38.10 Survey

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

36MQuestionnaireHousehold

36-Month Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

36M Questionnaire – Household, Phase 2g

OMB Specification


36M Questionnaire - Household


Event Category:

Time-Based

Event:

36M

Administration:

N/A

Instrument Target:

Child's Primary Residence

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 Event

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.


This page intentionally left blank.


36M Questionnaire - Household



TABLE OF CONTENTS





This page intentionally left blank.



36M Questionnaire - Household



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.





OCCUPATIONAL/HOBBY EXPOSURES


(TIME_STAMP_OE_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

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

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

  • IF MULT_CHILD = 1, DISPLAY "the children" AS APPROPRIATE THROUGHOUT THE INSTRUMENT.

  • OTHERWISE, DISPLAY "the child" IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.


OE01000. Now I would like to ask some questions about any jobs and hobbies that you have done recently.


SOURCE

National Children’s Study Legacy Phase  


OE02000/(HOBBIES_WORK_INSIDE_HOME). Does anyone have a hobby or business inside {the child/the children}'s home that uses solvents, greases, paint, or glue, or that generates dust or fumes, such as woodworking, soldering, welding or hair treatments (such as perms or dyes)?


INTERVIEWER INSTRUCTIONS

  • DO NOT INCLUDE HOBBIES OR BUSINESSES IN DETACHED GARAGES OR DONE OUTSIDE.


Label

Code

Go To

YES

1


NO

2

OE04000

REFUSED

-1

OE04000

DON’T KNOW

-2

OE04000


SOURCE

National Children’s Study, Legacy Phase (12M) (modified) 


OE03000/(HOBBY_BUSINESS_NAME). What is made or done in this hobby or business?

 

________________________________

HOBBY


INTERVIEWER INSTRUCTIONS

  • PROBE “Anything else?”

  • ENTER UP TO 5 HOBBIES. 

  • LIST HOBBIES SEPARATED BY COMMAS. 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (12M) (modified)


OE04000. Some people have jobs or hobbies where their skin, clothes, or shoes get dirty or stained.  By “dirty” or “stained,” we mean their skin or clothes have dust, grease, fibers, or other visible chemical spots on them. For the next few questions, please think about everyone in the household.  


OE05000/(ANY_DIRTY_CLOTHES). Does anyone routinely come into {the child/the children}'s home from their work or hobbies with dirty or stained skin, clothes, or shoes?  


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_OE_ET

REFUSED

-1

TIME_STAMP_OE_ET

DON'T KNOW

-2

TIME_STAMP_OE_ET


SOURCE

National Children’s Study, Vanguard  Phase (12M) (modified)


OE06000/(WHO_DIRTY_CLOTHES). Who is it that comes into {the child/the children}'s home with dirty or stained skin, clothes, or shoes?  Is it:


Label

Code

Go To

You

1


Others in the home

2


Both you and others in the home

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Vanguard  Phase (12M) (modified) 


OE07000. The following questions are about those who come into {the child/the children}'s home with dirty or stained skin, work clothes, or shoes.  


OE08000/(FREQ_DIRTY_HANDS). How often do you or anyone in the household come into the home from work or hobbies with dirty hands or skin?


Label

Code

Go To

Never

1


1-2 times a week

2


3-4 times a week

3


5-6 times a week

4


Every day

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (12M) (modified) 


OE09000/(FREQ_DIRTY_SHOES). How often do you or anyone in the household wear dirty shoes inside the home?


Label

Code

Go To

Never

1


1-2 times a week

2


3-4 times a week

3


5-6 times a week

4


Every day

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Legacy Phase (12M) (modified) 


OE10000/(FREQ_DIRTY_CLOTHES). How often do you or anyone in the household wear dirty clothes inside the home?


Label

Code

Go To

Never

1

BRING_HOME_MATERIAL

1-2 times a week

2


3-4 times a week

3


5-6 times a week

4


Every day

5


REFUSED

-1

BRING_HOME_MATERIAL

DON’T KNOW

-2

BRING_HOME_MATERIAL


SOURCE

National Children’s Study, Legacy Phase (12M) (modified) 


OE11000/(WASH_SEPARATE). How often are these dirty clothes washed separately from other clothes? Would you say they are washed separately…


Label

Code

Go To

Always

1


Often

2


Sometimes

3


Rarely

4


Never

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (12M) (modified) 


OE12000/(BRING_HOME_MATERIAL). What types of materials have you or anyone in the household brought into the home from work or hobbies on hands or skin, clothes or shoes?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.


Label

Code

Go To

Dirt

1


Wood dust

2


Grease

3


Pesticides

4


Metal dust

5


Coal or mining dust

6


Animal hair

7


Fibers (such as asbestos or fiberglass)

8


Or some other type of material

-5


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (12M) (modified) 


PROGRAMMER INSTRUCTIONS

  • IF BRING_HOME_MATERIAL = ANY COMBINATION OF VALUES 1-8, GO TO TIME_STAMP_OE_ET.

  • IF BRING_HOME_MATERIAL = -5, OR ANY COMBINATION OF VALUES 1-8 AND -5, GO TO BRING_HOME_MATERIAL_OTH.

  • IF BRING_HOME_MATERIAL = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO TIME_STAMP_OE_ET.


OE13000/(BRING_HOME_MATERIAL_OTH). SPECIFY: __________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (12M) (modified) 


(TIME_STAMP_OE_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.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified0000-00-00
File Created2021-01-27

© 2024 OMB.report | Privacy Policy