WIC NE Individuals/Household - Phase II

Appendix QQ.1:
Caregiver of Child Final CATI Survey—English

WIC Nutrition Education Study

Final Survey for Participant with Eligible Child

Telephone Questionnaire for Nonrespondents to Mail Survey

1. (month)	(day)	(year)

   RECORD TODAY’S DATE:

Please answer the survey questions for [Insert child’s name].

2. Different children like different foods. How much does your child like…? [READ ITEMS.] Would you say she or he…? SELECT ONE FOR EACH FOOD.

a. Vegetables, including baby food	Has Never Tried It	Doesn’t Like It at All	Likes It a Little	Likes It a Lot	-4 DON’T KNOW	-7 REFUSAL
b. Fruit, including baby food	Has Never Tried It	Doesn’t Like It at All	Likes It a Little	Likes It a Lot	-4 DON’T KNOW	-7 REFUSAL
c. Whole milk, 2%, or reduced fat milk	Has Never Tried It	Doesn’t Like It at All	Likes It a Little	Likes It a Lot	-4 DON’T KNOW	-7 REFUSAL
d. Low-fat, 1%, fat-free, or skim milk	Has Never Tried It	Doesn’t Like It at All	Likes It a Little	Likes It a Lot	-4 DON’T KNOW	-7 REFUSAL
e. Whole grains, such as whole grain bread, whole wheat or corn tortillas, or brown rice	Has Never Tried It	Doesn’t Like It at All	Likes It a Little	Likes It a Lot	-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.

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

3. In the past 30 days, how often did your child eat hot or cold cereals, including baby cereal? 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

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

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

4. In the past 30 days, how often did your child have any cow’s 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, 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

5. In the past 30 days, what kind of milk did your child 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 your child drink? ENTER RESPONSE. ____________________________

• -4 DON’T KNOW

• -7 REFUSAL

6. In the past 30 days, how often did your child 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

7. In the past 30 days, how often did your child 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

8. All families are different and eat 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 ITEMS.] Would you say you…? REPEAT AFTER EVERY THREE STATEMENTS. SELECT ONE FOR EACH STATEMENT.

a. Serve your child vegetables, including baby food, at dinner every day	Are Not Thinking About Doing It	Are Thinking About Doing It	Are Plan-ning 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. Serve your child fruit, including baby food, for a snack instead of cookies or chips every day	Are Not Thinking About Doing It	Are Thinking About Doing It	Are Plan-ning 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. [Check child’s age in profile data and only ask if child is 2 years or older.] Serve your child 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 Plan-ning 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 serve your child whole grain bread instead of white bread	Are Not Thinking About doing It	Are Thinking About Doing It	Are Plan-ning 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 serve your child brown rice instead of white rice	Are Not Thinking About Doing It	Are Thinking About Doing It	Are Plan-ning 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 serve your child whole wheat or corn tortillas instead of white flour tortillas	Are Not Thinking About Doing It	Are Thinking About Doing It	Are Plan-ning 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. Serve your child 100% juice no more than once a day	Are Not Thinking About Doing It	Are Thinking About Doing It	Are Plan-ning 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. Serve your child 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 Plan-ning 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

9. 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 ITEMS.] Would you say you are…? REPEAT AFTER EVERY 3 STATEMENTS. SELECT ONE FOR EACH STATEMENT.

a. Serve your child vegetables, including baby food, at dinner every day	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
b. Serve your child fruit, including baby food, for a snack instead of cookies or chips every day	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
c. [Only ask if child is 2 years or older.] Serve your child 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. Serve your child whole grain bread instead of white bread	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
e. Serve your child brown rice instead of white rice	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
f. Serve your child whole wheat or corn tortillas instead of white flour tortillas	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
g. Serve your child 100% juice no more than once a day	Not Sure	A Little Sure	Very Sure	-4 DON’T KNOW	-7 REFUSAL
h. Serve your child 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

10. For the next question, I’m going to read you four statements. Please tell me how much you agree or disagree with the statement…? Would you say you…? SELECT ONE FOR EACH STATEMENT.

a. It is easy to buy fresh fruit and vegetables where I live	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
b. It is expensive to buy fresh fruit and vegetables where I live	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
c. There is a large selection of fresh fruit and vegetables where I live	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL
d. The fresh fruit and vegetables where I live are of high quality	Disagree a Lot	Disagree a Little	Agree a Little	Agree a Lot	-4 DON’T KNOW	-7 REFUSAL

11. 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 tell me. 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. [Only ask if Question 2 = less than 12 months old; otherwise, select “did not receive from WIC.”] Baby food in jars	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL
g. [Only ask if Question 2 = less than 12 months old; otherwise, select “did not receive from WIC.”] Infant formula	YES	NO	DID NOT RECEIVE FROM WIC	-4 DON’T KNOW	-7 REFUSAL

12. For the next question, I’m going to read you two statements. Please tell me if this statement was true for your household in the past 12 months. Would you say this was…? SELECT ONE FOR EACH STATEMENT.

a. We worried whether our food would run out before we got money to buy more	Never True	Sometimes True	Often True	-4 DON’T KNOW	-7 REFUSAL
b. The food that we bought just didn’t last, and we didn’t have money to get more	Never True	Sometimes True	Often True	-4 DON’T KNOW	-7 REFUSAL

13. I’m going to list four activities. For each activity, please tell me how often you or your child does the activity. How often would you say…? [READ ITEMS.] Would you say…? SELECT ONE FOR EACH STATEMENT.

a. Your child eats a meal while watching TV or DVDs	Rarely or Never	Some Days	Most Days	Almost Every Day	Every Day	-4 DON’T KNOW	-7 REFUSAL
b. You sit and eat a meal with your child	Rarely or Never	Some Days	Most Days	Almost Every Day	Every Day	-4 DON’T KNOW	-7 REFUSAL
c. Your child is picky about the foods she or he eats	Rarely or Never	Some Days	Most Days	Almost Every Day	Every Day	-4 DON’T KNOW	-7 REFUSAL
d. You cook a homemade dinner for your child at home	Rarely or Never	Some Days	Most Days	Almost Every Day	Every Day	-4 DON’T KNOW	-7 REFUSAL

14. How many times do you usually offer a new food before you decide your child does not like it? Would you say…? SELECT ONE.

• Once

• Twice

• 3 to 5 times

• 6 to 10 times

• More than 10 times

• My child likes everything

• My child hasn’t tried new foods

• -4 DON’T KNOW

• -7 REFUSAL

15. For the next question, I’m going to read you a list of statements about some things that parents may do. Please tell me how often you did these things in the past 30 days. The first/next statement is… Would you say you did this ..? SELECT ONE FOR EACH STATEMENT.

a. Kept track of what my child eats and drinks	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
b. Tried to get my child to finish his or her food and drinks	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
c. Tried to get my child to eat even if she or he does not seem hungry	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
d. Carefully controlled how much my child eats or drinks	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
e. Talked to my child to encourage him or her to eat or drink	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
f. Let my child eat desserts or sweets to keep him or her happy	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
g. [Only ask if Question 2 = less than 12 months] Put cereal in my child’s bottle	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL

16. All families do things differently. For the next question, I’m going to list several activities. For each activity, please tell me how many times you or your child does the activity in a usual week or day. SELECT ONE FOR EACH STATEMENT.

a. How many times a week does your child eat breakfast?	0	1	2	3	4	5	6	7		-4 DON’T KNOW	-7 REFUSAL
b. How many times a week do you eat out?	0	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL
c. How many times a week does your child eat fast food?	0	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL
d. How many days a week does your child play outside?	0	1	2	3	4	5	6	7		-4 DON’T KNOW	-7 REFUSAL
e. How many hours a day does your child play outside?	0	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL
f. How many days a week do you play outside with your child?	0	1	2	3	4	5	6	7		-4 DON’T KNOW	-7 REFUSAL
g. How many hours a day does your child watch TV or DVDs?	0	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL
h. How many hours a day do you watch TV or DVDs?	0	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL
i. How many hours a day does your child play video or computer games, including games played on phones and other handheld devices?	0	1	2	3	4	5	6	7	8 OR MORE	-4 DON’T KNOW	-7 REFUSAL

17. 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
[If 0, go to Question 19]

18. 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

19. In the past 30 days, how often did your family or friends…? [READ ITEMS.] Would you say they did it…? SELECT ONE FOR EACH STATEMENT.

a. Encourage you to eat healthy foods	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
b. Complain about eating healthy foods	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
c. Encourage you to do physical activity	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL
d. Do physical activity with you	Almost Never	Once in a While	Sometimes	Often	Almost Always	-4 DON’T KNOW	-7 REFUSAL

20. 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

21. 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 old

• No one in your family [Go to Question 23]

• -4 DON’T KNOW

• -7 REFUSAL

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

• Yes [Go to Question 23]

• No, you are receiving WIC from another WIC office [Go to Question 23]

• No, you are not currently receiving WIC

• -4 DON’T KNOW

• -7 REFUSAL

(month)	(year)

22a. What month and year did you stop receiving WIC? ENTER MONTH AND YEAR.

23. 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 51]

• ONCE

• 2 TIMES

• 3 TIMES

• 4 TIMES

• 5 TIMES

• 6 OR MORE TIMES

• -4 DON’T KNOW

• -7 REFUSAL

24. 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

25. In the past 6 months, in between WIC visits, did you get any of the following from WIC with information on 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 WIC visit in which you got information on health or healthy eating.

26. 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

27. 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

28. For the next question, I’m going to read you two statements. For your most recent WIC visit, how much do you agree or disagree with the statement? [READ ITEMS.] 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

29. 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

30. 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

31. 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

32. 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

33. 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 39]

• 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 one-on-one time with a WIC staff person.

34. 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

35. 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

36. 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 ITEMS.] 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

37. 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 ITEMS.] SELECT ONE FOR EACH STATEMENT.

a. Serving more fruit and vegetables	YES	NO	-4 DON’T KNOW	-7 REFUSAL
b. Serving more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	YES	NO	-4 DON’T KNOW	-7 REFUSAL
c. [Only ask if child is 2 years or older.] Serving lower fat milk; that is, 1%, fat-free, or skim milk	YES	NO	-4 DON’T KNOW	-7 REFUSAL
d. Encouraging more physical activity	YES	NO	-4 DON’T KNOW	-7 REFUSAL
e. Preparing healthier foods for my family	YES	NO	-4 DON’T KNOW	-7 REFUSAL
f. Providing water instead of soda and sugary drinks	YES	NO	-4 DON’T KNOW	-7 REFUSAL

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

a. Serving 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. Serving 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. Serving 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. Encouraging 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. Preparing healthier foods for my family	Not Thinking About Doing It	Thinking About Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
f. Providing 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

39. 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 45]

• 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.

40. 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

41. 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

42. 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? 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

43. 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. Serving more fruit and vegetables	YES	NO	-4 DON’T KNOW	-7 REFUSAL
b. Serving more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	YES	NO	-4 DON’T KNOW	-7 REFUSAL
c. [Only ask if child is 2 years or older.] Serving lower fat milk; that is, 1%, fat-free, or skim milk	YES	NO	-4 DON’T KNOW	-7 REFUSAL
d. Encouraging more physical activity	YES	NO	-4 DON’T KNOW	-7 REFUSAL
e. Preparing healthier foods for my family	YES	NO	-4 DON’T KNOW	-7 REFUSAL
f. Providing water instead of soda and sugary drinks	YES	NO	-4 DON’T KNOW	-7 REFUSAL

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

a. Serving 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. Serving 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. Serving 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. Encouraging 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. Preparing healthier foods for my family	Not Thinking About Doing It	Thinking About Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
f. Providing 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

45. Which statements describe 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 50]

• -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.

46. 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

47. Which of the following 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

48. 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. Serving more fruit and vegetables	YES	NO	-4 DON’T KNOW	-7 REFUSAL
b. Serving more whole grains, like whole grain bread, whole wheat or corn tortillas, or brown rice	YES	NO	-4 DON’T KNOW	-7 REFUSAL
c. [Only ask if child is 2 years or older.] Serving lower fat milk, that is, 1%, fat-free, or skim milk	YES	NO	-4 DON’T KNOW	-7 REFUSAL
d. Encouraging more physical activity	YES	NO	-4 DON’T KNOW	-7 REFUSAL
e. Preparing healthier foods for my family	YES	NO	-4 DON’T KNOW	-7 REFUSAL
f. Providing water instead of soda and sugary drinks	YES	NO	-4 DON’T KNOW	-7 REFUSAL

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

a. Serving 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. Serving 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. Serving 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. Encouraging 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. Preparing healthier foods for my family	Not Thinking About Doing It	Thinking About Doing It	Planning on Doing It	Already Doing It	-4 DON’T KNOW	-7 REFUSAL
f. Providing 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

50. 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

51. Which best describes your current status? Are you…? SELECT ONE.

• Married

• Widowed

• Divorced

• Separated

• Single or never married

• Living with partner

• -4 DON’T KNOW

• -7 REFUSAL

52. In the past 6 months, have you been told by a doctor or other health care professional that your child…? SELECT ONE FOR EACH ITEM.

a. Was a preemie or premature as a baby	YES	NO	-4 DON’T KNOW	-7 REFUSAL
b. Needs special infant formula	YES	NO	-4 DON’T KNOW	-7 REFUSAL
c. Is low weight	YES	NO	-4 DON’T KNOW	-7 REFUSAL
d. Is overweight	YES	NO	-4 DON’T KNOW	-7 REFUSAL
e. Has high blood lead	YES	NO	-4 DON’T KNOW	-7 REFUSAL

53. Are you currently working for pay either full time or part time? SELECT ONE.

• YES, FULL TIME

• YES, PART TIME

• NO

• -4 DON’T KNOW

• -7 REFUSAL

54. 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)

55. How many people in your household are on WIC right now? Please include yourself. ENTER NUMBER _____

56. Do you have regular childcare for [Insert child’s name] where someone other than a family member in your home takes care of him or her on a regular basis? SELECT ONE.

• YES

• NO [Go to Question 57]

• -4 DON’T KNOW

• -7 REFUSAL

56a. How many hours per week is your child usually in childcare? ENTER NUMBER. ___________

57. Which of the following do you receive now? SELECT ALL THAT APPLY.

• Supplemental Nutrition Assistance Program benefits, sometimes called SNAP or Food Stamps

• Temporary Assistance to Needy Families, sometimes called TANF or welfare

• Medicaid or [insert state-specific name for Medicaid]

• Head Start

• Food from food bank, food pantry, or soup kitchen

• Other food assistance program; Specify:________________________________

• I DO NOT RECEIVE ANY ASSISTANCE BESIDES WIC

• -4 DON’T KNOW

• -7 REFUSAL

58. 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.						59. 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 Question 60]	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 child	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

60. What activities or changes would make WIC nutrition education more useful and helpful to you?

You have completed the last survey.

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