Form 45.1 Survey

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

RetrospectivePregnancyBirthCohortQuestionnaireAdult

Retrospective Pregnancy Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Retrospective Pregnancy - Birth Cohort Questionnaire – Adult, Phase 2g

OMB Specification


Retrospective Pregnancy - Birth Cohort Questionnaire - Adult


Event Category:

Time-Based

Event:

Birth, or 3M, or 6M

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

Estimated Administration Time:

26 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.
** Administer at Birth. If it was not administered at birth, then administered at 3M. If not administered at Birth & 3M, then administer at 6M.


This page intentionally left blank.


Retrospective Pregnancy - Birth Cohort Questionnaire - Adult



TABLE OF CONTENTS





This page intentionally left blank.



Retrospective Pregnancy - Birth Cohort 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.





INTRODUCTION


(TIME_STAMP_INT_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD PARTICIPANT ID (P_ID) AND RESPONDENT ID (R_P_ID) FOR BIOLOGICAL MOTHER.

  • PRELOAD AND DISPLAY R_FNAME AND PERSON_DOB FROM THE PARTICIPANT VERIFICATION AND TRACING QUESTIONNAIRE (INSTRUMENT_ID = XX) AS APPROPRIATE THROUGHOUT.

  • PRELOAD MULTIPLE_GESTATION FROM BIRTH QUESTIONNAIRE - CHILD (INSTRUMENT_ID = XX).

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

      • IF BABY'S NAME IS UNKNOWN (C_FNAME IN PARTICIPANT VERIFICATION AND TRACING = -1 OR -2) DISPLAY “baby” AND "the baby" AS APPROPRIATE THROUGHOUT THE INSTRUMENT.

      • IF BABY'S NAME IS KNOWN (C_FNAME IN PARTICIPANT VERIFICATION AND TRACING ≠ -1 OR -2) DISPLAY NAME AS APPROPRIATE THROUGHOUT THE INSTRUMENT.

    • OTHERWISE, IF MULTIPLE_GESTATION = 2 OR 3, DISPLAY “babies” AND "the babies" AS APPROPRIATE THROUGHOUT INSTRUMENT.


INT01000. Thank you for agreeing to participate in the National Children’s Study.  This interview will take about 30 minutes to complete.  Your answers are important to us. There are no right or wrong answers.

During this interview, we will ask you questions about yourself, your health and pregnancy, your household and where you live.  You can skip over any question or stop the interview at any time.  We will keep everything that you tell us confidential.

These questions may be similar to those asked during a previous pregnancy.  We are asking them again because sometimes the answers change and this will help us to update our information about you.


INT02000/(CORRECT_PART). First, we’d like to make sure we have your name recorded correctly.  Is your name {R_FNAME}?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard 1 Phase (PV1)


INT03000/(CORRECT_PART_DOB). Is your birth date {PERSON_DOB}?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard 1 Phase (PV1)


PROGRAMMER INSTRUCTIONS

  • IF CORRECT_PART AND/OR CORRECT_PART_DOB = 2, -1, OR -2 UPDATE INFORMATION IN THE PARTICIPANT VERIFICATION AND TRACING QUESTIONNAIRE (INSTRUMENT_ID = XX).


INT04000/(PART_READY). Are you ready to begin?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_HI_ET

REFUSED

-1

TIME_STAMP_HI_ET

DON'T KNOW

-2

TIME_STAMP_HI_ET


SOURCE

National Children’s Study, Legacy Phase, (T1 Mother )


(TIME_STAMP_INT_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



DEMOGRAPHICS


(TIME_STAMP_DEM_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


DEM01000. First, I’d like to ask some questions about you.


DEM02000/(EDUC). What is the highest degree or level of school that you have completed?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


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

LESS THAN A HIGH SCHOOL DIPLOMA OR GED

1


HIGH SCHOOL DIPLOMA OR GED

2


SOME COLLEGE BUT NO DEGREE

3


ASSOCIATE DEGREE OR CERTIFICATION

4


BACHELOR'S DEGREE (E.G., BA, BS)

5


POST GRADUATE DEGREE (E.G., MASTERS OR DOCTORAL)

6


REFUSED

-1


DON'T KNOW

-2



SOURCE

Census

Legacy:  National Children’s Study, Legacy Phase (P1, T1 Mother, T1 Father, 6M)


DEM03000/(MARISTAT). Now I’d like to ask about your marital status.  Are you:


Label

Code

Go To

Married

1


Not married but living together with a partner

2


Never been married

3

ETHNIC_ORIGIN

Divorced

4

ETHNIC_ORIGIN

Separated

5

ETHNIC_ORIGIN

Widowed

6

ETHNIC_ORIGIN

REFUSED

-1

ETHNIC_ORIGIN

DON'T KNOW

-2

ETHNIC_ORIGIN


SOURCE

National Survey for Family Growth

Legacy: National Children’s Study, Legacy Phase (P1, T1 Mother)


DEM04000/(SP_EDUC). What is the highest degree or level of school that your spouse or partner has completed?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


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

LESS THAN A HIGH SCHOOL DIPLOMA OR GED

1


HIGH SCHOOL DIPLOMA OR GED

2


SOME COLLEGE BUT NO DEGREE

3


ASSOCIATE DEGREE OR CERTIFICATION

4


BACHELOR'S DEGREE (E.G., BA, BS)

5


POST GRADUATE DEGREE (E.G., MASTERS OR DOCTORAL)

6


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from Census

Vanguard: National Children’s Study, vanguard Phase (Pre-Preg)


DEM05000. Next, I’d like to ask some questions about {your/you and your spouse or partner’s} race and ethnicity.


PROGRAMMER INSTRUCTIONS

  • IF MARISTAT ≠ 1 OR 2, DISPLAY “your” AND GO TO ETHNIC_ORIGIN.

  • IF MARISTAT = 1 OR 2, DISPLAY “you and your spouse or partner’s” AND GO TO SP_ETHNIC_1.


DEM06000/(SP_ETHNIC_1). Is your spouse or partner of Hispanic, Latino/a, or Spanish origin?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • PRELOAD MODE

  • IF SP_ETHNIC_1 = 1, GO TO SP_ETHNIC_2.

  • IF MODE = CAPI, AND IF SP_ETHNIC_1 ≠ 1, GO TO SP_RACE_NEW.

  • IF MODE = CATI, AND IF SP_ETHNIC_1 ≠ 1, GO TO SP_RACE_1.


DEM07000/(SP_ETHNIC_2). Is your spouse or partner one or more of the following?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

  • PROBE: Anything else?


Label

Code

Go To

Mexican, Mexican American, Chicano/a

1


Puerto Rican

2


Cuban

3


Another Hispanic, Latino/a, or Spanish origin

4


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF SP_ETHNIC_2 = -5, OR ANY COMBINATION OF 1 THROUGH 4 AND -5, GO TO SP_ETHNIC_2_OTH.

  • IF SP_ETHNIC_2 = ANY COMBINATION OF 1 THROUGH 4, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING SP_ETHNIC_2_OTH.

  • IF SP_ETHNIC_2 = -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO PROGRAMMER INSTRUCTIONS FOLLOWING SP_ETHNIC_2_OTH.


DEM08000/(SP_ETHNIC_2_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF MODE = CAPI, GO TO SP_RACE_NEW.

  • OTHERWISE, IF MODE = CATI, GO TO SP_RACE_1


DEM09000/(SP_RACE_NEW). What is your spouse or partner’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • PROBE FOR ANY OTHER RESPONSES

  • ONLY USE “SOME OTHER RACE” IF VOLUNTEERED.

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

WHITE

1


BLACK OR AFRICAN AMERICAN

2


AMERICAN INDIAN OR ALASKA NATIVE

3


ASIAN INDIAN

4


CHINESE

5


FILIPINO

6


JAPANESE

7


KOREAN

8


VIETNAMESE

9


OTHER ASIAN

10


NATIVE HAWAIIAN

11


GUAMANIAN OR CHAMORRO

12


SAMOAN

13


OTHER PACIFIC ISLANDER

14


SOME OTHER RACE

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF SP_RACE_NEW = ANY COMBINATION OF 1 THROUGH 14, GO TO ETHNIC_ORIGIN.

  • IF SP_RACE_NEW = -5, OR ANY COMBINATION OF 1 THROUGH 14 AND -5, GO TO SP_RACE_NEW_OTH.

  • IF SP_RACE_NEW =  -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO ETHNIC_ORIGIN.


DEM10000/(SP_RACE_NEW_OTH). SPECIFY: _____________________________ 


Label

Code

Go To

REFUSED

-1

ETHNIC_ORIGIN

DON'T KNOW

-2

ETHNIC_ORIGIN


SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • GO TO ETHNIC_ORIGIN


DEM11000/(SP_RACE_1). What is your spouse or partner’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • ONLY USE  “SOME OTHER RACE” IF VOLUNTEERED.

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

White

1


Black or African American

2


American Indian or Alaska Native

3


Asian

4


Native Hawaiian or other Pacific Islander

5


SOME OTHER RACE

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF SP_RACE_1 = ANY COMBINATION OF 1 THROUGH 3, GO TO ETHNIC_ORIGIN.

  • IF SP_RACE_1 = 4 OR ANY COMBINATION OF 4 WITH 1, 2, 3, AND/OR 5, GO TO SP_RACE_2.

  • IF SP_RACE_1 = 5 OR ANY COMBINATION OF 5 WITH 1 THROUGH 3, GO TO SP_RACE_3.

  • IF SP_RACE_1 = -5, OR ANY COMBINATION OF 1 THROUGH 5 WITH -5, GO TO SP_RACE_1_OTH.

  • IF SP_RACE_1 =  -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO ETHNIC_ORIGIN.


DEM12000/(SP_RACE_1_OTH). SPECIFY: _____________________________ 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF SP_RACE_1 = 4, OR ANY COMBINATION OF 1, 2, 3, AND/OR 5 WITH 4, GO TO SP_RACE_2.

  • IF SP_RACE_1 = 5, OR ANY COMBINATION OF 1 THROUGH 3 WITH 5, GO TO SP_RACE_3.

  • OTHERWISE, GO TO ETHNIC_ORIGIN.


DEM13000/(SP_RACE_2). What is your spouse or partner’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

Asian Indian

1


Chinese

2


Filipino

3


Japanese

4


Korean

5


Vietnamese

6


Other Asian

7


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF SP_RACE_1 = ANY COMBINATION INCLUDING BOTH 4 AND 5, GO TO SP_RACE_3.

  • OTHERWISE, GO TO ETHNIC_ORIGIN.


DEM14000/(SP_RACE_3). What is your spouse or partner’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

Native Hawaiian

1


Guamanian or Chamorro

2


Samoan

3


Other Pacific Islander

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


DEM15000/(ETHNIC_ORIGIN). Are you of Hispanic, Latino/a or Spanish origin?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF ETHNIC_ORIGIN = 1, GO TO ETHNIC_ORIGIN_2.

  • IF MODE = CAPI, AND IF ETHNIC_ORIGIN ≠ 1, GO TO RACE_NEW.

  • IF MODE = CATI, AND IF ETHNIC_ORIGIN ≠ 1, GO TO RACE_1.


DEM16000/(ETHNIC_ORIGIN_2). Are you one or more of the following?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

  • PROBE: Anything else?


Label

Code

Go To

Mexican, Mexican American, Chicano/a

1


Puerto Rican

2


Cuban

3


Another Hispanic, Latino/a, or Spanish origin

4


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF ETHNIC_ORIGIN_2 = -5, OR ANY COMBINATION OF 1 THROUGH 4 WITH -5, GO TO ETHNIC_ORIGIN_2_OTH.

  • IF ETHNIC_ORIGIN_2 = ANY COMBINATION OF 1 THROUGH 4, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING ETHNIC_ORIGIN_2_OTH.

  • IF ETHNIC_ORIGIN_2 = -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO PROGRAMMER INSTRUCTIONS FOLLOWING ETHNIC_ORIGIN_2_OTH.


DEM17000/(ETHNIC_ORIGIN_2_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF MODE = CAPI, GO TO RACE_NEW.

  • OTHERWISE, IF MODE = CATI, GO TO RACE_1.      


DEM18000/(RACE_NEW). What is your race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.

  • CODE “SOME OTHER RACE” ONLY IF VOLUNTEERED.

  • PROBE: Anything else?


Label

Code

Go To

WHITE

1


BLACK OR AFRICAN AMERICAN

2


AMERICAN INDIAN OR ALASKA NATIVE

3


ASIAN INDIAN

4


CHINESE

5


FILIPINO

6


JAPANESE

7


KOREAN

8


VIETNAMESE

9


OTHER ASIAN

10


NATIVE HAWAIIAN

11


GUAMANIAN OR CHAMORRO

12


SAMOAN

13


OTHER PACIFIC ISLANDER

14


SOME OTHER RACE

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF USING SHOWCARDS, DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS. 

  • OTHERWISE, DISPLAY RESPONSE CATEGORIES AS MIXED UPPER/LOWER CASE.

  • IF RACE_NEW = ANY COMBINATION OF 1 THROUGH 14, GO TO DEM24000.

  • IF RACE_NEW = -5, OR ANY COMBINATION OF 1 THROUGH 14 WITH -5, GO TO RACE_NEW_OTH.

  • IF RACE_NEW =  -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO DEM24000.


DEM19000/(RACE_NEW_OTH). SPECIFY: _____________________________ 


Label

Code

Go To

REFUSED

-1

DEM24000

DON'T KNOW

-2

DEM24000


SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • GO TO DEM24000.


DEM20000/(RACE_1). What is your race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • ONLY USE  “SOME OTHER RACE” IF VOLUNTEERED.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

White

1


Black or African American

2


American Indian or Alaska native

3


Asian

4


Native Hawaiian or other Pacific Islander

5


SOME OTHER RACE

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF RACE_1 = ANY COMBINATION OF 1 THROUGH 3, GO TO DEM24000.

  • IF RACE_1 = 4, OR ANY COMBINATION OF 4 WITH 1, 2, 3, AND/OR 5, GO TO RACE_2.

  • IF RACE_1 = 5, OR ANY COMBINATION OF 5 WITH 1 THROUGH 3, GO TO RACE_3.

  • IF RACE_1 = -5, OR ANY COMBINATION OF 1 THROUGH 5 WITH -5, GO TO RACE_1_OTH.

  • IF RACE_1 =  -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO DEM24000.


DEM21000/(RACE_1_OTH). SPECIFY: _____________________________ 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF RACE_1 = 4, OR 4 AND ANY COMBINATION OF 1, 2, 3, AND/OR 5, GO TO RACE_2.

  • IF RACE_1 = 5, OR 5 AND ANY COMBINATION OF 1 THROUGH 3, GO TO RACE_3.

  • OTHERWISE, GO TO DEM24000.


DEM22000/(RACE_2). What is your race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

Asian Indian

1


Chinese

2


Filipino

3


Japanese

4


Korean

5


Vietnamese

6


Other Asian

7


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


PROGRAMMER INSTRUCTIONS

  • IF RACE_1 = ANY COMBINATION INCLUDING BOTH 4 AND 5, GO TO RACE_3.

  • OTHERWISE, GO TO DEM24000.


DEM23000/(RACE_3). What is your race? (One or more categories may be selected).


PROGRAMMER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

Native Hawaiian

1


Guamanian or Chamorro

2


Samoan

3


Other Pacific Islander

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


DEM24000. These next questions are about the language that will be spoken to your {baby/babies}.


DEM25000/(HH_NONENGLISH_NEW ). Do you speak a language other than English at home?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_DEM_ET

REFUSED

-1

TIME_STAMP_DEM_ET

DON'T KNOW

-2

TIME_STAMP_DEM_ET


SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


DEM26000/(OTHER_LANG ). What is this language?


Label

Code

Go To

SPANISH

1

HH_PRIMARY_LANG

OTHER

-5


REFUSED

-1

TIME_STAMP_DEM_ET

DON'T KNOW

-2

TIME_STAMP_DEM_ET


SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


DEM27000/(OTHER_LANG_OTH ). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act.


DEM28000/(HH_PRIMARY_LANG ). What is the primary language spoken in your home?


Label

Code

Go To

ENGLISH

1

TIME_STAMP_DEM_ET

SPANISH

2

TIME_STAMP_DEM_ET

ARABIC

3

TIME_STAMP_DEM_ET

CHINESE

4

TIME_STAMP_DEM_ET

FRENCH

5

TIME_STAMP_DEM_ET

FRENCH CREOLE

6

TIME_STAMP_DEM_ET

GERMAN

7

TIME_STAMP_DEM_ET

ITALIAN

8

TIME_STAMP_DEM_ET

KOREAN

9

TIME_STAMP_DEM_ET

POLISH

10

TIME_STAMP_DEM_ET

RUSSIAN

11

TIME_STAMP_DEM_ET

TAGALOG

12

TIME_STAMP_DEM_ET

VIETNAMESE

13

TIME_STAMP_DEM_ET

URDU

14

TIME_STAMP_DEM_ET

PUNJABI

15

TIME_STAMP_DEM_ET

BENGALI

16

TIME_STAMP_DEM_ET

FARSI

17

TIME_STAMP_DEM_ET

SIGN LANGUAGE

18

TIME_STAMP_DEM_ET

CANNOT CHOOSE

19

TIME_STAMP_DEM_ET

OTHER

-5


REFUSED

-1

TIME_STAMP_DEM_ET

DON'T KNOW

-2

TIME_STAMP_DEM_ET


SOURCE

Early Childhood Longitudinal Study, Birth Cohort

Legacy: National Children’s Study, Legacy Phase (6M)


DEM29000/(HH_PRIMARY_LANG_OTH ). OTHER SPECIFY: ____________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort

Legacy: National Children’s Study, Legacy Phase (6M)


(TIME_STAMP_DEM_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



PREGNANCY INFORMATION


(TIME_STAMP_PI_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


PI01000. Now I’d like to change the subject and ask some questions about you, your health, and your health history.  I’ll begin by asking about your most recent pregnancy.


PI02000. What was the first day of your last menstrual period?


INTERVIEWER INSTRUCTIONS

  • IF PARTICIPANT KNOWS MONTH AND YEAR BUT IS UNSURE OF DAY, ENTER “15” FOR DAY.


SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


(LAST_PERIOD_MM)  

|___|___| 

  M    M  


Label

Code

Go To

REFUSED

-1

NUM_WEEKS_FIRST_LEARN

DON'T KNOW

-2

NUM_WEEKS_FIRST_LEARN


(LAST_PERIOD_DD)

|___|___| 

  D    D   


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(LAST_PERIOD_YYYY)  

|___|___|___|___|

   Y     Y     Y    Y


Label

Code

Go To

REFUSED

-1

NUM_WEEKS_FIRST_LEARN

DON'T KNOW

-2

NUM_WEEKS_FIRST_LEARN


PI03000/(RESP_GIVE_DATE). DID RESPONDENT GIVE DATE?


Label

Code

Go To

RESPONDENT GAVE COMPLETE DATE

1


INTERVIEWER ENTERED 15 FOR DAY

2



PI04000/(NUM_WEEKS_FIRST_LEARN). About how many weeks pregnant were you when you first learned that you were pregnant with {NAME OF BABY/the baby/the babies}?

 

|___|___|

WEEKS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study (Legacy Phase), T1 Mother


PI005000/(PREG_VITAMIN_2). While you were pregnant, did you regularly take multivitamins, prenatal vitamins, folate, or folic acid?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from Pregnancy Risk Assessment Monitoring System

Current: National Children’s Study, Vanguard Phase (LI Non & Preg)


PI06000. What was your due date?


INTERVIEWER INSTRUCTIONS

  • IF PARTICIPANT KNOWS MONTH AND YEAR BUT IS UNSURE OF DAY, ENTER “15” FOR DAY.


SOURCE

Pregnancy, Infection, and Nutrition Study

Legacy : National Children’s Study, Legacy Phase (T1 Mother)


(PREV_DUE_DATE_MM)

 

|___|___| 

  M    M  


Label

Code

Go To

REFUSED

-1

PREG_FEVER

DON'T KNOW

-2

PREG_FEVER


(PREV_DUE_DATE_DD)  

|___|___|

   D    D   


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREV_DUE_DATE_YYYY) |___|___|___|___|

   Y     Y     Y    Y


Label

Code

Go To

REFUSED

-1

PREG_FEVER

DON'T KNOW

-2

PREG_FEVER


PI07000/(KNEW_DATE_2). DID RESPONDENT GIVE DATE?


Label

Code

Go To

RESPONDENT GAVE COMPLETE DATE

1


INTERVIEWER ENTERED 15 FOR DAY

2



PI08000/(PREG_FEVER). While you were pregnant, were there any days on which you had a fever over 101 degrees? (IF NEEDED: or 38.3 degrees Celsius?)


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase, (T1 Mother )


PI09000/(TOOK_HORMONES). During your pregnancy, did you take any medications such as hormones to prevent pregnancy complications or pregnancy loss?


Label

Code

Go To

YES

1


NO

2

MORNING_SICKNESS

REFUSED

-1

MORNING_SICKNESS

DON'T KNOW

-2

MORNING_SICKNESS


SOURCE

Modified from  National Birth Defects Prevention Study  Interview, 4/10, A55


PI10000/(MEDS_PREVENT_LOSS). Did you take any of these medications to prevent pregnancy complications or pregnancy loss?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

BRETHINE/TERBUTALINE

1


CALCIUM CHANNEL BLOCKERS (NORVASC)

2


PROGESTERONE

3


NIFEDIPINE (PROCARDIA)

4


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from  National Birth Defects Prevention Study Interview, 4/10, A56


PROGRAMMER INSTRUCTIONS

  • IF MEDS_PREVENT_LOSS = ANY COMBINATION OF 1 THROUGH 4, GO TO MORNING_SICKNESS.

  • IF MEDS_PREVENT_LOSS = -5, OR ANY COMBINATION OF 1 THROUGH 4 AND -5, GO TO MEDS_PREVENT_LOSS_OTH.

  • IF MEDS_PREVENT_LOSS = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO ​MORNING_SICKNESS.


PI10100/(MEDS_PREVENT_LOSS_OTH). ​SPECIFY: _________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from  National Birth Defects Prevention Study Interview, 4/10, A56


PI11000/(MORNING_SICKNESS). During this pregnancy, did you have morning sickness or nausea?


Label

Code

Go To

YES

1


NO

2

REC_WIC

REFUSED

-1

REC_WIC

DON'T KNOW

-2

REC_WIC


SOURCE

Modified from National Birth Defects Prevention Study Interview, 4/10, A61


PI12000/(MED_NAUSEA). Did you take any medications for your nausea or vomiting?


Label

Code

Go To

YES

1


NO

2

REC_WIC

REFUSED

-1

REC_WIC

DON'T KNOW

-2

REC_WIC


SOURCE

Modified from National Birth Defects Prevention Study Interview, 4/10, A65


PI13000/(TYPE_NAUSEA_MED). Did you take any of these medications for your nausea and vomiting?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

EMETROL

1


COMPAZINE

2


TIGAN

3


PHENERGAN

4


REGLAN

5


ZOFRAN

6


OTHER

-5


REFUSED

-1


DON'T KNOW

-2


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF TYPE_NAUSEA_MED = ANY COMBINATION OF 1 THROUGH 6, GO TO REC_WIC.

  • IF TYPE_NAUSEA_MED = -5 OR ANY COMBINATION OF 1 THROUGH 6 AND -5, GO TO TYPE_NAUSEA_MED_OTH.

  • IF TYPE_NAUSEA_MED = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO ​REC_WIC.


PI13100/(TYPE_NAUSEA_MED_OTH). SPECIFY: _________________________________


Label

Code

Go To

REFUSED

-1


REFUSED

-1


DON'T KNOW

-2


DON'T KNOW

-2



SOURCE

NEW


PI14000/(REC_WIC). During your pregnancy, did you receive benefits from the WIC program, that is, the Women, Infants and Children program?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from SLAITS 2011 National Survey of Child Health

Vanguard: Modified from National Children’s Study, Vanguard  Phase (Core)


PI15000/(REC_FOOD_STAMP). During your most recent pregnancy, were you or any members of your household authorized to receive Food Stamps (which includes a food stamp card or voucher, or cash grants from the state for food)?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from SLAITS 2011 National Survey of Child Health

Vanguard: Modified from National Children’s Study, Vanguard  Phase (Core)


PI16000/(WAYS_BECOME_PREG). Before your most recent pregnancy,did you or your partner talk to a doctor or other health care provider about ways to help you become pregnant? 


Label

Code

Go To

YES

1


NO

2

PI26000

REFUSED

-1

PI26000

DON'T KNOW

-2

PI26000


SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)


PI17000/(TYPE_BECOME_PREG). What types of services or treatments did you receive to help you become pregnant with this pregnancy?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

ADVICE ONLY

1


MEDICINES OR SHOTS TO IMPROVE YOUR OVULATION

2


SURGERY TO CORRECT BLOCKED TUBES

3


OTHER TYPE OF SURGERY

4


ARTIFICIAL INSEMINATION

5


IN VITRO FERTILIZATION

6


OTHER TYPES OF MEDICAL HELP

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF TYPE_BECOME_PREG = 4, OR ANY COMBINATION INCLUDING 4, GO TO TYPE_BECOME_PREG_1_OTH.

  • IF TYPE_BECOME_PREG = -5, OR ANY COMBINATION OF 1 – 3, 5 – 6, AND -5, GO TO TYPE_BECOME_PREG_2_OTH.

  • IF TYPE_BECOME_PREG = 5, OR ANY COMBINATION INCLUDING 5 BUT NOT INCLUDING 4 AND -5, GO TO SPERM_DONOR.

  • IF TYPE_BECOME_PREG = 6, OR ANY COMBINATION INCLUDING 6 BUT NOT INCLUDING 4, 5, AND -5, GO TO DONATE_EGG.

  • OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EGG_DONOR.


PI18000/(TYPE_BECOME_PREG_1_OTH). SPECIFY: ____________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF TYPE_BECOME_PREG = -5, OR ANY COMBINATION OF 1 – 6, AND -5, GO TO TYPE_BECOME_PREG_2_OTH.

  • IF TYPE_BECOME_PREG = 5, OR ANY COMBINATION INCLUDING 5 BUT NOT INCLUDING -5, GO TO SPERM_DONOR.

  • IF TYPE_BECOME_PREG = 6, OR ANY COMBINATION INCLUDING 6 BUT NOT INCLUDING 5 AND -5, GO TO DONATE_EGG.

  • OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EGG_DONOR


PI19000/(TYPE_BECOME_PREG_2_OTH). SPECIFY: ____________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF TYPE_BECOME_PREG = 5, OR ANY COMBINATION INCLUDING 5, GO TO SPERM_DONOR.

  • IF TYPE_BECOME_PREG = 6, OR ANY COMBINATION INCLUDING 6 BUT NOT INCLUDING 5, GO TO DONATE_EGG.

  • OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EGG_DONOR.


PI20000/(SPERM_DONOR). Please tell me who donated the sperm. Was it:


Label

Code

Go To

Your husband or partner

1


An anonymous donor

2


Both your husband or partner and an anonymous donor

3


Some other person

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase  (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF SPERM_DONOR = -5, GO TO SPERM_DONOR_OTH.

  • OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING SPERM_DONOR_OTH.


PI20100/(SPERM_DONOR_OTH). ​SPECIFY: ______________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase  (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF TYPE_BECOME_PREG = 6, OR ANY COMBINATION INCLUDING 6, GO TO DONATE_EGG.

  • OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EGG_DONOR.


PI21000/(DONATE_EGG). As part of in vitro fertilization, sometimes a donor egg is used.  Was a donor egg used for your in vitro fertilization?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF DONATE_EGG = 1, GO TO EGG_DONOR.

  • OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EGG_DONOR.


PI22000/(EGG_DONOR). Please tell me who donated the egg. Was it:


Label

Code

Go To

A relative that you are biologically related to

1


A relative that you are not biologically related to

2


A friend

3


An anonymous donor

4


Some other person

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF EGG_DONOR = -5, GO TO EGG_DONOR_OTH.

  • IF EGG_DONOR ≠  -5 AND,

    • IF TYPE_BECOME_PREG = 2, OR ANY COMBINATION INCLUDING 2, GO TO DRUG_BECOME.

  • OTHERWISE, GO TO PI26000.


PI23000/(EGG_DONOR_OTH). SPECIFY: ______________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF TYPE_BECOME_PREG = 2, OR ANY COMBINATION INCLUDING 2, GO TO DRUG_BECOME.

  • OTHERWISE, GO TO PI26000.


PI24000/(DRUG _BECOME ). Which of these drugs did you use prior to this pregnancy to help you become pregnant ?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

CLOMID

1


GONAL F

2


BRAVELLE

3


FOLLISTIM

4


REPRONEX

5


PERGONAL

6


PREGNYL

7


PROFASI

8


NOVAREL

9


OTHER DRUG

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase  (T1 Mother) 


PROGRAMMER INSTRUCTIONS

  • IF DRUG_BECOME = -5, OR ANY COMBINATION OF 1 THROUGH 9 AND -5, GO TO DRUG_BECOME_OTH.

  • OTHERWISE, GO TO PI26000.


PI25000/(DRUG_BECOME_OTH). SPECIFY: ______________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase  (T1 Mother)


PI26000. Part of the National Children’s Study may include a study visit with the baby’s biological father.  What is the first and last name of your baby’s biological father?                                           


SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


(FATHER_FNAME) ____________________                          

          FIRST NAME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(FATHER_LNAME) ________________________

                LAST NAME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PI27000/(BABY_LIVE_BIO_FATHER). Is the biological father of your baby living in this household?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


PI28000/(MAY_CONTACT). May the Study contact him?


Label

Code

Go To

YES

1


NO

2

FIRST_PREG_W_PARTNER

REFUSED

-1

FIRST_PREG_W_PARTNER

DON'T KNOW

-2

FIRST_PREG_W_PARTNER


SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


PI29000. What is his home address and phone number?


SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


(FATHER_CONTACT_STREET)  

_____________________________________________________

STREET ADDRESS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(FATHER_CONTACT_CITY)  

_____________________________________________________

CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(FATHER_CONTACT_STATE)

 

|___|___|            

STATE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(FATHER_CONTACT_ZIP)  

|___|___|___|___|___|

ZIP CODE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(FATHER_CONTACT_PHONE)  

|___|___|___|___|___|___|___|___|___|___|

PHONE NUMBER


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PI30000/(FIRST_PREG_W_PARTNER). Is this your first pregnancy with this partner?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)


(TIME_STAMP_PI_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



MATERNAL BIRTH HISTORY


(TIME_STAMP_MBH_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


MBH01000. Next, I’d like to ask you about your birth.


MBH02000/(MOTHER_BIRTH_PREMATURE). Were you born prematurely, that is more than 3 weeks early?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MBH03000/(MOTHER_LOW_ BIRTH_WEIGHT). Were you a low birth weight baby, that is, did you weigh less than 5 pounds 8 ounces (2500 grams) or 5 pounds 8 ounces (or 2500 grams) at birth?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MBH04000/(MOTHER_BIRTH_MULTI).  

When you were born, were you born as a singleton, or as a twin, a triplet, or some other multiple birth?


Label

Code

Go To

SINGLETON

1

TIME_STAMP_MBH_ET

TWIN

2

TIME_STAMP_MBH_ET

TRIPLET

3

TIME_STAMP_MBH_ET

OTHER

-5


REFUSED

-1

TIME_STAMP_MBH_ET

DON'T KNOW

-2

TIME_STAMP_MBH_ET


SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MBH05000/(MOTHER_BIRTH_MULT_OTH). SPECIFY: _____________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


(TIME_STAMP_MBH_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



MATERNAL MEDICAL HISTORY


(TIME_STAMP_MMH_ST).


PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP


MMH01000. Next, I have some general questions about your health.


MMH02000/(GENERAL_HEALTH). Would you say your health in general is . . .


Label

Code

Go To

Excellent

1


Very good

2


Good

3


Fair

4


Poor

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MMH03000. How tall are you without shoes?


SOURCE

Behavioral Risk Factor Surveillance System

Legacy: National Children’s Study, Legacy Phase (T1 Mother);

Vanguard: National Children’s Study, Vanguard  Phase (PV1)


(MOTHER_HEIGHT_FEET)  

|___|                        

FEET


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(MOTHER_HEIGHT_INCHES)  

|___|___|

INCHES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



MMH04000/(MOTHER_WEIGHT_PRE_PREG). What was your weight just before you became pregnant?

 

|___|___|___|

    POUNDS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Behavioral Risk Factor Surveillance System

Legacy: National Children’s Study, Legacy Phase (T1 Mother);

National Children’s Study, Vanguard  Phase (PV1)


MMH05000. Next are some questions about dental health and gum disease.  Gum disease is a common problem. People with gum disease might have swollen gums, receding gums, sore or infected gums, or loose teeth.


MMH06000/(GUM_DISEASE). Do you think you might have gum disease?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MMH07000/(GEN_DENTAL_HEALTH). Overall, how would you rate the health of your teeth and gums?


Label

Code

Go To

Excellent

1


Very good

2


Good

3


Fair

4


Poor

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MMH08000/(TREAT_GUM_DISEASE). In the past 12 months, have you had treatment for gum disease such as scaling and root planing, sometimes called “deep cleaning”?  This does not include visits to the dentist just for routine cleanings.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MMH09000/(LOST_BONE_TEETH). Have you ever been told by a dental professional that you have lost bone around your teeth?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MMH10000. The next questions are about medical conditions or health problems you might have now or may have had in the past, as well as about medications you may have taken during your pregnancy or in the last 12 months.


MMH11000/(ASTHMA). Have you ever been told by a doctor or other health care provider that you had asthma?


Label

Code

Go To

YES

1


NO

2

HYPERTENSION_NOT_PREG

REFUSED

-1

HYPERTENSION_NOT_PREG

DON'T KNOW

-2

HYPERTENSION_NOT_PREG


SOURCE

National Children’s Study, Legacy Phase,  (T1 Mother)


MMH12000/(ASTHMA_DRUG_DURING_PREG). During your pregnancy, did you take any drugs to treat asthma?


Label

Code

Go To

YES

1


NO

2

HYPERTENSION_NOT_PREG

REFUSED

-1

HYPERTENSION_NOT_PREG

DON'T KNOW

-2

HYPERTENSION_NOT_PREG


SOURCE

NEW


MMH13000/(ASTHMA_DRUG_TYPE). Did you use any of these medications to treat asthma?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

BECLOMETHASONE PROPIONATE HFA

1


BUDESONIDE

2


BUDESONIDE IN COMBINATION WITH FORMOTEROL

3


CICLESONIDE

4


FLUNISOLIDE

5


FLUTICASONE PROPIONATE

6


FLUTICASONE IN COMBINATION WITH SALMETEROL

7


MOMETASONE

8


MOMETASONE IN COMBINATION WITH FORMETEROL

9


TRIAMCINOLONE ACETONIDE

10


ALBUTEROL SULFATE

11


FORMOTEROL FUMARATE

12


SALMETEROL XINAFOATE

13


ARFORMOTEROL TARTRATE

14


FORMOTEROL FUMARATE

15


CROMOLYN SODIUM

16


THEOPHYLLINE

17


MONTELUKAST

18


ZAFIRLUKAST

19


ZILEUTON

20


OMALIZUMAB

21


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF ASTHMA_DRUG_TYPE = -5, OR ANY COMBINATION INCLUDING -5, GO TO ASTHMA_DRUG_TYPE_OTH.

  • OTHERWISE, GO TO ​HYPERTENSION_NOT_PREG.


MMH15000/(ASTHMA_DRUG_TYPE_OTH). Do you remember the name of the medicine? 

 

SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


MMH16000/(HYPERTENSION_NOT_PREG). Have you ever been told by a doctor or other health care provider that you had hypertension or high blood pressure when you’re not pregnant?


Label

Code

Go To

YES

1


NO

2

EPILEPSY

REFUSED

-1

EPILEPSY

DON'T KNOW

-2

EPILEPSY


SOURCE

Modified from National Health and Nutrition Examination Survey 2004

Legacy: National Children’s Study, Legacy Phase (T1 Mother);

Vanguard: National Children’s Study, Vanguard  Phase (PV1)


MMH17000/(HYPERTENSION_MED_WHILE_PREG). During your pregnancy, did you take any medications to treat high blood pressure?


Label

Code

Go To

YES

1


NO

2

EPILEPSY

REFUSED

-1

EPILEPSY

DON'T KNOW

-2

EPILEPSY


SOURCE

NEW


MMH18000/(HYPERTENSION_MED_TAKE_TYPE). Which medications did you take for high blood pressure during your pregnancy….


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

ALISKIREN, ALSO CALLED TEKTURNA

1


ATENOLOL

2


AMLODIPINE, ALSO CALLED NORVASC

3


CAPTOPRIL, ALSO CALLED CAPOTEN

4


DILTIAZEM HCL, ALSO CALLED CARDIZEM OR DILACOR XR

5


ENALAPRIL MALEATE, ALSO CALLED VASOTEC OR LEXXEL

6


HYDRALAZINE/HCTZ ALSO CALLED APRESAZIDE OR HYDRAZIDE

7


LOSARTAN, ALSO CALLED COZAAR

8


LISINOPRIL, ALSO CALLED PRINIVIL OR ZESTRIL

9


METOPROLOL, ALSO CALLED LOPRESSOR OR TOPROL XL

10


METHYLDOPA, ALSO CALLED ALDOMET

11


NADOLOL, ALSO CALLED CORGARD

12


NIFEDIPINE, ALSO CALLED ADALAT OR PROCARDIA

13


PENBUTOLOL, ALSO CALLED LEVATOL

14


PROPRANOLOL, ALSO CALLED INDERAL OR INNOPRAN

15


QUINAPRIL HCL, ALSO CALLED ACCUPRIL OR ACCURETIC

16


RAMIPRIL, ALSO CALLED ALTACE

17


OLMESARTAN, ALSO CALLED BENICAR

18


VALSARTAN, ALSO CALLED DIOVAN

19


VERAPAMIL, ALSO CALLED ISIOTUB OR COVERA-HS

20


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF HYPERTENSION_MED_TAKE_TYPE = -5, OR ANY COMBINATION OF 1 THROUGH 20 AND -5, GO TO HYPERTENSION_MED_TAKE_TYPE_OTH.

  • OTHERWISE, GO TO EPILEPSY.


MMH19000/(HYPERTENSION_MED_TAKE_TYPE_OTH). Do you remember the name of the medicine?

 

SPECIFY: ______________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


MMH20000/(EPILEPSY ). Have you ever been told by a doctor or other health care provider that you had epilepsy or seizures?


Label

Code

Go To

YES

1


NO

2

DIABETES_NOT_PREG

REFUSED

-1

DIABETES_NOT_PREG

DON'T KNOW

-2

DIABETES_NOT_PREG


SOURCE

National Children’s Study, Legacy Phase, (T1 Mother)


MMH21000/(EPILEPSY_DRUG_WHILE_PREG). During your pregnancy, did you take any medications for epilepsy?


Label

Code

Go To

YES

1


NO

2

DIABETES_NOT_PREG

REFUSED

-1

DIABETES_NOT_PREG

DON'T KNOW

-2

DIABETES_NOT_PREG


SOURCE

NEW


MMH22000/(EPILEPSY_MED_TYPE). Did you take any of these medications for epilepsy during your preganacy?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

DEPAKENE, DEPAKOTE, OR VALPROIC ACID

1


DILANTIN OR PHENYTOIN

2


FELBATOL

3


KLONOPIN OR CLONAZEPAM

4


LAMICTAL

5


PHENOBARBITAL

6


TEGRETOL OR CARBATROL

7


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF EPILEPSY_MED_TYPE = -5, OR ANY COMBINATION OF 1 THROUGH 7 AND -5, GO TO EPILEPSY_MED_TYPE_OTH.

  • OTHERWISE, GO TO DIABETES_NOT_PREG.


MMH23000/(EPILEPSY_MED_TYPE_OTH). Do you remember the name of the medicine?

 

SPECIFY: _______________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


MMH24000/(DIABETES_NOT_PREG). Have you ever been told by a doctor or other health care provider that you had diabetes when you’re not pregnant?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Health and Nutrition Examination Survey 2004

Legacy: National Children’s Study, Legacy Phase (T1 Mother);

Vanguard: National Children’s Study, Vanguard  Phase (PV1)


MMH25000/(DIABETES_MED_WHILE_PREG). During your pregnancy, did you take any medicine or receive other medical treatment for diabetes?


Label

Code

Go To

YES

1


NO

2

HIGH_CHOLESTEROL

REFUSED

-1

HIGH_CHOLESTEROL

DON'T KNOW

-2

HIGH_CHOLESTEROL


SOURCE

Modified from National Health and Nutrition Examination Survey 2004

Legacy: National Children’s Study, Legacy Phase (T1 Mother);

Vanguard: National Children’s Study, Vanguard  Phase (PV1)


MMH25100/(DIABETES_TX_TYPE). During your pregnancy, ​which of the following types of treatment did you use for your diabetes?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.


Label

Code

Go To

Insulin

1


Dietary changes

2


Exercise

3


Anything else

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF DIABETES_TX_TYPE = -5, OR ANY COMBINATION OF 1 THROUGH 3 AND -5, GO TO DIABETES_TX_TYPE_OTH.

  • OTHERWISE, GO TO ​INSULIN.


MMH25200/(DIABETES_TX_TYPE_OTH). What other medicine or treatment did you receive?

 

SPECIFY: ______________________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


MMH26000/(INSULIN). Have you ever taken insulin?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Health and Nutrition Examination Survey 2004

Legacy: National Children’s Study, Legacy Phase (T1 Mother);

Vanguard: National Children’s Study, Vanguard  Phase (PV1)


MMH27000/(HIGH_CHOLESTEROL). Have you ever been told by a doctor or other health care provider that you had high cholesterol?


Label

Code

Go To

YES

1


NO

2

HYPOTHYROID

REFUSED

-1

HYPOTHYROID

DON'T KNOW

-2

HYPOTHYROID


SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


MMH28000/(CHOLESTEROL_MED_PREG). Did you take any drugs for high cholesterol during your pregnancy?


Label

Code

Go To

YES

1


NO

2

HYPOTHYROID

REFUSED

-1

HYPOTHYROID

DON'T KNOW

-2

HYPOTHYROID


SOURCE

NEW


MMH29000/(CHOL_MEDICATIONS_PREG). Did you take any of these medicines for high cholesterol during your pregnancy?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

ATORVASTATIN, ALSO CALLED LIPITOR

1


LOVASTATIN, ALSO CALLED ALTOPREV OR MEVACOR

2


PRAVASTATIN, ALSO CALLED PRAVACHOL

3


SIMVASTATIN, ALSO CALLED PRAVACHOL

4


FLUVASTATIN, ALSO CALLED LESCOL

5


ROSUVASTATIN, ALSO CALLED CRESTOR

6


CADUET, A COMBINATION OF ATORVASTAIN AND AMLODIPINE

7


ADVIOCOR, A COMBINATION OF LOVASTATIN AND NIACIN

8


VYTORIN, A COMBINATION OF SIMVASTATIN AND EZETIMIBE

9


SIMCOR, A COMBINATION OF SIMVASTATIN AND NIACIN

10


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF CHOL_MEDICATIONS_PREG = -5, OR ANY COMBINATION OF 1 THROUGH 10 AND -5, GO TO CHOL_MEDICATIONS_PREG_OTH.

  • OTHERWISE, GO TO HYPOTHYROID.


MMH30000/(CHOL_MEDICATIONS_PREG_OTH). Do you remember the name of the medicine?

 

SPECIFY: _____________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


MMH31000/(HYPOTHYROID). Have you ever been told by a doctor or other health care provider that you had hypothyroidism, that is, an under active thyroid?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Health and Nutrition Examination Survey 2004

Legacy: National Children’s Study, Legacy Phase (T1 Mother);

Vanguard: National Children’s Study, Vanguard  Phase (PV1)


MMH32000/(HYPERTHYROID). Have you ever been told by a doctor or other health care provider that you had hyperthyroidism, that is, an overactive thyroid?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF HYPOTHYROID AND HYPERTHYROID = 2, -1, OR -2, GO TO DEPRESSION.

  • OTHERWISE, GO TO THYROID_MED.


MMH33000/(THYROID_MED). Have you taken any medicine or received other medical treatment for a thyroid problem during your pregnancy?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Health and Nutrition Examination Survey 2004

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother);

National Children’s Study, Vanguard  Phase (PV1)


MMH34000/(THYROID_MED_PREG). Did you take any of these thyroid medications during pregnancy?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

DESICCATED THYROID HORMONE ALSO CALLED ARMOUR THYROID, NATURE-THYROID OR WESTHROID

1


LEVOTHYROXINE, ALSO CALLED SYNTHROID, LEVOXYL, LEVOTHYROID, TEROSINE, UNITHROID

2


LIOTRIX, ALSO CALLED THYROLAR

3


LIOTHYRONINE, ALSO CALLED TRIOSTAT OR CYTOMEL

4


METHIMAZOLE

5


PROPYLTHIOURACIL

6


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF THYROID_MED_PREG = -5, OR ANY COMBINATION OF 1 THROUGH 6 WITH -5, GO TO THYROID_MED_PREG_OTH.

  • OTHERWISE, GO TO DEPRESSION.


MMH35000/(THYROID_MED_PREG_OTH). Do you remember the name of the medicine?

 

SPECIFY: _______________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


MMH36000/(DEPRESSION). Have you ever been told by a doctor or other health care provider that you had depression, not including bipolar disorder?


Label

Code

Go To

YES

1


NO

2

MMH40000

REFUSED

-1

MMH40000

DON'T KNOW

-2

MMH40000


SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


MMH37000/(DEPRESSION_MED). Did you take any drugs for depression during your pregnancy?


Label

Code

Go To

YES

1


NO

2

MMH40000

REFUSED

-1

MMH40000

DON'T KNOW

-2

MMH40000


SOURCE

NEW


MMH38000/(DEPRESSION_MED_PREG). Did you take any of these medications for depression during your pregnancy?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

ABILIFY ALSO KNOWN AS ARIPIPRAZOLE

1


CELEXA ALSO KNOWN AS CITALOPRAM

2


CYMBALTA ALSO KNOWN AS DULOXETINE

3


EFFEXOR ALSO KNOWN AS VENLAFAXINE

4


ELAVIL ALSO KNOWN AS AMITRIPTYLINE

5


INVEGA ALSO KNOWN AS PALIPERIDONE

6


LEXAPRO ALSO KNOWN AS ESCITALOPRAM

7


NUVIGIL ALSO KNOWN AS ARMODAFINIL

8


PAXIL ALSO KNOWN AS PAROXETINE

9


PRISTIQ DESVENLAFAXINE

10


PROZAC ALSO KNOWN AS FLUOXETINE

11


REMERON ALSO KNOWN AS MIRTAZAPINE

12


STRATTERA ALSO KNOWN AS ATOMOXETINE

13


VIIBRYD ALSO KNOWN AS VILAZODONE

14


WELLBUTRIN ALSO KNOWN AS BUPROPION

15


XANAX ALSO KNOWN AS ALPRAZOLAM

16


ZOLOFT ALSO KNOWN AS SERTRALINE

17


ZYPREXA ALSO KNOWN AS OLANZAPINE

18


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF DEPRESSION_MED_PREG = -5, OR ANY COMBINATION OF 1 THROUGH 18 WITH -5, GO TO DEPRESSION_MED_PREG_OTH.

  • OTHERWISE, GO TO MMH40000.


MMH39000/(DEPRESSION_MED_PREG_OTH). SPECIFY: ___________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


MMH40000. We are interested in some prescription and nonprescription medicines that you may have taken during your pregnancy.  As I read the list, please tell me whether you took the medicine or not.  In answering the questions, please respond ‘yes’ only if you took the drug during your pregnancy or around the time you became pregnant, that is, between your last menstrual period and when you found out you were pregnant.


MMH41000/(PAIN_MEDS_PREG). During your pregnancy, did you take any of these pain medications? 


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

ACETOMINOPHEN (DATRIL, TYLENOL)

1


IBUPROFEN (ADVIL, MOTRIN, NUPRIN)

2


NAPROXIN (ALEVE)

3


ASPIRIN (ANACIN, BAYER, BUFFERIN)

4


DID NOT TAKE PAIN MEDICATIONS

-7


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF PAIN_MEDS_PREG ​= -7, -1, OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES.


MMH42000/(MOOD_MEDS_PREG). During your pregnancy, did you take any of these mood medications? 


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

FLUOXETINE (PROZAC)

1


BUPROPION (WELLBUTRIN)

2


PAROXETINE (PAXIL)

3


SERTRALINE (ZOLOFT)

4


VENALAFAXINE (EFFEXOR)

5


CITALOPRAM (CELEXA)

6


DID NOT TAKE MOOD MEDICATIONS

-7


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF MOOD_MEDS_PREG ​= -7, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES.


MMH43000/(INFECTIONS_MED_PREG). During your pregnancy, did you take any of these medications to treat infections? 


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

LEVOFLOXACIN

1


AMOXICILLIN

2


AUGMENTIN

3


BACTRIM

4


SEPTRA

5


CIPRO

6


DOXYCYCLINE

7


ZITHROMAX

8


RELENZA

9


ZANAMIVIR

10


TAMIFLU

11


OSELTAMIVIR

12


DID NOT HAVE AN INFECTION/DID NOT TAKE MEDICATION FOR INFECTION

-7


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF INFECTIONS_MED_PREG = -7, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES.


MMH44000/(ALLERGY_MEDS_PREG). During your pregnancy, did you take any of these allergy medications? 


DATA COLLECTOR INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

LORATADINE (CLARITIN)

1


FEXOFENADINE (ALLEGRA)

2


CETIRIZINE (ZYRTEC)

3


DOES NOT HAVE ALLERGIES/DID NOT TAKE ALLERGY MEDICATIONS

-7


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF ALLERGY_MEDS_PREG = -7, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES.


MMH45000/(OTHER_MEDS_PREG). The last few drugs are used to treat several conditions.  During your pregnancy, did you take any of these medications?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

CYTOTEC

1


MISOPROSTOL

2


ACCUTANE

3


THALIDOMIDE

4


MYFORTIC

5


CELLCEPT

6


METHOTREXATE

7


DID NOT TAKE ANY OF THESE MEDICATIONS

-7


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF OTHER_MEDS_PREG = -7, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES.


MMH46000/(ADDITIONAL_MEDS_PREG). Are there any other medications that you took during your pregnancy, that we have not talked about?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_MMH_ET

REFUSED

-1

TIME_STAMP_MMH_ET

DON'T KNOW

-2

TIME_STAMP_MMH_ET


SOURCE

NEW


MMH47000/(ADDITIONAL_MEDS_PREG_OTH). SPECIFY: ______________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


(TIME_STAMP_MMH_ET).


PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP



HEALTH BEHAVIORS PART 1


(TIME_STAMP_HB_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


HB01000. Now I’d like to change topics and ask you some questions about drinking beverages with caffeine.


HB02000/(PREGNANCY_DRINK). During the last 3 months of your pregnancy, did you drink the following:


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY


Label

Code

Go To

Caffeinated coffee

1


Caffeinated tea

2


Soda with caffeine (Coke, Pepsi, Dr. Pepper, Mountain Dew)

3


Energy drinks with caffeine (Red Bull, Amp)

4


NONE

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF PREGNANCY_DRINK = 5, -1 OR -2, GO TO DRINK_BEFORE_PREG.

  • OTHERWISE, GO TO PREGNANCY_DRINK_FREQ.


HB03000/(PREGNANCY_DRINK_FREQ). How many {caffeinated coffees/caffeinated teas/sodas with caffeine/energy drinks with caffeine} did you have per day?

 

|___|___|

NUMBER OF DRINKS PER DAY


INTERVIEWER INSTRUCTIONS

  • IF RESPONDENT DRINKS LESS THAN 1 DRINK PER DAY, WRITE IN “1” FOR HOW MANY PER DAY.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • LOOP THROUGH PREGNANCY_DRINK_FREQ UNTIL NUMBER OF LOOPS = 4.

  • DISPLAY “caffeinated coffees” FOR FIRST LOOP, “caffeinated teas” FOR SECOND LOOP, “sodas with caffeine” FOR THIRD LOOP, AND “energy drinks with caffeine” FOR FOURTH LOOP.


HB04000/(DRINK_BEFORE_PREG). In the 3 months before you knew you were pregnant, did you drink:


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY


Label

Code

Go To

Caffeinated coffee

1


Caffeinated tea

2


Soda with caffeine (Coke, Pepsi, Dr. Pepper, Mountain Dew)

3


Energy drinks with caffeine (Red Bull, Amp)

4


NONE

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • IF DRINK_BEFORE_PREG = 5, -1 OR -2, GO TO TIME_STAMP_HB_ET.

  • OTHERWISE, GO TO ​DRINK_BEFORE_PREG_FREQ.


HB05000/(DRINK_BEFORE_PREG_FREQ). How many {caffeinated coffees/caffeinated teas/sodas with caffeine/energy drinks with caffeine} did you have per day?

 

|___|___|

NUMBER OF DRINKS PER DAY


INTERVIEWER INSTRUCTIONS

  • IF RESPONDENT DRINKS LESS THAN 1 DRINK PER DAY, WRITE IN “1” FOR HOW MANY PER DAY.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (T1 Mother)


PROGRAMMER INSTRUCTIONS

  • LOOP THROUGH DRINK_BEFORE_PREG_FREQ UNTIL NUMBER OF LOOPS = 4.

  • DISPLAY “caffeinated coffees” FOR FIRST LOOP, “caffeinated teas” FOR SECOND LOOP, “sodas with caffeine” FOR THIRD LOOP, AND “energy drinks with caffeine” FOR FOURTH LOOP.


(TIME_STAMP_HB_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



DOCTOR VISITS AND HOSPITALIZATIONS


(TIME_STAMP_DVA_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


DVA01000. I am now going to ask some questions about your visits to a doctor or other health care provider during your pregnancy.


DVA02000/(HEALTH_CARE). What kind of place did you usually go to when you needed routine or preventive care, such as a physical examination or check-up?


Label

Code

Go To

Clinic or health center

1


Doctor's office or Health Maintenance Organization (HMO)

2


Hospital emergency room

3


Hospital outpatient department

4


Some other place

5


DOESN'T GO TO ONE PLACE MOST OFTEN

6


DOESN'T GET PREVENTIVE CARE ANYWHERE

7


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Health and Nutrition Examination Survey 2004

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother, T3 Prior);

National Children’s Study, Vanguard  Phase (PV1)


DVA03000/(ROUTINE_PREG_VISIT). What kind of place did you go for routine pregnancy visits?


Label

Code

Go To

Clinic or health center

1


Doctor's office or Health Maintenance Organization (HMO)

2


Hospital emergency room

3


Hospital outpatient department

4


Some other place

5


DOESN'T GO TO ONE PLACE MOST OFTEN

6


DOESN'T GET ROUTINE CARE ANYWHERE

7


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Health and Nutrition Examination Survey 2004

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother, T3 Prior);

Vanguard: National Children’s Study, Vanguard  Phase (PV1)


DVA04000/(PROCEDURES_DURING_PREG). Did you have any of the following procedures during your pregnancy?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY


Label

Code

Go To

Ultrasound or sonogram

1


Amniocentesis

2


Chorionic Villus Sampling or CVS

3


DID NOT HAVE ANY PROCEDURES

-7


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother, T3 Prior)


DVA05000/(PRENATAL_PROVIDER). What type of provider did you usually see for routine prenatal visits?  Was it an:


Label

Code

Go To

Obstetrician/Gynecologist (OB/GYN)

1

NIGHT_HOSP_PREG

Family physician

2

NIGHT_HOSP_PREG

Nurse/Midwife

3

NIGHT_HOSP_PREG

Another type of provider

-5


DID NOT HAVE ROUTINE PRENATAL VISITS

-7

NIGHT_HOSP_PREG

REFUSED

-1

NIGHT_HOSP_PREG

DON'T KNOW

-2

NIGHT_HOSP_PREG


SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother, T3 Prior)


DVA06000/(PRENATAL_PROVIDER_OTH). SPECIFY: ________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother, T3 Prior)


DVA07000/(NIGHT_HOSP_PREG). Did you spend any nights in the hospital while you were pregnant with {Baby’s Name/the baby/the babies}?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_DVA_ET

REFUSED

-1

TIME_STAMP_DVA_ET

DON'T KNOW

-2

TIME_STAMP_DVA_ET


SOURCE

Modified from Pregnancy Risk Assessment Monitoring System

Legacy:  Modified from National Children’s Study, Legacy Phase (T1 Mother, T3 Prior);

Vanguard: National Children’s Study, Vanguard  Phase (PV2)


DVA08000/(NIGHT_HOSP_REASONS). Please choose the scenarios that describe the reason you were in the hospital. Please select all the scenarios that were applicable to you.


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY


Label

Code

Go To

YOU WERE ADMITTED TO THE HOSPITAL IN LABOR NEAR YOUR DUE DATE AND DELIVERED YOUR BABY BEFORE YOU WERE RELEASED

1


YOU WERE ADMITTED TO THE HOSPITAL TO INDUCE YOUR LABOR OR FOR A C-SECTION (ONLY IF YOUR LABOR INDUCTION OR C-SECTION WERE SCHEDULED BEFORE YOU WERE ADMITTED TO THE HOSPITAL)

2


YOU WERE ADMITTED TO THE HOSPITAL TO TREAT AN INJURY, DISEASE OR PREGNANCY COMPLICATION AND DELIVERED YOUR BABY WHILE STILL IN THE HOSPITAL

3


YOU WERE ADMITTED TO THE HOSPITAL TO TREAT AN INJURY, DISEASE OR PREGNANCY COMPLICATION AND WERE STILL PREGNANT WHEN YOU WERE RELEASED FROM THE HOSPITAL

4


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • IF NIGHT_HOSP_REASONS = -5, OR ANY COMBINATION OF 1 THROUGH 4 WITH -5, GO TO NIGHT_HOSP_REASONS_OTH.

  • OTHERWISE, GO TO DVA10000.


DVA09000/(NIGHT_HOSP_REASONS_OTH). What was the reason?

 

SPECIFY: __________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


DVA10000. Thinking of the most recent time you were released from the hospital while you were still pregnant, what was the admission date of this hospital stay?


SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother, T3 Prior);

Vanguard: National Children’s Study, Vanguard  Phase (PV2)


(PREG_ADMIT_MM) MONTH:  

|___|___|

   M    M


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREG_ADMIT_DD) DAY: 

 |___|___|

   D     D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREG_ADMIT_YYYY) YEAR: 

 |___|___|___|___|

  Y     Y     Y     Y


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



DVA11000/(ADMITTED_HOSPITAL). Which hospital were you admitted to?

 

______________________________________

HOSPITAL NAME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


DVA12000/(ADMITTED_NUM_NIGHTS). How many nights did you stay in the hospital?

 

|___|___|___|

NUMBER OF NIGHTS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from Pregnancy Risk Assessment Monitoring System

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother, T3 Prior);

Vanguard: National Children’s Study, Vanguard  Phase (PV2)


(TIME_STAMP_DVA_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



OCCUPATIONAL/HOBBY EXPOSURES


(TIME_STAMP_OE_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


OE01000. Now I would like to ask some questions about any jobs that you have done recently.  Please only include jobs that you worked at least four hours per week.


OE02000/(WORKING). During your pregnancy, did you work at any full time or part-time jobs?


Label

Code

Go To

YES

1


NO

2

HOBBY_CHEM_EXP_PREG

REFUSED

-1

HOBBY_CHEM_EXP_PREG

DON'T KNOW

-2

HOBBY_CHEM_EXP_PREG


SOURCE

Modified from Pregnancy, Infection, and Nutrition Study

Legacy: Modifyed from  National Children’s Study, Legacy Phase (T1 Mother, T3)

Vanguard:  Modifyed from National Children’s Study, Vanguard (PV1, PV2)


OE03000/(HOURS). Approximately how many hours each week did you work?

 

|___|___|___|

NUMBER OF HOURS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from Pregnancy, Infection, and Nutrition Study

Legacy: Modifyed from  National Children’s Study, Legacy Phase (T1 Mother, T3)

Vanguard:  Modifyed from National Children’s Study, Vanguard (PV1, PV2)


OE04000/(SHIFT_WORK). Did you work a shift that started after 2 pm?


Label

Code

Go To

YES

1


NO

2


SOMETIMES

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children

Legacy: Modified from  National Children’s Study, Legacy Phase (T1 Mother, T3)

Vanguard:  Modifyed from National Children’s Study, Vanguard (PV1, PV2)


OE05000. The next questions are about the type of work you did while you were pregnant.  If you worked more than one job while you were pregnant, please answer about the job you worked the most hours for during your pregnancy.  Do you have that job in mind? 


OE06000/(JOB_TITLE). What was your job title or occupation?

 

_____________________________________________________

JOB TITLE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from  National Children’s Study, Legacy Phase (T1 Mother, T3)


OE07000/(JOB_ACTIVITIES). What types of activities did you do most often at that job?

 

_____________________________________________________

ACTIVITY


INTERVIEWER INSTRUCTIONS

  • PROBE: Did you, for example, teach classes, work on the computer, photocopy, answer phones, wait tables, treat patients, do lab work or carpentry?

  • PROBE: Anything else that you did frequently?

  • SEPARATE MULTIPLE JOB ACTIVITIES WITH COMMAS.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from  National Children’s Study, Legacy Phase (T1 Mother, T3)


OE08000/(BUSINESS_INDUSTRY). In what kind of business or industry was this job?  That is, what does the company make or do?

 

_____________________________________________________

INDUSTRY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

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


OE09000/(WORK_NAME). What was the name of the company or business where you worked?

 

________________________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from  National Children’s Study, Legacy Phase (T1 Mother, T3)


OE10000/(HOBBY_CHEM_EXP_PREG). During your pregnancy, did you {have a hobby/have a hobby or work at a business} that used solvents, greases, paint, or glue, or that generated dust or fumes, such as woodworking, soldering, welding, or hair treatments (such as perms or dyes)?


Label

Code

Go To

YES

1


NO

2

OE14000

REFUSED

-1

OE14000

DON'T KNOW

-2

OE14000


SOURCE

National Children’s Study, Vanguard (36-Month)


PROGRAMMER INSTRUCTIONS

  • IF WORKING = 2, -1 OR -2, DISPLAY "have a hobby."

  • IF WORKING = 1, DISPLAY "have a hobby or work at a business."


OE11000/(WHAT_MADE_HOBBY). What is made or done in this {hobby/hobby or business}?

 

________________________________________________________________________


INTERVIEWER INSTRUCTIONS

  • PROBE, "Anything else?"

  • ENTER UP TO 5 HOBBIES.

  • LIST HOBBIES SEPARATED BY COMMAS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard (36-Month)


PROGRAMMER INSTRUCTIONS

  • IF WORKING = 2, -1, OR -2, DISPLAY, "hobby."

  • IF WORKING = 1, DISPLAY, "hobby or business."


OE12000/(HOBBY_WORK_MATERIALS). What types of materials were you exposed to in this {hobby/hobby or work} environment?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

DIRT

1


WOOD DUST

2


GREASE

3


PESTICIDES

4


METAL DUST

5


COAL OR MINING DUST

6


ANIMAL HAIR

7


FIBERS (SUCH AS ASBESTOS OR FIBERGLASS)

8


SOLVENTS AND POLISHES (INCLUDING NAIL POLISH/REMOVER)

9


HAIR TREATMENT PRODUCTS (SUCH AS DYES AND PERMS)

10


SOME OTHER TYPE OF MATERIAL

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard (36-Month)


PROGRAMMER INSTRUCTIONS

  • IF WORKING = 2, -1 OR -2, DISPLAY "hobby."

  • IF WORKING = 1, DISPLAY "hobby or work."

  • IF HOBBY_WORK_MATERIALS = -5 OR ANY COMBINATION INCLUDING -5, GO TO HOBBY_WORK_MATERIALS_OTH.

  • OTHERWISE, GO TO ​OE14000.


OE13000/(HOBBY_WORK_MATERIALS_OTH). What other type of material were you exposed to?

 

SPECIFY: ___________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


OE14000. Some people have jobs or hobbies where their skin, clothes, or shoes get dirty or stained. By "dirty" or "stained," we mean their skin or clothes have dust, grease, fibers, or other visible chemical spots on them.  For the next few questions, please think about everyone in the household.


OE15000/(JOB_HOBBY_STAIN_PREG). During your pregnancy, did anyone routinely come into your home from their work or hobbies with dirty or stained skin, clothes, or shoes?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_OE_ET

REFUSED

-1

TIME_STAMP_OE_ET

DON'T KNOW

-2

TIME_STAMP_OE_ET


SOURCE

Modified from ​National Children’s Study, Vanguard (36-Month)


OE16000/(WHO_STAIN_PREG). Who is it that routinely came into your home with dirty or stained skin, clothes, or shoes during your pregnancy​? Was it:


Label

Code

Go To

You

1


Others in the home

2


Both you and others in the home

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from ​National Children’s Study, Vanguard (36-Month)


OE17000/(MATERIAL_EXP_HOME_PREG). What types of materials did you or anyone in the household bring into the home from work or hobbies on hands or skin, clothes, or shoes while you were pregnant?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

DIRT

1


WOOD DUST

2


GREASE

3


PESTICIDES

4


METAL DUST

5


COAL OR MINING DUST

6


ANIMAL HAIR

7


FIBERS (SUCH AS ASBESTOS OR FIBERGLASS)

8


SOME OTHER TYPE OF MATERIAL

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Vanguard (36-Month)


PROGRAMMER INSTRUCTIONS

  • IF MATERIAL_EXP_HOME_PREG = -5, OR ANY COMBINATION INCLUDING -5, GO TO MATERIAL_EXP_HOME_PREG_OTH.

  • OTHERWISE, GO TO ​TIME_STAMP_OE_ET.


OE18000/(MATERIAL_EXP_HOME_PREG_OTH). What other type of material was brought into your home from work or hobbies on hands or skin, clothes, or shoes while you were pregnant?

 

SPECIFY: _____________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


(TIME_STAMP_OE_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



COMMUTING


(TIME_STAMP_COM_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


COM01000. My next questions are about trips to places you go to often, at least three days a week.


COM02000/(REG_TRAVEL). While you were pregnant with {Baby Name/the baby/the babies} was there a place, such as work, school, or elsewhere, that you regularly traveled to at least 3 days a week?


Label

Code

Go To

YES

1


NO

2

LOCAL_TRAV

REFUSED

-1

LOCAL_TRAV

DON'T KNOW

-2

LOCAL_TRAV


SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modifyed from National Children’s Study, Vanguard (PV1)


COM03000. Think of the trips that you made at least three times a week.  Please identify the longest trip.  We will call this trip your longest regular commute.  The next two questions are about this trip. 


COM04000/(COMMUTE). During your recent pregnancy, how did you normally travel to the destination of your longest regular commute?  


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY


Label

Code

Go To

CAR

1


BUS

2


TRAIN, SUBWAY, RAIL, OR LIGHT RAIL

3


WALK, BIKE (NON-MOTORIZED)

4


DOES NOT HAVE A REGULAR COMMUTE

-7


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1)


PROGRAMMER INSTRUCTIONS

  • IF COMMUTE = ANY COMBINATION OF 1 THROUGH 4, GO TO COMMUTE_TIME.

  • IF COMMUTE = -5, OR ANY COMBINATION OF 1 THROUGH 4, WITH -5, GO TO COMMUTE_OTH.

  • IF COMMUTE =  -7, -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND  GO TO LOCAL_TRAV.


COM05000/(COMMUTE_OTH ). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modifyed from National Children’s Study, Vanguard (PV1)


COM06000/(COMMUTE_TIME). About how many minutes did this commute usually take from the time you left your home until you got to your destination?  Include any usual stops or side trips.

 

|___|___|___|

NUMBER OF MINUTES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modifyed from National Children’s Study, Vanguard (PV1)


COM07000/(LOCAL_TRAV). While you were pregnant with {Baby Name/the baby/the babies}, how did you normally get to other places, for example, shopping, doctor, visiting friends, or church?  


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY.


Label

Code

Go To

CAR

1


BUS

2


TRAIN, SUBWAY, RAIL, OR LIGHT RAIL

3


WALK, BIKE (NON-MOTORIZED)

4


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modifyed from National Children’s Study, Vanguard (PV1)


PROGRAMMER INSTRUCTIONS

  • IF LOCAL_TRAV = ANY COMBINATION OF 1 THROUGH 4, GO TO COM09000.

  • IF LOCAL_TRAV = -5, OR ANY COMBINATION OF 1 THROUGH 4 WITH -5, GO TO LOCAL_TRAV_OTH.

  • IF LOCAL_TRAV = -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND  GO TO COM09000.


COM08000/(LOCAL_TRAV_OTH ). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modifyed from National Children’s Study, Vanguard (PV1)


COM09000. Next, I’d like to find out about how often you pumped gasoline.


COM10000/(PUMP_GAS). When you were pregnant, about how often did you pump gasoline into a motor vehicle such as a car, truck, motorcycle, or boat?


Label

Code

Go To

Every day

1


4-6 times per week

2


2-3 times per week

3


Once a week

4


One to three times a month

5


Less than once a month

6


Never

7


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1)


COM11000/(LAWNMOWER). When you were pregnant, about how often did you pour gasoline into a small engine such as a lawnmower, chainsaw or generator?


Label

Code

Go To

Every day

1


4-6 times per week

2


2-3 times per week

3


Once a week

4


One to three times a month

5


Less than once a month

6


Never

7


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1)


(TIME_STAMP_COM_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



PERCEIVED STRESS


(TIME_STAMP_PS_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


PS01000. The following questions ask about your feelings and thoughts during the last month. Please tell me how often you felt or thought a certain way.


PS02000/(UPSET_UNEXPECTED). In the last month, how often have you been upset because of something that happened unexpectedly?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS03000/(NO_CONTROL). In the last month, how often have you felt that you were unable to control the important things in your life?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS04000/(NERVOUS_STRESS). (In the last month,) how often have you felt nervous and “stressed”?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS05000/(CONFIDENT_PROB). (In the last month,) how often have you felt confident about your ability to handle your personal problems?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS06000/(GOING_WAY). (In the last month,) how often have you felt that things were going your way?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS07000/(NOT_COPE). (In the last month,) how often have you found that you could not cope with all the things that you had to do?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS08000/(CONTROL_IRRITATE). (In the last month,) how often have you been able to control irritations in your life?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS09000/(FELT_ON_TOP). (In the last month,) how often have you felt you were on top of 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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS10000/(ANGRY_NO_CONT). (In the last month,) how often have you been angered because of things that were outside of your control?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS11000/(DIFF_PILE_HIGH). (In the last month,) how often have you felt difficulties were piling up so high that you could not overcome them?


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

NEVER

1


ALMOST NEVER

2


SOMETIMES

3


FAIRLY OFTEN

4


VERY OFTEN

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PS12000. Now I’m going to change the subject and ask you about your relationship with your spouse or partner.  Most people have disagreements in their relationships.  Please tell me the approximate extent of agreement or disagreement between you and your spouse or partner for each item.


PS13000/(REL_PARTNER_CONFIRM). DOES RESPONDENT VOLUNTEER “I DON’T HAVE A SPOUSE / PARTNER”?


Label

Code

Go To

RESPONDENT DOES NOT SAY ANYTHING ABOUT HAVING A SPOUSE/PARTNER

1


RESPONDENT VOLUNTERS SHE DOES NOT HAVE A SPOUSE/PARTNER

2

TIME_STAMP_PS_ET


PS14000/(PHILOSOPHY). Philosophy of life.  Do you and your spouse or partner:


Label

Code

Go To

Always agree

1


Almost always agree

2


Sometimes agree

3


Hardly ever agree

4


Never agree

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Dyadic Adjustment Scale


PS15000/(AIMS_GOALS). Aims, goals and things believed important.  Do you and your spouse or partner:


Label

Code

Go To

Always agree

1


Almost always agree

2


Sometimes agree

3


Hardly ever agree

4


Never agree

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Dyadic Adjustment Scale


PS16000/(TIME_SPENT_TO). Amount of time spent together.  Do you and your spouse or partner:


Label

Code

Go To

Always agree

1


Almost always agree

2


Sometimes agree

3


Hardly ever agree

4


Never agree

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Dyadic Adjustment Scale


PS17000/(INTEREST_CHAT). Please tell me how often you do the following with your spouse or partner.

How often do you have an interesting chat:


Label

Code

Go To

Never

1


Less than once a month

2


Once or twice a month

3


Once or twice a week

4


Once a day

5


More often

6


REFUSED

-1


DON'T KNOW

-2



SOURCE

Dyadic Adjustment Scale


PS18000/(CALMLY_DISCUSS). How often do you calmly discuss something:


Label

Code

Go To

Never

1


Less than once a month

2


Once or twice a month

3


Once or twice a week

4


Once a day

5


More often

6


REFUSED

-1


DON'T KNOW

-2



SOURCE

Dyadic Adjustment Scale


PS19000/(TOGETHER_PROJECT). How often do you work together on a project:


Label

Code

Go To

Never

1


Less than once a month

2


Once or twice a month

3


Once or twice a week

4


Once a day

5


More often

6


REFUSED

-1


DON'T KNOW

-2



SOURCE

Dyadic Adjustment Scale


PS20000/(DEGREE_HAPPY). Please indicate the degree of happiness in your relationship. Are you:


Label

Code

Go To

Very unhappy

1


Somewhat unhappy

2


Fairly happy

3


Mostly happy

4


Very happy

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Dyadic Adjustment Scale


(TIME_STAMP_PS_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



SOCIAL SUPPORT


(TIME_STAMP_SS_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


SS01000. For the following questions, please choose the answer that best describes your life during your pregnancy.


SS02000/(LISTEN). During your pregnancy, how often was there someone available to you whom you could count on to listen to you when you need to talk?


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

NONE OF THE TIME

1


A LITTLE OF THE TIME

2


SOME OF THE TIME

3


MOST OF THE TIME

4


ALL OF THE TIME

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Medical Outcomes Survey

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV2)


SS03000/(ADVICE). How often was there someone available to give you good advice about a problem?


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

NONE OF THE TIME

1


A LITTLE OF THE TIME

2


SOME OF THE TIME

3


MOST OF THE TIME

4


ALL OF THE TIME

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Medical Outcomes Survey

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV2)


SS04000/(AFFECTION). How often was there someone available to you who showed you love and affection?


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

NONE OF THE TIME

1


A LITTLE OF THE TIME

2


SOME OF THE TIME

3


MOST OF THE TIME

4


ALL OF THE TIME

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Medical Outcomes Survey

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV2)


SS05000/(DAILY_HELP).  How often was there someone available to help you with daily chores?


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

NONE OF THE TIME

1


A LITTLE OF THE TIME

2


SOME OF THE TIME

3


MOST OF THE TIME

4


ALL OF THE TIME

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Medical Outcomes Survey

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV2)


SS06000/(EMOT_SUPPORT). How often could you count on anyone to provide you with emotional support (talking over problems or helping you make a difficult decision)?


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

NONE OF THE TIME

1


A LITTLE OF THE TIME

2


SOME OF THE TIME

3


MOST OF THE TIME

4


ALL OF THE TIME

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Medical Outcomes Survey

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV2)


SS07000/(AMT_SUPPORT). How often did you have as much contact as you would like with someone you felt close to, someone in whom you can trust and confide?


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

NONE OF THE TIME

1


A LITTLE OF THE TIME

2


SOME OF THE TIME

3


MOST OF THE TIME

4


ALL OF THE TIME

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from Medical Outcomes Survey

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV2)


(TIME_STAMP_SS_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



HEALTH INSURANCE


(TIME_STAMP_HI_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


HI01000. Now I’m going to switch the subject and ask about health insurance.


HI02000/(INSURE). During your pregnancy, were you covered by any kind of health insurance or by any other kind of health care plan?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_HI_ET

REFUSED

-1

TIME_STAMP_HI_ET

DON'T KNOW

-2

TIME_STAMP_HI_ET


SOURCE

Modified from American Community Survey 2006

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1, PV2)


HI03000. Now I’ll read a list of different types of insurance.  Please tell me which types you had during pregnancy.  Did you have…


HI04000/(INS_EMPLOY). Insurance through an employer or union either through yourself or another family member?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from American Community Survey 2006

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1, PV2)


HI05000/(INS_MEDICAID). Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from American Community Survey 2006

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1, PV2)


HI06000/(INS_TRICARE). TRICARE, VA, or other military health care?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from American Community Survey 2006

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1, PV2)


HI07000/(INS_IHS). Indian Health Service?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from American Community Survey 2006

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1, PV2)


HI08000/(INS_MEDICARE). Medicare, for people 65 and older, or people with certain disabilities?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from American Community Survey 2006

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1, PV2)


HI09000/(INS_OTH). Any other type of health insurance or health coverage plan?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from American Community Survey 2006

Legacy: Modified from National Children’s Study, Legacy Phase (T1 Mother)

Vanguard:  Modified from National Children’s Study, Vanguard (PV1, PV2)


(TIME_STAMP_HI_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 26 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.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified0000-00-00
File Created2021-01-28

© 2024 OMB.report | Privacy Policy