WIC Participant

WIC Infant and Toddler Feeding Practices Study-2

App.J.1_Eng.1 Month Participant Interview (revised)

WIC Participant

OMB: 0584-0580

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OMB Approval No. 0584-XXXX

Approval Expires: XX/XX/20XX


APPENDIX J.1

WIC ITFPS-2 Participant Interview

1 Month - ENGLISH


SOCIODEMOGRAPHICS AND BACKGROUND


I’d like to start today by asking you some background questions about your baby and yourself. Let’s start with some questions about your baby.


Child Sex

Enrollment or if recruited prenatal, 1 mo


SD8. Is your baby a boy or a girl? [Source: WIC IFPS-1]

Boy 01

Girl 02

Single or Multiple Birth

Enrollment or if recruited prenatal, 1 mo


SD7. Did you have twins, or more than one baby? [Source: FDA IFPS-2]

Yes 01

No 02

If yes, need to sample one child for study

Child Name

Enrollment or if recruited prenatal, 1 mo


SD9. What is your baby's full name? Please spell that for me. [Source: New Development]

Record full name:


First________________________________________________


Middle______________________________________________


Last ________________________________________________

a. Is there a nickname you use for {CHILD} that you would like me to use while talking with you?

(If yes) Nickname _____________________________________

Infant DOB

Enrollment if postnatal or if recruited prenatal, 1 mo


SD5. {EN: Thinking of the child you enrolled in WIC today,}What month was {EN: this child/ 1 mo: CHILD} born? [Source: WIC IFPS-1]

Month [January – December]


SD6. {EN: Thinking of the child you enrolled in WIC today/ 1 mo: And } what day of the month was {CHILD} born?

Day [1-31]

{Year – autofill for last occurrence of the month}

Don't know 98

Refused 99

Birth Weight
1


HF28. What was {CHILD’S} weight at birth? [Source: WIC IFPS-1]

Pounds [number]

Ounces [0-15]

Gestational Age (birth <37 weeks)

1


HF29. Was {CHILD} born more than 3 weeks before (his/her) due date? [Source: PHFE WIC Postpartum Questionnaire 2010]

Yes 01

No 02

Don’t know 98

HF30. (If yes) How many weeks pregnant were you when {CHILD} was born? [Source: PHFE WIC Postpartum Questionnaire 2010]

Weeks [22-37]

Child Ethnicity

Enrollment or if recruited prenatal, 1 mo


SD10. Is {CHILD} Latino or Hispanic?

Hispanic or Latino 01

Not Hispanic or Latino 02

Don’t know 98

Refused 99

Child Race

Enrollment or if recruited prenatal, 1 mo


SD11. What is {CHILD’S} race? (choose all that apply) [Source: OMB Standard Categories]

American Indian or Alaska Native 01

Asian 02

Black or African American 03

Native Hawaiian or Other Pacific Islander 04

White 05

Other (specify____________________________________) 06

Don't know 98

Refused 99

Respondent still Caregiver?

1, 3, 5, 7, 9, 11, 13, 15, 18, 24


SD12. (1 mo.: Before we go any further/ All other: Before we begin today), I need to ask whether you are still {CHILD's} caregiver. [Source: New Development]

Yes 01

No 02

(If no, go to a)

a. Does {CHILD} still live with you?

Yes 01

No 02

b. (If a is Yes): Can you please tell me who in your household is now {CHILD's} caregiver? Can I speak with that person?

Name of New Caregiver______________________________________________

c. (If a is No): Can you please tell me who is caring for {CHILD} now, and how I could reach that person?

Name of New Caregiver______________________________________________

Phone of New Caregiver______________________________________________

Address of New Caregiver____________________________________________

Relation of New Caregiver to Child_____________________________________

Now I’m going to ask some questions about you.

Continuation/discontinuation of WIC participation (timing, reasons, location)

1, 3, 5, 7, 9, 11, 13, 15, 18, 24


SD31. Are you currently getting WIC food or checks for yourself or {CHILD}? [Source: FDA IFPS-2; modified]

Yes 01

No 02

(if no for the first time go to #SD 34)

SD32. The last time we talked with you, you were going to WIC at [fill in location]. Do you still go there, or do you go to a new location? [Source: FDA IFPS-2 modified]

Yes, still that location 01

No, new location 02

SD33. (If SD32 is no) Please tell me where you go now

Record location _______________________________________

Ask SD34 and SD35 only if SD31 is 'no'

SD34. How old was {CHILD} when you stopped going to WIC? [Source: LA WIC Survey; modified]

Age [weeks/months]

SD35. I'm going to read some reasons why you might have stopped going to WIC. Please tell me if each one is a reason you stopped going to WIC: [Source: LA WIC Survey; modified]

You no longer qualify for WIC 01

It was inconvenient for you 02

You no longer need WIC 03

Other reason (record response) 04

Employment status during pregnancy

1


SD28. Some women work for pay during pregnancy and some do not. How many months did you work for pay while you were pregnant with {CHILD}? [Source: New Development]

Months [0 to 9]

HOSPITAL EXPERIENCES AND FEEDING PRACTICES


Next I’d like to ask you some questions about your experience in the hospital when {CHILD} was born.


NICU Feeding Module

1, *3 for last question


HF1. Did {CHILD} spend any time in the NICU (If needed: The NICU is the Neonatal Intensive Care Unit, a special hospital unit for newborn babies who are premature or who have special medical problems)?[Source: New Development]

Yes 01

No (if no, skip to HF7) 02

HF2. (If yes) What was the reason? [Source: New Development]

Premature delivery 01

Other health problem (specify ______________________) 02

HF3. How long was she/he in the NICU? [Source: New Development]

Time [days/weeks]

Still there 96

HF4. While she/he was in the NICU, did you feed him/her breastmilk directly from your breast, pump breastmilk for him/her, both feed from your breast and pump, or did you not feed your baby breastmilk at all? (If still there, change to present tense - are you feeding him/her directly from your breast, pumping breastmilk for him/her, both feeding from your breast and pumping, or are you not feeding your baby breastmilk?) [Source: New Development]

Feeding directly from breast 01

Pumping breastmilk 02

Both from breast and pumping 03

Not feeding breastmilk 04

Mode of delivery

1


HF7. How was your baby delivered? [Source: FDA Project First]

vaginally and not induced 01

vaginally and induced 02

a planned caesarean/c-section 03

an unplanned or emergency caesarean/c-section 04

Rooming arrangement in hospital

1


HF8. While you were in the hospital, did {CHILD} stay in the same room with you, or in a nursery? Do not include time your child was out of your room briefly for things such as medical procedures, bathing, or weighing. [Source: WIC IFPS-1; modified]

Only in my room 01

Only in the nursery 02

Both 03

In NICU, never in my room or in the nursery 04

In NICU, then nursery 05

In NICU, then my room 06

In NICU, then both my room and the nursery 07

First Feeding/Initiation of breastfeeding

1


HF9. What was the very first thing that {CHILD} was fed after birth? Was it formula, your breastmilk, sugar water, plain water, or something else? [Source: WIC IFPS-1]

Formula 01

Breastmilk 02

Sugar water 03

Plain water 04

Other 05

Don’t know 98

If baby was in NICU and mother indicated in HF4 she was feeding breast milk, skip to HF11

HF10. (If first thing fed was other than breastmilk) Did you start to breastfeed your baby while still in the hospital? [Source: New Development]

Yes 01

No 02

HF11. (If first fed was breastmilk or started breastfeeding in hospital) Did you start breastfeeding in the first hour after birth or later? [Source: WIC IFPS-1; modified]

First hour 01

Later 02

Don’t remember 98

Initial bf problems/barriers to initiating bf.

1


HF12. (If started to breastfeed in hospital) Did you have any problems with breastfeeding while you were in the hospital? [Source: WIC IFPS-1]

Yes 01

No 02

If no to HF12, skip toHF18

HF13. Did you have problems with your breasts being so full that milk wouldn’t come out or your baby had trouble latching on? [Source: WIC IFPS-1]

Yes 01

No 02

HF14. Did you have problems with breast or nipple pain? [Source: WIC IFPS-1, modified]

Yes 01

No 02

HF15. Did you have problems with thinking the baby was not getting enough milk? [Source: WIC IFPS-1]

Yes 01

No 02

HF16. Did you have problems with it taking too long for your milk to come in? [Source: WIC IFPS-1]

Yes 01

No 02

HF17. Did any of the people working at the hospital assist you with any of these problems? [Source: WIC IFPS-1]

Yes 01

No 02

Receipt of gift package from hospital? Contents?

1


HF18. When you left the hospital, were you given a gift pack? [Source: WIC IFPS-1]

Yes 01

No 02

HF19. (If yes) Which of the following things were in the gift pack? [Source: WIC IFPS-1, modified]

a. Formula

Yes 01

No 02

b. Coupons for formula or discounts on formula

Yes 01

No 02

c. A pacifier

Yes 01

No 02

d. An empty bottle

Yes 01

No 02

Breastfeeding on set schedule or on demand?

1

Ask only if breastfeeding in the hospital

HF20. While you were in the hospital, did you feed your baby breastmilk, either from your breast or from a bottle, on a set schedule or whenever [HE/SHE] cried or seemed hungry? [Source: WIC IFPS -1]

Schedule 01

Cried or seemed hungry 02

Both on a schedule and when baby cried or seemed hungry 03

Pump breasts in hospital

1


HF21. While you were in the hospital, did you pump milk or try to pump milk from your breasts? [Source: WIC IFPS-1]

Yes 01

No 02

Encouragement of bf in hospital

1


HF22. While you were in the hospital, did your doctor, the nurses or other hospital staff encourage you to breastfeed your baby? [Source: New Development]

Yes 01

No 02

Availability of bf support in hospital

1


HF23. Was there someone in the hospital whose job it was to help you with breastfeeding, like a lactation consultant or another trained specialist? [Source: WIC IFPS-1; modified]

Yes 01

No 02

Don’t know 98

Breastfeeding-related hospital support services used
1


HF24. While you were in the hospital, did you use any of the following support services, information, or equipment for breastfeeding? [Source: New Development]

a. Did you use brochures, pamphlets, or TV classes

Yes 01

No 02

b. Did you use a lactation consultant

Yes 01

No 02

c. Did you use another trained specialist who helped with breastfeeding

Yes 01

No 02

d. While you were in the hospital did you use breastfeeding support groups or classes

Yes 01

No 02

e. Did you use equipment for breastfeeding support such as pumps, breast shields, or other equipment

Yes 01

No 02

f. Did you use counseling that you asked for

Yes 01

No 02

g. Did you use counseling offered when you hadn’t asked

Yes 01

No 02

h. Did you use a hotline or number in the hospital to call for breastfeeding questions

Yes 01

No 02

i. Did you use the name and number of a specific hospital staff member to call for questions

Yes 01

No 02

j While you were in the hospital did you use any other services, information, or equipment not mentioned

Yes (specify ____________________________) 01

No 02

Feeding type at hospital discharge (human milk, formula, both)

1


HF25. When you left the hospital, were you feeding your baby only breastmilk, only formula, or both breastmilk and formula? [Source: WIC IFPS-1]

only breastmilk 01

only formula 02

both breastmilk and formula 03

Length of hospital stay for mother

1


HF26. How many nights did you stay in the hospital after {CHILD’s} birth? [Source: FDA Project First; modified]

Nights [number]

Length of hospital stay for infant

1


HF27. How many nights did {CHILD} stay in the hospital after birth? [Source: FDA Project First; modified]

Nights [number]

Don’t remember 98

CURRENT FEEDING PRACTICES


AMPM Module (Asking child’s food intake in past 24 hours)


24-HR Recall for Food Intake

1, 3, 5, 7, 9, 11, 13, 15, 18, 24


Nutrition intake

Number of breastmilk/formula feedings per day

Type of formula used

Adherence to formula dilution instructions

Use/timing of supplemental formula for breastfeeding mothers

Addition of anything other than human milk/formula to child’s bottle

Specific food item intake

Use of jarred baby foods

Meal and snack pattern

Eating locations (eating on the go)

Use of dietary supplements for infants (direct administration)


Now I’m going to ask you some questions about things you might be doing to feed your baby.

Current feeding choice

1, 3, 5, 7, 9, 11, 13


CF1. Are you currently feeding {CHILD} breastmilk either from your breast or from a bottle, formula, (1-5 months: or both) (7-13 months: both, or neither)? [Source: New Development]

Only breastmilk 01

Only formula 02

Both breastmilk and formula 03

Neither breastmilk nor formula 04


First postnatal interview (1 or 3), if mother indicates formula feeding only in CF1, and if 1 month answered no to HF10 breastfeeding initiated in hospital, ask:

CF29. Did you ever feed your baby breastmilk, either from your breast or from a bottle? [Source: FDA IFPS-2, modified]

Yes 01

No 02


IF CF1 = 02, SKIP TO CF19

Breastfeeding Module (Asked only if mother currently feeding breastmilk, based on CF1)

Questions CF2 – CF18

Frequency and nature of breastfeeding problems

Resolution of breastfeeding problems

1, 3, 5

You said that you are currently feeding {CHILD} breastmilk. I’d like to ask you some questions about that now.

CF2. I would like to ask you about some of the problems you might have had with breastfeeding during the past month. During the past month, have you had any of the following problems:

Ask items (a/b) only at 1 month, then drop at 3 and 5.

a. In the past month, did your baby have trouble latching on?

Yes 01

No 02

b. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)

Turned to someone for advice 01

Bottle fed baby with formula 02

Pumped breastmilk to be fed to baby with bottle 03

Nothing, just continued breastfeeding 04

Other (specify ____________________________________) 05

Ask at 1, 3, 5

c. In the past month did your baby have problems with choking?

Yes 01

No 02

d. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)

Turned to someone for advice 01

Bottle fed baby with formula 02

Pumped breastmilk to be fed to baby with bottle 03

Nothing, just continued breastfeeding 04

Other (specify ____________________________________) 05

e. In the past month did you have sore or cracked nipples?

Yes 01

No 02

f. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)

Turned to someone for advice 01

Took medications or used creams 02

Bottle fed baby with formula 03

Pumped breastmilk to be fed to baby with bottle 04

Nothing, just continued breastfeeding 05

Other (specify ____________________________________) 06

g. In the past month did you have a breast infection?

Yes 01

No 02

h. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)

Turned to someone for advice 01

Took medications or used creams 02

Bottle fed baby with formula 03

Pumped breastmilk to be fed to baby with bottle 04

Nothing, just continued breastfeeding 05

Other (specify ____________________________________) 06

i. In the past month were your breasts too full?

Yes 01

No 02

j. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)

Turned to someone for advice 01

Bottle fed baby with formula 02

Pumped breastmilk to be fed to baby with bottle 03

Pumped or expressed breastmilk to relieve fullness 04

Nothing, just continued breastfeeding 05

Other (specify ____________________________________) 06

k. In the past month did you not have enough milk to satisfy the baby?

Yes 01

No 02

l. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)

Turned to someone for advice 01

Changed what I ate 02

Bottle fed baby with formula 03

Pumped breastmilk to be fed to baby with bottle 04

Nothing 05

Other (specify ____________________________________) 06

m. In the past month did you have any other problems breastfeeding? (specify___________________________________)

Yes 01

No 02

n. (If yes) What did you do about this problem? (Interviewer allow open-ended and check all responses offered)

Turned to someone for advice 01

Took antibiotics/medications 02

Bottle fed baby with formula 03

Pumped breastmilk to be fed to baby with bottle 04

Nothing, just continued breastfeeding 05

Other (specify ____________________________________) 06

Support received for breastfeeding problem

1, 3, 5


CF3. (If yes to any problem in CF2) When you have encountered problems with breastfeeding have any of the following people given you advice about what to do? [Source: IFPS-1, modified]

a. People who work at your WIC office or clinic

Yes 01

No 02

b. Doctors or nurses

Yes 01

No 02

c. Friends or relatives

Yes 01

No 02

d. Breastfeeding support people outside of WIC such as La Leche League or a lactation counselor

Yes 01

No 02

e. Anyone else?

Yes 01

No 02

Frequency and nature of breastfeeding barriers

Best solutions to identified barriers

1, 3, 5


CF4. I’m going to read you some statements about things that might make it hard to breastfeed or keep you from breastfeeding. For each one, please tell me if this has happened to you in the past month: [FDA IFPS-2, modified]

a. I had to return to work or school and I could not or did not want to pump or breastfeed there. Did this happen to you in the past month?

Yes 01

No 02

b. Breastfeeding took too much out of me. Did this happen to you in the past month?

Yes 01

No 02

c. I did not have time to breastfeed. Did this happen to you in the past month?

Yes 01

No 02

d. I felt tied down by breastfeeding. Did this happen to you in the past month?

Yes 01

No 02

e. My husband or boyfriend was against it. Did this happen to you in the past month?

Yes 01

No 02

CF5. (If yes to any barriers in CF4) What do you think is the best way to deal with this/these things that made it hard to breastfeed? (Interviewer allow open-ended and check all responses offered) [Source: New Development]

Seek support from a friend or relative to help you

to continue breastfeeding 01

Seek support from a health professional to help you

to continue breastfeeding 02

Make arrangements with work or school to continue

breastfeeding or pumping during the day 03

Stop breastfeeding and switch to formula feeding 04

Mix breastfeeding with formula feeding 05

Nothing, just continue breastfeeding 06

Other (specify_____________________________) 07

Use of breast pump

1, 3, 5, 7, 9, 11, 13


CF6. Some mothers are able to pump breastmilk and others are not. Are you currently pumping breastmilk?

Interviewer: code yes if mother is pumping at all, even if infrequently.

Yes 01

No 02

Refused 99

If CF6 is NO, skip to CF18

From where mom received pump

1, 3 (ask at 1 month, or at 3 if mother indicates pumping for the first time at 3 months)


Ask only if currently pumping breastmilk in CF6



CF7. What are you using most often to pump breastmilk, is it an electric pump, a manual pump, pumping by hand, or something else? [Source: New Development]

An electric pump 01

A manual pump 02

Pumping by hand 03

Other 04

CF10. (Do not ask if CF7 pumping by hand) How did you get the breast pump that you use most often? (Interviewer read options)[Source: FDA IFPS-2, modified]

WIC loaned it to you or paid for it 01

You bought it or rented it 02

You borrowed it from a friend or relative 03

It was given to you as a gift 04

You use one provided by a hospital,

your place of work, or someplace else 05

Time of day of pumping

1, 3, 5, 7, 9, 11, 13


Ask only if currently pumping breastmilk in CF6



CF12. Now I’d like to ask you about the times of day when you usually pump. [Source: New Development]

a. When you pump, how often do you pump in the morning, before noon? Would you say usually, sometimes, or never?

Usually 01

Sometimes 02

Never 03

Don’t know 98

Refused 99

b. When you pump, how often do you pump mid-day, from noon to 5pm? Would you say usually, sometimes, or never?

Usually 01

Sometimes 02

Never 03

Don’t know 98

Refused 99

c. When you pump, how often to you pump in the evening or night time, after 5pm? Would you say usually, sometimes, or never?

Usually 01

Sometimes 02

Never 03

Don’t know 98

Refused 99

Frequency of pumping

1, 3, 5, 7, 9, 11, 13


Ask only if currently pumping breastmilk in CF6



CF11. Thinking about the past two weeks, how many times did you pump milk? (Interviewer allow open-ended, calculate numbers for response if needed, and confirm with respondent)[Source: FDA IFPS-2, modified]

Times pumped [times]



Amount of milk pumped

1


Ask only if currently pumping breastmilk in CF6



CF13. During the past 24 hours, about how many ounces of breastmilk did you pump, that is since (time) yesterday? ([Prompt:] Your best estimate or guess is fine. Think about the bottle or bottles you filled with pumped breastmilk and about the size of the bottles.) [Source: New Development]

Interviewer note: If the mother didn’t pump in the past 24 hours, enter 0.

Ounces [number]

What mom did with pumped milk

1


Ask only if currently pumping breastmilk in CF6


If CF13 = 0, skip to CF15.

CF14. What did you do with the breastmilk that you pumped in the past 24 hours? Did you… [Source: New Development]

a. Feed any of it to {CHILD} immediately

Yes 01

No 02

b. Store any of it for later use

Yes 01

No 02

c. Throw any of it away

Yes 01

No 02

Reasons for pumping

1, 3, 5, 7


Ask only if currently pumping breastmilk in CF6



CF15. I’m going to read you some reasons why you might have pumped breastmilk in the past month. For each one, tell me if this was a reason you pumped breastmilk. (CATI to randomize order of sub-items) [Source: FDA IFPS-2, modified]

a. To relieve engorgement or swelling

Yes 01

No 02

b. To keep your milk supply up when your baby could not nurse, such as while you were away from your baby or when your baby was too sick to nurse

Yes 01

No 02

c. To mix with cereal or other food

Yes 01

No 02

d. To increase your milk supply

Yes 01

No 02

e. To have an emergency supply of milk

Yes 01

No 02

f. To get milk so that someone else can feed your baby

Yes 01

No 02

g. Any other reason you have pumped breastmilk in the past month?

Yes (specify_________________________________) 01

No 02

Storage practices for pumped/expressed human milk

1, 3, 5, 7, 9, 11, 13


Ask only if currently pumping breastmilk in CF6



CF16. In the last month, how long was your pumped milk usually stored in the refrigerator? [Source: FDA IFPS-2, modified]

I do not store milk in a refrigerator 01

1 day or less 02

2 to 3 days 03

4 to 5 days 04

6 to 8 days 05

More than 8 days 06


CF17. How long is your frozen milk usually stored? [Source: FDA IFPS-2]

Only include 4 months or more after the 5 month interview

I do not freeze my milk 01

Less than 1 week 02

1 to 4 weeks 03

1 to 3 months 04

4 months or more 05

How is breastmilk feeding schedule determined (time schedule, child seems hungry, mixed)

1, 3, 5, 7, 9, 11, 13


CF18. Do you breastfeed or feed {CHILD} breastmilk from a bottle on a regular schedule, or when [HE/SHE] cries or seems hungry? [Source: IFPS-1, modified]

Schedule 01

Cries or seems hungry 02

Both on a schedule and when baby cries or seems hungry 03


IF CF1 = 01 SKIP TO CF52

Formula Feeding Module (Asked only if mother currently formula feeding)

Questions CF19 – CF27

Who provided formula

1, 3, 5, 7, 9, 11, 13

You said that you are currently feeding {CHILD} formula. I’d like to ask you some questions about that.

CF19. Where do you get the formula that you use to feed {CHILD}? Do you get it from WIC, from somewhere else, or both WIC and somewhere else? [Source: New Development]

WIC 01

Somewhere else 02

Both WIC and somewhere else 03


If CF19 = 02, skip to CF21.

CF20. (If indicated in CF19 getting formula from WIC) Is the amount of formula that you get from WIC to help feed {CHILD} more than you usually need, less than you usually need, or about right? [Source: PHFE WIC Survey 2010, modified]

More 01

Less 02

About right 03

Don’t know 98

Refused 99



Reasons for formula use

1, 3, 5, 7, 9, 11, 13 (ask for the last time at the interview where mom indicates she has completely stopped breastfeeding)


CF21. There are many reasons for using formula. Please tell me if any of the following are reasons why you feed your baby formula? [Source: FDA IFPS-2, modified]

If not currently breastfeeding at all (CF1) and never tried to breastfeed (HF10, CF29), skip to h.


Ask (a) only in months 1, 3, 5

a. My baby had trouble sucking or latching on to the breast

Yes 01

No 02

b. My baby lost interest in nursing or began to stop nursing by him or herself

Yes 01

No 02

c. Breastmilk alone did not satisfy my baby

Yes 01

No 02

d. I thought that my baby was not gaining enough weight

Yes 01

No 02

e. I didn’t have enough breastmilk

Yes 01

No 02

f. Breastfeeding was too painful

Yes 01

No 02

g. I wanted my baby to have both formula and breastmilk.

Yes 01

No 02

Ask h-n if mother is either exclusively formula feeding or feeding both breastmilk and formula

h. I chose not to breastfeed

Yes 01

No 02

i. My baby was sick and could not breastfeed

Yes 01

No 02

j. I was sick or had to take medicine

Yes 01

No 02

k. Breastfeeding seemed too inconvenient

Yes 01

No 02

l. I could not or did not want to pump

Yes 01

No 02

m. I wanted or needed someone else to feed my baby

Yes 01

No 02

n. For another reason

Yes (specify______________________________________) 01

No 02

If not adhering to formula dilution instructions, why? Prescribed by Dr., nutritionist?

1, 3, 5, 7, 9, 11, 13


CF22. In the past month, did you ever mix the formula with extra water to make it last longer? [Source: IFPS-1]

Yes 01

No 02

If CF22 = NO, skip to CF24.

CF23. (If yes to CF22) Who told you to prepare the formula this way? [Source: New Development]

Doctor 01

Someone who works at the WIC office or clinic 02

Another health care provider 03

Friend 04

Family member 05

Other 06

No one told me 07

CF24. In the past month, did you ever mix the formula with less water than directed in order to concentrate it or make it stronger? [Source: IFPS-1, modified]

Yes 01

No 02

Not applicable – use ready-to-feed 03

If CF24 = NO, skip to CF27.

CF25. (If yes to CF24) Who told you to prepare the formula this way? [Source: New Development]

Doctor 01

Someone who works at the WIC office or clinic 02

Another health care provider 03

Friend 04

Family member 05

Other 06

No one told me 07

How is formula feeding schedule determined (set, on demand, mixed)

1, 3, 5, 7, 9, 11, 13


CF27. Do you feed {CHILD} formula on a regular schedule or when [HE/SHE] cries or seems hungry? [Source: IFPS-1]

Schedule 01

Cries or seems hungry 02

Both on a schedule and when baby cries or seems hungry 03

Move to Partial Breastfeeding

Timing of move to partial breastfeeding

(any time 1-13)


Ask of all women who indicated fully BF in CF1. Once answered affirmatively, drop from subsequent interviews.

CF52. Has {CHILD} ever been fed infant formula, even just one time? Do not count while you were in the hospital after {CHILD’s} birth.

Yes 01 (go to CF53)

No 02 (go to CF32)

Don’t know 03

Refused 04


Ask of fully BF women who answered yes to CF52, partially BF women (based on CF1), and fully formula feeding women (based in CF1) who indicated that they ever breastfed in CF29 or HF10. Ask once, first time formula feeding indicated in CF1 or CF52, then drop from subsequent interviews.

CF53. How old was {CHILD} the first time he/she was fed infant formula? Do not count while you were in the hospital after {CHILD’S} birth.

Age [days/weeks/months]

Don’t know 98

Refused 99


Asked of all partially BF women and all fully formula feeding women who ever breastfed based on CF29 or HF10. Ask until an age, don’t know, or refused is given in response, then drop from subsequent interviews.

CF28. How old was {CHILD} when (he/she) was first fed formula every day? [Source: FITS 2002, modified]

Age [days/weeks/months]

Child is not fed formula every day 97

Don’t Know 98

Refused 99

Breastfeeding Cessation Module: (asked once first time mother indicates not currently feeding breastmilk in CF1)

Questions CF30 – CF31

Timing of cessation of breastfeeding

(any time 1-13)


Ask at first interview when mother says she is not feeding breastmilk, if she indicated feeding breastmilk in CF1 on previous interviews or if she answered ‘yes’ to ever breastfed or tried to breastfeed in CF29

CF30. How old was {CHILD} when you completely stopped breastfeeding or feeding [HIM/HER] breastmilk from a bottle? [Source: IFPS-1, modified]

Age [days/weeks/months]

Reasons for cessation of breastfeeding

(any time 1-13)


CF31. There are many reasons mothers stop breastfeeding. Please tell me if any of the following reasons helped you to decide to stop breastfeeding {CHILD}? [Source: FDA IFPS-2, modified]

Do not ask (a) if interview is 5 months or later

a. My baby had trouble sucking or latching on

Yes 01

No 02

b. My baby began to bite

Yes 01

No 02

c. My baby lost interest in nursing or began to stop nursing by him or herself

Yes 01

No 02

d. Breastmilk alone did not satisfy my baby

Yes 01

No 02

e. I thought that my baby was not gaining enough weight

Yes 01

No 02

f. I didn’t have enough milk

Yes 01

No 02

g. Breastfeeding was too painful

Yes 01

No 02

h. I was sick or had to take medicine

Yes 01

No 02

i. Breastfeeding was too inconvenient

Yes 01

No 02

j. I wanted or needed someone else to feed my baby

Yes 01

No 02

k. I did not want to breastfeed in public

Yes 01

No 02

l. Another reason (specify ________________________________)

Yes 01

No 02

Supplemental Foods Initiation (asked all interviews 1-24 until all endorsed)

Fed other than breastmilk or formula

1, 3, 5, 7, 9, 11, 13, 15, 18, 24



Ask CF32 at every interview until mother answers yes, then drop from later interviews and go straight to CF33.

CF32. Has {CHILD} been given anything to eat or drink besides formula or breastmilk? [Source: WIC IFPS-1, modified]

Yes 01

No 02

Were foods other than breastmilk or formula fed by bottle? If so, why?

1, 3, 5, 7


CF36. Now I’m going to ask you some questions about things you might have added to your baby’s bottle of infant formula or pumped breastmilk.: [Source: FDA IFPS-2, modified; New Development for reasons]

a In the past two weeks, how often have you added baby cereal to your baby’s bottle?

Every feeding 01

At most feedings 02

About once a day 03

Every few days 04

Rarely 05

Never 06

b. (If anything other than never) Why did you add baby cereal to your baby’s bottle?

To make him/her full 01

To make him/her drink more milk 02

To give him/her a special treat 03

As a remedy 04

A doctor or other health professional told me to 05

A friend or relative told me to 06

Other 07

c. In the past two weeks, how often have you added sweetener to your baby’s bottle?

Every feeding 01

At most feedings 02

About once a day 03

Every few days 04

Rarely 05

Never 06

d. (If anything other than never) Why did you add sweetener to your baby’s bottle?

To make him/her full 01

To make him/her drink more milk 02

To give him/her a special treat 03

As a remedy 04

A doctor or other health professional told me to 05

A friend or relative told me to 06

Other 07

e. Have you added anything else?(Specify OTHER)_____________________) In the past two weeks, how often have you added [OTHER] to your baby’s bottle?

Every feeding 01

At most feedings 02

About once a day 03

Every few days 04

Rarely 05

Never 06

f. (If anything other than never) Why did you add [OTHER] to your baby’s bottle?

To make him/her full 01

To make him/her drink more milk 02

To give him/her a special treat 03

As a remedy 04

A doctor or other health professional told me to 05

A friend or relative told me to 06

Other 07

If CF32 = NO, skip to MH3.

Time to introduction of supplemental foods

1, 3, 5, 7, 9, 11, 13, 15, 18, 24

Only ask CF33 if CF32 = YES

Next I’m going to ask you some questions about when you first started feeding {CHILD} different types of foods.

Ask each food until answer is affirmative, then stop asking that food in subsequent interviews

CF33. For each of the following, please tell me if {CHILD} has been given this food or drink, and if so, how old {CHILD} was when he/she first had that food. [Sources: FITS 2008; IFPS-1; WHO Toolkit 1996]

a. Has [HE/SHE] been given plain bottled or tap water?

Yes 01

No 02

b. (If yes) How old was {CHILD} when [HE/SHE] was first fed plain bottled or tap water?

Age [weeks/months]

Don’t know 98

Refused 99

c. Has [HE/SHE] been given soda or soft drinks?

Yes 01

No 02

d. (If yes) How old was {CHILD} when [HE/SHE] was first fed soda or soft drinks?

Age [weeks/months]

Don’t know 98

Refused 99

e. Has [HE/SHE] been given other sweetened beverages (such as Kool Aid, Hi-C, Fruit Punch, sweetened juice, sweetened or flavored water, Gatorade, or sweet tea)?

Yes 01

No 02

f. (If yes) How old was {CHILD} when [HE/SHE] was first fed other sweetened beverages?

Age [weeks/months]

Don’t know 98

Refused 99

g. Has [HE/SHE] been given 100% fruit juice such as apple juice, orange juice, or other types of 100% juice. Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to?

Yes 01

No 02

h. (If yes) How old was {CHILD} when [HE/SHE] was first fed 100% fruit juice?

Age [weeks/months]

Don’t know 98

Refused 99

i. Has [HE/SHE] been given other drinks and liquids, including teas and broths?

Yes 01

No 02

j. (If yes) How old was {CHILD} when [HE/SHE] was first fed Other drinks and liquids, including teas and broths?

Age [weeks/months]

Don’t know 98

Refused 99

k. Has [HE/SHE] been given Cow’s milk, including whole milk, 2%, 1%, or skim? Please include milk you add to other foods such as cereal.

Yes 01

No 02

l. (If yes) How old was {CHILD} when [HE/SHE] was first fed cow’s milk?

Age [weeks/months]

Don’t know 98

Refused 99

m. Has [HE/SHE] been given dairy products other than cow’s milk including cheese, yogurt, or goat’s milk? Please include any dairy products other than cow’s milk that you add to other foods.

Yes 01

No 02

n. (If yes) How old was {CHILD} when [HE/SHE] was first fed dairy products other than cow’s milk?

Age [weeks/months]

Don’t know 98

Refused 99

o. Has [HE/SHE] been given baby cereal, either with a spoon or by adding it to a bottle of breastmilk or formula?

Yes 01

No 02

p. (If yes) How old was {CHILD} when [HE/SHE] was first fed baby cereal?

Age [weeks/months]

Don’t know 98

Refused 99

q. Has [HE/SHE] been given other cereal besides baby cereal?

Yes 01

No 02

r. (If yes) How old was {CHILD} when [HE/SHE] was first fed other cereal besides baby cereal?

Age [weeks/months]

Don’t know 98

Refused 99

s. Has [HE/SHE] been given eggs?

Yes 01

No 02

t. (If yes) How old was {CHILD} when [HE/SHE] was first fed eggs?

Age [weeks/months]

Don’t know 98

Refused 99

u. Has [HE/SHE] been given fruit, including baby food or regular fruit?

Yes 01

No 02

v. (If yes) How old was {CHILD} when [HE/SHE] was first fed fruit?

Age [weeks/months]

Don’t know 98

Refused 99

w. Has [HE/SHE] been given vegetables, including baby food or regular vegetables?

Yes 01

No 02

x. (If yes) How old was {CHILD} when [HE/SHE] was first fed vegetables?

Age [weeks/months]

Don’t know 98

Refused 99

y. Has [HE/SHE] been given beans, such as black beans, pinto beans, or chick peas?

Yes 01

No 02

z. (If yes) How old was {CHILD} when [HE/SHE] was first fed beans?

Age [weeks/months]

Don’t know 98

Refused 99

aa. Has [HE/SHE] been given peanut butter

Yes 01

No 02

bb. (If yes) How old was {CHILD} when [HE/SHE] was first fed peanut butter?

Age [weeks/months]

Don’t know 98

Refused 99

cc. Has [HE/SHE] been given meats,, chicken, or fish, including baby food and baby food combination dinners containing these foods?

Yes 01

No 02

dd. (If yes) How old was {CHILD} when [HE/SHE] was first fed meat, chicken, or fish?

Age [weeks/months]

Don’t know 98

Refused 99

ee. Has [HE/SHE] been given salty snacks, such as chips, pretzels, crackers, or other snack foods including baby snacks?

Yes 01

No 02

ff. (If yes) How old was {CHILD} when [HE/SHE] was first fed salty snacks?

Age [weeks/months]

Don’t know 98

Refused 99

gg. Has [HE/SHE] been given sweets, such as cake, cookies, candy, or jam

Yes 01

No 02

hh. (If yes) How old was {CHILD} when [HE/SHE] was first fed sweets?

Age [weeks/months]

Don’t know 98

Refused 99

MATERNAL HEALTH AND LIFESTYLE


Next I’m going to ask you some questions about your health.


Pregnancy weight gain

1


MH3. At the end of your pregnancy and right before you delivered {CHILD}, about how much did you weigh, without shoes? [Source: PHFE WIC Postpartum Questionnaire 2010]

Weight [pounds]

a. Based on what you told us before, this means that you gained about [CATI calculates difference between pre-pregnancy weight (MH2 from screening) and post-pregnancy weight (MH3)] during your pregnancy with {CHILD}. Is that about right?

Yes 01

No (ask for correction to weights) 02

Maternal weight

1, 3, 13, 24


MH13. Right now, about how much do you weigh, without shoes? [Source: PHFE WIC Postpartum Questionnaire 2010]

Pounds [number]

Health problems during pregnancy

1


MH4. Did you have any of the following health problems during your pregnancy? [Source: WIC IFPS-1]

a. Diabetes, which is high sugar

Yes 01

No 02

Don’t know 98

Refused 99

b. High blood pressure while you were pregnant

Yes 01

No 02

Don’t know 98

Refused 99

c. Swelling at the wrists or ankles while you were pregnant

Yes 01

No 02

Don’t know 98

Refused 99

Actions taken to rectify maternal health problems

1 (put this before the hospitalization question)


MH6. (If yes to any of the health problems in MH4) Did you get treatment from your doctor for your pregnancy health problems? [Source: New Development]

Yes 01

No 02

Don’t know 98

Refused 99

Health problems during pregnancy

1


MH5. Did you have any problems during your pregnancy that required you to stay in the hospital overnight before the time you went in and had your baby? [Source: WIC IFPS-1. modified]

Yes 01

No 02

Don’t know 98

Refused 99

a. (If yes), How many total nights were you in the hospital?

Nights [number]


b. (If > 1 night) Was this during a single hospital stay or at different times during your pregnancy?

Single stay 01

Different times 02

Don’t know 98

Refused 99

Prenatal care receipt

1


MH10. Where did you go for prenatal medical care - a private obstetrician, a private other doctor, a public clinic, a midwife, or somewhere else? [Source: WIC IFPS-1; modified]

Private obstetrician 01

Private other doctor 02

Public clinic 03

Midwife 04

Other 05

Timing of first prenatal OB visit

1


MH11. When you had your first visit for prenatal care with a doctor or healthcare provider, how many weeks or months pregnant were you? [Source: PHFE WIC Postpartum Questionnaire 2010]

Weeks [1-40]

Or Months [1-9]

Health care coverage during pregnancy

1


MH12. During your pregnancy with {CHILD}, were you covered by health insurance or any other kind of health care plan? (if necessary, say:) This includes health insurance obtained through your or a spouse’s employer, a plan you bought independently, or one you got through a plan provided by the government? [Source: PHFE WIC Postpartum Questionnaire 2010]

Yes 01

No 02

Don’t know 98

Refused 99

Maternal physical health post-birth

1


MH14. How would you rate your own overall health today? [Source: Medical Outcomes Study]

Excellent 01

Good 02

Fair 03

Poor 04

Actions taken to rectify any maternal health conditions

1


MH15. (If answer to MH14 is Fair or Poor) What, if anything, are you doing to take care of health problems? (Interviewer: ask open-ended, select all that apply) [Source: New Development]

Going to doctor 01

Dieting 02

Exercising 03

Taking medications 04

Nothing 05

Other (specify _____________________________________) 06

EXPERIENCE, KNOWLEDGE, ADVICE, BELIEFS


Next I’m going to ask you some questions about decisions you’ve made and advice you’ve gotten about how to feed your baby.


How long intend to breastfeed

1


KA20. (If still exclusively breastfeeding at 1 month from CF1) How old do you think your baby will be when you feed him or her something other than breastmilk? [Source: WIC IFPS-1]

Age [weeks/months/years]

KA21. (If still doing any breastfeeding at 1 month from CF1): How old do you think your baby will be when you completely stop giving him or her breastmilk? [Source: WIC IFPS-1]

Age [weeks/months/years]

Influences on decision to breastfeed or formula feed

Prenatal, 1


1 Month Question:


Now I’m going to ask you about talks you might have had with different people about the way you feed your baby.


KA23. Have you talked with any of the following people about the ways you are currently feeding your baby, such as breastfeeding, formula feeding, or feeding solid foods? [Source:WIC IFPS-1, modified]

a. Your husband or boyfriend?

Yes 01

No 02

Don’t know 98

Not applicable 99

(If yes) How important was this talk with your husband/boyfriend in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?

Very important 01

Somewhat important 02

Not important 03

b. Your mother?

Yes 01

No 02

Don’t know 98

Not applicable 99

(If yes) How important was this talk with your mother in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?

Very important 01

Somewhat important 02

Not important 03

c. Other relatives?

Yes 01

No 02

Don’t know 98

Not applicable 99

(If yes) How important was this talk with your relatives in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?

Very important 01

Somewhat important 02

Not important 03

d. Friends?

Yes 01

No 02

Don’t know 98

Not applicable 99

(If yes) How important was this talk with your friends in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?

Very important 01

Somewhat important 02

Not important 03

e. People who work at your WIC office or clinic?

Yes 01

No 02

Don’t know 98

Not applicable 99

(If yes) How important was this talk with people who work at your WIC office or clinic in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?

Very important 01

Somewhat important 02

Not important 03

f. Your child’s doctor or another health professional?

Yes 01

No 02

Don’t know 98

Not applicable 99

(If yes) How important was this talk with your child’s doctor or another health professional in helping you decide how to feed your baby? Would you say that it was very important, somewhat important, or not important?

Very important 01

Somewhat important 02

Not important 03

Receipt of advice about breastfeeding

1


KA31. Mothers often get advice from family about breastfeeding. I’m going to ask you some questions about advice you might have gotten. [Source: New Development]

a. Has your husband or boyfriend encouraged you to breastfeed {CHILD}, discouraged you from breastfeeding {CHILD}, given mixed advice, or has he not given you advice about this?

Encourage 01

Discourage 02

Mixed advice 03

No advice 04

Not applicable 97

b. Has your mother encouraged you to breastfeed {CHILD}, discouraged you from breastfeeding {CHILD}, given mixed advice, or has she not given you advice about this ?

Encourage 01

Discourage 02

Mixed advice 03

No advice 04

Not applicable 97

c. Have other relatives encouraged you to breastfeed {CHILD}, discouraged you from breastfeeding {CHILD}, given you mixed advice, or have you not gotten advice about this from other relatives?

Encourage 01

Discourage 02

Mixed advice 03

No advice 04

Not applicable 97

KA32. Now I’d like to ask you some questions about information you may have gotten about feeding {CHILD}. Since {CHILD} was born did you get any information about breastfeeding from the following people or groups, not including people who work at your WIC office or clinic? [Source: WIC IFPS-1, modified]

a. Did a doctor or nurse give you information about breastfeeding?

Yes 01

No 02

Don’t know 98

Not applicable 99

b. Did a childbirth education class give you information about breastfeeding?

Yes 01

No 02

Don’t know 98

Not applicable 99

c. Did a lactation specialist give you information about breastfeeding?

Yes 01

No 02

Don’t know 98

Not applicable 99

KA33. Which of the following best describes the kind of advice that people who work at your WIC office or clinic gave you about feeding {CHILD}: Did they say breastfeeding only is better, formula feeding only is better, or that there is no difference between breastfeeding and formula feeding? [Sources: IFPS-1, PHFE WIC Survey 2010, modified]

Breastfeeding is better 01

Formula feeding is better 02

No difference between breastfeeding and formula feeding 03

Didn’t give advice about feeding 04

Don’t know 98

KA34. Does your baby’s doctor recommend breastfeeding only, formula feeding only, or that both are equally ok? [Source: WIC IFPS-1, modified]

Breastfeeding 01

Formula feeding 02

Both are equally OK 03

Didn’t give advice about feeding 04

Don’t know 98

Receipt of counseling about infant feeding and care (sources - physician, WIC, other)

Any advice from physician specific to premature birth status

1


KA35. Now I’d like to ask you about who has given you counseling or education about how to feed and care for {CHILD} more generally. [Source: New Development]

a. Did the people who work at your WIC office or clinic give you counseling or education about how to feed and care for {CHILD}?

Yes 01

No 02

Don’t know 98

Not applicable 99

b. Did a dietitian at a hospital give you counseling or education about how to feed and care for {CHILD}?

Yes 01

No 02

Don’t know 98

Not applicable 99

c. Did a doctor or nurse give you counseling or education about how to feed and care for {CHILD}?

Yes 01

No 02

Don’t know 98

Not applicable 99

d. (If baby born before 37 weeks) Did a doctor or nurse give you any advice about feeding a premature infant?

Yes 01

No 02

Don’t know 98

Not applicable 99

CHILD HEALTH, BEHAVIOR, AND CHILD REARING


Health status/conditions

1, 3, 5, 7, 9, 11, 13, 15, 18, 24

Finally I’m going to ask you about your child’s health.

CH2. Has the doctor told you that {CHILD} has any long-term medical problems or conditions that may affect what or how (he/she) eats? [Source: FITS 2008, modified]

(Interviewer, if necessary add) These medical problems or conditions may be things like food allergies, diabetes, metabolic disorders such as PKU or galactosemia, gastrointestinal problems such as gastric reflux, other problems like cleft palate or other mouth or facial conditions – any long-term problems that affect the baby’s ability to eat and swallow.

Yes 01

No 02

Don’t Know 98

(If yes) What medical problem or condition does {CHILD} have?

Specify ______________________________________________

CH3. (If yes to health status/conditions in CH2): What are you currently doing to treat this medical problem? [Source: New Development] (Open-ended, Interviewer check all that apply)

Taking her/him to the doctor for treatment 01

Treating him/her at home with medicine 02

Treating him/her at home with something other than

medicine (such as herbal remedies, special teas, or other

forms of treatment) 03

Changing his/her diet 04

Other 05

Don’t Know 98

Refused 99

PARTICIPANT CONTACT INFORMATION UPDATE

Thank you for taking the time to speak with me today. Because we’ll be calling you again for your next interview (EN: in a couple of weeks / all other times: when your child is {AGE – next interview}), I’d like to be sure we have all the right ways to contact you.


CM1. Is your full name still {NAME}?

Yes 01

No 02

(If no, go to a)

a. Can you please tell me what your full legal name is now?

_____________________________________________

Ask only if still on WIC:

CM2. {If have WIC ID on file: We have your WIC ID as {FILL}, is that correct?/If don’t have WIC ID on file: Do you know what your current WIC ID is?}

WIC ID is the same (fill below) 01

New WIC ID (specify below) 02

Don’t know WIC ID 98

Refused WIC ID 99


WIC ID___________________________________

CM3. I reached you today at {FILL #}. Will that still be the best number to call you at for your next interview?

Yes (if yes, go to b) 01

No (if no, go to a) 02


a. What is the best number to call you at for your next interview?

Number (specify ---/---/----)

NO PHONE (go to CM4) 97

Is that number home, work, cell, or something else?

Home 01

Work 02

Cell 03

Other (specify__________________) 04


b. Is there another number we could try in case we have trouble reaching you?


Number (specify ---/---/----)

Is that number home, work, cell, or something else?

Home 01

Work 02

Cell 03

Other (specify__________________) 04


We’d like to keep in touch with you even if we can’t get you by phone or your phone number changes, so I’m going to ask you about a few additional ways we might be able to contact you.

CM4. If have email on file: We have your email address as {FILL}, is that correct?/If no email: Do you have an email address we could use to contact you if necessary?

Email is the same (fill below) 01

New Email (specify below) 02

Don’t know Email 98

Refused Email 99


Email___________________________________

CM5. If mailing address on file: We have your current mailing address as {FILL}. Is that correct? If no mailing address on file: Can I get a mailing address we could use to contact you if necessary?

Address is the same (fill below) 01

New address (specify below) 02

Don’t know/don’t have address 98

Refused address 99


a. Can you please tell me what your current mailing address is?

Street/Apt#________________________________________

City______________________________________________

State_____________________________________________

ZIP______________________________________________

b. (If CM3a is 97 – no phone): Earlier you indicated that you do not have a phone. Since we need to speak with you by phone we will mail you a study phone. You will receive the phone before your next interview. The package will contain instructions on how to use the phone. Should we mail the phone to the mailing address you just provided?

Address is the same (fill below) 01

New address (specify below) 02

Don’t know/don’t have address 98

Refused address 99


Can you please provide the address where the phone should be mailed?

Street/Apt#________________________________________

City______________________________________________

State_____________________________________________

ZIP______________________________________________

CM6. [Social Media – will develop question when procedure is finalized]

CM7. (If contacts on file: Earlier you provided the names and contact information for two people who would always know how to find you. Can I read that information back to you and check that it’s still up to date?/If no contacts on file: Just in case we can’t get in touch with you using the information you just gave me, I’d like to ask you for the names and contact information for two people who would always know how to find you.

Person #1 (If contacts on file, read fill info and correct as needed)

Name

Who is this person to you?

Phone

Address

Email



Person #2 (If contacts on file, read fill info and correct as needed)

Name

Who is this person to you?

Phone

Address

Email

Ask only if core sample, at the 1st interview after the child is born:

CM8. As we mentioned when you first joined the study, we’d like to get information from the hospital where {CHILD} was born, and you gave us permission to do that. Can I please have the name of the hospital, the phone number if you have it, and the city and state where you gave birth to {CHILD}?

Hospital name

Location

Phone

Child not born in a hospital 97

Don’t know 98

Refused 99



According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB number.  The valid OMB control number for this information collection is 0584-XXXX.  The time required to complete this information collection is estimated to average 27 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.


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