8.3 Survey

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

BirthQuestionnaireChild

Birth Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/15/2014

Birth Questionnaire – Child, Phase 2g

OMB Specification


Birth Questionnaire – Child


Event Category:

Time-Based

Event:

Birth

Administration:

N/A

Instrument Target:

Child

Instrument Respondent:

Biological Mother

Domain:

Questionnaire

Document Category:

Questionnaire

Method:

Data Collector Administered

Mode (for this instrument*):

In-Person, CAI;
Phone, CAI

OMB Approved Modes:

In-Person, CAI;
Phone, CAI;
Web-Based, CAI

Estimated Administration Time:

6 minutes

Multiple Child/Sibling Consideration:

Per Child

Special Considerations:

N/A

Version:

1.0

MDES Release:

4.0


*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.


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Birth Questionnaire – Child



TABLE OF CONTENTS





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Birth Questionnaire – Child



GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:


DATA ELEMENT FIELDS

MAXIMUM CHARACTERS PERMITTED

DATA TYPE

PROGRAMMER INSTRUCTIONS

ADDRESS AND EMAIL FIELDS

100

CHARACTER


UNIT AND PHONE FIELDS

10

CHARACTER


_OTH AND COMMENT FIELDS

255

CHARACTER

  • Limit text to 255 characters

FIRST NAME AND LAST NAME

30

CHARACTER

  • Limit text to 30 characters

ALL ID FIELDS

36

CHARACTER


ZIP CODE

5

NUMERIC


ZIP CODE LAST FOUR

4

NUMERIC


CITY

50

CHARACTER


DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)

10

NUMERIC


CHARACTER



  • DISPLAY AS MM/DD/YYYY

  • STORE AS YYYY-MM-DD

  • HARD EDITS:

MM MUST EQUAL 01 TO 12

DD MUST EQUAL 01 TO 31

YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.

TIME VARIABLES

TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION

NUMERIC

  • HARD EDITS:

HOURS MUST BE BETWEEN 00 AND 12;

MINUTES MUST BE BETWEEN 00 AND 59


Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).


POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.



A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.





INTERVIEWER-COMPLETED QUESTIONS - OPENING


(TIME_STAMP_IQO_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

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

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

  • IF C_FNAME ≠ -1 OR -2, DISPLAY APPROPRIATE NAME IN “C_FNAME” THROUGHOUT THE INSTRUMENT.

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

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

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

  • PRELOAD MODE.


IQO01000/(BIRTH_DELIVER). WHERE DID PARTICIPANT DELIVER BABY OR BABIES?


Label

Code

Go To

HOSPITAL

1


BIRTHING CENTER

2


AT HOME

3


SOME OTHER PLACE

-5



PROGRAMMER INSTRUCTIONS

  • IF BIRTH_DELIVER = 1, DISPLAY “hospital” THROUGHOUT THE INSTRUMENT. 

  • IF BIRTH_DELIVER = 2, DISPLAY “birthing center” THROUGHOUT THE INSTRUMENT. 

  • IF BIRTH_DELIVER = -5, DISPLAY “other place” THROUGHOUT THE INSTRUMENT. 


IQO02000/(MULTIPLE). WAS THIS A MULTIPLE BIRTH?


Label

Code

Go To

YES

1


NO

2

RELEASE


PROGRAMMER INSTRUCTIONS

  • IF MULTIPLE = 1, DISPLAY “babies” THROUGHOUT INSTRUMENT AS APPROPRIATE.

  • IF MULTIPLE = 2, DISPLAY “baby” THROUGHOUT INSTRUMENT AS APPROPRIATE.


IQO03000/(MULTIPLE_NUM). HOW MANY BABIES WERE DELIVERED?

 

|___|___|

NUMBER OF BABIES


IQO04000/(RELEASE). {HAS BABY/HAVE BABIES} BEEN RELEASED FROM THE {HOSPITAL/BIRTHING CENTER/OTHER PLACE}?


INTERVIEWER INSTRUCTIONS

  • ASK ONLY IF NEEDED.

  • IF MULTIPLE BIRTH AND AT LEAST ONE BABY HAS BEEN RELEASED FROM HOSPITAL, SELECT “1”.


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF MULTIPLE = 2 DISPLAY “HAS BABY”.

  • IF MULTIPLE = 1 DISPLAY “HAVE BABIES”.


(TIME_STAMP_IQO_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



BABY CHARACTERISTICS


(TIME_STAMP_BC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


BC01000. First, let’s talk about {C_FNAME}.


BC02000. How much did {C_FNAME/your baby} weigh when {he/she} was born?


SOURCE

National Health Interview Survey


(BABY_BWT_LB) POUNDS:    |___|___|

                    P     P


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(BABY_BWT_OZ) OUNCES:    |___|___|

                    O     O


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



BC03000/(BABY_ETHNIC_ORIGIN). Is {C_FNAME/the child} of Hispanic, Latino/a or Spanish origin?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


PROGRAMMER INSTRUCTIONS

  • IF BABY_ETHNIC_ORIGIN = 1, GO TO BABY_ETHNIC_ORIGIN_1.

  • IF BABY_ETHNIC_ORIGIN ≠ 1 AND:

    • IF MODE = CAPI, GO TO BABY_RACE_NEW.

    • IF MODE ​= CATI, GO TO BABY_RACE_1.


BC04000/(BABY_ETHNIC_ORIGIN_1). Is {C_FNAME/the child} one or more of the following?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

  • PROBE: Anything else?


Label

Code

Go To

Mexican, Mexican American, Chicano/a

1


Puerto Rican

2


Cuban

3


Another Hispanic, Latino/a, or Spanish origin

4


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


PROGRAMMER INSTRUCTIONS

  • IF BABY_ETHNIC_ORIGIN_1 = -5 OR ANY COMBINATION OF 1 THROUGH 4 AND -5, GO TO BABY_ETHNIC_ORIGIN_1_OTH.

  • IF BABY_ETHNIC_ORIGIN_1 = ANY COMBINATION OF 1 THROUGH 4, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING BABY_ETHNIC_ORIGIN_1_OTH.

  • IF BABY_ETHNIC_ORIGIN_1 = -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO PROGRAMMER INSTRUCTIONS FOLLOWING BABY_ETHNIC_ORIGIN_1_OTH.


BC05000/(BABY_ETHNIC_ORIGIN_1_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


PROGRAMMER INSTRUCTIONS

  • IF MODE = CAPI, GO TO BABY_RACE_NEW.

  • IF MODE = CATI, GO TO BABY_RACE_1.


BC06000/(BABY_RACE_NEW). What is {C_FNAME/the child}’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.

  • CODE “SOME OTHER RACE” ONLY IF VOLUNTEERED.

  • PROBE: Anything else?


Label

Code

Go To

WHITE

1


BLACK OR AFRICAN AMERICAN

2


AMERICAN INDIAN OR ALASKA NATIVE

3


ASIAN INDIAN

4


CHINESE

5


FILIPINO

6


JAPANESE

7


KOREAN

8


VIETNAMESE

9


OTHER ASIAN

10


NATIVE HAWAIIAN

11


GUAMANIAN OR CHAMORRO

12


SAMOAN

13


OTHER PACIFIC ISLANDER

14


SOME OTHER RACE

-5


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


PROGRAMMER INSTRUCTIONS

  • IF BABY_RACE_NEW = ANY COMBINATION OF 1 THROUGH 14, GO TO LIVE_MOM.

  • IF BABY_RACE _NEW= -5 OR ANY COMBINATION OF 1 THROUGH 14 AND -5, GO TO BABY_RACE_NEW_OTH.

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


BC07000/(BABY_RACE_NEW_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


PROGRAMMER INSTRUCTIONS

  • GO TO LIVE_MOM.


BC08000/(BABY_RACE_1). What is {C_FNAME/the child}’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

  • CODE “SOME OTHER RACE” ONLY IF VOLUNTEERED.

  • PROBE: Anything else?


Label

Code

Go To

White

1


Black or African American

2


American Indian or Alaska Native

3


Asian

4


Native Hawaiian or other Pacific Islander

5


SOME OTHER RACE

-5


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


PROGRAMMER INSTRUCTIONS

  • IF BABY_RACE_1 = ANY COMBINATION OF 1 THROUGH 3, GO TO LIVE_MOM.

  • IF BABY_RACE_1 = 4 OR ANY COMBINATION OF 4 AND 1, 2, 3, AND/OR 5, GO TO BABY_RACE_2.

  • IF BABY_RACE_1 = 5 OR ANY COMBINATION OF 5 AND 1 THROUGH 3, GO TO BABY_RACE_3.

  • IF BABY_RACE_1 = -5 OR ANY COMBINATION OF 1 THROUGH 5 AND -5, GO TO BABY_RACE_1_OTH.

  • IF BABY_RACE_1 = -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO LIVE_MOM.


BC09000/(BABY_RACE_1_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


PROGRAMMER INSTRUCTIONS

  • IF BABY_RACE_1 = 4 OR ANY COMBINATION OF 4 AND 1, 2, 3, AND/OR 5, GO TO BABY_RACE_2.

  • IF BABY_RACE_1 = 5 OR ANY COMBINATION OF 5 AND 1 THROUGH 3, GO TO BABY_RACE_3.

  • OTHERWISE, IF BABY_RACE_1 DOES NOT INCLUDE 4 OR 5, GO TO LIVE_MOM.


BC10000/(BABY_RACE_2). What is {C_FNAME/the child}’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

Asian Indian

1


Chinese

2


Filipino

3


Japanese

4


Korean

5


Vietnamese

6


Other Asian

7


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


PROGRAMMER INSTRUCTIONS

  • IF BABY_RACE_1 = INCLUDES 5, GO TO BABY_RACE_3.

  • OTHERWISE, IF BABY_RACE_1 DOES NOT INCLUDE 5, GO TO LIVE_MOM.


BC11000/(BABY_RACE_3). What is {C_FNAME/the child}’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

Native Hawaiian

1


Guamanian or Chamorro

2


Samoan

3


Other Pacific Islander

4


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status.


BC12000/(LIVE_MOM). {Does {C_FNAME/your baby}}/{When {C_FNAME/your baby} leaves the} {hospital/birthing center/other place} {will} {he/she} live with you?


Label

Code

Go To

YES

1

TIME_STAMP_BC_ET

NO

2


REFUSED

-1

TIME_STAMP_BC_ET

DON'T KNOW

-2

TIME_STAMP_BC_ET


SOURCE

National Children’s Study, Vanguard Phase (Birth)


PROGRAMMER INSTRUCTIONS

  • IF EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “Does {C_FNAME/your baby}”.

  • IF RELEASE = 2, DISPLAY “When {C_FNAME/your baby} leaves the” AND “will”.


BC13000/(LIVE_OTH). With whom {does {he/she}}/{will {he/she}} live?


Label

Code

Go To

BABY’S FATHER

1


BABY’S GRANDPARENT(S)

2


OTHER FAMILY MEMBER

3


PLACING IN FOSTER CARE

4


PLACING FOR ADOPTION

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Birth)


PROGRAMMER INSTRUCTIONS

  • IF MULTIPLE = 2 AND EITHER RELEASE=1 OR BIRTH_DELIVER = 3, DISPLAY “does {he/she}”.

  • IF MULTIPLE = 2 AND RELEASE=2, DISPLAY “will {he/she}”.


(TIME_STAMP_BC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



INFANT FEEDING


(TIME_STAMP_IF_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


IF01000/(FED_BABY). Have you fed {C_FNAME/your baby} since {his/her} birth?


Label

Code

Go To

YES

1


NO

2

PLAN_FEED

REFUSED

-1

PLAN_FEED

DON'T KNOW

-2

PLAN_FEED


SOURCE

Avon Longitudinal Study of Parents and Children (modified)


IF02000/(HOW_FED). How have you fed {C_FNAME/your baby}?  Did you breast or bottle feed?


Label

Code

Go To

BREAST ONLY

1


BOTTLE ONLY

2


BOTH BREAST AND BOTTLE

3


OTHER

4


REFUSED

-1


DON’T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents and Children (modified)


PROGRAMMER INSTRUCTIONS

  • IF LIVE_MOM = 2, GO TO TIME_STAMP_IF_ET.

  • OTHERWISE, GO TO PLAN_FEED.


IF03000/(PLAN_FEED). {Have you fed/Do you plan to feed} the baby breast milk, formula or both?


Label

Code

Go To

BREAST MILK

1


FORMULA

2


BOTH BREAST MILK AND FORMULA

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Birth)


PROGRAMMER INSTRUCTIONS

  • IF FED_BABY = 2, -1, OR -2, DISPLAY “Do you plan to feed”.

  • OTHERWISE, DISPLAY “Have you fed”.


(TIME_STAMP_IF_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



INFANT SLEEP ENVIRONMENT AND ROUTINE


(TIME_STAMP_IS_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


IS01000/(POS_HOSP). {Do/Did} the nurses in the {hospital/birthing center/other place} usually put {C_FNAME/your baby} to sleep on {his/her} stomach, back, or side? 


Label

Code

Go To

STOMACH

1


BACK

2


SIDE

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Birth)


PROGRAMMER INSTRUCTIONS

  • IF RELEASE = 1, DISPLAY “Did.”

  • IF RELEASE = 2, DISPLAY “Do."


IS02000/(POS_HOME). In what position do you {usually put {C_FNAME/your baby}}/{plan to put {C_FNAME/your baby}} to sleep at home?


Label

Code

Go To

STOMACH

1


BACK

2


SIDE

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Infant Sleep Position Study (modified)


PROGRAMMER INSTRUCTIONS

  • IF BIRTH_DELIVER = 3 OR RELEASE= 1, DISPLAY “usually put {C_FNAME/your baby}”.

  • OTHERWISE, DISPLAY “plan to put {C_FNAME/your baby}”.


IS03000/(SLEEP_ROOM). {When you go home from the {hospital/birthing center/other place}, do you plan for}/{Does} {C_FNAME/your baby} {to} sleep…


Label

Code

Go To

In {his/her} own room

1


In a room with other children

2


In your bedroom

3


Another location

-5


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Birth)


PROGRAMMER INSTRUCTIONS

  • IF RELEASE = 2, DISPLAY “When you go home from the {hospital/birthing center/other place}, do you plan for” and “to”.

  • IF BIRTH_DELIVER = 3 OR RELEASE=1, DISPLAY "Does".


IS04000/(BED). {When you go home from the {hospital/birthing center/other place}, do you plan for}/{Does}{C_FNAME/your baby} {to} sleep in …


Label

Code

Go To

A bassinette

1

TIME_STAMP_IS_ET

A crib

2

TIME_STAMP_IS_ET

A co-sleeper

3

TIME_STAMP_IS_ET

An adult bed alone

4

TIME_STAMP_IS_ET

An adult bed with you

5

TIME_STAMP_IS_ET

An adult bed with another child

6

TIME_STAMP_IS_ET

Something else

-5


REFUSED

-1

TIME_STAMP_IS_ET

DON’T KNOW

-2

TIME_STAMP_IS_ET


SOURCE

National Children’s Study, Vanguard Phase (Birth)


PROGRAMMER INSTRUCTIONS

  • IF RELEASE = 2, DISPLAY “When you go home from the {hospital/birthing center/other place}, do you plan for” and “to”

  • IF BIRTH_DELIVER = 3 OR RELEASE=1, DISPLAY “Does”


IS05000/(BED_OTH). SPECIFY: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Birth)


(TIME_STAMP_IS_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



WELL BABY CARE AND IMMUNIZATIONS


(TIME_STAMP_WBC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


WBC01000/(HCARE). Where do you plan to take your new baby for well-baby checkups?


Label

Code

Go To

Hospital clinic

1

VACCINE

Health department clinic

2

VACCINE

Private doctor's office or health maintenance organization (HMO)

3

VACCINE

Some other place

-5


REFUSED

-1

VACCINE

DON'T KNOW

-2

VACCINE


SOURCE

Pregnancy Risk Assessment and Monitoring System (modified)


WBC02000/(HCARE_OTH). SPECIFY: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Risk Assessment and Monitoring System (modified)


WBC03000/(VACCINE). Do you plan for your new baby to have well-baby shots or vaccinations?


Label

Code

Go To

YES

1


YES, ON A DELAYED SCHEDULE

2


NO

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Risk Assessment and Monitoring System (modified)


(TIME_STAMP_WBC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


PLANS FOR CHILDCARE


(TIME_STAMP_PFC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


PFC10100. Next I would like to ask you a few questions about your plans for child care.


PFC11000/(CHILDCARE). Will {C_FNAME/your baby} receive regularly scheduled care from someone other than you or the baby’s father?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_PFC_ET

REFUSED

-1

TIME_STAMP_PFC_ET

DON'T KNOW

-2

TIME_STAMP_PFC_ET


SOURCE

Study of Early Child Care and Youth Development, Early Childhood Longitudinal Program Birth Cohort, National Household Examination Survey, Child Care Decision Making Study (Australia) (modified)


PFC12000/(CCARE_TYPE). Please describe the type of setting in which most of the child care will occur.


Label

Code

Go To

PARTICIPANT’S HOME

1

CCARE_WHO

OTHER PRIVATE HOME

2

CCARE_WHO

CHILD CARE CENTER

3

CCARE_WHO

OTHER

-5


REFUSED

-1

CCARE_WHO

DON’T KNOW

-2

CCARE_WHO


SOURCE

Study of Early Child Care and Youth Development, Early Childhood Longitudinal Program Birth Cohort, National Household Examination Survey, Child Care Decision Making Study (Australia) (modified)


PFC13000/(CCARE_TYPE_OTH). SPECIFY: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Study of Early Child Care and Youth Development, Early Childhood Longitudinal Program Birth Cohort, National Household Examination Survey, Child Care Decision Making Study (Australia) (modified)


PFC14000/(CCARE_WHO). Which best describes the person who will be caring for {C_FNAME/your baby}?


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

YOUR MOTHER

1

TIME_STAMP_PFC_ET

YOUR FATHER

2

TIME_STAMP_PFC_ET

YOUR MOTHER IN-LAW

3

TIME_STAMP_PFC_ET

YOUR FATHER IN-LAW

4

TIME_STAMP_PFC_ET

GUARDIAN

5

TIME_STAMP_PFC_ET

OTHER RELATIVE

6


FRIEND

7

TIME_STAMP_PFC_ET

NANNY

8

TIME_STAMP_PFC_ET

PROFESSIONAL IN-HOME DAYCARE

9

TIME_STAMP_PFC_ET

PROFESSIONAL CENTER-BASED DAYCARE

10

TIME_STAMP_PFC_ET

OTHER

-5

CCARE_WHO_OTH

REFUSED

-1

TIME_STAMP_PFC_ET

DON’T KNOW

-2

TIME_STAMP_PFC_ET


SOURCE

National Children’s Study, Vanguard Phase (Birth)


PFC15000/(REL_CARE_OTH). SPECIFY: ________________________ 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Birth)


PROGRAMMER INSTRUCTIONS

  • GO TO TIME_STAMP_PFC_ET.


PFC16000/(CCARE_WHO_OTH). SPECIFY: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Birth)


(TIME_STAMP_PFC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



INFANT MEDICAL CARE LOG INTRODUCTION


(TIME_STAMP_IMC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


IMC01000. In order to help keep track of the child’s doctor visits or other health care provider visits, we {are providing you with/will mail you} an Infant and Child Health Care Log. At each Study visit or telephone interview, we will ask you about any health care visits the child had since the last Study visit or telephone interview. This log will help you remember that information.

 

{The Infant and Child Health Care Log is very similar to the Pregnancy Health Care Log, and will be used the same way. The only difference is the addition of the Immunization/Vaccination/Shot Log which is where all of the child’s vaccination information will need to be written down.}

 

It will be very helpful if you use the log to write down information whenever the child receives health care, so that you will be able to remember it accurately during NCS Study visits or telephone interviews.


SOURCE

National Children’s Study, Vanguard Phase (Birth)


INTERVIEWER INSTRUCTIONS

  • DISTRIBUTE INFANT AND CHILD HEALTH CARE LOG.

  • EXPLAIN INFANT AND CHILD HEALTH CARE LOG.


PROGRAMMER INSTRUCTIONS

  • IF MODE ​= CAPI, DISPLAY “are providing you with”.

  • OTHERWISE, IF MODE = CATI, DISPLAY “will mail you”.

  • IF EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY “The Infant and Child Health Care Log is very similar to the Pregnancy Health Care Log, and will be used the same way. The only difference is the addition of the Immunization/Vaccination/Shot Log which is where all of the child’s vaccination information will need to be written down”.


(TIME_STAMP_IMC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.

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