42.4 Survey

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

PhysicalActivityMonitorSetUpInstrument

Physical Activity Subsample Study

OMB: 0925-0593

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OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Physical Activity Monitor Set-Up Instrument, Phase 2g

OMB Specification


Physical Activity Monitor Set-Up Instrument


Event Category:

Time-Based

Event:

36M, 48M, 60M

Administration:

N/A

Instrument Target:

Child

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:

10 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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Physical Activity Monitor Set-Up Instrument



TABLE OF CONTENTS





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Physical Activity Monitor Set-Up 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.





PHYSICAL ACTIVITY MONITOR SET-UP


(TIME_STAMP_PAM_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

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

  • PRELOAD CHILD’SFIRST NAME (C_FNAME) AND DISPLAY NAME FOR “C_FNAME” THROUGHOUT DOCUMENT.

  • USE “the child” IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT IF CHILD’S NAME IS REFUSED.

  • IF CHILD_SEX IN PVST INSTRUMENT = 1, DISPLAY “his”, “he”, OR “himself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

  • IF CHILD_SEX IN PVST INSTRUMENT = 2, DISPLAY “her”, “she”, OR “herself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

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

  • IF MULT_CHILD = 1, PRELOAD CHILD_QNUM


PAM01000/(STAFF_ID). ENTER STAFF ID

___________________________________________

STAFF ID


PAM02000. PHYSICAL ACTIVITY MONITOR BROCHURE AND WEAR LOG DISTRIBUTION


DATA COLLECTOR INSTRUCTIONS

  • DISTRIBUTE THE PHYSICAL ACTIVITY BROCHURE AND PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG IN ACCORDANCE WITH THE PHYSICAL ACTIVITY MEASUREMENT SOP.


PAM03000/(MMS_SETUP_OKAY ). We would like to place this physical activity monitor on {C_FNAME/the child}’s wrist. The monitor should stay on for a week. It is waterproof so it can be worn in the shower or tub or when swimming. It does not need to be recharged. Is that okay?


Label

Code

Go To

YES

1

PAM06000

NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health & Nutrition Examination Survey (NHANES) (Modified)


PAM04000/(MMS_REFUSE). RECORD REASON FOR REFUSAL.


Label

Code

Go To

NONE GIVEN

1

MMS_SETUP_COMMENTS

NOT INTERESTED IN PHYSICAL ACTIVITY MONITORING

2

MMS_SETUP_COMMENTS

DOES NOT WANT EQUIPMENT PUT ON CHILD

3

MMS_SETUP_COMMENTS

OTHER

-5



PAM05000/(MMS_REFUSE_OTH). SPECIFY: _________________________________


PROGRAMMER INSTRUCTIONS

  • GO TO MMS_SETUP_COMMENTS


PAM06000. PHYSICAL ACTIVITY MONITOR PLACEMENT INSTRUCTIONS


DATA COLLECTOR INSTRUCTIONS

  • PLACE THE MONITOR ON THE SELECTED WRIST IN ACCORDANCE WITH THE PHYSICAL ACTIVITY MEASUREMENT SOP.


PAM07000/(MMS_SETUP). WERE YOU ABLE TO PLACE THE PHYSICAL ACTIVITY MONITOR ON THE CHILD’S WRIST?


Label

Code

Go To

YES

1

SAMPLE_ID

NO

2



PAM08000/(MMS_NOT_SETUP). WHY WERE YOU NOT ABLE TO PLACE THE PHYSICAL ACTIVITY MONITOR ON THE CHILD’S WRIST?


Label

Code

Go To

SUPPLIES/EQUIPMENT NOT AVAILABLE

1

MMS_SETUP_COMMENTS

EQUIPMENT PROBLEM

2

PAM10000

RAN OUT OF TIME

3

MMS_SETUP_COMMENTS

CHILD UNCOOPERATIVE

4

MMS_SETUP_COMMENTS

REFUSAL

5

MMS_SETUP_COMMENTS

OTHER

-5



PAM09000/(MMS_NOT_SETUP_OTH). SPECIFY: ________________________________


PROGRAMMER INSTRUCTIONS

  • GO TO MMS_SETUP_COMMENTS


PAM10000. PHYSICAL ACTIVITY MONITOR PROBLEM


DATA COLLECTOR INSTRUCTIONS

  • COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.


PROGRAMMER INSTRUCTIONS

  • GO TO MMS_SETUP_COMMENTS.


PAM11000/(SAMPLE_ID). PHYSICAL ACTIVITY MEASUREMENT SAMPLE ID

|E|__|__|__|__|__|__|__|__|-MT01

PHYSICAL ACTIVITY MEASUREMENT SAMPLE ID


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH MT01.


PAM12000/(EQUIP_ID). PHYSICAL ACTIVITY MONITOR ID

___________________________________________


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE EQUIPMENT ID OF THE PHYSICAL ACTIVITY MONITOR


PAM13000. PHYSICAL ACTIVITY MONITOR SET-UP DATE


(MMS_SET_DATE_MM) MONTH:|___|___|

                 M    M


(MMS_SET_DATE_DD) DAY:       |___|___|

                 D     D


(MMS_SET_DATE_YYYY) YEAR:     |___|___|___|___|

                   Y    Y    Y    Y


PROGRAMMER INSTRUCTIONS

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


PAM14000. PHYSICAL ACTIVITY MONITOR SET-UP TIME


(MMS_SET_TIME) |___|___| : |___|___|              

  H    H         M    M


(MMS_SET_TIME_UNIT)


Label

Code

Go To

AM

1


PM

2



PAM16000/(MMS_SETUP_COMMENTS). RECORD ANY COMMENTS ABOUT THE PHYSICAL ACTIVITY MONITOR PLACEMENT.

COMMENTS: __________________________________________________


(TIME_STAMP_PAM_ET).


PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

GPS MONITOR SET-UP


(TIME_STAMP_GMS_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


GMS01000/(GPS_SETUP_OKAY). We would also like to place this GPS monitor on {C_FNAME/the child}’s waist. The monitor should be worn for a week. It is not waterproof so it cannot be worn in the shower, tub, or while swimming. Please take it off and set it near the child when {he/she} is in water or when {he/she} is sleeping. The monitor needs to be recharged every evening. Is that okay?


Label

Code

Go To

YES

1

GMS04000

NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health & Nutrition Examination Survey (NHANES) (Modified)


GMS02000/(GPS_REFUSE). RECORD REASON FOR REFUSAL.


Label

Code

Go To

NONE GIVEN

1

GPS_SETUP_COMMENTS

NOT INTERESTED IN GPS MONITORING

2

GPS_SETUP_COMMENTS

DOES NOT WANT EQUIPMENT PUT ON CHILD

3

GPS_SETUP_COMMENTS

OTHER

-5



GMS03000/(GPS_REFUSE_OTH). SPECIFY:  _________________________________


PROGRAMMER INSTRUCTIONS

  • GO TO GPS_SETUP_COMMENTS


GMS04000. GPS MONITOR PLACEMENT INSTRUCTIONS


DATA COLLECTOR INSTRUCTIONS

  • PLACE THE GPS MONITOR ON THE SELECTED WAIST LOCATION IN ACCORDANCE WITH THE PHYSICAL ACTIVITY MEASUREMENT SOP.


GMS05000/(GPS_SETUP). WERE YOU ABLE TO PLACE THE GPS MONITOR ON THE CHILD’S WAIST?


Label

Code

Go To

YES

1

SAMPLE_1_ID

NO

2



GMS06000/(GPS_NOTSET_UP). WHY WERE YOU NOT ABLE TO PLACE THE GPS MONITOR ON THE CHILD’S WAIST?


Label

Code

Go To

SUPPLIES/EQUIPMENT NOT AVAILABLE

1

GPS_SETUP_COMMENTS

EQUIPMENT FAILURE

2

GMS08000

RAN OUT OF TIME

3

GPS_SETUP_COMMENTS

CHILD UNCOOPERATIVE

4

GPS_SETUP_COMMENTS

REFUSAL

5

GPS_SETUP_COMMENTS

OTHER

-5



GMS07000/(GPS_NOTSET_UP_OTH). SPECIFY: ________________________________


PROGRAMMER INSTRUCTIONS

  • GO TO GPS_SETUP_COMMENTS


GMS08000. GPS MONITOR PROBLEM


DATA COLLECTOR INSTRUCTIONS

  • COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.


PROGRAMMER INSTRUCTIONS

  • GO TO GPS_SETUP_COMMENTS.


GMS09000/(SAMPLE_1_ID). GPS MEASUREMENT SAMPLE ID

|E|__|__|__|__|__|__|__|__|-GP01

GPS MEASUREMENT SAMPLE ID


PROGRAMMER INSTRUCTIONS

  • ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH GP01.


GMS10000/(EQUIP_1_ID). GPS MONITOR ID

___________________________________________


DATA COLLECTOR INSTRUCTIONS

  • ENTER THE EQUIPMENT ID OF THE GPS MONITOR


GMS11000. GPS MONITOR SET-UP DATE


(GPS_SET_DATE_MM) MONTH:|___|___|

                 M    M


(GPS_SET_DATE_DD) DAY:       |___|___|

                 D     D


(GPS_SET_DATE_YYYY) YEAR:     |___|___|___|___|

                  Y   Y      Y     Y


PROGRAMMER INSTRUCTIONS

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


GMS12000. GPS MONITOR SET-UP TIME


(GPS_SET_TIME)  |___|___| : |___|___|              

   H    H         M    M


(GPS_SET_TIME_UNIT)


Label

Code

Go To

AM

1


PM

2



GMS14000/(GPS_SETUP_COMMENTS). RECORD ANY COMMENTS ABOUT THE GPS MONITOR PLACEMENT:

COMMENTS:____________________________


(TIME_STAMP_GMS_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • IF MMS_SETUP=2 AND GPS_SETUP = 2, GO TO TIME_STAMP_MSI_ET.

  • OTHERWISE, GO TO TIME_STAMP_PAA_ST.



PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG DISTRIBUTION


(TIME_STAMP_PAA_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


PAA01000. PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG DISTRIBUTION


DATA COLLECTOR INSTRUCTIONS

  • DISTRIBUTE AND EXPLAIN THE PHYSICAL ACTIVITY ANDGPS MONITOR WEAR LOG IN ACCORDANCE WITH THE PHYSICAL AVTIVITY MONITOR SOP.


PAA02000/(MLG_LOG_OKAY). We would like to leave this log with you. It will come back with the physical activity monitors. Is that okay?


Label

Code

Go To

YES

1

MLG_LOG_COMMENTS

NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PAA03000/(MLG_LOG_REFUSE). RECORD REASON FOR REFUSAL.


Label

Code

Go To

NONE GIVEN

1

MLG_LOG_COMMENTS

DOES NOT WANT TO FILL OUT A LOG

2

MLG_LOG_COMMENTS

OTHER

-5



PAA04000/(MLG_LOG_REFUSE_OTH). SPECIFY:  _________________________________


PAA05000/(MLG_LOG_COMMENTS). RECORD ANY COMMENTS ABOUT THE PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG DISTIBUTION ACTIVITY.

COMMENTS: ____________________________


(TIME_STAMP_PAA_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



PHYSICAL ACTIVITY AND GPS MONITOR SHIPPING INSTRUCTIONS


(TIME_STAMP_MSI_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


MSI01000/(MSI_PARTICIPANT_MAILBACK). AT THIS VISIT, WILL THE PARTICIPANT BE ASKED TO MAIL BACK THE PHYSICAL ACTIVITY MONITORS AND LOG?


DATA COLLECTOR INSTRUCTIONS

  • CHECK ROC EVENT SPECIFICATIONS.


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_MSI_ET


MSI02000. PHYSICAL ACTIVITY MONITOR SAQ AND SHIPPING INSTRUCTIONS DISTRIBUTION


DATA COLLECTOR INSTRUCTIONS

  • DISTRIBUTE THE PHYSICAL ACTIVITY MONITOR SAQ AND PHYSICAL ACTIVITY AND GPS MONITOR SHIPPING INSTRUCTIONS IN ACCORDANCE WITH THE PHYSICAL ACTIVITY MONITOR SOP.


MSI03000/(MSI_PARTICIPANT_MAILBACK_OKAY). At the end of the week, we would like you to send the monitors, questionnaire, and log back to us. We have a kit with a pre-paid shipper to help you with that. Is that okay?


Label

Code

Go To

YES

1

SHIPMENT_TRACKING_NUM

NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MSI04000/(MSI_PART_MAILBACK_REFUSE). RECORD REASON FOR REFUSAL.


Label

Code

Go To

NONE GIVEN

1

KIT_DISTRIB_COMMENTS

WANTS DATA COLLECTOR TO PICK UP

2

KIT_DISTRIB_COMMENTS

TOO MUCH TROUBLE TO MAIL BACK

3

KIT_DISTRIB_COMMENTS

OTHER

-5



MSI05000/(MSI_PART_MAILBACK_REFUSE_OTH). SPECIFY:  _________________________________


PROGRAMMER INSTRUCTIONS

  • GO TO KIT_DISTRIB_COMMENTS


MSI06000/(SHIPMENT_TRACKING_NUM). SHIPMENT TRACKING NUMBER:

TRACKING NUMBER:______________________________


DATA COLLECTOR INSTRUCTIONS

  • DISTRIBUTE THE PHYSICAL ACTIVITY MONITOR SHIPPING KIT IN ACCORDANCE WITH THE PHYSICAL ACTIVITY MEASUREMENT SOP.

  • ENTER THE SHIPMENT TRACKING NUMBER THAT IS PRINTED ON THE SHIPPING LABEL INCLUDED IN THE KIT.


MSI07000. RECORD THE EXPECTED SHIPMENT DATE FOR THE MONITORS:


(TARGET_SHIP_DATE_MM) MONTH:|___|___|

                 M    M


(TARGET_SHIP_DATE_DD) DAY:       |___|___|

                 D     D


(TARGET_SHIP_DATE_YYYY) YEAR:     |___|___|___|___|

                  Y    Y      Y    Y


PROGRAMMER INSTRUCTIONS

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


MSI08000/(KIT_DISTRIB_COMMENTS). RECORD ANY COMMENTS ABOUT DISTRIBUTING THE MONITOR SHIPMENT KIT.

COMMENTS:  ______________________________


(TIME_STAMP_MSI_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for 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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