Form 43.1 Survey

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

VacuumBagDustInstrument

Environmental Sample Collection (Prenatal)

OMB: 0925-0593

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OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Vacuum Bag Dust Instrument, Phase 2g

OMB Specification


Vacuum Bag Dust Instrument


Event Category:

Trigger-Based, PV1; Time-Based, 12M, 36M, 48M, 60M

Event:

PV1, 12M, 36M, 48M, 60M

Administration:

N/A

Instrument Target:

Child's Primary Residence

Instrument Respondent:

Primary Caregiver

Domain:

Environmental

Document Category:

Sample Collection

Method:

Data Collector Administered

Mode (for this instrument*):

In-Person, CAI

OMB Approved Modes:

In-Person, CAI

Estimated Administration Time:

3 minutes

Multiple Child/Sibling Consideration:

Per Event

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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Vacuum Bag Dust Instrument



TABLE OF CONTENTS





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Vacuum Bag Dust Instrument



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.





VACUUM BAG DUST INSTRUMENT


(TIME_STAMP_VBD_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD DWELLING_UNIT_ID FOR THE DWELLING UNIT

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

  • PRELOAD MULT_CHILD AND CHILD_NUM (IF MULT_CHILD = 1), FROM PVST INSTRUMENT.

  • IF MULT_CHILD = 1, PRELOAD CHILD_QNUM


VBD01000/(STAFF_ID). ENTER STAFF ID

__________________________________________

STAFF ID


VBD02000/(VB_SAMPLES). WHICH VACUUM BAG DUST SAMPLES ARE SCHEDULED FOR THIS VISIT?


Label

Code

Go To

VACUUM BAG DUST PRIMARY

1

VBD04000

VACUUM BAG DUST PRIMARY AND QC SAMPLE(S)

2



VBD03000/(VB_SUBSAMPLES). WHICH VACUUM BAG DUST QC SAMPLES ARE SCHEDULED FOR THIS VISIT?


DATA COLLECTOR INSTRUCTIONS

  • SELECT ALL THAT APPLY.


Label

Code

Go To

VACUUM BAG DUST SPIKE

1


VACUUM BAG DUST SPLIT

2



VBD04000. DATE VACUUM BAG DUST SAMPLE COLLECTED


(VB_COLL_MM) MONTH:|___|___|

               M    M


(VB_COLL_DD) DAY:|___|___|

          D    D


(VB_COLL_YYYY) YEAR:|___|___|___|___|

            Y     Y     Y     Y 


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF MM, DD OR YYYY ARE OUTSIDE CRITERIA DEFINED IN GENERAL PROGRAMMER INSTRUCTIONS.


VBD05000. Now we are going to ask you some questions that will help us collect the vacuum bag dust sample.


SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)


VBD06000/(VACUUM_IN_HOME). Do you have a vacuum cleaner in your home?


Label

Code

Go To

YES

1


NO

2

VB_COMMENTS

REFUSED

-1

VACUUM_REFUSE

DON'T KNOW

-2

VB_COMMENTS


SOURCE

American Healthy Homes Survey (AHHS)


VBD07000/(VACUUM_OKAY). We would like to collect the dust from your vacuum cleaner.  Is that okay?


Label

Code

Go To

YES

1

VACUUM_TYPE

NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)


VBD08000/(VACUUM_REFUSE). RECORD REASON FOR REFUSAL IF GIVEN.


Label

Code

Go To

NONE GIVEN

1

VB_COMMENTS

NO REPLACEMENT VACUUM BAG

2

VACUUM_CONTENTS

VACUUM NOT IN HOME

3

VB_COMMENTS

OTHER

-5



SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)


VBD09000/(VACUUM_REFUSE_OTH). SPECIFY: ___________________________________


SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)


PROGRAMMER INSTRUCTIONS

  • GO TO VB_COMMENTS.


VBD100000/(VACUUM_CONTENTS). We would like to collect the dust from your vacuum bag.  Is that okay?


Label

Code

Go To

YES

1


NO

2

VB_COMMENTS

REFUSED

-1

VB_COMMENTS

DON'T KNOW

-2

VB_COMMENTS


SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)


VBD110000/(VACUUM_TYPE). Can you show us the vacuum that is used most often in your home?  This is the vacuum that we would like to collect dust from.


DATA COLLECTOR INSTRUCTIONS

  • RECORD THE TYPE OF VACUUM THAT YOU WILL COLLECT THE DUST FROM.


Label

Code

Go To

UPRIGHT OR FULL SIZED VACUUM

1

VACUUM_BAG_TYPE

HANDHELD VACUUM

2

VACUUM_BAG_TYPE

CENTRAL HOUSE COLLECTION SYSTEM

3

VACUUM_BAG_TYPE

ROBOTIC VACUUM

4

VACUUM_MAKE_MODEL

HARD SURFACE VACUUM

5

VACUUM_BAG_TYPE

SHOP VAC

6

VACUUM_BAG_TYPE

OTHER

-5



SOURCE

American Health Homes Survey (AHHS)


VBD120000/(VAC_TYPE_OTH). SPECIFY: _________________________________


SOURCE

American Healthy Homes Survey (AHHS)


VBD130000/(VACUUM_BAG_TYPE). RECORD THE TYPE OF VACUUM BAG FROM WHICH THE DUST SAMPLE IS COLLECTED.


Label

Code

Go To

BAGLESS

1


REUSABLE BAG

2


DISPOSABLE BAG

3



VBD140000/(VACUUM_MAKE_MODEL). RECORD THE MAKE AND MODEL OF THE VACUUM YOU ARE GOING TO COLLECT THE SAMPLE FROM.

MAKE: ___________________________

MODEL:__________________________


VBD150000. {Approximately how long has it been since the vacuum bag was changed?/Approximately how long has it been since you emptied the dust from the vacuum cleaner?}


SOURCE

American Healthy Homes Survey (AHHS)


(VACUUM_BAG_CHANGED) |___|___|

 NUMBER


(VACUUM_BAG_CHANGED_FREQ)


Label

Code

Go To

DAYS

1


WEEKS

2


MONTHS

3


YEARS

4


REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF VACUUM_BAG_TYPE= 1 OR 2 DISPLAY “Approximately how long has it been since you changed the vacuum bag or emptied the dust from the vacuum cleaner?”

  • OTHERWISE, DISPLAY: “Approximately how long has it been since the vacuum bag was changed?”


VBD150000/(VAC_USED_OUTSIDE). {Since you changed the vacuum bag or the dust was emptied from your vacuum/Since the vacuum bag was changed} has your vacuum been used to clean a place other than your home such as…


DATA COLLECTOR INSTRUCTIONS

  • SELECT ALL THAT APPLY


Label

Code

Go To

Never used vacuum outside home

1


Your car

2


Your garage

3


Your porch

4


Someone else's home

5


Somewhere outside your apartment, but within your apartment building

6


REFUSED

-1


DON'T KNOW

-2


OTHER

-5



SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)


PROGRAMMER INSTRUCTIONS

  • IF VACUUM_BAG_TYPE = 1 OR 2, DISPLAY “Since the dust was emptied from your vacuum.”

  • OTHERWISE, DISPLAY, “Since the vacuum bag was changed.

  • IF VAC_USED_OUTSIDE = ANY COMBINATION OF 2 THROUGH 6, GO TO VB_COMMENTS

  • IF VAC_USED_OUTSIDE = -5 OR ANY COMBINATION OF 2 THROUGH 6 AND -5, GO TO VAC_USED_OUTSIDE_OTH.

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


VBD160000/(VAC_USED_OUTSIDE_OTH). SPECIFY: _______________________________


SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)


VBD170000/(VB_COMMENTS). RECORD ANY COMMENTS ABOUT THE VACUUM BAG DUST SAMPLE COLLECTION:

COMMENTS: __________________________________


(TIME_STAMP_VBD_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • IF VACUUM _IN_HOME = 2, -1 OR -2, VACUUM_OKAY = 2, -1, OR -2, OR VACUUM_CONTENT= 2, -1, OR -2, GO TO TIME_STAMP_VSS_ET.

  • OTHERWISE, GO TO TIME_STAMP_VBP_ST.



VACUUM BAG PRIMARY SAMPLE


(TIME_STAMP_VBP_ST).


VBP01000/(VBP001). VACUUM BAG DUST SAMPLE COLLECTION INSTRUCTIONS


DATA COLLECTOR INSTRUCTIONS

  • COLLECT THE VACUUM BAG DUST SAMPLE IN ACCORDANCE WITH THE VACUUM BAG DUST SAMPLE COLLECTION SOP.


VBP02000/(VACUUM_COLLECT). WAS A VACUUM BAG SAMPLE COLLECTED?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF VACUUM_COLLECT = 1, SET SAMPLE_NUMBER = 1 AND GO TO VACUUM_MOST_USED.

  • OTHERWISE, GO TO VACUUM_NOTCOLLECT.


VBP03000/(VACUUM_NOTCOLLECT). WHY WAS A VACUUM BAG SAMPLE NOT COLLECTED?


Label

Code

Go To

KIT NOT AVAILABLE

1

VB_PRIM_COMMENTS

SUPPLIES PROBLEM

2

VB_PRIM_COMMENTS

RAN OUT OF TIME

3

VB_PRIM_COMMENTS

TROUBLE REMOVING BAG/CUP

4

VB_PRIM_COMMENTS

REFUSAL

5

VB_PRIM_COMMENTS

OTHER

-5



VBP04000/(VACUUM_NOTCOLLECT_OTH). SPECIFY: ________________________________


PROGRAMMER INSTRUCTIONS

  • GO TO VB_PRIM_COMMENTS.


VBP05000/(VACUUM_MOST_USED). WAS THE SAMPLE COLLECTED FROM THE MOST USED VACUUM?


Label

Code

Go To

YES

1


NO

2



VBP06000/(EQUIP_ID). T/RH METER ID

__________________________________________


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE ID OF THE T/RH METER.


VBP07000/(VACUUM_TEMP). TEMPERATURE WHEN THE VACUUM BAG DUST SAMPLE WAS COLLECTED:

|___|___|___|.|___|°F


DATA COLLECTOR INSTRUCTIONS

  • IF UNABLE TO COLLECT VACUUM_TEMP, RECORD 999.9 °F AND COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.


PROGRAMMER INSTRUCTIONS

  • DISPLAY SOFT EDIT ERROR MESSAGE IF VACUUM_TEMP IS LESS THAN 14 OR GREATER THAN 114.


VBP08000/(VACUUM_RH). RELATIVE HUMIDITY WHEN THE VACUUM BAG DUST SAMPLE WAS COLLECTED:

|___|___|___|.|___|%


DATA COLLECTOR INSTRUCTIONS

  • IF UNABLE TO COLLECT VACUUM_RH, RECORD 999.9% AND COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.


PROGRAMMER INSTRUCTIONS

  • DISPLAY SOFT EDIT ERROR MESSAGE IF VACUUM_RH IS LESS THAN 10 OR GREATER THAN 113.

  • IF VACUUM_BAG_TYPE = 3, GO TO VACUUM_BAG.

  • OTHERWISE, GO TO SAMPLE_PR_ID.


VBP09000/(VACUUM_BAG). DID YOU INCLUDE THE VACUUM BAG WITH THE SAMPLE?


Label

Code

Go To

YES, BAG WAS INCLUDED INTACT

1

SAMPLE_PR_ID

NO, DUST WAS REMOVED FROM BAG

2

SAMPLE_PR_ID

YES, BUT BAG WAS CUT OPEN

3

SAMPLE_PR_ID

OTHER

-5


NOT APPLICABLE

-7

SAMPLE_PR_ID


VBP10000/(VACUUM_BAG_OTH). SPECIFY: ______________________________


VBP11000/(SAMPLE_PR_ID). PRIMARY SAMPLE ID:

|E|__|__|__|__|__|__|__|__|-DB01

VACUUM BAG DUST ID


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE PRIMARY SAMPLE ID ON THE SAMPLE ID LABEL.


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DB01


VBP12000/(VACUUM_PROBLEMS). DID YOU HAVE ANY PROBLEMS COLLECTING THE VACUUM SAMPLE?


Label

Code

Go To

NO PROBLEMS

1

VB_PRIM_COMMENTS

TROUBLE REMOVING BAG/CUP

2

VB_PRIM_COMMENTS

LOTS OF DUST FELL ON FOIL

3

VB_PRIM_COMMENTS

TROUBLE PUTTING VACUUM BACK TOGETHER

4

VB_PRIM_COMMENTS

OTHER

-5



VBP13000/(VACUUM_PROBLEMS_OTH). SPECIFY: ___________________________


VBP14000/(VB_PRIM_COMMENTS). RECORD ANY COMMENTS ABOUT THE VACUUM BAG DUST PRIMARY SAMPLE COLLECTION:

COMMENTS: ___________________________________


(TIME_STAMP_VBP_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIMESTAMP

  • IF VB_SAMPLES = 1 OR VACUUM_COLLECT = 2, GO TO  TIME_STAMP_VSS_ET

  • IF VACUUM_COLLECT= 1 AND

    • IF VB_SUBSAMPLES = 1 ONLY, OR 1 AND 2, GO TO TIME_STAMP_VBS_ST.

    • IF VB_SUBSAMPLES = 2 ONLY, GO TO TIME_STAMP_VSS_ST.



VACUUM BAG SPIKE SAMPLE


(TIME_STAMP_VBS_ST).


VBS01000/(VB_SPIKE_COLLECT). DID YOU INCLUDE A VACUUM BAG DUST SPIKE SAMPLE?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF VB_SPIKE_COLLECT = 1, SET SAMPLE_NUMBER = 4 AND GO TO SAMPLE_SK_ID.

  • OTHERWISE, GO TO VB_SPIKE_NOTCOLLECT.


VBS02000/(VB_SPIKE_NOTCOLLECT). WHY WAS THE VACUUM BAG DUST SPIKE SAMPLE NOT INCLUDED?


Label

Code

Go To

KIT NOT AVAILABLE

1

VB_SPIKE_COMMENTS

SUPPLIES PROBLEM

2

VB_SPIKE_COMMENTS

RAN OUT OF TIME

3

VB_SPIKE_COMMENTS

OTHER

-5



VBS03000/(VB_SPIKE_NOTCOLLECT_OTH). SPECIFY: _______________________________


PROGRAMMER INSTRUCTIONS

  • GO TO VB_SPIKE_COMMENTS


VBS04000/(SAMPLE_SK_ID). SPIKE SAMPLE ID:

|E|__|__|__|__|__|__|__|__|-DB01

VACUUM BAG DUST SPIKE ID


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE VACUUM BAG DUST SPIKE SAMPLE ID ON THE SAMPLE ID LABEL.


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DB01.

  • DISPLAY SOFT EDIT IF SAMPLE_SK_ID = SAMPLE_PR_ID.


VBS05000/(VB_SPIKE_COMMENTS). RECORD ANY COMMENTS ABOUT THE VACUUM BAG DUST SPIKE SAMPLE:

COMMENTS: __________________________________


(TIME_STAMP_VBS_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • IF VACUUM_COLLECT = 1 AND

    • IF VB_SUBSAMPLES = 1 ONLY, GO TO TIME_STAMP_VSS_ET.

    • IF VB_SUBSAMPLES = 1 AND 2, GO TO TIME_STAMP_VSS_ST



VACUUM SPLIT SAMPLE


(TIME_STAMP_VSS_ST).


VSS01000/(VB_SPLIT_COLLECT). DID YOU INCLUDE A SET OF VACUUM BAG DUST SPLIT SAMPLE ID LABELS?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF VB_SPLIT_COLLECT = 1, SET SAMPLE_NUMBER = 5 AND GO TO SAMPLE_SL_ID.

  • OTHERWISE, GO TO VB_SPLIT_NOTCOLLECT.


VSS02000/(VB_SPLIT_NOTCOLLECT). WHY WERE THE VACUUM BAG DUST SPLIT SAMPLE ID LABELS NOT INCLUDED?


Label

Code

Go To

SUPPLIES PROBLEM

1

VB_SPLIT_COMMENTS

SPLIT SAMPLE ID MISSING FROM KIT

2

VB_SPLIT_COMMENTS

RAN OUT OF TIME

3

VB_SPLIT_COMMENTS

OTHER

-5



VSS03000/(VB_SPLIT_NOTCOLLECT_OTH). SPECIFY: _______________________________


PROGRAMMER INSTRUCTIONS

  • GO TO VB_SPLIT_COMMENTS.


VSS04000/(SAMPLE_SL_ID). SPLIT SAMPLE ID:

|E|__|__|__|__|__|__|__|__|-DB01

VACUUM BAG DUST SPLIT ID


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE VACUUM BAG DUST SPLIT SAMPLE ID ON THE SAMPLE ID LABEL.


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DB01.

  • DISPLAY SOFT EDIT IF SAMPLE_SL_ID = SAMPLE_SK_ID AND/OR SAMPLE_PR_ID.


VSS05000/(VB_SPLIT_COMMENTS). RECORD ANY COMMENTS ABOUT THE VACUUM BAG DUST SPLIT SAMPLE:

COMMENTS:__________________________________


(TIME_STAMP_VSS_ET).


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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