12.3 Survey

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

6MonthQuestionnaireChild

6-Month Interview

OMB: 0925-0593

Document [docx]
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OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

6M Questionnaire - Child, Phase 2g

OMB Specification


6M Questionnaire - Child


Event Category:

Time-Based

Event:

6M

Administration:

N/A

Instrument Target:

Child

Instrument Respondent:

Primary Caregiver

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:

5 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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6M Questionnaire - Child



TABLE OF CONTENTS





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6M 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.





CHILD DEVELOPMENT - TEETH


(TIME_STAMP_CDT_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD PARTICIPANT ID (P_ID) FOR CHILD AND RESPONDENT ID (R_P_ID) FOR PARENT/CAREGIVER.

  • PRELOAD FIRST NAME OF CHILD (C_FNAME) FROM  PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE AND DISPLAY APPROPRIATE NAME IN “C_FNAME” THROUGHOUT THE INSTRUMENT.

  • OTHERWISE, IF C_FNAME IN PARTICIPANT VERIFICATION, SCHEDULING, & TRACING = -1 OR -2, DISPLAY “the child” IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT.

  • IF CHILD_SEX IN PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE = 1, DISPLAY “his”, “he”, OR “himself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

  • IF CHILD_SEX IN PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE = 2, DISPLAY “her”, “she”, OR “herself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

  • PRELOAD SEC_RES FROM PARTICIPANT VERIFICATION, SCHEDULING & TRACING QUESTIONNAIRE.


CDT01000/(CHILD_HAVE_TEETH). Does {C_FNAME/the child} have any teeth?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_CDT_ET

REFUSED

-1

TIME_STAMP_CDT_ET

DON'T KNOW

-2

TIME_STAMP_CDT_ET


SOURCE

New


CDT02000/(CHILD_TEETH_NUM). How many teeth does {he/she} have?

 

         |___|___|

         NUMBER OF TEETH


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Study of Parents And Children 15 Month Questionnaire (modified)


(TIME_STAMP_CDT_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



SLEEP ENVIRONMENT AND ROUTINE


(TIME_STAMP_SE_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


SE01000. Now I would like to ask you a few questions about {C_FNAME/the child}’s sleeping habits.  {When responding to the questions in this section, please think about the responses in relation to {C_FNAME/the child}’s primary address or the place where {he/she} spends most of the time.}


INTERVIEWER INSTRUCTIONS

  • IF NECESSARY, REMIND THE PARENT/CAREGIVER THAT THE RESPONSES TO THIS SECTION SHOULD BE IN REFERENCE TO THE CHILD’S PRIMARY RESIDENCE, THE PLACE WHERE THE CHILD SPENDS MOST OF HIS OR HER TIME.    


SOURCE

National Children’s Study, Vanguard 2.0 Phase (Core)


PROGRAMMER INSTRUCTIONS

  • IF SEC_RES = 1, DISPLAY "When responding to the questions in this section, please think about the responses in relation to {C_FNAME/the child}’s primary address or the place where {he/she} spends most of the time."


SE02000/(SLEEP_ROOM). In which room does the child sleep?


Label

Code

Go To

In {his/her} own room on {his/her} own

1

CHILD_SLEEP_OFTEN

In a room with other children

2

CHILD_SLEEP_OFTEN

In your bedroom

3

CHILD_SLEEP_OFTEN

OTHER

-5


REFUSED

-1

CHILD_SLEEP_OFTEN

DON'T KNOW

-2

CHILD_SLEEP_OFTEN


SOURCE

Avon Longitudinal Survey of Parents And Children My Young Baby Girl Questionnaire (modified)


SE03000/(SLEEP_ROOM_OTH). SPECIFY: __________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Survey of Parents And Children My Young Baby Girl Questionnaire (modified)


SE04000/(CHILD_SLEEP_OFTEN). Please tell me where {C_FNAME/the child} usually sleeps at night. 


Label

Code

Go To

A CRIB

1

CHILD_POSITION_USUAL

A BASSINETTE

2

CHILD_POSITION_USUAL

A CRADLE

3

CHILD_POSITION_USUAL

A CARRY COT OR TRAVELING BED

4

CHILD_POSITION_USUAL

AN ADULT BED OR MATTRESS

5

CHILD_SLEEP_ALONE

A SOFA

6

CHILD_POSITION_USUAL

A PLAYPEN

7

CHILD_POSITION_USUAL

A CAR OR INFANT SEAT

8

CHILD_POSITION_USUAL

A COT

9

CHILD_POSITION_USUAL

A DRAWER

10

CHILD_POSITION_USUAL

A BOX

11

CHILD_POSITION_USUAL

THE FLOOR

12

CHILD_POSITION_USUAL

A BABY BED

13

CHILD_POSITION_USUAL

A SWING

14

CHILD_POSITION_USUAL

A STROLLER OR BUGGY

15

CHILD_POSITION_USUAL

SOMEPLACE ELSE

-5


REFUSED

-1

CHILD_POSITION_USUAL

DON'T KNOW

-2

CHILD_POSITION_USUAL


SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months (modified)


SE05000/(CHILD_SLEEP_OFTEN_OTH). SPECIFY: __________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months (modified)


PROGRAMMER INSTRUCTIONS

  • GO TO CHILD_POSITION_USUAL.


SE06000/(CHILD_SLEEP_ALONE). Does {C_FNAME/the child} usually sleep alone on an adult bed or mattress or share it with another person? 


Label

Code

Go To

ALONE

1

CHILD_SHARE_SOMETIMES

SHARES WITH PARENT(S) OR GUARDIAN

2


SHARES WITH ANOTHER ADULT

3


SHARES WITH ANOTHER CHILD

4


SHARES WITH ADULT AND OTHER CHILD(REN)

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


SE07000/(CHILD_SHARE_NUM). Counting {C_FNAME/the child}, how many {people/children} ​usually sleep on an adult bed or mattress with {him/her}?

 

|___|___|

NUMBER


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months (modified)


PROGRAMMER INSTRUCTIONS

  • IF CHILD_SLEEP_ALONE = 2, 3, OR 5, DISPLAY "people".

  • IF CHILD_SLEEP_ALONE = 4, DISPLAY "children".

  • GO TO CHILD_POSITION_USUAL.


SE08000/(CHILD_SHARE_SOMETIMES). You said {C_FNAME/the child} usually sleeps alone. Does {C_FNAME/the child}, sometimes share a bed with another person? 


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


SE09000/(CHILD_POSITION_USUAL). There are a number of positions that babies can be put to sleep in. Do you have a position that you ​usually place {C_FNAME/the child} in? 


INTERVIEWER INSTRUCTIONS

  • IF PARENT/CAREGIVER SAYS "YES", PROBE: "Would that be on [his/her] side, on [his/her] stomach - with [his/her] head face down, on [his/her] stomach - with [his/her] head turned to the side, on [his/her] back or in some other position?"

  • IF PARENT/CAREGIVER SAYS "ON THE STOMACH", PROBE: "When you place the baby on [his/her] stomach is [his/her] head face down in the bed or is [his/her] head turned to the side?")

  • IF PARENT/CAREGIVER SAYS "In my arms" or "I rock [him/her] to sleep", PROBE: "In what position do you place [him/her] to sleep?"


Label

Code

Go To

YES, ON {HIS/HER} SIDE

1

CHILD_SLEEP_WITH

YES, ON {HIS/HER} STOMACH, FACE DOWN

2

CHILD_SLEEP_WITH

YES, ON {HIS/HER} STOMACH, HEAD TO THE SIDE

3

CHILD_SLEEP_WITH

YES, ON {HIS/HER} BACK

4

CHILD_SLEEP_WITH

YES, SOME OTHER POSITION

-5


NO

5

CHILD_SLEEP_WITH

REFUSED

-1

CHILD_SLEEP_WITH

DON'T KNOW

-2

CHILD_SLEEP_WITH


SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


SE10000/(CHILD_POSITION_USUAL_OTH). SPECIFY: ____________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


SE11000/(CHILD_SLEEP_WITH). During the past two weeks, which of the following items were usually under {C_FNAME/the child}, while {he/she} slept? Please answer yes or no to each one. 


INTERVIEWER INSTRUCTIONS

  • PROBE: "Would that be YES or NO?"


Label

Code

Go To

A blanket

1


A sheet

2


A bean bag

3


A waterbed

4


A mattress

5


A thin pad

6


A rug

7


A sheepskin

8


A cushion

9


A sleeping bag

10


A pillow

11


Mattress pad

12


Cloth diaper/towel

13


Waterproof pad

14


Triangle prop

15


Anything else

-5


NONE OF THE ABOVE

16


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


PROGRAMMER INSTRUCTIONS

  • IF CHILD_SLEEP_WITH = 16, -1 OR -2, DO NOT ALLOW SELECTION OF OTHER VALUES AND GO TO CHILD_WEAR_BED.

  • IF CHILD_SLEEP_WITH = ANY COMBINATION OF 1 THROUGH 15, GO TO CHILD_WEAR_BED. 

  • IF CHILD_SLEEP_WITH = -5 OR ANY COMBINATION OF 1 THROUGH 15 AND -5, GO TO CHILD_SLEEP_WITH_OTH.


SE12000/(CHILD_SLEEP_WITH_OTH). SPECIFY: ___________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


SE13000/(CHILD_WEAR_BED). On an average night during the past two weeks, how many layers of clothing, not including diapers, did {C_FNAME/the child} usually wear to bed at night? 


INTERVIEWER INSTRUCTIONS

  • READ LIST IF NECESSARY.


Label

Code

Go To

NONE

1


ONE

2


TWO

3


MORE THAN TWO

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


SE14000/(USUAL_COVER_CHILD). During the past two weeks, which of the following were usually used to cover {C_FNAME/the child} when {he/she} slept at night? Please answer yes or no to each one.


Label

Code

Go To

A blanket

1


A sheet

2


A quilt or comforter

3


A sheepskin

4


A pillow

5


Anything else

-5


NOTHING

-7


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


PROGRAMMER INSTRUCTIONS

  • IF USUAL_COVER_CHILD = -7, -1 OR -2,DO NOT ALLOW SELECTION OF OTHER VALUES AND GO TO TIME_STAMP_SE_ET.

  • IF USUAL_COVER_CHILD = ANY COMBINATION OF 1 THROUGH 5, GO TO BLANKET_TYPE.

  • IF USUAL_COVER_CHILD = 5 ONLY, GO TO COVERS_CHILD_NUM.

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


SE15000/(USUAL_COVER_CHILD_OTH). SPECIFY: ________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


PROGRAMMER INSTRUCTIONS

  • IF USUAL_COVER_CHILD = ANY COMBINATION OF 1 THROUGH 5 AND -5, GO TO BLANKET_TYPE.

  • IF USUAL_COVER_CHILD = 5 AND -5, GO TO COVERS_CHILD_NUM.


SE16000/(BLANKET_TYPE). Would you describe the blanket you used during the past two weeks as ...


Label

Code

Go To

Thin, like a receiving blanket

1


Thick, like a regular blanket

2


Or did you use both types of blankets

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months (modified)


SE17000/(COVERS_CHILD_NUM). On an average night during the past two weeks, how many covers did {C_FNAME/the child} usually have on at one time?


Label

Code

Go To

NONE

1


ONE

2


TWO

3


MORE THAN TWO

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Infant Sleep Position, Survey of Households with Children 0-7 Months


(TIME_STAMP_SE_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 5 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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