding Practices Study II Month 9 Questionnaire (modified)

SIF22000. In the past 7 days, about how often did your baby drink from each of the following types of bottles and cups?

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

SIF22100/(B_TYPE_1). Plastic baby bottle with disposable bottle liner.

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

​National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

SIF22200/(B_TYPE_2). Plastic baby bottle without disposable bottle liner.

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

​National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

SIF22300/(B_TYPE_3). Other plastic bottle (for example, a water bottle).

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

​National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

SIF22400/(B_TYPE_4). Glass baby bottle.

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

​National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

SIF22500/(B_TYPE_5). Plastic “no spill” cup

Label	Code	Go To
Never	1
Sometimes	2
Most of the time	3
Always	4

SOURCE

​National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

SIF23000/(PACIFIER). Has your baby used a pacifier in the past 7 days?

Label	Code	Go To
Yes	1
No	2

SOURCE

Infant Feeding Practices Study II 9 Month Questionnaire

SIF24000/(COWS_MILK_1). Has your baby ever been fed cow’s milk that was not sold especially for babies? (This includes whole, lowfat, nonfat, or chocolate milk.)

Label	Code	Go To
Yes	1
No	2	JUICE

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

SIF25000. How old was your baby when he/she was first fed cow’s milk that was not sold especially for babies?

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

(COWS_MILK_2) |___|___| Number of 

(COWS_MILK_2_UNIT) (circle one) Days/ Weeks

Label	Code	Go To
Days	1
Weeks	2

SIF26000/(JUICE). Have you ever fed your baby fruit juice that was not sold especially for babies?

Label	Code	Go To
Yes	1
No	2	SIF29000

SOURCE

Infant Feeding Practices Study II Month 12 Questionnaire (modified)

SIF27000. How old was your baby when he/she was first fed fruit juice that was not sold especially for babies?

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

(JUICE_AGE) |___|___| Number of 

(JUICE_AGE_UNIT) (circle one) Days/ Weeks

Label	Code	Go To
Days	1
Weeks	2

SIF28000/(JUICE_CALCIUM). About how often was the fruit juice fortified with calcium?

Label	Code	Go To
Always	1
Sometimes	2
Rarely	3
Never	4
Don’t Know	-2

SOURCE

Infant Feeding Practices Study II Month 12 Questionnaire (modified)

SIF29000. Now think about fruits, vegetables, and meats that may have been fed to your baby in the past 7 days. How often was each of the foods your baby ate commercial baby food? (Commercial baby food is food sold for babies. Foods that are NOT commercial baby food are table foods your whole family eats, foods you made especially for your baby, fresh fruit, and fruit juices that are not sold especially for babies.)

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified) 

SIF30000/(C_FOOD1). In the past 7 days, how often did you feed your baby commercially available fruit and vegetable juice?

Label	Code	Go To
Always	1
Usually	2
Sometimes	3
Never	4
Not Fed to My Baby	-7

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF31000/(C_FOOD2). In the past 7 days, how often did you feed your baby commercially available fruit?

Label	Code	Go To
Always	1
Usually	2
Sometimes	3
Never	4
Not Fed to My Baby	-7

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF32000/(C_FOOD3). In the past 7 days, how often did you feed your baby commercially available vegetables?

Label	Code	Go To
Always	1
Usually	2
Sometimes	3
Never	4
Not Fed to My Baby	-7

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF33000/(C_FOOD4). In the past 7 days, how often did you feed your baby commercially available meat, chicken and turkey?

Label	Code	Go To
Always	1
Usually	2
Sometimes	3
Never	4
Not Fed to My Baby	-7

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified) 

SIF34000/(C_FOOD5). In the past 7 days, how often did you feed your baby commercially available combination dinner (for example, Spaghetti Dinner, Pasta and Vegetable Dinner, or a Turkey and Rice Dinner)?

Label	Code	Go To
Always	1
Usually	2
Sometimes	3
Never	4
Not Fed to My Baby	-7

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF35000/(ORGANIC). During the past 7 days, were the baby foods your baby ate always, sometimes, rarely, or never organic baby foods?

Label	Code	Go To
Always	1
Sometimes	2
Rarely	3
Never	4
Don’t Know	-2

SOURCE

National Children’s Study, Legacy Phase (6M Infant Feeding Questionnaire)

SIF36000/(SUPPLEMENT). Which of the following supplements was your child given at least three days a week during the past 2 weeks?

Label	Code	Go To
Fluoride	1
Iron	2
Vitamin D	3
Other vitamins or supplements	-5
None	5

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

PARTICIPANT INSTRUCTIONS

If you selected "Other vitamins or supplements" or any combination of "Fluoride," "Iron," "Vitamin D," and "Other Vitamin Supplements," go to SIF37000.

 

If you did not select "Other vitamins or supplements" or "None," go to SIF38000.

 

If you selected "None," go to SIF39000.

SIF37000/(SUPPLEMENT_OTH). SPECIFY: _______________________________________________

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF38000/(SUPP_FORM). Were the supplements you gave your baby in the form of drops or pills? (Mark crushed pills mixed with liquid as “pills”.)

Label	Code	Go To
Drops	1
Pills	2

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified) 

SIF39000/(HERBAL). Was your baby given any herbal or botanical preparations or any kind of tea or home remedy in the past 7 days?  Do not count preparations put on the baby’s skin or anything the baby may have gotten from breast milk after you took an herbal or botanical preparation

Label	Code	Go To
Yes	1
No	2	SIF41000

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified)

SIF40000/(HERBAL_OTH). Please write in the name of all the kinds of herbal or botanical preparations, teas or home remedies your baby was given in the past 7 days.

 

____________________________________________________________

 

____________________________________________________________

 

____________________________________________________________

 

____________________________________________________________

 

____________________________________________________________

SOURCE

Infant Feeding Practices Study II Month 6 Questionnaire (modified) 

SIF41000. Thank you for participating in the National Children’s Study and for taking the time to complete this survey.

FOR OFFICE USE ONLY:

FOU01000/(P_ID). Participant ID:________________________________

FOU02000/(R_P_ID). Respondent ID:____________________________________

Public reporting burden for this collection of information is estimated to average 7 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.