22.5 Survey

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

DustWipeOrganicsInstrument

Environmental Sample Collection (Postnatal)

OMB: 0925-0593

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OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Dust Wipe-Organics Instrument, Phase 2g

OMB Specification


Dust Wipe-Organics Instrument


Event Category:

Time-Based

Event:

36M, 48M, 60M

Administration:

N/A

Instrument Target:

Child's Primary Residence

Instrument Respondent:

Primary Caregiver

Domain:

Environmental

Document Category:

Sample Collection

Method:

Data Collector Administered

Mode (for this instrument*):

In-Person, CAI

OMB Approved Modes:

In-Person, CAI

Estimated Administration Time:

1 minute

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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Dust Wipe-Organics Instrument



TABLE OF CONTENTS





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Dust Wipe-Organics Instrument



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.





WIPE-ORGANICS INSTRUMENT - DATA COLLECTOR QUESTIONS


(TIME_STAMP_WOI_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.

  • PRELOAD DWELLING_UNIT_ID FOR THE DWELLING UNIT.

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

  • PRELOAD MULT_CHILD AND CHILD_NUM (IF MULT_CHILD = 1), FROM PVST INSTRUMENT.

  • IF MULT_CHILD = 1, PRELOAD CHILD_QNUM.


WOI01000/(STAFF_ID). ENTER STAFF ID

__________________________________________

STAFF ID


WOI02000/(WIPE_ORG_SAMPLES). WHICH WIPE-ORGANICS SAMPLES ARE SCHEDULED FOR THIS VISIT?


Label

Code

Go To

WIPE-ORGANICS PRIMARY ONLY

1

WIPE_ORG_OKAY

WIPE-ORGANICS PRIMARY AND QC SAMPLE(S)

2



WOI03000/(WIPE_ORG_SUBSAMPLES). WHICH WIPE-ORGANICS QC SAMPLES ARE SCHEDULED FOR THIS VISIT?


DATA COLLECTOR INSTRUCTIONS

  • SELECT ALL THAT APPLY.


Label

Code

Go To

WIPE-ORGANICS BLANK

1


WIPE-ORGANICS DUPLICATE

2


WIPE-ORGANICS SPIKE

3



WOI04000/(WIPE_ORG_OKAY). We would like to collect a wipe sample from your home.  Is that okay?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


WOI05000/(WIPE_ORG_REFUSE). RECORD REASON FOR REFUSAL IF GIVEN.


Label

Code

Go To

NONE GIVEN

1

WIPE_ORG_COMMENTS

NOT INTERESTED IN WIPE SAMPLE COLLECTION

2

WIPE_ORG_COMMENTS

OTHER

-5



WOI06000/(WIPE_ORG_REFUSE_OTH). SPECIFY: _________________________________


SOURCE

New


WOI07000/(WIPE_ORG_COMMENTS). RECORD ANY COMMENTS ABOUT THE WIPE-ORGANICS SAMPLE COLLECTION:

COMMENTS: _____________________________________________________


(TIME_STAMP_WOI_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.

  • IF WIPE_ORG_OKAY = 2, -1, OR -2, GO TO TIME_STAMP_WOS_ET.

  • OTHERWISE, GO TO TIME_STAMP_WOP_ST.



WIPE-ORGANICS PRIMARY SAMPLE


(TIME_STAMP_WOP_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.


WOP01000. COLLECTION INSTRUCTIONS


DATA COLLECTOR INSTRUCTIONS

  • COLLECT THE WIPE-ORGANICS SAMPLE AT THE BORDER OF THE PARTICIPANT’S MOST USED ROOM FROM NON-CARPETED FLOORING IN ACCORDANCE WITH THE SOP.


WOP02000/(WIPE_ORG_COLLECT). WAS A WIPE-ORGANICS SAMPLE COLLECTED?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF WIPE_ORG_COLLECT = 1, SET SAMPLE_NUMBER = 1 AND GO TO WOP05000.

  • OTHERWISE, GO TO WIPE_ORG_NOTCOLLECT.


WOP03000/(WIPE_ORG_NOTCOLLECT). WHY WAS A WIPE-ORGANICS SAMPLE NOT COLLECTED?


Label

Code

Go To

KIT NOT AVAILABLE

1

WIPE_ORG_PRIM_COMMENTS

SUPPLIES PROBLEM

2

WIPE_ORG_PRIM_COMMENTS

RAN OUT OF TIME

3

WIPE_ORG_PRIM_COMMENTS

NOT ENOUGH SPACE

4

WIPE_ORG_PRIM_COMMENTS

REFUSAL

5

WIPE_ORG_PRIM_COMMENTS

OTHER

-5



WOP04000/(WIPE_ORG_NOTCOLLECT_OTH). SPECIFY: ____________________________


PROGRAMMER INSTRUCTIONS

  • GO TO WIPE_ORG_PRIM_COMMENTS.


WOP05000. DATE WIPE-ORGANICS SAMPLE COLLECTED:


(WIPE_ORG _COLL_MM) MONTH: |___|___|

                M    M


(WIPE_ORG_COLL_DD) DAY: |___|___|

           D     D


(WIPE_ORG_COLL_YYYY) YEAR: |___|___|___|___|

             Y     Y     Y     Y


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF MM, DD, OR YYYY ARE OUTSIDE CRITERIA DEFINED IN GENERAL PROGRAMMER INSTRUCTIONS.


WOP06000/(SAMPLE_PR_ID). PRIMARY SAMPLE ID:

|E||__|__|__|__|__|__|__|-DP01

WIPE-ORGANICS ID


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE WIPE-ORGANICS PRIMARY SAMPLE ID ON THE SAMPLE ID LABEL.


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DP01.


WOP07000/(WIPE_ORG_ROOM). IN WHICH ROOM WAS THE WIPE-ORGANICS SAMPLE COLLECTED?


Label

Code

Go To

COMMON LIVING AREA

1

WIPE_ORG_SURF

CHILD'S BEDROOM

2

WIPE_ORG_SURF

MOTHER'S BEDROOM

3

WIPE_ORG_SURF

KITCHEN

4

WIPE_ORG_SURF

OTHER

-5



WOP08000/(WIPE_ORG_ROOM_OTH). SPECIFY: __________________________________________


WOP09000/(WIPE_ORG_SURF). WHAT TYPE OF SURFACE WAS WIPED WHEN COLLECTING THE WIPE-ORGANICS SAMPLE?


Label

Code

Go To

SMOOTH SURFACE

1

WIPE_ORG_SURF_MAT

ROUGH SURFACE

2

WIPE_ORG_SURF_MAT

OTHER

-5



WOP10000/(WIPE_ORG_SURF_OTH). SPECIFY: ____________________________________________


WOP11000/(WIPE_ORG_SURF_MAT). WHAT MATERIAL WAS THE SURFACE WIPED WHEN COLLECTING THE WIPE-ORGANICS SAMPLE?


Label

Code

Go To

VINYL

1

WIPE_ORG_ROOM_AREA

LINOLEUM

2

WIPE_ORG_ROOM_AREA

WOOD

3

WIPE_ORG_ROOM_AREA

CORK

4

WIPE_ORG_ROOM_AREA

RUBBER

5

WIPE_ORG_ROOM_AREA

CONCRETE

6

WIPE_ORG_ROOM_AREA

PAINTED

7

WIPE_ORG_ROOM_AREA

TILE

8

WIPE_ORG_ROOM_AREA

OTHER

-5



WOP12000/(WIPE_ORG_SURF_MAT_OTH). SPECIFY: ____________________________________________


WOP13000/(WIPE_ORG_ROOM_AREA). WHERE IN THE ROOM WAS THE WIPE-ORGANICS SAMPLE COLLECTED?


Label

Code

Go To

LESS THAN ONE FOOT FROM WALL

1


ONE FOOT OR MORE FROM WALL

2



WOP14000/(WIPE_ORG_PRIM_COMMENTS). RECORD ANY COMMENTS ABOUT THE WIPE-ORGANICS PRIMARY SAMPLE COLLECTION:

COMMENTS: __________________________________________________________


(TIME_STAMP_WOP_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.

  • IF WIPE_ORG_SAMPLES = 1 OR WIPE_ORG_COLLECT= 2, GO TO TIME_STAMP_WOS_ET.

  • IF WIPE_ORG_COLLECT = 1 AND

    • IF WIPE_ORG_SUBSAMPLES = 2 ONLY, OR 2 AND 3, GO TO TIME_STAMP_WOD_ST.

    • IF WIPE_ORG_SUBSAMPLES = 3 ONLY, GO TO TIME_STAMP_WOS_ST.

    • IF WIPE_ORG_SUBSAMPLES = 1 ONLY, 1 AND 2, 1 AND 3, OR 1, 2 AND 3, GO TO TIME_STAMP_WOB_ST.



WIPE-ORGANICS BLANK SAMPLE


(TIME_STAMP_WOB_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.


WOB01000/(WIPE_ORG_BLANK_COLLECT). WAS THE WIPE-ORGANICS BLANK SAMPLE COLLECTED?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF WIPE_ORG_BLANK_COLLECT = 1, SET SAMPLE_NUMBER = 2 AND GO TO SAMPLE_BL_ID.

  • OTHERWISE, GO TO WIPE_ORG_BLANK_NOTCOLLECT.


WOB02000/(WIPE_ORG_BLANK_NOTCOLLECT). WHY WAS THE WIPE-ORGANICS BLANK SAMPLE NOT COLLECTED?


Label

Code

Go To

KIT NOT AVAILABLE

1

WIPE_ORG_BLANK_COMMENTS

SUPPLIES PROBLEM

2

WIPE_ORG_BLANK_COMMENTS

OUT OF TIME

3

WIPE_ORG_BLANK_COMMENTS

OTHER

-5



WOB03000/(WIPE_ORG_BLANK_NOTCOLLECT_OTH). SPECIFY: __________________________


PROGRAMMER INSTRUCTIONS

  • GO TO WIPE_ORG_BLANK_COMMENTS.


WOB04000/(SAMPLE_BL_ID). BLANK SAMPLE ID:

|E||__|__|__|__|__|__|__|-DP01

WIPE-ORGANICS BLANK ID


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE WIPE-ORGANICS BLANK SAMPLE ID ON THE SAMPLE ID LABEL.


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DP01.

  • DISPLAY SOFT EDIT IF SAMPLE_BL_ID = SAMPLE_PR_ID.


WOB05000/(WIPE_ORG_BLANK_COMMENTS). RECORD ANY COMMENTS ABOUT THE WIPE-ORGANICS BLANK SAMPLE COLLECTION:

COMMENTS: _____________________________________________________


(TIME_STAMP_WOB_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.

  • IF WIPE_ORG_COLLECT= 1 AND

    • IF WIPE_ORG_SUBSAMPLES = 1 ONLY, GO TO TIME_STAMP_WOS_ET.

    • IF WIPE_ORG_SUBSAMPLES = 1 AND 2, OR 1, 2, AND 3, GO TO TIME_STAMP_WOD_ST.

    • IF WIPE_ORG_SUBSAMPLES = 1 AND 3, GO TO TIME_STAMP_WOS_ST.



WIPE-ORGANICS DUPLICATE SAMPLE


(TIME_STAMP_WOD_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.


WOD01000/(WIPE_ORG_DUP_COLLECT). WAS THE WIPE-ORGANICS DUPLICATE SAMPLE COLLECTED?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF WIPE_ORG_DUP_COLLECT = 1, SET SAMPLE_NUMBER = 3, AND GO TO SAMPLE_DP_ID.

  • OTHERWISE, GO TO WIPE_ORG_DUP_NOTCOLLECT.


WOD02000/(WIPE_ORG_DUP_NOTCOLLECT). WHY WAS THE WIPE-ORGANICS DUPLICATE SAMPLE NOT COLLECTED?


Label

Code

Go To

KIT NOT AVAILABLE

1

WIPE_ORG_DUP_COMMENTS

SUPPLIES PROBLEM

2

WIPE_ORG_DUP_COMMENTS

OUT OF TIME

3

WIPE_ORG_DUP_COMMENTS

NOT ENOUGH SPACE

4

WIPE_ORG_DUP_COMMENTS

REFUSAL

5

WIPE_ORG_DUP_COMMENTS

OTHER

-5



WOD03000/(WIPE_ORG_DUP_NOTCOLLECT_OTH). SPECIFY: ____________________________


PROGRAMMER INSTRUCTIONS

  • GO TO WIPE_ORG_DUP_COMMENTS.


WOD04000/(SAMPLE_DP_ID). DUPLICATE SAMPLE ID:

|E||__|__|__|__|__|__|__|-DP01

WIPE-ORGANICS DUPLICATE ID


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE WIPE-ORGANICS DUPLICATE SAMPLE ID ON THE SAMPLE ID LABEL.


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DP01.

  • DISPLAY SOFT EDIT IF SAMPLE_DP_ID = SAMPLE_PR_ID AND/OR SAMPLE_BL_ID.


WOD05000/(WIPE_ORG_DUP_SURF). WHAT TYPE OF SURFACE WAS WIPED WHEN COLLECTING THE WIPE-ORGANICS DUPLICATE SAMPLE?


Label

Code

Go To

SMOOTH SURFACE

1

WIPE_ORG_DUP_SURF_MAT

ROUGH SURFACE

2

WIPE_ORG_DUP_SURF_MAT

OTHER

-5



WOD06000/(WIPE_ORG_DUP_SURF_OTH). SPECIFY: ____________________________________________


WOD07000/(WIPE_ORG_DUP_SURF_MAT). WHAT MATERIAL WAS THE SURFACE WIPED WHEN COLLECTING THE WIPE-ORGANICS DUPLICATE SAMPLE?


Label

Code

Go To

VINYL

1

WIPE_ORG_DUP_ROOM_AREA

LINOLEUM

2

WIPE_ORG_DUP_ROOM_AREA

WOOD

3

WIPE_ORG_DUP_ROOM_AREA

CORK

4

WIPE_ORG_DUP_ROOM_AREA

RUBBER

5

WIPE_ORG_DUP_ROOM_AREA

CONCRETE

6

WIPE_ORG_DUP_ROOM_AREA

PAINTED

7

WIPE_ORG_DUP_ROOM_AREA

TILE

8

WIPE_ORG_DUP_ROOM_AREA

OTHER

-5



WOD08000/(WIPE_ORG_DUP_SURF_MAT_OTH). SPECIFY: ____________________________________________


WOD09000/(WIPE_ORG_DUP_ROOM_AREA). WHERE IN THE ROOM WAS THE WIPE-ORGANICS DUPLICATE SAMPLE COLLECTED?


Label

Code

Go To

LESS THAN ONE FOOT FROM WALL

1


ONE FOOT OR MORE FROM WALL

2



WOD10000/(WIPE_ORG_DUP_COMMENTS). RECORD ANY COMMENTS ABOUT THE WIPE-ORGANICS DUPLICATE SAMPLE COLLECTION:

COMMENTS: _____________________________________________________


(TIME_STAMP_WOD_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.

  • IF WIPE_ORG_COLLECT= 1 AND?

    • IF WIPE_ORG_SUBSAMPLES = 2 ONLY, OR 1 AND 2, GO TO TIME_STAMP_WOS_ET.

    • IF WIPE_ORG_SUBSAMPLES = 2 AND 3 OR 1, 2, AND 3, GO TO TIME_STAMP_WOS_ST.


WIPE-ORGANICS SPIKE SAMPLE


(TIME_STAMP_WOS_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.


WOS01000/(WIPE_ORG_SPIKE_COLLECT). WAS THE WIPE-ORGANICS SPIKE SAMPLE INCLUDED?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF WIPE_ORG_SPIKE_COLLECT = 1, SET SAMPLE_NUMBER = 4 AND GO TO SAMPLE_SP_ID.

  • OTHERWISE, GO TO WIPE_ORG_SPIKE_NOTCOLLECT.


WOS02000/(WIPE_ORG_SPIKE_NOTCOLLECT). WHY WAS THE WIPE-ORGANICS SPIKE SAMPLE NOT INCLUDED?


Label

Code

Go To

SPIKE NOT AVAILABLE

1

WIPE_ORG_SPIKE_COMMENTS

OUT OF TIME

2

WIPE_ORG_SPIKE_COMMENTS

OTHER

-5



WOS03000/(WIPE_ORG_SPIKE_NOTCOLLECT_OTH). SPECIFY: ________________________________


WOS04000/(SAMPLE_SP_ID). SPIKE SAMPLE ID:

|E||__|__|__|__|__|__|__|-DP01

WIPE-ORGANICS SPIKE ID


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE WIPE-ORGANICS SPIKE SAMPLE ID ON THE SAMPLE ID LABEL.


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DP01.

  • DISPLAY SOFT EDIT IF SAMPLE_SP_ID = SAMPLE_PR_ID, SAMPLE_BL_ID AND/OR SAMPLE_DP_ID.


WOS05000/(WIPE_ORG_SPIKE_COMMENTS). RECORD ANY COMMENTS ABOUT THE WIPE-ORGANICS SPIKE SAMPLE COLLECTION:

COMMENTS: _____________________________________________________


(TIME_STAMP_WOS_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.


Public reporting burden for this collection of information is estimated to average 1 minute 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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