45.2 Survey

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

RetrospectivePregnancyBirthCohortQuestionnaireHousehold

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 - Household, Phase 2g

OMB Specification


Retrospective Pregnancy - Birth Cohort Questionnaire - Household


Event Category:

Time-Based

Event:

Birth, or 3M, or 6M

Administration:

N/A

Instrument Target:

Child’s Primary Residence

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:

10 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.


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Retrospective Pregnancy - Birth Cohort Questionnaire - Household



TABLE OF CONTENTS





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Retrospective Pregnancy - Birth Cohort Questionnaire - Household



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.





HOUSEHOLD COMPOSITION


(TIME_STAMP_HC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD HOUSEHOLD ID FOR CHILD'S PRIMARY RESIDENCE (HH_ID) AND RESPONDENT ID (R_P_ID) FOR BIOLOGICAL MOTHER.

  • PRELOAD MULT_CHILD FROM INSTRUMENT_ID = XX (PARTICIPANT VERIFICATION, SCHEDULING & TRACING QUESTIONNAIRE). 

  • IF MULT_CHILD = 1, DISPLAY "the babies" AND "they" AS APPROPRIATE THROUGHOUT THE INSTRUMENT.

  • IF MULT_CHILD ≠ 1:

    • PRELOAD C_FNAME AND CHILD_SEX FROM INSTRUMENT_ID = XX (PARTICIPANT VERIFICATION, SCHEDULING & TRACING QUESTIONNAIRE). 

    • IF C_FNAME ≠ -1, -2, OR -4, DISPLAY CHILD'S FIRST NAME IN "C_FNAME" THROUGHOUT THE INSTRUMENT.

    • OTHERWISE, IF C_FNAME  = -1, -2, OR -4, DISPLAY "the baby" IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT.

    • IF CHILD_SEX  = 1, DISPLAY “his”, “he”, OR “himself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

    • IF CHILD_SEX = 2, DISPLAY “her”, “she”, OR “herself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.


HC01000. First, I’d like to get some information about the people who lived with you during this most recent pregnancy.


HC02000/(PEOPLE_IN_HOUSEHOLD). How many people, both children and adults, lived in your household?  Include any persons who usually live with you but were temporarily away on business, vacation, in the hospital, on full-time active military duty, or students living temporarily away from home.  Do not include anyone who was in a nursing home or other institution.  Including yourself, what was the total number of people who lived in your household?

 

|___|___|

NUMBER


INTERVIEWER INSTRUCTIONS

  • CONFIRM THE NUMBER OF PEOPLE IN THE HOUSEHOLD WITH THE PARTICIPANT.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PROGRAMMER INSTRUCTIONS

  • DISPLAY SOFT EDIT IF RESPONSE < 0 OR > 15.


HC03000/(LIVED_WHEN_GOT_PREG). When you got pregnant, who lived in the same house with you? 


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

YOUR HUSBAND OR PARTNER

1


ANY CHILDREN AGED 5 YEARS AND YOUNGER

2


ANY CHILDREN AGED 6 YEARS AND OLDER

3


YOUR MOTHER

4


YOUR FATHER

5


YOUR HUSBAND'S OR PARTNER'S PARENT(S)

6


ANY FRIENDS OR ROOMMATES

7


OTHER FAMILY MEMBERS OR RELATIVES

8


I LIVED ALONE

9


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Risk Assessment Monitoring System, Phase 5,  QXP3 (modified)


PROGRAMMER INSTRUCTIONS

  • IF LIVED_WHEN_GOT_PREG = -5, OR ANY COMBINATION OF 1 THROUGH 8 AND -5, GO TO LIVED_WHEN_GOT_PREG_OTH.

  • IF LIVED_WHEN_GOT_PREG = 2, OR ANY COMBINATION OF 1, 3 THROUGH 8 AND 2, GO TO NUM_CHILD_UNDER_5.

  • IF LIVED_WHEN_GOT_PREG = 3, OR ANY COMBINATION OF 1, 4 THROUGH 8 AND 3, GO TO NUM_CHILD_UNDER_6.

  • IF LIVED_WHEN_GOT_PREG = -1, -2, OR 9, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO TIME_STAMP_HC_ET.

  • IF LIVED_WHEN_GOT_PREG = ANY COMBINATION NOT INCLUDING -5, 2, OR 3, GO TO TIME_STAMP_HC_ET.


HC04000/(LIVED_WHEN _GOT_PREG_OTH). SPECIFY: ____________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Risk Assessment Monitoring System, Phase 5, QXP3


PROGRAMMER INSTRUCTIONS

  • IF LIVED_WHEN_GOT_PREG INCLUDES 2, GO TO NUM_CHILD_UNDER_5.

  • IF LIVED_WHEN_GOT_PREG DOES NOT INCLUDE 2, BUT INCLUDES 3, GO TO NUM_CHILD_UNDER_6.

  • OTHERWISE, IF LIVED_WHEN_GOT_PREG DOES NOT INCLUDE 2 OR 3, GO TO TIME_STAMP_HC_ET.


HC04100/(NUM_CHILD_UNDER_5). How many children aged 5 years and under?

 

|___|___|

NUMBER


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Risk Assessment Monitoring System, Phase 5, QXP3


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF NUM_CHILD_ENDER_5PEOPLE_IN_HOUSEHOLD.

  • IF LIVED_WHEN_GOT_PREG INCLUDES 3, GO TO NUM_CHILD_UNDER_6.

  • OTHERWISE, IF LIVED_WHEN_GOT_PREG DOES NOT INCLUDE 3, GO TO TIME_STAMP_HC_ET.


HC04200/(NUM_CHILD_ABOVE_6). How many children aged 6 years and over?

 

|___|___|

NUMBER


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Risk Assessment Monitoring System, Phase 5, QXP3


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF NUM_CHILD_ABOVE_6 > PEOPLE_IN_HOUSEHOLD.


(TIME_STAMP_HC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



HOUSING CHARACTERISTICS


(TIME_STAMP_HCZ_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


HCZ01000. Now I’d like to find out more about the homes in which you live now and lived while you were pregnant with {C_FNAME/the baby/the babies}.


HCZ02000/(OWN_HOME). Is your current home…


Label

Code

Go To

Owned or being bought by you or someone in your household

1

LIVE_ENTIRE_HOME

Rented by you or someone in your household

2

LIVE_ENTIRE_HOME

Occupied without payment of rent

3

LIVE_ENTIRE_HOME

SOME OTHER ARRANGEMENT

-5


REFUSED

-1

LIVE_ENTIRE_HOME

DON'T KNOW

-2

LIVE_ENTIRE_HOME


SOURCE

Survey of Income and Program Participation

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

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


HCZ03000/(OWN_HOME_OTH ). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Survey of Income and Program Participation

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

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


HCZ04000/(LIVE_ENTIRE_HOME). Did you live in your current home during your entire pregnancy with {C_FNAME/the baby/the babies}?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


HCZ05000. ​What is the address of your current home?


SOURCE

new


(HOME_ADDRESS_STREET) ___________________________________________

STREET ADDRESS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HOME_ADDRESS_CITY) ______________________________

CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HOME_ADDRESS_STATE) |___|___|

STATE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HOME_ADDRESS_ZIP) |___|___|___|___|___|

ZIP CODE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



HCZ06000. How long have you lived in this home?


INTERVIEWER INSTRUCTIONS

  • ENTER IN NUMERIC VALUE AND SELECT ASSOCIATED UNIT OF TIME


SOURCE

National Survey of Lead and Allergens in Housing

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

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


(LENGTH_RESIDE) |___|___|

NUMBER


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(LENGTH_RESIDE_UNIT)


Label

Code

Go To

WEEKS

1


MONTHS

2


YEARS

3


REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF LIVE_ENTIRE_HOME = 1, -1, OR -2, GO TO HCZ10000.

  • OTHERWISE, IF LIVE_ENTIRE_HOME = 2, GO TO HCZ07000.


HCZ07000/(NUM_HOMES_PREG). How many other homes did you live in during your pregnancy with {C_FNAME/the baby/the babies}?

 

|___|___|

NUMBER


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

  • DISPLAY SOFT EDIT IF RESPONSE > 10.

  • GO TO HCZ10000.


HCZ08000. What is the address of the home you lived in prior to your current home?


SOURCE

NEW


(PREVIOUS_ADDRESS)  

_____________________________________________________

STREET ADDRESS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREVIOUS_CITY)  

_____________________________________________________

CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREVIOUS_STATE)  

|___|___|                  

STATE                               


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREVIOUS_ZIP)  

|___|___|___|___|___|

ZIP CODE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



HCZ09000. How long did you live in that home?


SOURCE

NEW


(PREV_LENGTH_RESIDE)

|___|___|

NUMBER


INTERVIEWER INSTRUCTIONS

  • ENTER IN NUMERIC VALUE AND SELECT ASSOCIATED UNIT OF TIME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(PREV_LENGTH_RESIDE_UNIT)


Label

Code

Go To

WEEKS

1


MONTHS

2


YEARS

3


REFUSED

-1


DON'T KNOW

-2



HCZ10000. Now I’m going to ask about how your home was heated and cooled.


HCZ11000/(MAIN_HEAT). I am going to give you a list of heat sources.  Please tell me which one was the main heating fuel source for the home you lived in during your pregnancy with {C_FNAME/the baby/the babies}. 


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

ELECTRIC

1

HEAT2

GAS – PROPANE OR LP

2

HEAT2

OIL

3

HEAT2

WOOD

4

HEAT2

KEROSENE OR DIESEL

5

HEAT2

COAL OR COKE

6

HEAT2

SOLAR ENERGY

7

HEAT2

HEAT PUMP

8

HEAT2

NO HEATING SOURCE

-7

COOLING

OTHER

-5


REFUSED

-1

COOLING

DON'T KNOW

-2

COOLING


SOURCE

American Healthy Homes Survey

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

Vanguard: National Children’s Study, Vanguard  Phase (PV1, PV2) (modified)

 


HCZ12000/(MAIN_HEAT_OTH ). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey

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

Vanguard: National Children’s Study, Vanguard  Phase (PV1, PV2) (modified)


HCZ13000/(HEAT2). Were any other types of heat used regularly during the heating season to heat your home 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.

  • IF RESPONDENT ANSWERS "YES," PROBE: which types?

  • PROBE: Do you have any space heaters, or any secondary method for heating your home?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

ELECTRIC

1


GAS – PROPANE OR LP

2


OIL

3


WOOD

4


KEROSENE OR DIESEL

5


COAL OR COKE

6


SOLAR ENERGY

7


HEAT PUMP

8


NO OTHER HEATING SOURCE

9


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey

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

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


PROGRAMMER INSTRUCTIONS

  • IF HEAT2 = ANY COMBINATION OF VALUES 1 – 8, THEN GO TO COOLING.

  • IF HEAT2 = 9, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO COOLING.

  • IF HEAT2 = -5, OR ANY COMBINATION OF VALUES 1 – 8 AND -5, GO TO HEAT2_OTH.


HCZ14000/(HEAT2_OTH ). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

American Healthy Homes Survey

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

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


HCZ15000/(COOLING). Did the home you lived in while you were pregnant have any type of cooling or air conditioning besides fans? 


Label

Code

Go To

YES

1


NO

2

HCZ18000

REFUSED

-1

HCZ18000

DON'T KNOW

-2

HCZ18000


SOURCE

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

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


HCZ16000/(COOL). While you were pregnant, did you regularly use any of the following cooling systems in your home?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY


Label

Code

Go To

Window or wall air conditioners

1


Central air conditioning

2


Evaporative cooler (swamp cooler)

3


NO COOLING OR AIR CONDITIONING REGULARLY USED

-7


Some other cooling system

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Survey of Lead and Allergens in Housing and American Healthy Homes Survey

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

Vanguard: National Children’s Study, Vanguard Phase (PV1, PV2) (modified)


PROGRAMMER INSTRUCTIONS

  • IF COOL = ANY COMBINATION OF VALUES 1 – 3, THEN GO TO HCZ18000.

  • IF COOL = -7, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO HCZ18000.

  • IF COOL = -5, OR ANY COMBINATION OF VALUES 1 – 3 AND -5, GO TO COOL_OTH.


HCZ17000/(COOL_OTH). SPECIFY: ________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Survey of Lead and Allergens in Housing and American Healthy Homes Survey

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

Vanguard: National Children’s Study, Vanguard Phase (PV1, PV2) (modified)


HCZ18000. Now I’d like to ask about the water in your home.


HCZ19000/(WATER_DRINK). While you were pregnant, which of the following water sources in your home did you use most often for drinking?


Label

Code

Go To

Tap water

1

WATER_COOK

Filtered tap water

2

WATER_COOK

Bottled water

3

WATER_COOK

Some other source

-5


REFUSED

-1

WATER_COOK

DON'T KNOW

-2

WATER_COOK


SOURCE

National Human Exposure Assessment Survey

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

Vanguard: National Children’s Study, Vanguard Phase (PV1, PV2) (modified)


HCZ20000/(WATER_DRINK_OTH). SPECIFY: ____________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Human Exposure Assessment Survey

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

Vanguard: National Children’s Study, Vanguard Phase (PV1, PV2) (modified)


HCZ21000/(WATER_COOK). While you were pregnant, which of the following water sources in your home did you use most often for cooking?


Label

Code

Go To

Tap water

1

PRIVATE_WELL

Filtered tap water

2

PRIVATE_WELL

Bottled water

3

PRIVATE_WELL

Some other source

-5


REFUSED

-1

PRIVATE_WELL

DON'T KNOW

-2

PRIVATE_WELL


SOURCE

National Human Exposure Assessment Survey

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

Vanguard: National Children’s Study, Vanguard Phase (PV1, PV2) (modified)


HCZ22000/(WATER_COOK_OTH). SPECIFY: ____________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Human Exposure Assessment Survey

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

Vanguard: National Children’s Study, Vanguard Phase (PV1, PV2) (modified)


HCZ23000/(PRIVATE_WELL). Is the tap water in your home from a private well?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


HCZ24000. Water damage is a common problem that occurs inside of many homes.  Water damage includes water stains on the ceiling or walls, rotting wood, and flaking sheetrock or plaster. This damage may be from broken pipes, a leaky roof, or floods.  In answering the next question, please consider the home in which you lived over the past 12 months.


HCZ25000/(WATER). In the past 12 months, have you seen any water damage inside your home?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Modified from American Healthy Homes Survey

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

Vanguard: National Children’s Study, Vanguard Phase (PV1, PV2) (modified)


HCZ26000/(MOLD). In the past 12 months, have you seen any mold or mildew on walls or other surfaces inside your home, other than in the shower or bathtub?


Label

Code

Go To

YES

1


NO

2

HCZ29000

REFUSED

-1

HCZ29000

DON'T KNOW

-2

HCZ29000


SOURCE

American Healthy Homes Survey (modified)

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

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

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


HCZ27000/(ROOM_MOLD). In which rooms have you seen the mold or mildew?


INTERVIEWER INSTRUCTIONS

  • PROBE: Any other rooms?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

KITCHEN

1


LIVING ROOM

2


HALL/LANDING

3


RESPONDENT’S BEDROOM

4


OTHER BEDROOM

5


BATHROOM/TOILET

6


BASEMENT

7


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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

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


PROGRAMMER INSTRUCTIONS

  • IF ROOM_MOLD = ANY COMBINATION OF VALUES 1 – 7, THEN GO TO HCZ29000.

  • IF ROOM_MOLD = -5, OR ANY COMBINATION OF VALUES 1 – 7 AND -5, GO TO ROOM_MOLD_OTH.

  • IF ROOM_MOLD = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO HCZ29000.


HCZ28000/(ROOM_MOLD_OTH). SPECIFY: _____________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

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

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


HCZ29000. The next questions ask about additions or renovations to any of the places that you lived in during your recent pregnancy.  

  


HCZ30000/(PRENOVATE). While you were pregnant  with {C_FNAME/the baby/the babies}, have any additions or renovations been done to your home? Include only major projects that made your home larger or involved construction. Do not count smaller projects such as painting or wallpapering, carpeting, or refinishing floors.


Label

Code

Go To

YES

1


NO

2

PDECORATE

REFUSED

-1

PDECORATE

DON'T KNOW

-2

PDECORATE


SOURCE

National Survey of Lead and Allergens in Housing and American Healthy Homes Survey

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

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


HCZ31000/(PRENOVATE_ROOM). Which rooms were renovated?


INTERVIEWER INSTRUCTIONS

  • PROBE: Any others?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

KITCHEN

1


LIVING ROOM

2


HALL/LANDING

3


RESPONDENT’S BEDROOM

4


OTHER BEDROOM

5


BATHROOM/TOILET

6


BASEMENT

7


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Survey of Lead and Allergens in Housing and American Healthy Homes Survey (modified)

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

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


PROGRAMMER INSTRUCTIONS

  • IF PRENOVATE_ROOM = ANY COMBINATION OF VALUES 1 – 7, THEN GO TO PDECORATE.

  • IF PRENOVATE_ROOM = -5, OR ANY COMBINATION OF VALUES 1 – 7 AND -5, GO TO PRENOVATE_ROOM_OTH.

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


HCZ32000/(PRENOVATE_ROOM_OTH). SPECIFY: _____________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Survey of Lead and Allergens in Housing and American Healthy Homes Survey (modified)

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

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


HCZ33000/(PDECORATE). While you were pregnant, were any smaller projects done in your home, such as painting, wallpapering, refinishing floors, or installing new carpet?  Please consider all the homes you lived in during your recent pregnancy.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children

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

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


PROGRAMMER INSTRUCTIONS

  • IF PDECORATE = 1, GO TO PDECORATE_ROOM.

  • IF PDECORATE ≠ 1, AND

    • IF LIVE_ENTIRE_HOME = 1, -1, OR -2, OR IF NUM_HOMES_PREG = 0, GO TO TIME_STAMP_HCZ_ET.

    • IF NUMBER OF LOOPS = NUM_HOMES_PREG, GO TO TIME_STAMP_HCZ_ET.

    • IF NUMBER OF LOOPS < NUM_HOMES_PREG, GO TO HCZ08000 AND BEGIN NEXT LOOP.


HCZ34000/(PDECORATE_ROOM). In which rooms were these smaller projects done?


INTERVIEWER INSTRUCTIONS

  • PROBE: Any others?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

KITCHEN

1


LIVING ROOM

2


HALL/LANDING

3


RESPONDENT’S BEDROOM

4


OTHER BEDROOM

5


BATHROOM/TOILET

6


BASEMENT

7


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children

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

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


PROGRAMMER INSTRUCTIONS

  • IF PDECORATE_ROOM = ANY COMBINATION OF VALUES 1 – 7, AND

    • IF LIVE_ENTIRE_HOME = 1, -1, OR -2, OR IF NUM_HOMES_PREG = 0, GO TO TIME_STAMP_HCZ_ET.

    • IF NUMBER OF LOOPS = NUM_HOMES_PREG, GO TO TIME_STAMP_HCZ_ET.

    • IF NUMBER OF LOOPS < NUM_HOMES_PREG, GO TO HCZ08000 AND BEGIN NEXT LOOP.

  • IF PDECORATE_ROOM = -5, OR ANY COMBINATION OF VALUES 1 – 7 AND -5, GO TO PDECORATE_ROOM_OTH.

  • IF PDECORATE_ROOM = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND 

    • IF LIVE_ENTIRE_HOME = 1, -1, OR -2, OR IF NUM_HOMES_PREG = 0, GO TO TIME_STAMP_HCZ_ET.

    • IF NUMBER OF LOOPS = NUM_HOMES_PREG, GO TO TIME_STAMP_HCZ_ET.

    • IF NUMBER OF LOOPS < NUM_HOMES_PREG, GO TO HCZ08000 AND BEGIN NEXT LOOP.


HCZ35000/(PDECORATE_ROOM_OTH). SPECIFY: ______________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children

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

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


PROGRAMMER INSTRUCTIONS

  • IF LIVE_ENTIRE_HOME = 1, -1, OR -2, OR IF NUM_HOMES_PREG = 0, GO TO TIME_STAMP_HCZ_ET.

  • IF NUMBER OF LOOPS = NUM_HOMES_PREG, GO TO TIME_STAMP_HCZ_ET.

  • IF NUMBER OF LOOPS < NUM_HOMES_PREG, GO TO HCZ08000 AND BEGIN NEXT LOOP.


(TIME_STAMP_HCZ_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



EXPOSURES TO PETS AND PESTICIDE USE


(TIME_STAMP_ETP_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


ETP01000. Now I’d like to ask about any pets you may have had in your home during your pregnancy.


ETP02000/(PETS). Were there any pets that spent any time inside your home during your pregnancy?


Label

Code

Go To

YES

1


NO

2

ETP07000

REFUSED

-1

ETP07000

DON'T KNOW

-2

ETP07000


SOURCE

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


ETP03000/(PET_TYPE). What kind of pets were these?


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

  • SELECT ALL THAT APPLY.


Label

Code

Go To

DOG

1


CAT

2


SMALL MAMMAL, SUCH AS A RABBIT, GERBIL, HAMSTER, GUINEA PIG, FERRET, OR MOUSE

3


BIRD

4


FISH OR REPTILE, SUCH AS A TURTLE, SNAKE, OR LIZARD

5


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


PROGRAMMER INSTRUCTIONS

  • IF PET_TYPE = ANY COMBINATION OF VALUES 1 – 5, THEN GO TO PET_PRODUCT.

  • IF PET_TYPE = -5, OR ANY COMBINATION OF VALUES 1 – 5 AND -5, GO TO PET_TYPE_OTH.

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


ETP04000/(PET_TYPE_OTH ). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children (modified)

Legacy:  National Children’s Study, Legacy Phase (P1, T1 Mother, T3 Prior, 6M, 12M)


ETP05000/(PET_PRODUCT). Were any products ever used on your pets to control fleas, ticks, or mites?  This includes flea collars, flea and tick powders, shampoos, or other flea, tick and mite control products. (This does not include pills given to your pet to control for fleas or other insects.)


Label

Code

Go To

YES

1


NO

2

ETP07000

REFUSED

-1

ETP07000

DON'T KNOW

-2

ETP07000


SOURCE

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


ETP06000/(APPLY_PET_PRODUCT). Did you personally handle or apply any of these products to your pets?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


ETP07000. I would now like to ask about products that may have been used in your home or yard to control for ants, termites, cockroaches, bees, wasps, moths, or other insects.  Please include only applications to homes you were residing in at the time of the application.


ETP08000/(PESTICIDES). During your most recent pregnancy, were any pesticides used inside or outside your home to control for insects?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_ETP_ET

REFUSED

-1

TIME_STAMP_ETP_ET

DON'T KNOW

-2

TIME_STAMP_ETP_ET


SOURCE

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


ETP09000/(PESTICIDE_APPLY_WHERE). Where was the pesticide applied?


Label

Code

Go To

Inside

1


Outside

2


Both inside and outside

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


ETP10000/(PESTICIDE_TYPE). What pests were targeted? 


INTERVIEWER INSTRUCTIONS

  • PROBE Do you remember any of the kinds of pests targeted?

  • PROBE: Were there any specific pests you were worried about?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

Ants

1


Bees

2


Cockroaches

3


Moths

4


Termites

5


Wasps

6


Other

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


PROGRAMMER INSTRUCTIONS

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

  • IF PESTICIDE_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF OTHER RESPONSES AND GO TO PESTICIDE_WHO_APPLY.

  • IF PESTICIDE_TYPE = ANY COMBINATION OF 1 THORUGH 6, GO TO PESTICIDE_WHO_APPLY.


ETP11000/(PESTICIDE_TYPE_OTH). SPECIFY: ___________________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

NEW


ETP12000/(PESTICIDE_WHO_APPLY). Who applied the pesticide? Was it….


Label

Code

Go To

You

1


A professional exterminator

2


Someone else

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

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


(TIME_STAMP_ETP_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*).  Do not return the completed form to this address.

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