WIC NE Individuals/Household - Phase II

WIC Nutrition Education Study

LL.1_Pregnant_Interim CATI English

WIC NE Individuals/Household - Phase II

OMB: 0584-0599

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Appendix LL.1:
Pregnant Women Interim CATI Survey—English

Shape1

OMB Control Number: 0584-XXXX
Expiration date: XX/XX/XXXX

WIC Nutrition Education Study

Interim Survey for Pregnant Women

Telephone Questionnaire for Nonrespondents to Mail Survey

(month)

(day)

(year)

RECORD TODAY’S DATE:

Different people like different foods. How much do you like…? [READ ITEMS.] Would you say you…? SELECT ONE.

a. Vegetables	Have Never Tried It	Don’t Like It at All	Like It a Little	Like It a Lot	-4 DON’T KNOW	-7 REFUSAL
b. Fruit	Have Never Tried It	Don’t Like It at All	Like It a Little	Like It a Lot	-4 DON’T KNOW	-7 REFUSAL
c. Low-fat, 1%, fat-free, or skim milk	Have Never Tried It	Don’t Like It at All	Like It a Little	Like It a Lot	-4 DON’T KNOW	-7 REFUSAL
d. Whole grains, such as whole grain bread, whole wheat or corn tortillas, or brown rice	Have Never Tried It	Don’t Like It at All	Like It a Little	Like It a Lot	-4 DON’T KNOW	-7 REFUSAL

The next questions are about the different kinds of foods you ate or drank during the past month, that is, the past 30 days. When answering, please include meals and snacks eaten at home, at work or school, in restaurants, and anyplace else.

In the past 30 days, how often did you eat hot or cold cereals? Would you say…? SELECT ONE.

Never [Go to Question 4]
Once last month
2 to 3 times last month
Once a week
Twice a week
3 to 4 times per week
5 to 6 times per week
Once a day
More than once a day
-4 DON’T KNOW
-7 REFUSAL

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 20 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.

3a. In the past 30 days, what kind of cereal did you usually eat? ENTER NAME OF CEREAL.

3b. If there was another kind of cereal that you ate in the past 30 days, what kind was it? ENTER NAME OF CEREAL, OR IF NONE, ENTER 1.

In the past 30 days, how often did you have any milk either to drink or on cereal? Please include regular milk, chocolate or flavored milk, lactose-free milk, and buttermilk. Do not include soy milk, almond milk, rice milk, etc. or small amounts of milk added to coffee or tea. Would you say…? SELECT ONE.

Never [Go to Question 6]
Once last month
2 to 3 times last month
Once a week
Twice a week
3 to 4 times per week
5 to 6 times per week
Once a day
More than once a day
-4 DON’T KNOW
-7 REFUSAL

In the past 30 days, what kind of milk did you usually drink? Would you say…? SELECT ALL THAT APPLY.

Whole or vitamin D milk
2% milk, which is also called reduced-fat milk
1% milk, which is also called low-fat milk
Skim milk, which is also called fat-free or nonfat milk
Soy milk
Chocolate or flavored milk
Another kind of milk. [If selected] What kind of milk did you drink? ENTER RESPONSE. ____________________________
-4 DON’T KNOW
-7 REFUSAL

In the past 30 days, how often did you drink…? [READ ITEMS.] Would you say…? SELECT ONE FOR EACH ITEM.

a. Regular soda or pop that contains sugar. Do not include diet soda.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
b. 100% pure fruit juices with no added sugar, such as orange, mango, apple, grape, and pineapple juices	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
c. Coffee or tea that had sugar or honey added to it, such as coffee and tea you sweetened yourself, or presweetened tea and coffee drinks, such as Arizona Iced Tea and Frappuccino. Do not include coffee or diet tea with artificial sweeteners, such as Equal, Sweet’N Low, or Splenda.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
d. Sweetened fruit drinks, sports drinks, or energy drinks, such as Kool-Aid, lemonade, HiC, cranberry drink, Gatorade, Red Bull, Vitamin Water, or fruit juices that you made at home and added sugar. Do not include diet drinks with artificial sweeteners, such as Equal, Sweet’N Low, or Splenda.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL

In the past 30 days, how often did you eat…? [READ ITEMS.] Would you say…? REPEAT AFTER EVERY THREE FOODS. SELECT ONE FOR EACH ITEM.

a. Fruit, including fresh, frozen, dried, or canned fruit. Do not include juices.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
b. Green leafy or lettuce salad, with or without other vegetables	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
c. Any kind of fried potatoes, including French fries, home fries, or hash brown potatoes	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
d. Any other kind of potatoes, such as baked, boiled, mashed potatoes; sweet potatoes; or potato salad	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
e. Refried beans, baked beans, beans in soup, pork and beans, or any other type of cooked dried beans. Do not include green beans.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
f. Brown rice or other cooked whole grains, such as bulgur, cracked wheat, or millet. Do not include white rice.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
g. Other vegetables, including fresh, frozen, dried, or canned vegetables. Do not include green salads, potatoes, or cooked dried beans.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
h. Mexican-type salsa made with tomatoes	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
i. Pizza, including frozen pizza, take-out pizza, pizza in restaurants, and homemade pizza	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
j. Tomato sauce served with spaghetti or noodles or mixed into other foods such as lasagna. Do not include tomato sauce on pizza.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
k. Any kind of cheese, including cheese as a snack; cheese on burgers and sandwiches; and cheese in foods such as lasagna, quesadillas, or casseroles. Do not include cheese on pizza.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
l. Corn or whole wheat tortillas. Do not include white flour tortillas.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
m. Whole grain bread, including whole wheat, rye, oatmeal, and pumpernickel toast and rolls and in sandwiches. Do not include white bread.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
n. Chocolate or any other types of candy. Do not include sugar-free candy.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
o. Doughnuts, sweet rolls, Danish, muffins, pan dulce, or Pop-Tarts. Do not include sugar-free kinds.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
p. Cookies, cake, pie, or brownies. Do not include sugar-free kinds.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL
q. Ice cream or other frozen desserts. Do not include sugar-free kinds.	Never	Once Last Month	2 to 3 Times Last Month	Once a Week	Twice a Week	3 to 4 Times per Week	5 to 6 Times per Week	Once a Day	More than Once a Day	-4 DON’T KNOW	-7 REFUSAL

Everyone is different and eats different foods. For the next question, I’m going to list several activities. For each activity, please tell me if at this time you are not thinking about doing it; thinking about doing it; planning to do it next month; have been doing it for less than 6 months; or have been doing it for 6 months or longer.

The first/next activity is… [READ STATEMENTS.] Would you say you…? REPEAT AFTER EVERY THREE STATEMENTS. SELECT ONE FOR EACH STATEMENT.

a. Eat vegetables at dinner every day	Are Not Thinking about Doing It	Are Thinking about Doing It	Are Planning to Do It Next Month	Have Been Doing It for Less Than 6 Months	Have Been Doing It for 6 Months or Longer	-4 DON’T KNOW	-7 REFUSAL
b. Eat fruit for a snack instead of cookies or chips every day	Are Not Thinking about Doing It	Are Thinking about Doing It	Are Planning to Do It Next Month	Have Been Doing It for Less Than 6 Months	Have Been Doing It for 6 Months or Longer	-4 DON’T KNOW	-7 REFUSAL
c. Drink low-fat, 1%, fat-free, or skim milk instead of whole milk, 2%, or reduced fat milk every day	Are Not Thinking about Doing It	Are Thinking about Doing It	Are Planning to Do It Next Month	Have Been Doing It for Less Than 6 Months	Have Been Doing It for 6 Months or Longer	-4 DON’T KNOW	-7 REFUSAL
d. Almost always eat whole grain bread instead of white bread	Are Not Thinking about Doing It	Are Thinking about Doing It	Are Planning to Do It Next Month	Have Been Doing It for Less Than 6 Months	Have Been Doing It for 6 Months or Longer	-4 DON’T KNOW	-7 REFUSAL
e. Almost always eat brown rice instead of white rice	Are Not Thinking about Doing It	Are Thinking about Doing It	Are Planning to Do It Next Month	Have Been Doing It for Less Than 6 Months	Have Been Doing It for 6 Months or Longer	-4 DON’T KNOW	-7 REFUSAL
f. Almost always eat whole wheat or corn tortillas instead of white flour tortillas	Are Not Thinking about Doing It	Are Thinking about Doing It	Are Planning to Do It Next Month	Have Been Doing It for Less Than 6 Months	Have Been Doing It for 6 Months or Longer	-4 DON’T KNOW	-7 REFUSAL
g. Drink 100% juice no more than once a day	Are Not Thinking about Doing It	Are Thinking about Doing It	Are Planning to Do It Next Month	Have Been Doing It for Less Than 6 Months	Have Been Doing It for 6 Months or Longer	-4 DON’T KNOW	-7 REFUSAL
h. Drink regular soda or pop, sweetened fruit drinks, sports drinks or energy drinks no more than once a month	Are Not Thinking about Doing It	Are Thinking about Doing It	Are Planning to Do It Next Month	Have Been Doing It for Less Than 6 Months	Have Been Doing It for 6 Months or Longer	-4 DON’T KNOW	-7 REFUSAL

Again, I’m going to read you a list of activities. For each activity, please tell me how sure you are you could do the activity. How sure are you that you can…? [READ STATEMENTS.] Would you say you are …? SELECT ONE FOR EACH STATEMENT.

a. Only formula feed your baby, not breastfeed at all	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
b. Breastfeed your baby or at least try	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
c. Breastfeed without using any formula or other milk when your baby is 30 days old	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
d. Breastfeed without using any formula or other milk when your baby is 6 months old	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL

I’m going to read you a list of activities. For each activity, please tell me how sure you are you could do the activity. How sure are you that you can…? [READ STATEMENTS.] Would you say you are…? REPEAT AFTER EVERY 3 STATEMENTS. SELECT ONE FOR EACH STATEMENT.

a. Eat vegetables at dinner every day	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
b. Eat fruit for a snack instead of cookies or chips every day	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
c. Drink low-fat, 1%, fat-free, or skim milk instead of whole milk, 2%, or reduced fat milk every day	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
d. Eat whole grain bread instead of white bread	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
e. Eat brown rice instead of white rice	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
f. Eat whole wheat or corn tortillas instead of white flour tortillas	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
g. Drink 100% juice no more than once a day	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
h. Drink regular soda or pop, sweetened fruit drinks, sports drinks or energy drinks no more than once a month	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL

For the next question, I’m going to list some WIC foods. Please tell me whether you bought the WIC food in the past 30 days. If you did not receive the food from WIC, please let me know. In the past 30 days, did you buy…? [READ ITEMS.] SELECT ONE FOR EACH STATEMENT.

a. Juice	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL
b. Fruit and vegetables	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL
c. Milk	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL
d. Cereal	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL
e. Other whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL
f. Baby food in jars	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL
g. Infant formula	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL

I’m going to list two activities. For each activity, please tell me how often you do the activity. How often do you…? [READ ITEMS.] Would you say…? SELECT ONE FOR EACH STATEMENT.

a. Eat a meal while watching TV	Rarely or Never	Some Days	Most Days	Almost Every Day	Every Day	-4 DON’T KNOW	-7 REFUSAL
b. Cook a homemade dinner at home	Rarely or Never	Some Days	Most Days	Almost Every Day	Every Day	-4 DON’T KNOW	-7 REFUSAL

All people do things differently. For each activity, please tell me how many times you do the activity in a usual week or day. SELECT ONE FOR EACH ACTIVITY.

a. How many times a week do you eat breakfast?	1	2	3	4	5	6	7		-4 DON’T KNOW	-7 REFUSAL
b. How many times a week do you eat out?	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL
c. How many times a week do you eat fast food?	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL
d. How many hours a day do you watch TV or DVDs?	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL

In the past 7 days, on how many days did you do moderate or vigorous physical activities like walking, jogging, dancing, or bicycling? Think only about physical activities that you did for at least 10 minutes at a time. SELECT ONE.

0	1	2	3	4	5	6	7	-4 DON’T KNOW	-7 REFUSAL
								-4 DON’T KNOW	-7 REFUSAL
[If 0, go to Question 16]

On the days that you did more than 10 minutes of moderate or vigorous physical activities, how many minutes in a day did you usually spend doing these physical activities? Would you say…? SELECT ONE.

10 to 20 minutes
21 to 30 minutes
31 to 40 minutes
41 to 50 minutes
51 to 60 minutes
More than 60 minutes
-4 DON’T KNOW
-7 REFUSAL

In the past 30 days, how often did you…? [READ ITEMS.] Would you say…? SELECT ONE FOR EACH STATEMENT.

a. Plan meals ahead of time	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
b. Use Nutrition Facts on food labels to choose foods	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL

Who in your family currently gets WIC benefits? Would you say…? SELECT ALL THAT APPLY.

You, because you are pregnant
You, because you recently gave birth
Your baby who is less than 12 months old
Your child or children who are over 12 months of age
No one in your family [Go to Question 19]
-4 DON’T KNOW
-7 REFUSAL

Do your WIC benefits come from the [Insert name] WIC office? Would you say…? SELECT ONE.

Yes [Go to Question 19]
No, you are receiving WIC from another WIC office [Go to Question 19]
No, you are not currently receiving WIC
-4 DON’T KNOW
-7 REFUSAL


(month)	(year)

18a. What month and year did you stop receiving WIC? ENTER MONTH AND YEAR.

In the past 6 months, how many times did you visit a WIC office and get information on health or healthy eating? Do not include visits for other reasons, such as picking up a food instrument or voucher or taking a friend to her appointment. SELECT ONE.

NONE [Go to Question 47]
ONCE
2 TIMES
3 TIMES
4 TIMES
5 TIMES
6 OR MORE TIMES
-4 DON’T KNOW
-7 REFUSAL

For the next question, please include your most recent visit to WIC. In the past 6 months, during WIC visits, how many times did you…? [READ ITEMS.] SELECT ONE FOR EACH STATEMENT.

a. Talk one-on-one with a WIC staff person about health or healthy eating	NONE	1	2	3	4	5	6 OR MORE	-4 DON’T KNOW	-7 REFUSAL
b. Attend a group session about health or healthy eating	NONE	1	2	3	4	5	6 OR MORE	-4 DON’T KNOW	-7 REFUSAL
c. Watch a video or DVD about health or healthy eating	NONE	1	2	3	4	5	6 OR MORE	-4 DON’T KNOW	-7 REFUSAL
d. Use the WIC Web site about health or healthy eating	NONE	1	2	3	4	5	6 OR MORE	-4 DON’T KNOW	-7 REFUSAL

In the past 6 months, in between WIC visits, did you get any of the following from WIC with information that told you about health or healthy eating? Do not include things you got during your WIC visit. SELECT ALL THAT APPLY.

Personal phone call
Text message
Email message
Online education that I could log into from home or someplace else
Invitation or link to Facebook, Twitter, or other social media site
Brochure or handout in the mail
NONE OF THE ABOVE
-4 DON’T KNOW
-7 REFUSAL

The next questions are about your most recent visit to WIC in which you got information on health or healthy eating.

When was your most recent WIC visit? Would you say…? SELECT ONE.

Less than 2 weeks ago
2 to 4 weeks ago
1 to 2 months ago
Over 2 months ago
-4 DON’T KNOW
-7 REFUSAL

What did you do at your most recent WIC visit? Did you…? SELECT ALL THAT APPLY.

Talk one-on-one with a WIC staff person about health or healthy eating
Spend time in a group session on health or healthy eating
Use a WIC Web site on health or healthy eating
Use a WIC video or DVD on health or healthy eating
NONE OF THE ABOVE
-4 DON’T KNOW
-7 REFUSAL

For the next question, I’m going to read you several statements. For your most recent WIC visit, how much do you agree or disagree with the statement? [READ STATEMENTS.] Would you say you…? SELECT ONE FOR EACH STATEMENT.

a. I learned good reasons to eat healthy	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
b. I learned good ways to eat healthy	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
c. I learned good reasons to breastfeed	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
d. I learned good ways to breastfeed	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL

Some people say that some WIC visits are more helpful than others. Which of the following statements best describes the information you received at your most recent WIC visit? SELECT ONE.

The information was helpful because it was new to me.
The information was helpful. I knew the information, but it was good to hear it again.
The information was not that helpful because I already knew it.
The information was not that helpful because it did not apply to me.
-4 DON’T KNOW
-7 REFUSAL

Which of the following statements best describes your most recent WIC visit? SELECT ONE.

I did not have any children with me
I had a child with me so it made it hard to listen to the WIC information
I had a child with me but it was easy to listen to the WIC information
-4 DON’T KNOW
-7 REFUSAL

At your most recent WIC visit, did the WIC staff show you any of the following or use any of these with you while they talked about health or healthy eating? SELECT ALL THAT APPLY.

Brochure, handout, or paper with information
Bulletin board or poster
Video or DVD
Tasting or cooking demonstration
Activity or game
Other items that you could pass around like measuring cups or food containers
NONE OF THE ABOVE
Something else. [If selected] What did she or he show you? ENTER RESPONSE. ________________________________________________
-4 DON’T KNOW
-7 REFUSAL

When you enroll in WIC and then 6 to 12 months later, WIC asks you to bring proof of address or income to make sure you can be on WIC. Did you bring proof to your most recent WIC visit? SELECT ONE.

YES
NO
-4 DON’T KNOW
-7 REFUSAL

At your most recent WIC visit, how long did you talk one-on-one with a WIC staff person about health or healthy eating? Would you say …? SELECT ONE.

I did not talk one-on-one about health or healthy eating [Go to Question 35]
Less than 5 minutes
5–15 minutes
16–30 minutes
More than 30 minutes
-4 DON’T KNOW
-7 REFUSAL

For the next set of questions, please think about your most recent one-on-one time with a WIC staff person.

Which of the following statements best describes your most recent one-on-one time with a WIC staff person? SELECT ONE.

The WIC staff person chose what we talked about
I chose what we talked about
The WIC staff person and I together chose what we talked about
-4 DON’T KNOW
-7 REFUSAL

A health goal means trying to become healthier by changing something you do. Which of the following statements best describes your most recent one-on-one time with a WIC staff person? SELECT ONE.

She worked with me to set health goals for me or my child
She talked about health goals, but I did not set any
She did not talk about setting health goals
-4 DON’T KNOW
-7 REFUSAL

For the next question, I’m going to read you three statements. For your most recent one-on-one time with a WIC staff person, how much do you agree or disagree with the statement? [READ STATEMENTS.] Would you say you…? SELECT ONE FOR EACH STATEMENT.

a. The WIC staff person talked most of the time	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
b. The WIC staff person listened to me and understood my concerns	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
c. The WIC staff person followed up on issues or questions from my last one-on-one visit	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL

Please tell me if you talked about any of the following topics in your most recent one-on-one time with a WIC staff person. Did you talk about…? [READ STATEMENTS.] SELECT ONE FOR EACH STATEMENT.

a. Eating more fruit and vegetables	YES	NO	-4 DON’T KNOW	-7 REFUSAL
b. Eating more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	YES	NO	-4 DON’T KNOW	-7 REFUSAL
c. Drinking lower fat milk; that is, 1%, fat-free, or skim milk	YES	NO	-4 DON’T KNOW	-7 REFUSAL
d. Getting more physical activity	YES	NO	-4 DON’T KNOW	-7 REFUSAL
e. Shopping for and preparing healthier foods	YES	NO	-4 DON’T KNOW	-7 REFUSAL
f. Drinking water instead of soda and sugary drinks	YES	NO	-4 DON’T KNOW	-7 REFUSAL
g. Breastfeeding	YES	NO	-4 DON’T KNOW	-7 REFUSAL

[If yes to any topics] Now I would like to know if you have made or think you will make a change to your eating or activities since discussing the topic, [READ TOPIC]. Would you say you are…? SELECT ONE FOR EACH STATEMENT.

a. Eating more fruit and vegetables	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
b. Eating more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
c. Drinking lower fat milk, that is, 1%, fat-free, or skim milk	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
d. Getting more physical activity	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
e. Shopping for and preparing healthier foods	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
f. Drinking water instead of soda and sugary drinks	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
g. Breastfeeding	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL

At your most recent WIC visit, how long did you spend in a group session talking about health or healthy eating? Would you say…? SELECT ONE.

I was not in a group session [Go to Question 41]
Less than 5 minutes
5 to 15 minutes
16 to 30 minutes
More than 30 minutes
-4 DON’T KNOW
-7 REFUSAL

For the next set of questions, please think about your most recent WIC group session.

Which of the following statements best describes your most recent WIC group session? SELECT ONE.

She mostly talked and would stop to ask if we had questions
We watched a video or DVD, and at the end, she asked if we had questions
She shared information, and we had a discussion. She asked me and the other people in the group about our thoughts and opinions.
-4 DON’T KNOW
-7 REFUSAL

A health goal means trying to become healthier by changing something you do. Which of the following statements best describes your most recent group session with a WIC staff person? SELECT ONE.

She worked with me to set health goals for me or my child
She talked about health goals, but I didn’t set any
She did not talk about setting health goals
-4 DON’T KNOW
-7 REFUSAL

For the next question, I’m going to read you two statements. For your most recent WIC group session, how much do you agree or disagree with the statement? [READ STATEMENTS.] Would you say you…? SELECT ONE FOR EACH STATEMENT.

a. The WIC staff person listened to the group and understood our concerns	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
b. I had a chance to bring up topics that were important to me	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL

Please tell me if you talked about any of the following topics in your most recent WIC group session. Did you talk about…? [READ ITEMS.] SELECT ONE FOR EACH STATEMENT.

a. Eating more fruit and vegetables	YES	NO	-4 DON’T KNOW	-7 REFUSAL
b. Eating more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	YES	NO	-4 DON’T KNOW	-7 REFUSAL
c. Drinking lower fat milk, that is, 1%, fat-free, or skim milk	YES	NO	-4 DON’T KNOW	-7 REFUSAL
d. Getting more physical activity	YES	NO	-4 DON’T KNOW	-7 REFUSAL
e. Shopping for and preparing healthier foods	YES	NO	-4 DON’T KNOW	-7 REFUSAL
f. Drinking water instead of soda and sugary drinks	YES	NO	-4 DON’T KNOW	-7 REFUSAL
g. Breastfeeding	YES	NO	-4 DON’T KNOW	-7 REFUSAL

a. Eating more fruit and vegetables	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
b. Eating more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
c. Drinking lower fat milk, that is, 1%, fat-free, or skim milk	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
d. Getting more physical activity	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
e. Shopping for and preparing healthier foods	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
f. Drinking water instead of soda and sugary drinks	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
g. Breastfeeding	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL

Which of the following statements describes how you used a WIC Web site on health or healthy eating in the past 6 months? SELECT ALL THAT APPLY.

I used a WIC Web site on health or healthy eating in the WIC office by myself
I used a WIC Web site on health or healthy eating instead of going to a WIC appointment
I used a WIC Web site on health or healthy eating before or after going to a WIC appointment
I have not used a WIC Web site on health or healthy eating in the past 6 months [Go to Question 46]
-4 DON’T KNOW
-7 REFUSAL

For the next set of questions, please think about the last time you used a WIC Web site on health or healthy eating in the past 6 months

How long did you spend using the WIC Web site? Please include time in and outside of WIC office. SELECT ONE.

Less than 5 minutes
5 to 15 minutes
15 to 30 minutes
More than 30 minutes
-4 DON’T KNOW
-7 REFUSAL

Which of the following statements best describes how the topic for the WIC Web site was chosen? SELECT ONE.

There was a list of topics, and I chose one of them myself
There was a list of topics, and a WIC staff person helped me choose one
There was only one topic available
The topic was chosen another way. [If selected] How was the topic for the WIC Web site chosen? ENTER RESPONSE. ____________________________
-4 DON’T KNOW
-7 REFUSAL

Please tell me if you read or viewed any of the following topics on the WIC Web site. Did you read or view anything about…? [READ ITEMS.] SELECT ONE FOR EACH STATEMENT.

a. Eating more fruit and vegetables	YES	NO	-4 DON’T KNOW	-7 REFUSAL
b. Eating more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	YES	NO	-4 DON’T KNOW	-7 REFUSAL
c. Drinking lower fat milk; that is, 1%, fat-free, or skim milk	YES	NO	-4 DON’T KNOW	-7 REFUSAL
d. Getting more physical activity	YES	NO	-4 DON’T KNOW	-7 REFUSAL
e. Shopping for and preparing healthier foods	YES	NO	-4 DON’T KNOW	-7 REFUSAL
f. Drinking water instead of soda and sugary drinks	YES	NO	-4 DON’T KNOW	-7 REFUSAL
g. Breastfeeding	YES	NO	-4 DON’T KNOW	-7 REFUSAL

[If yes to any topics] Now I would like to know if you have made or think you will make a change to your eating or activities since reading or viewing the topic, [READ TOPIC]. Would you say you are…? SELECT ONE FOR EACH STATEMENT.

a. Eating more fruit and vegetables	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
b. Eating more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
c. Drinking lower fat milk; that is, 1%, fat-free, or skim milk	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
d. Getting more physical activity	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
e. Shopping for and preparing healthier foods	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
f. Drinking water instead of soda and sugary drinks	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
g. Breastfeeding	Not Thinking about Doing It	Thinking about Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL

Which statements describe how you used a WIC video/DVD on health or healthy eating in the past 6 months? SELECT ALL THAT APPLY.

I used a WIC video or DVD on health or healthy eating in the WIC office by myself
I used a WIC video or DVD on health or healthy eating in the WIC office in a group
I used a WIC video or DVD on health or healthy eating instead of going to a WIC appointment
I used a WIC video or DVD on health or healthy eating before or after going to a WIC appointment
I have not used a WIC video or DVD on health or healthy eating in the past 6 months

-4 DON’T KNOW
-7 REFUSAL

Are you currently pregnant? SELECT ONE.

(month)

(day)

(year)

YES. [If selected] When is your due date? ENTER

(month)

(year)

NO, I HAD MY BABY. [If selected] When did you have your baby? ENTER

NO, I LOST THE BABY OR ENDED THE PREGNANCY

Think about the number of people who live in your household right now. How many people are there in each of the following age groups?

	ENTER NUMBER. IF NONE, ENTER ZERO
a. Infants under 12 months of age
b. Children 1 to 4 years of age
c. Children 5 to 17 years of age
d. Adults 18 years or older, include yourself

How many people in your household are on WIC right now? Please include yourself. ENTER NUMBER _____
Do you have regular childcare for your youngest child where someone other than you or your child’s other parent takes care of him or her on a regular basis? SELECT ONE.

CHILD HAS NOT BEEN BORN YET [Go to Question 51]
YES
NO [Go to Question 51]

-4 DON’T KNOW
-7 REFUSAL

50a. How many hours per week is your child usually in childcare? ENTER NUMBER _____

In the past 6 months, which of the following topics did you discuss in WIC one-on-one or group sessions or watch in videos, DVDs, or Web sites? SELECT ALL THAT APPLY.					You selected [READ LIST OF YES RESPONSES]. Of these, which one was most helpful? SELECT ONE.
DOES NOT APPLY. HAS NOT BEEN IN WIC IN THE PAST 6 MONTHS. [Go to end script]	YES	NO	-4 DON’T KNOW	-7 REFUSAL
a. Breastfeeding	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
b. Weaning from a bottle	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
c. Drinking milk or choosing lower fat milk	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
d. Drinking water	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
e. Fruit and vegetables	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
f. Healthy snacking	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
g. Healthy weight for myself	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
h. Introducing solid foods to my baby	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
i. Medical conditions such as low iron or high blood sugar	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
j. Physical activity	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
k. Picky eaters	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
l. Shopping for and preparing healthy foods	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
m. Sodas and sugary drinks	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
n. Whole grains	YES	NO	-4 DON’T KNOW	-7 REFUSAL	
o. NONE OF THE ABOVE	YES	NO	-4 DON’T KNOW	-7 REFUSAL

We will send you another survey in several months.

Thank you for taking part in the WIC Nutrition Education Study (NEST)!

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	APPENDIX K:
Author	scc
File Modified	0000-00-00
File Created	2021-01-27

WIC NE Individuals/Household - Phase II

WIC Nutrition Education Study

LL.1_Pregnant_Interim CATI English