15.4 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

18M Questionnaire - Child, Phase 2g

OMB Specification

18M Questionnaire - Child

Event Category:	Time-Based
Event:	18M
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:	3 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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18M Questionnaire - Child

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

SLEEP ENVIRONMENT 3

USE OF PACIFIER 7

BREAST-FEEDING 9

PRODUCT USE - HOUSEHOLD AND CHILD 11

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18M 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.

SLEEP ENVIRONMENT

(TIME_STAMP_SLE_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

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

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

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

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

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

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

SLE01000. 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 ADULT 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."

SLE02000/(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)

SLE03000/(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)

SLE04000/(CHILD_SLEEP_OFTEN). Please tell me where {C_FNAME/the child} usually sleeps at night.

Label	Code	Go To
A CRIB	1	SLEEP_PARENT_FREQ
A BASSINETTE	2	SLEEP_PARENT_FREQ
A CRADLE	3	SLEEP_PARENT_FREQ
A CARRY COT OR TRAVELING BED	4	SLEEP_PARENT_FREQ
AN ADULT BED OR MATTRESS	5	CHILD_SLEEP_ALONE
A SOFA	6	SLEEP_PARENT_FREQ
A PLAYPEN	7	SLEEP_PARENT_FREQ
A CAR OR INFANT SEAT	8	SLEEP_PARENT_FREQ
A COT	9	SLEEP_PARENT_FREQ
A DRAWER	10	SLEEP_PARENT_FREQ
A BOX	11	SLEEP_PARENT_FREQ
THE FLOOR	12	SLEEP_PARENT_FREQ
A BABY BED	13	SLEEP_PARENT_FREQ
A SWING	14	SLEEP_PARENT_FREQ
A STROLLER OR BUGGY	15	SLEEP_PARENT_FREQ
SOMEPLACE ELSE	-5
REFUSED	-1	SLEEP_PARENT_FREQ
DON'T KNOW	-2	SLEEP_PARENT_FREQ

SOURCE

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

SLE05000/(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 SLEEP_PARENT_FREQ.

SLE06000/(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 

SLE07000/(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

PROGRAMMER INSTRUCTIONS

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

• IF CHILD_SLEEP_ALONE = 4, DISPLAY "children".

• GO TO SLEEP_PARENT_FREQ.

SLE08000/(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 

SLE09000/(SLEEP_PARENT_FREQ). How often does {C_FNAME/the child} sleep in the same bed with you?

Label	Code	Go To
Always	1
Almost always	2
Sometimes	3
Never	4
REFUSED	-1
DON'T KNOW	-2

SOURCE

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

(TIME_STAMP_SLE_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

USE OF PACIFIER

(TIME_STAMP_UOP_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

UOP01000/(PACIFIER). Does {C_FNAME/the child} use a pacifier?

Label	Code	Go To
YES	1
NO	2	TIME_STAMP_UOP_ET
REFUSED	-1	TIME_STAMP_UOP_ET
DON'T KNOW	-2	TIME_STAMP_UOP_ET

SOURCE

National Institute of Child Health and Human Development (NICHD) National Infant Sleep Position, Survey of Households with Children 

UOP02000/(PACIFIER_NIGHT). How often does {C_FNAME/the child} use a pacifier during nighttime sleep?

Label	Code	Go To
Never	1
Usually	2
Sometimes	3
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Institute of Child Health and Human Development (NICHD) National Infant Sleep Position, Survey of Households with Children  (modified)

UOP03000/(PACIFIER_DAY). How often does {C_FNAME/the child} use a pacifier during daytime sleep?

Label	Code	Go To
Never	1
Usually	2
Sometimes	3
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Institute of Child Health and Human Development (NICHD) National Infant Sleep Position, Survey of Households with Children 

UOP04000/(PACIFIER_AWAKE). How often does {C_FNAME/the child} use a pacifier while awake?

Label	Code	Go To
Never	1
Usually	2
Sometimes	3
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Institute of Child Health and Human Development (NICHD) National Infant Sleep Position, Survey of Households with Children 

(TIME_STAMP_UOP_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

BREAST-FEEDING

(TIME_STAMP_BF_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• IF RESP_REL = 1 (BIOLOGICAL MOTHER), GO TO BREAST_FEED.

• IF RESP_REL ≠ 1 (BIOLOGICAL MOTHER), GO TO TIME_STAMP_BF_ET.

BF01000/(BREAST_FEED). Are you currently breast-feeding {C_FNAME/the child}?

Label	Code	Go To
YES	1	TIME_STAMP_BF_ET
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

Infant Feeding Practices Study II (modified)

BF02000/(PUMPED). Did you ever feed {C_FNAME/the child} breast milk? 

Label	Code	Go To
YES	1
NO	2	TIME_STAMP_BF_ET
REFUSED	-1	TIME_STAMP_BF_ET
DON'T KNOW	-2	TIME_STAMP_BF_ET

SOURCE

Adapted from Infant Feeding Practices Study II 

BF03000. How old was {C_FNAME/the child} when you completely stopped feeding your baby breast milk?

SOURCE

​Adapted from Infant Feeding Practices Study II

(BREAST_STOP) |___|___| NUMBER OF

(BREAST_STOP_UNIT)

Label	Code	Go To
WEEKS	1
MONTHS	2
REFUSED	-1
DON'T KNOW	-2

(TIME_STAMP_BF_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

PRODUCT USE - HOUSEHOLD AND CHILD

(TIME_STAMP_PUH_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

PUH01000/(INSECT_REPELLENT). In the past six months, about how often have you used any insect repellent in the form of spray, lotion, or towelettes on {C_FNAME/the child}? 

Label	Code	Go To
EVERY DAY	1
A FEW TIMES A WEEK	2
ABOUT ONCE A WEEK	3
1-3 TIMES A MONTH	4
LESS THAN ONCE A MONTH	5
NOT AT ALL	6
REFUSED	-1
DON'T KNOW	-2

SOURCE

T1 Survey

PUH02000. The next question asks about lice exposure and treatment.

PUH03000/(TREAT_LICE). In the past 6 months, have you treated {C_FNAME/the child} in your home for lice or scabies?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase (T1 Mother, T3 Prior, 6M, 12M)

(TIME_STAMP_PUH_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 3 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.