Form 13.1 Survey

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

9MonthQuestionnaireChild

9-Month Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

9M Questionnaire - Child, Phase 2g

OMB Specification


9M Questionnaire - Child


Event Category:

Time-Based

Event:

9M

Administration:

N/A

Instrument Target:

Child

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:

3 minutes

Multiple Child/Sibling Consideration:

Per Child

Special Considerations:

N/A

Version:

3.0

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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9M Questionnaire - Child



TABLE OF CONTENTS





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9M Questionnaire - Child



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

CHARACTER


ZIP CODE LAST FOUR

4

CHARACTER


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

NUMBER OF HOURS PER DAY

TWO-DIGIT HOUR

NUMERIC

  • HARD EDITS:

HOURS MUST BE BETWEEN 1 AND 24

NUMBER OF DAYS PER WEEK

ONE-DIGIT

NUMERIC

  • HARD EDITS:

DAYS PER WEEK MUST BE BETWEEN 1 AND 7





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.





CHILD DEVELOPMENT


(TIME_STAMP_CD_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

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

  • 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 IN PARTICIPANT VERIFICATION, SCHEDULING, & TRACING = -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.


CD01000. First, I will read you a list of things {C_FNAME/the child} may already do or may start doing when {he/she} gets older.  Does {C_FNAME/the child}:


CD02000/(EYES_FOLLOW). Follow you with {his/her} eyes?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Young Baby Girl Questionnaire (modified) 


CD03000/(SMILE). Smile when you smile at {him/her}?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD04000/(REACH_1). Try to get a toy that is out of reach?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD05000/(FEED). Feed {himself/herself} a cracker or cereal?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD06000/(WAVE). Wave goodbye?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Infant Son Questionnaire (modified) 


CD07000/(GRAB). Grab an object like a block or rattle from you?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD08000/(SWITCH_HANDS). Move a toy or block from one hand to the other?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD09000/(PICKUP). Pick up a small object like a Cheerio or raisin?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified )


CD10000/(HOLD). Hold two toys or blocks at a time, one in each hand?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Herald Study Instrument #23 Six-Month Home Interview (modified) 


CD11000/(SOUND_3). Turn toward someone when they’re speaking?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified)


CD12000/(SPEAK_1). Make sounds as though {he/she} is trying to speak?


Label

Code

Go To

YES

1


NO

2

HEADUP

REFUSED

-1

HEADUP

DON'T KNOW

-2

HEADUP


SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD13000/(SPEAK_2). Say mama or dada?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD14000/(HEADUP). Keep {his/her} head steady when sitting or held up?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD15000/(ROLL_2). Roll from back to stomach?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD16000/(SITUP). Sit up by {himself/herself}?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD17000/(STAND). Stand while holding onto something?


Label

Code

Go To

YES

1


NO

2

SCRIBBLE

REFUSED

-1

SCRIBBLE

DON'T KNOW

-2

SCRIBBLE


SOURCE

Avon Longitudinal Study of Parents and Children My Daughter Questionnaire (modified) 


CD18000/(STAND_ALONE). Stand alone, without holding onto something?


Label

Code

Go To

YES

1


NO

2

SCRIBBLE

REFUSED

-1

SCRIBBLE

DON'T KNOW

-2

SCRIBBLE


SOURCE

Avon Longitudinal Study of Parents and Children My Girl Toddler Questionnaire (modified) 


CD19000/(WALK). Walk by {himself/herself}, without holding onto something?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Girl Toddler Questionnaire (modified) 


CD20000/(SCRIBBLE). Scribble or draw with a pencil, crayon, or marker?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Girl Toddler Questionnaire (modified)


CD21000/(FORK_SPOON). Try to use a fork or spoon when eating?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children My Girl Toddler Questionnaire (modified)


(TIME_STAMP_CD_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



HEALTH CARE


(TIME_STAMP_HC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


HC01000. The next questions are about {C_FNAME/the child}’s health care.


HC02000/(R_HCARE). First, what kind of place does {C_FNAME/the child} usually go to when {he/she} needs routine or well-child care, such as a check-up or well-baby shots (immunizations)?


Label

Code

Go To

Clinic or health center

1

C_HEALTH

Doctor's office or Health Maintenance Organization (HMO)

2

C_HEALTH

Hospital emergency room

3

C_HEALTH

Hospital outpatient department

4

C_HEALTH

Some other place

-5


DOESN'T GO TO ONE PLACE MOST OFTEN

5

C_HEALTH

DOESN'T GET WELL-CHILD CARE ANYWHERE

-7

C_HEALTH

REFUSED

-1

C_HEALTH

DON’T KNOW

-2

C_HEALTH


SOURCE

National health Interview Survey (NHIS) 2007 Child Access to Health Care & Utilization (modified) 


HC03000/(R_HCARE_OTH). SPECIFY: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National health Interview Survey (NHIS) 2007 Child Access to Health Care & Utilization (modified) 


HC04000/(C_HEALTH). Would you say {C_FNAME/the child}’s health in general is poor, fair, good, or excellent?


Label

Code

Go To

POOR

1


FAIR

2


GOOD

3


EXCELLENT

4


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Health Interview Survey 2010 Family Health Status & Limitations (modified)


HC05000/(USE_IC_LOG). Are you using the Infant and Child Health Care Log? This is the booklet that you or your health care provider (pediatrician or family medicine doctor, specialist (like a surgeon, heart, allergy, or skin doctor), nurse practitioner, physician assistant, nurse, social worker/counselor, etc.) uses to record information about the child’s medical visits.


INTERVIEWER INSTRUCTIONS

  • READ TEXT IN PARENTHESES IF NEEDED.


Label

Code

Go To

YES

1

NUM_PROV_IC_LOG

NO

2


REFUSED

-1

HC12000

DON'T KNOW

-2

HC12000


SOURCE

National Children’s Study, Vanguard Phase (3M)


HC06000/(REASON_NO_IC_LOG). Is that because


INTERVIEWER INSTRUCTIONS

  • IF THE ADULT CAREGIVER REPORTS THEY HAVE "misplaced the log," DISTRIBUTE A NEW LOG OR OFFER TO MAIL ONE.


Label

Code

Go To

The child hasn’t had a medical visit since our last interview

1

HC14000

You’ve misplaced the log

2

HC12000

You’ve forgotten to bring it to the child’s medical visits

3

HC09000

The log was too much trouble to complete

4

HC09000

The log was too difficult to understand

5

HC12000

OTHER

-5


REFUSED

-1

HC09000

DON’T KNOW

-2

HC09000


SOURCE

National Children’s Study, Vanguard Phase (3M)


HC07000/(REASON_NO_IC_LOG_OTH). SPECIFY: _______________________________


Label

Code

Go To

REFUSED

-1

HC12000

DON"T KNOW

-2

HC12000


SOURCE

National Children’s Study, Vanguard Phase (3M)


PROGRAMMER INSTRUCTIONS

  • GO TO HC12000.


HC09000. This information is very important to the study. Please keep the log in a safe place and bring the log with you to all of the child’s medical visits.


PROGRAMMER INSTRUCTIONS

  • GO TO HC12000.


HC10000/(NUM_PROV_IC_LOG). How many health care providers has the child seen since you first started using this Infant and Child Health Care Log?

 

|___|___|

NUMBER OF PROVIDERS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (3M) (modified)


PROGRAMMER INSTRUCTIONS

  • IF NUM_PROV_IC_LOG = 0, -1, OR -2, GO TO HC12000.

  • OTHERWISE, GO TO NUM_PROV_REC.


HC11000/(NUM_PROV_REC). Of those providers that {C_FNAME/the child} has seen, for how many providers have you recorded contact information such as their address or phone number?

 

|___|___|

NUMBER OF CONTACTS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (3M) (modified)


HC12000. I am now going to ask some questions about the child’s visits to a doctor or other health care provider. It would be helpful if you referred to {the Infant and Child Health Care Log that you received as part of this study or to} personal records or a calendar that you keep that would help you to remember the dates of these visits.  If you have this information available, please go and get it now.


INTERVIEWER INSTRUCTIONS

  • READ TEXT IN PARENTHESES IF NEEDED.


PROGRAMMER INSTRUCTIONS

  • IF USE_IC_LOG = 1, DISPLAY "the Infant and Child Health Care Log that you received as part of this study or to". 


HC13000. What was the date of {C_FNAME/the child}’s most recent well-child visit or checkup?


INTERVIEWER INSTRUCTIONS

  • SHOW CALENDAR TO ASSIST IN DATE RECALL.

  • ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND A FOUR-DIGIT YEAR.


SOURCE

National Children’s Study, Legacy Phase (3M Phone, 6M Mother, 9M Phone)


(LAST_VISIT_MM) MONTH:

 

|___|___|

  M   M


Label

Code

Go To

HAS NOT HAD A VISIT

-7

SAME_CARE

REFUSED

-1

SAME_CARE

DON’T KNOW

-2

SAME_CARE


(LAST_VISIT_DD) DAY:

 

|___|___|

   D    D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(LAST_VISIT_YYYY) YEAR:

 

|___|___|___|___|

  Y     Y     Y    Y


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF LAST_VISIT_YYYY <> -1 OR -2, AND

    • IF USE_IC_LOG = 1, GO TO HC14000.

    • IF USE_IC_LOG = 2, -1 OR -2, GO TO SAME_CARE.?

  • IF LAST_VISIT_YYYY = -1 OR -2, GO TO SAME_CARE.


HC14000. If you haven’t yet, please put a check mark in the box next to the visit you just told me about in your Infant and Child Health Care Log.


HC14100/(VISIT_WT). What was {C_FNAME/the child}'s weight at that visit?

 

|___|___|

POUNDS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (3M Phone, 6M Mother, 9M Phone, 12M Mother)


HC15000/(SAME_CARE). If {C_FNAME/the child} is sick or if you have concerns about {his/her} health, does {he/she} go to the same place as for well-child visits?


Label

Code

Go To

YES

1

HOSPITAL

NO

2


NOT APPLICABLE/HAS NOT BEEN SICK

-7

TIME_STAMP_HC_ET

REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (9M)


HC16000/(HCARE_SICK). What kind of place does {C_FNAME/the child} usually go to when {he/she} is sick, doesn’t feel well, or if you have concerns about {his/her} health?


Label

Code

Go To

Clinic or health center

1

HOSPITAL

Doctor's office or Health Maintenance Organization (HMO)

2

HOSPITAL

Hospital emergency room

3

HOSPITAL

Hospital outpatient department

4

HOSPITAL

Some other place

-5


DOESN'T GO TO ONE PLACE MOST OFTEN

5

HOSPITAL

NOT APPLICABLE/HAS NOT BEEN SICK

-7

TIME_STAMP_HC_ET

REFUSED

-1

HOSPITAL

DON’T KNOW

-2

HOSPITAL


SOURCE

National Health Interview Survey (NHIS)


HC17000/(HCARE_SICK_OTH). SPECIFY: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey (NHIS)


HC18000/(HOSPITAL). Since {DATE OF LAST INTERVIEW}, has {C_FNAME/the child} spent at least one night in the hospital?


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

National Health Interview Survey 2007 Family Interview (modified) 


PROGRAMMER INSTRUCTIONS

  • PRELOAD AND DISPLAY THE DATE OF THE LAST INTERVIEW IN "{DATE OF LAST INTERVIEW}".


HC19000/(HOSPITAL_TIMES). How many times since {DATE OF LAST INTERVIEW} has {C_FNAME/the child} spent at least one night in the hospital?

 

 

|___|___|

TIMES


Label

Code

Go To

REFUSED

-1

TIME_STAMP_HC_ET

DON'T KNOW

-2

TIME_STAMP_HC_ET


SOURCE

National Health Interview Survey 2007 Family Interview (modified) 


DATA COLLECTOR INSTRUCTIONS

  • LOOP THROUGH ADMIN_DATE_MM, ADMIN_DATE_DD, ADMIN_DATE_YYYY, HOSP_NIGHTS, DIAGNOSE, DIAGNOSES (IF DIAGNOSE = 1), AND HC24000 (IF USE_IC_LOG = 1) FOR EACH HOSPITAL ADMISSION UNTIL TOTAL NUMBER OF LOOPS = HOSPITAL_TIMES .


HC20000. What was the admission date of {C_FNAME/the child}’s {most recent/next most recent} hospital stay?


INTERVIEWER INSTRUCTIONS

  • SHOW CALENDAR TO ASSIST IN DATE RECALL.

  • ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND A FOUR-DIGIT YEAR


SOURCE

National Children’s Study, Legacy Phase (T1 Mom, T3 Prior)


(ADMIN_DATE_MM) MONTH:

|___|___|

   M    M


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(ADMIN_DATE_DD) DAY:

 

|___|___|

   D    D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(ADMIN_DATE_YY) YEAR:

 

|___|___|___|___|

  Y     Y     Y    Y


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY “most recent”.

  • OTHERWISE, DISPLAY “next most recent”.


HC21000/(HOSP_NIGHTS). How many nights did {C_FNAME/the child} stay in the hospital during this hospital stay?

 

|___|___|___|

NUMBER OF NIGHTS


INTERVIEWER INSTRUCTIONS

  • CONFIRM RESPONSE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2007 Family Interview (modified) 


HC22000/(DIAGNOSE). Did a doctor or other health care provider give you a diagnosis for {C_FNAME/the child} during this hospital stay?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (3M Phone, 6M Mother, 12M Mother)


PROGRAMMER INSTRUCTIONS

  • IF DIAGNOSE = 1, GO TO DIAGNOSES.

  • IF DIAGNOSE = 2, -1, OR -2 AND USE_IC_LOG =1, GO TO HC24000.

  • IF DIAGNOSE = 2, -1, OR -2, AND USE_IC_LOG = 2, -1, OR -2, AND

    • IF NUMBER OF LOOPS = HOSPITAL_TIMES, GO TO TIME_STAMP_HC_ET.

    • IF NUMBER OF LOOPS < HOSPITAL_TIMES, GO TO HC20000.


HC23000/(DIAGNOSES). What was the diagnosis?

________________________________

DIAGNOSES


INTERVIEWER INSTRUCTIONS

  • ENTER ALL DIAGNOSES IN FIELD SEPARATED BY COMMAS OR AN “AND”.

  • PROBE: “Anything else?”


SOURCE

National Children’s Study, Legacy Phase (3M Phone, 6M Mother, 12M Mother)


PROGRAMMER INSTRUCTIONS

  • IF USE_IC_LOG = 1, GO TO HC24000.

  • IF USE_IC_LOG = 2, -1 OR -2, AND

    • IF NUMBER OF LOOPS = HOSPITAL_TIMES, GO TO TIME_STAMP_HC_ET.

    • IF NUMBER OF LOOPS < HOSPITAL_TIMES, GO TO HC20000.


HC24000. If you haven’t yet, please put a check mark in the box next to the visit you just told me about in your Infant and Child Health Care Log.


PROGRAMMER INSTRUCTIONS

  • IF NUMBER OF LOOPS = HOSPITAL_TIMES, GO TO TIME_STAMP_HC_ET.

  • IF NUMBER OF LOOPS < HOSPITAL_TIMES, GO TO HC20000.


(TIME_STAMP_HC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 3 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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