15.4 Survey

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

18MQuestionnaireChild

18-Month Interview

OMB: 0925-0593

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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





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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.

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