26.1 Revised Survey

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

CoreQuestionnaireChild_REVISED

Core Questionnaire - Child, Adult, & Household

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Core Questionnaire - Child, Phase 2g

OMB Specification


Core Questionnaire - Child


Event Category:

Time-Based

Event:

6M, 12M, 18M, 24M, 30M, 36M, 42M, 48M, 54M, 60M

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:

21 minutes: (6M), 17 minutes: (12M, 24M, 36M, 48M, 60M), 16 minutes: (18M, 30M, 42M, 54M)

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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Core Questionnaire - Child



TABLE OF CONTENTS





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Core 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.





CHILD CARE / DAY CARE ARRANGEMENTS – (EVERY 6M)


(TIME_STAMP_CC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

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

  • PRELOAD C_FNAME FROM PARTICIPANT VERIFICATION, SCHEDULING AND TRACING QUESTIONNAIRE AND DISPLAY NAME IN "C_FNAME" THROUGHOUT THE INSTRUMENT.

  • IF C_FNAME = -1 OR -2, DISPLAY "the child" IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT.

  • PRELOAD CHILD_SEX FROM PARTICIPANT VERIFICATION, SCHEDULING, AND TRACING QUESTIONNAIRE AND IF = 1, DISPLAY "he", him", "his" AND "himself" IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

  • IF CHILD_SEX = 2, DISPLAY "she", "her," AND "herself" IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

  • PRELOAD SEC_RES​ FROM PARTICIPANT VERIFICATION, SCHEDULING, AND TRACING QUESTIONNAIRE.

  • IF CHILDCARE COLLECTED IN PREVIOUS INTERVIEW, GO TO CHILDCARE_CHANGE.

  • OTHERWISE, GO TO ​CC01000.


CC01000. I’d like to ask you about different types of child care {C_FNAME/the child} may receive from someone other than parents or guardians.  This includes regularly scheduled care arrangements with relatives and non-relatives; day care or early childhood programs, whether or not there is a charge or fee; and Head Start programs, but not occasional baby-sitting.


SOURCE

National Children’s Study, Vanguard Phase (Core)


PROGRAMMER INSTRUCTIONS

  • GO TO ​CHILDCARE.


CC02000/(CHILDCARE_CHANGE). You told me about child care on {DATE OF LAST INTERVIEW}.  Has there been a change in arrangements since that time?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_CC_ET

REFUSED

-1

TIME_STAMP_CC_ET

DON'T KNOW

-2

TIME_STAMP_CC_ET


SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


PROGRAMMER INSTRUCTIONS

  • PRELOAD AND DISPLAY DATE OF LAST INTERVIEW


CC03000/(CHILDCARE). Does {C_FNAME/the child} currently receive any regularly scheduled care from someone other than a parent or guardian, for example from relatives, non-relatives, or a child care program?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_CC_ET

REFUSED

-1

TIME_STAMP_CC_ET

DON'T KNOW

-2

TIME_STAMP_CC_ET


SOURCE

National Children's Study, Legacy Phase (3M, 6M, 9M, 12M)


CC04000. I want to ask you about the specific type of care {C_FNAME/the child} receives. Does {C_FNAME/the child} receive:


SOURCE

New


CC05000/(RELATIVE_CARE). Relative care? 


INTERVIEWER INSTRUCTIONS

  • IF NECESSARY READ “This includes all regularly scheduled care arrangements with relatives that happen at least weekly, but does not include occasional baby-sitting.”


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


CC06000/(FAM_BASED_CARE). Family-based or neighborhood care out of your home or someone else’s home?


INTERVIEWER INSTRUCTIONS

  • IF NECESSARY READ “This includes all regularly scheduled care arrangements with non-relatives that happen at least weekly, including home child care providers, regularly scheduled sitter arrangements, or neighbors.  This does not include day care centers, early childhood programs, or occasional babysitting.”


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


CC07000/(CENTER_BASE_CARE). Center-based child care?


INTERVIEWER INSTRUCTIONS

  • IF NECESSARY READ “This includes day care centers, nursery schools, and preschools.”


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


CC08000/(HEAD_START). Head Start?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF RELATIVE_CARE = 1, GO TO CC09000.

  • IF RELATIVE_CARE = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CC15000.


CC09000. The next few questions are about the care {C_FNAME/the child} receives from relatives. 


CC10000/(RELATIVE_CARE_HRS). Approximately how many total hours each week does {C_FNAME/the child} receive care from relatives?

 

|___|___|___|

NUMBER OF HOURS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF RELATIVE_CARE_HRS ≤ 0 OR ≥ 120.

  • DISPLAY SOFT EDIT IF RELATIVE_CARE_HRS > 80 BUT < 120


CC11000/(RELATIVE_CARE_NUM_ADULTS). How many adults are usually in {C_FNAME/the child}'s room or group?

 

|___|___|

NUMBER OF ADULTS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF RELATIVE_CARE_NUM_ADULTS < 0 OR ≥ 25.

  • DISPLAY SOFT EDIT IF RELATIVE_CARE_NUM_ADULTS > 8 BUT < 25.


CC12000/(RELATIVE_CARE_NUM_CHILDREN). How many children are usually in {C_FNAME/the child}'s room or group?

 

|___|___|

NUMBER OF CHILDREN


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF RELATIVE_CARE_NUM_CHILDREN < 0 OR ≥ 75.

  • DISPLAY SOFT EDIT IF RELATIVE_CARE_NUM_CHILDREN > 30 BUT < 75.


CC13000/(RELATIVE_CARE_LOCATION). In what location does {C_FNAME/the child} go for this care?


Label

Code

Go To

{His/her} own home

1


Relative’s home

2


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • IF RELATIVE_CARE_LOCATION = 1, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CC15000.

  • IF RELATIVE_CARE_LOCATION = 2, GO TO CC15000.

  • IF RELATIVE_CARE_LOCATION = -5, GO TO RELATIVE_CARE_LOCATION_OTH.


CC14000/(RELATIVE_CARE_LOCATION_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


CC15000. What is the name and address of the place where {C_FNAME/the child} receives relative care?


INTERVIEWER INSTRUCTIONS

  • PROBE AND ENTER AS MUCH INFORMATION AS ADULT CAREGIVER KNOWS.


SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


(R_NAME_1)  

_______________________________

NAME 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(R_ADDRESS_1)  

__________________________________________________

ADDRESS 1 - STREET/PO BOX 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(R_ADDRESS_2)  

_____________________________________

ADDRESS 2 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(R_UNIT)                                                                                                       

________________________

UNIT 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(R_CITY)  

____________________________________

CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(R_STATE)  

|___|___|                            

STATE 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(R_ZIP)  

|___|___|___|___|___| 

ZIP CODE 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(R_ZIP4)  

- |___|___|___|___|

  ZIP+4


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF FAM_BASED_CARE = 1, GO TO CC16000.

  • OTHERWISE, IF FAM_BASED_CARE = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING ​CC22000.


CC16000. The next few questions are about the child care arrangements {C_FNAME/the child} receives from a family-based or neighborhood care. 


CC17000/(NEIGHBORHOOD_CARE_HRS). Approximately how many total hours each week does {C_FNAME/the child} receive care from this family-based or neighborhood care?

 

|___|___|___|

NUMBER OF HOURS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF NEIGHBORHOOD_CARE_HRS ≤ 0 OR ≥ 120.

  • DISPLAY SOFT EDIT IF NEIGHBORHOOD_CARE_HRS > 80 BUT < 120.


CC18000/(NEIGHBORHOOD_CARE_NUM_ADULTS). How many adults are usually in {C_FNAME/the child}'s room or group?

 

|___|___|

NUMBER OF ADULTS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF NEIGHBORHOOD_CARE_NUM_ADULTS < 0 OR ≥ 25.

  • DISPLAY SOFT EDIT IF NEIGHBORHOOD_CARE_NUM_ADULTS ​> 8 BUT < 25.


CC19000/(NEIGHBORHOOD_CARE_NUM_CHILDREN). How many children are usually in {C_FNAME/the child}'s room or group?

 

|___|___|

NUMBER OF CHILDREN


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF NEIGHBORHOOD_CARE_NUM_CHILDREN < 0 OR ≥ 75.

  • DISPLAY SOFT EDIT IF NEIGHBORHOOD_CARE_NUM_CHILDREN ​> 30 BUT < 75.


CC22000. What is the name and address of the place where {C_FNAME/the child} receives family-based or neighborhood care?


INTERVIEWER INSTRUCTIONS

  • PROBE AND ENTER AS MUCH INFORMATION AS ADULT CAREGIVER KNOWS.


SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


(N_NAME_1)  

_____________________________________

NAME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(N_ADDRESS_1)  

_____________________________________

ADDRESS 1 - STREET/PO BOX


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(N_ADDRESS_2)
_________________________________
ADDRESS 2


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(N_UNIT)  

__________________________________

UNIT


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(N_CITY)  

_____________________________________

CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(N_STATE)  

|___|___|                            

STATE 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(N_ZIP)  

|___|___|___|___|___| 

ZIP CODE 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(N_ZIP4)  

- |___|___|___|___|

ZIP CODE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF CENTER_BASE_CARE = 1, GO TO CC23000.

  • OTHERWISE, IF CENTER_BASE_CARE = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING ​CC28000.


CC23000. The next few questions are about the care {C_FNAME/the child} receives from a center-based care setting. 


CC24000/(CENTERBASED_CARE_HRS). Approximately how many total hours each week does {C_FNAME/the child} receive care from a center-based care setting {not including Head Start}?

 

|___|___|___|

NUMBER OF HOURS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF CENTERBASED_CARE_HRS ≤ 0 OR ≥ 120

  • DISPLAY SOFT EDIT IF CENTERBASED_CARE_HRS > 80 BUT < 120

  • DISPLAY "not including Head Start" IF HEAD_START​ = 1.


CC25000/(CENTERBASED_CARE_NUM_ADULTS). How many adults are usually in {C_FNAME/the child}'s room or group?

 

|___|___|

NUMBER OF ADULTS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF CENTERBASED_CARE_NUM_ADULTS < 0 OR ≥ 25.

  • DISPLAY SOFT EDIT IF CENTERBASED_CARE_NUM_ADULTS ​> 8 BUT < 25.


CC26000/(CENTERBASED_CARE_NUM_CHILDREN). How many children are usually in {C_FNAME/the child}'s room or group?

 

|___|___|

NUMBER OF CHILDREN


SOURCE

Early Childhood Longitudinal Program, Birth Cohort, National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF CENTERBASED_CARE_NUM_CHILDREN < 0 OR ≥ 75.

  • DISPLAY SOFT EDIT IF CENTERBASED_CARE_NUM_CHILDREN ​> 30 BUT < 75


CC28000. What is the name and address of the place where {C_FNAME/the child} receives center-based care?


INTERVIEWER INSTRUCTIONS

  • PROBE AND ENTER AS MUCH INFORMATION AS ADULT CAREGIVER KNOWS.


SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


(CB_NAME_1)  

_______________________________

NAME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(CB_ADDRESS_1)  

__________________________________

ADDRESS 1 - STREET/PO BOX


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(CB_ADDRESS_2)  

_____________________________

ADDRESS 2


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(CB_UNIT)  

______________________________

UNIT


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(CB_CITY)
____________________________
CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(CB_STATE)  

|___|___|                            

STATE 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(CB_ZIP)

|___|___|___|___|___| 

ZIP CODE  


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(CB_ZIP4)  

- |___|___|___|___|

   ZIP+4 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF HEAD_START = 1, GO TO CC29000.

  • OTHERWISE, IF HEAD_START = 2, -1 OR -2, GO TO ​TIME_STAMP_CC_ET.


CC29000. The next few questions are about the care {C_FNAME/the child} receives from Head Start. 


CC30000/(HEAD_START_CARE_HRS). Approximately how many total hours each week does {C_FNAME/the child} receive care from Head Start?

 

|___|___|___|

NUMBER OF HOURS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF HEAD_START_CARE_HRS ≤ 0 OR ≥ 70


CC31000/(HEAD_START_CARE_NUM_ADULTS). How many adults are usually in {C_FNAME/the child}'s room or group?

 

|___|___|

NUMBER OF ADULTS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF HEAD_START_CARE_NUM_ADULTS < 0 OR ≥ 25.

  • DISPLAY SOFT EDIT IF HEAD_START_CARE_NUM_ADULTS > 8 BUT < 25.


CC32000/(HEAD_START_CARE_NUM_CHILDREN). How many children are usually in {C_FNAME/the child}'s room or group?

 

|___|___|

NUMBER OF CHILDREN


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort; National Household Education Surveys (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF HEAD_START_CARE_NUM_CHILDREN < 0 OR ≥ 75.

  • DISPLAY SOFT EDIT IF HEAD_START_CARE_NUM_CHILDREN > 30 BUT < 75.


CC35000. What is the name and address of the place where {C_FNAME/the child} receives care from Head Start?


SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


(HS_NAME_1)  

_________________________________

NAME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HS_ADDRESS_1) __________________________________________________

ADDRESS 1 - STREET/PO BOX  


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HS_ADDRESS_2)                                                                                                       

____________________________________

ADDRESS 2 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HS_UNIT)  

____________________________

UNIT


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HS_CITY)  

__________________________

CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HS_STATE) |___|___|                            

STATE 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HS_ZIP)

|___|___|___|___|___| 

ZIP CODE  


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HS_ZIP4)  

-|___|___|___|___|

ZIP+4 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(TIME_STAMP_CC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



VIEWING OF MEDIA/READING BOOKS – (EVERY 6M, BEGINNING AT 12 M)


(TIME_STAMP_VOM_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


VOM01000. Now I would like to ask you a few questions about the amount of time {C_FNAME/the child} spends watching TV or videos and reading books.  


SOURCE

National Children’s Study, Vanguard Phase (Core)


VOM02000. On a typical day, how much time does {C_FNAME/the child} spend watching television or videos?  By watching, we mean that the child was in a place where {he/she} could see a television or other media that was on.


INTERVIEWER INSTRUCTIONS

  • ENTER HOURS AND MINUTES FOR A TYPICAL DAY.

 


SOURCE

Project VIVA!


(TIME_TV_HRS)  

|___|___|               

HOURS


INTERVIEWER INSTRUCTIONS

  • ENTER 0 AS NEEDED.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF TIME_TV_HRS > 24.


(TIME_TV_MIN)  

|___|___|   

MINUTES


INTERVIEWER INSTRUCTIONS

  • ENTER 0 AS NEEDED.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF TIME_TV_MIN ​> 60.


VOM03000. On a typical day, how much time does {C_FNAME/the child} spend playing games displayed on media such as television, desktop computers, laptops, portable DVD players, tablet computers, or smartphones?  


INTERVIEWER INSTRUCTIONS

  • ENTER HOURS AND MINUTES FOR A TYPICAL DAY.

 


SOURCE

National Children’s Study, Vanguard Phase (Core)


(TIME_MEDIA_HRS)

|___|___|                

HOURS


INTERVIEWER INSTRUCTIONS

  • ENTER 0 AS NEEDED.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF TIME_MEDIA_HRS TIME_TV_HRS ​> 24.


(TIME_MEDIA_MIN)  

|___|___|   

MINUTES


INTERVIEWER INSTRUCTIONS

  • ENTER 0 AS NEEDED.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF TIME_MEDIA_MIN > 60.


VOM04000/(FREQ_BOOKS). On average, how many days per week do you or someone else read or look at books with {C_FNAME/the child}?

 

|___|                

DAYS        


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Parents, Children and Media: A Kaiser Family Foundation Survey, June 2007 (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF FREQ_BOOKS ​< 0 OR > 7.


VOM05000/(TV_ROOM). Is there a TV in {C_FNAME/the child}’s bedroom, even if it doesn’t get any channels?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Parents, Children and Media: A Kaiser Family Foundation Survey, June 2007 (modified)


VOM06000/(MEDIA_ROOM). Are there any desktop computers, laptops, portable DVD players, tablet computers, in {C_FNAME/the child}’s bedroom?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


VOM07000/(INTERNET_ACCESS). Does {C_FNAME/the child}’s {primary} residence have internet access?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Kaiser Family Foundation Survey on Parents, Children and Media, June 2007 (modified)


PROGRAMMER INSTRUCTIONS

  • IF SEC_RES ​= 1, DISPLAY "primary."


VOM08000. ​Now I would like to ask you a few questions about the amount of time {C_FNAME/the child} spends in activities such as music, dance, drama, drawing, and, painting with you or someone else.


SOURCE

Survey of Public Participation in the Arts (SPPA), 2012 (modified)


VOM09000/(DANCE_DAYS). On average, how many days per week do you or someone else spend some time dancing with {C_FNAME/the child}?

|___|

DAYS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Survey of Public Participation in the Arts (SPPA), 2012 (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF DANCE_DAYS ​> 7.


VOM10000/(THEATER_DAYS). On average, how many days per week do you or someone else spend some time in theater, play-acting, or make believe with {C_FNAME/the child}?

|___|

DAYS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Survey of Public Participation in the Arts (SPPA), 2012 (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF THEATER_DAYS ​> 7.


VOM11000/(MUSIC_DAYS). On average, how many days per week do you or someone else spend some time playing musical instruments, singing, or listening to music with {C_FNAME/the child}?

|___|

DAYS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Survey of Public Participation in the Arts (SPPA), 2012 (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF MUSIC_DAYS ​> 7.


VOMXXXXX/(DRAWPAINT_DAYS). On average, how many days per week do you or someone else spend some time drawing or painting with {C_FNAME/the child}?

|___|

DAYS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


VOM12000/(ART_EVENT_DAYS). On average, how many days per week do you or someone else take {C_FNAME/the child} to arts-related events outside of the home? This includes groups, classes or lessons that focus on arts, music, dance, and/or theater. This also includes attending live performances and going to arts galleries or museums.

|___|

DAYS PER WEEK


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Survey of Public Participation in the Arts (SPPA), 2012 (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF ART_EVENT_DAYS ​> 7.


(TIME_STAMP_VOM_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • IF EVENT_TYPE = 24, 30, 36, 38, OR XX (54-MONTH EVENT), GO TO TIME_STAMP_PP_ST.

  • OTHERWISE, GO TO TIME_STAMP_GH_ST.



PROGRAM PARTICIPATION (ANNUAL – 6M, 18M, 30M, 42M, 54M)


(TIME_STAMP_PP_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


PP01000. The following questions ask about {C_FNAME/the child}’s participation in programs that provide different types of assistance to families. 


SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


PP02000/(PP_TANF). At any time during the past 12 months, even for one month, did anyone in the household receive any cash assistance from a state or county welfare program, such as [STATE TANF NAME]?


INTERVIEWER INSTRUCTIONS

  • REFERENCE STATE TANF NAME.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) 2011 National Survey of Child Health


PP03000/(PP_FOOD_STAMPS). During the past 12 months, did {C_FNAME/the child} receive Food Stamps or Supplemental Nutrition Assistance Program Benefits?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) 2011 National Survey of Child Health


PP04000/(PP_WIC). Does {C_FNAME/the child} currently receive benefits from the Women, Infants, and Children (WIC) program?


INTERVIEWER INSTRUCTIONS

  • READ IF NECESSARY: WIC is a federally-funded health and nutrition program for women, infants, and children.  WIC benefits include food, checks or vouchers for food, health care referrals, and nutrition education.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) 2011 National Survey of Child Health (modified) 


PP05000/(PP_OTHER_BENEFITS). Does {C_FNAME/the child} currently receive any other government benefits or assistance?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_PP_ET

REFUSED

-1

TIME_STAMP_PP_ET

DON'T KNOW

-2

TIME_STAMP_PP_ET


SOURCE

National Children’s Study, Vanguard Phase (Core)


PP06000/(PP_OTHER_BENEFITS_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


(TIME_STAMP_PP_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



HEALTH INSURANCE (ANNUAL – 6M, 18M, 30M, 42M, 54M)


(TIME_STAMP_HI_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


HI01000. Now I’m going to switch to another subject and ask about health insurance. 


SOURCE

American Community Survey 2006

Current: NCS Alternative Recruitment Substudy (6M, 12M, 24M)


INTERVIEWER INSTRUCTIONS

  • IF INSURE COLLECTED PREVIOUSLY AND ≠ -1 OR -2, GO TO INSURE_CONFIRM.

  • OTHERWISE, IF INSURE NOT COLLECTED  PREVIOUSLY OR = -1 OR -2, GO TO INSURE.


HI02000/(INSURE_CONFIRM). I'd like to confirm {C_FNAME/the child}’s health care coverage.  I have it recorded as {CHILD’S HEALTH INSURANCE}/{C_FNAME/the child} does not have health insurance}.  Is this correct?


Label

Code

Go To

YES

1

TIME_STAMP_HI_ET

NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


PROGRAMMER INSTRUCTIONS

  • IF INSURE FROM MOST RECENT INTERVIEW = 1, PRELOAD CHILD’S HEALTH INSURANCE COLLECTED DURING MOST RECENT INTERVIEW AS FOLLOWS:

    • IF INS_EMPLOY = 1, DISPLAY, “Insurance through an employer or union”.

    • IF INS_SELF = 1 DISPLAY, “Insurance purchased directly from an insurance company.”

    • IF INS_MEDICAID = 1, DISPLAY “Medicaid or any government-assistance plan”.

    • IF INS_TRICARE = 1, DISPLAY “TRICARE, VA, or other military health care”.

    • IF INS_IHS = 1, DISPLAY “Indian Health Service”.

    • IF INS_MEDICARE =1, DISPLAY “Medicare”.

    • IF INS_OTHER = 1, DISPLAY “Another type of health plan”

    • SEPARATE EACH INSURANCE TYPE WITH A SEMI-COLON.

  • IF INSURE FROM MOST RECENT INTERVIEW = 2, DISPLAY, “{C_FNAME/the child} does not have health insurance.”


HI03000/(INSURE). Is {C_FNAME/the child} currently covered by any kind of health insurance or some other kind of health care plan?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_HI_ET

REFUSED

-1

TIME_STAMP_HI_ET

DON'T KNOW

-2

TIME_STAMP_HI_ET


SOURCE

American Community Survey 2008


HI04000. Now I’ll read a list of different types of insurance. Please tell me which types {C_FNAME/the child} currently has.  Does {C_FNAME/the child}  currently have…


SOURCE

American Community Survey 2008


HI05000/(INS_EMPLOY). Insurance through an employer or union, either through yourself or another family member?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Does {C_FNAME/the child}  currently have…) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Community Survey 2008 (modified)


HI06000/(INS_SELF). Insurance purchased directly from an insurance company, either through yourself or another family member?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Does {C_FNAME/the child}  currently have…) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Community Survey 2008 (modified)


HI07000/(INS_MEDICAID). Medicaid or the State Children’s Health Insurance Program, S-CHIP?   In this state, the program is sometimes called {MEDICAID NAME, SCHIP NAME}?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Does {C_FNAME/the child}  currently have…) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey 2007 National Survey of Children's Health


PROGRAMMER INSTRUCTIONS

  • PRELOAD EXAMPLES OF LOCAL MEDICAID/S-CHIP PROGRAMS AND DISPLAY IN QUESTION TEXT.


HI08000/(INS_TRICARE). TRICARE, VA, or other military health care?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Does {C_FNAME/the child}  currently have…) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Community Survey 2008 (modified)


HI09000/(INS_IHS). Indian Health Service?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Does {C_FNAME/the child}  currently have…) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Community Survey 2008


HI10000/(INS_MEDICARE). Medicare, for people with certain disabilities?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Does {C_FNAME/the child}  currently have…) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

American Community Survey 2008 (modified)


HI11000/(INS_OTHER). Any other type of health insurance or health coverage plan?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Does {C_FNAME/the child}  currently have…) AS NEEDED.


Label

Code

Go To

YES

1


NO

2

INS_NONE

REFUSED

-1

INS_NONE

DON'T KNOW

-2

INS_NONE


SOURCE

American Community Survey 2008


HI12000/(INS_OTHER_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

American Community Survey 2008


HI13000/(INS_NONE). During the past 12 months, was there any time when {C_FNAME/the child} was not covered by any health insurance?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Children’s Health 2007


HI14000/(INS_MEET_NEEDS). How much does {C_FNAME/the child}’s health insurance offer benefits or cover services that meet {his/her} needs?  Would you say …


Label

Code

Go To

Never

1


Sometimes

2


Usually

3


Always

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Children’s Health 2007 (modified)


(TIME_STAMP_HI_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



HEALTH CARE UTILIZATION/ACCESS - (ANNUAL – 6M, 18M, 30M, 42M, 54M)


(TIME_STAMP_HCU_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


HCU01000. Now I would like to ask a few questions about {C_FNAME/the child} and the health care services that {he/she} uses.


SOURCE

National Children’s Study, Vanguard Phase (Core)


HCU02000/(USUAL_CARE_PLACE). Is there a place {C_FNAME/the child} usually goes when {he/she} needs routine or preventive care, such as a physical examination or a (well baby/child) check up?


Label

Code

Go To

YES

1


NO

2

HCARE_SICK

REFUSED

-1

HCARE_SICK

DON'T KNOW

-2

HCARE_SICK


SOURCE

National Health Interview Survey (NHIS) 2011 (modified)


HCU03000/(HCARE). What kind of place does {C_FNAME/the child} usually go to when {he/she} needs routine or preventive care, such as a physical examination or (well baby/child) check-up?


Label

Code

Go To

Clinic or health center

1

HCARE_SICK

Doctor’s office or health maintenance organization (HMO)

2

HCARE_SICK

Hospital emergency room

3

HCARE_SICK

Hospital outpatient department

4

HCARE_SICK

Some other place

-5


DOESN'T GO TO ONE PLACE MOST OFTEN

5

HCARE_SICK

DOESN'T GET WELL-CHILD CARE ANYWHERE

6

HCARE_SICK

REFUSED

-1

HCARE_SICK

DON'T KNOW

-2

HCARE_SICK


SOURCE

National Health Interview Survey (NHIS) 2011


HCU04000/(HCARE_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey (NHIS) 2011


HCU05000/(HCARE_SICK). What kind of place does {C_FNAME/the child} usually go to when {he/she} is sick, doesn’t feel well, or if you have concerns about {his/her} health?


Label

Code

Go To

Clinic or health center

1

PERS_DOC

Doctor's office or Health Maintenance Organization (HMO)

2

PERS_DOC

Hospital emergency room

3

PERS_DOC

Hospital outpatient department

4

PERS_DOC

Some other place

-5


DOESN'T GO TO ONE PLACE MOST OFTEN

5

PERS_DOC

HAS NOT BEEN SICK

6

PERS_DOC

REFUSED

-1

PERS_DOC

DON'T KNOW

-2

PERS_DOC


SOURCE

National Health Interview Survey (NHIS)


HCU06000/(HCARE_SICK_ OTH). SPECIFY: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey (NHIS)


HCU07000/(PERS_DOC). A personal doctor or nurse is a health professional who knows the child well and is familiar with the child’s health history.  This can be a general doctor, pediatrician, a special doctor, a nurse practitioner, or a physician assistant.  Do  you have one or more persons you think of as {C_FNAME/the child}’s personal doctor or nurse?


INTERVIEWER INSTRUCTIONS

  • IF ADULT CAREGIVER RESPONDS "YES," PROBE TO DETERMINE WHETHER ONE OR MORE.


Label

Code

Go To

YES, ONE PERSON

1


YES, MORE THAN ONE PERSON

2


NO

3

PROVIDER_TROUBLE_FIND

REFUSED

-1

PROVIDER_TROUBLE_FIND

DON'T KNOW

-2

PROVIDER_TROUBLE_FIND


SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) 2012 National Survey of Child Health


HCU08000/(DOC_NAME). What is {C_FNAME/the child}'s health care professional's name?

 

SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


HCU09000/(DOC_PHONE). What is {C_FNAME/the child}’s doctor’s phone number?

 

|___|___|___| - |___|___|___| - |___|___|___|___|


INTERVIEWER INSTRUCTIONS

  • ENTER PHONE NUMBER AND CONFIRM.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


HCU10000. What is {C_FNAME/the child}’s doctor’s address?


INTERVIEWER INSTRUCTIONS

  • PROBE AND ENTER AS MUCH INFORMATION AS ADULT CAREGIVER KNOWS.


SOURCE

New


(DOC_ADDRESS_1)  

__________________________________________________

ADDRESS 1 - STREET/PO BOX


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(DOC_ADDRESS_2)  

___________________________________                  

ADDRESS 2


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(DOC_UNIT)  

__________________________________

UNIT


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(DOC_CITY)  

_______________________________

CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(DOC_STATE)  

|___|___|                            

STATE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(DOC_ZIP)  

|___|___|___|___|___|

ZIP CODE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(DOC_ZIP4)  

-|___|___|___|___|

ZIP+4 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



HCU14000/(DENTIST). During the past 12 months, has {C_FNAME/the child} been seen by a dentist?  Please include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey (NHIS) 2011 (modified)


HCU15000/(INS_DELAYED). Sometimes people have difficulty getting healthcare when they need it.  By health care, I mean medical care as well as other kinds of care like dental care and mental health services.  During the past 12months, was there any time when {C_FNAME/the child} needed health care but it was delayed or not received?


Label

Code

Go To

YES

1


NO

2

AFFORD_MED_BILLS

REFUSED

-1

AFFORD_MED_BILLS

DON'T KNOW

-2

AFFORD_MED_BILLS


SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Children’s Health 2007


HCU16000/(INS_DELAYED_TYPE). What type of care was delayed or not received?  Was it medical care, dental care, mental health services, or something else?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY


Label

Code

Go To

MEDICAL CARE

1


DENTAL CARE

2


MENTAL HEALTH SERVICES

3


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Children’s Health 2007


PROGRAMMER INSTRUCTIONS

  • IF INS_DELAYED_TYPE = ANY COMBINATION OF 1 -3, GO TO HCU18000.

  • IF INS_DELAYED_TYPE = -5, OR ANY COMBINATION OF 1 - 3 AND -5, GO TO INS_DELAYED_TYPE_OTH.

  • IF INS_DELAYED_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSES AND GO TO HCU18000.


HCU17000/(INS_DELAYED_TYPE_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Children’s Health 2007


(TIME_STAMP_HCU_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



GENERAL HEALTH – (EVERY 6M)


(TIME_STAMP_GH_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


GH01000. Now I’d like ask about {C_FNAME/the child}’s general health.


SOURCE

National Children's Study, Vanguard Phase (6M)


GH02000/(GENERAL_HEALTH_CHILD). Would you say {C_FNAME/the child}’s health in general is excellent, very good, good, fair, or poor?


Label

Code

Go To

EXCELLENT

1


VERY GOOD

2


GOOD

3


FAIR

4


POOR

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Behavioral Risk Factor Surveillance System 2011


GH03000. What is {C_FNAME/the child}’s current weight?


INTERVIEWER INSTRUCTIONS

  • RECORD CHILD'S WEIGHT IN POUNDS AND OUNCES.


SOURCE

National Children’s Study, Vanguard Phase (3M, 6M, 9M, 12M, 18M and 24M)


(CURRENT_WT_LBS)

|___|___|___|            

POUNDS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(CURRENT_WT_OZ)

|___|___|              

OUNCES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • HARD EDIT: INCLUDE HARD EDIT IF OUNCES IS NOT BETWEEN 00 AND 15.


GH04000/(CURRENT_HT). What is {C_FNAME/the child}’s current {height/length}?

 

|___|___|

 INCHES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 24, 27, OR 30, DISPLAY "length."

  • OTHERWISE, DISPLAY "height."


(TIME_STAMP_GH_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • IF EVENT_TYPE = 24, 30, 36, 38, OR XX (54-MONTH EVENT), GO TO TIME_STAMP_MC2_ST.

  • OTHERWISE, GO TO TIME_STAMP_MC_ST.



MEDICAL CONDITIONS – GENERAL - (ANNUAL – 12M, 24M, 36M, 48M, 60M)


(TIME_STAMP_MC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


MC01000. Now I’d like to ask about {C_FNAME/the child}’s possible medical conditions.


SOURCE

National Children's Study, Vanguard Phase (6M)


MC02000. In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...


SOURCE

Early Childhood Longitudinal Program, Birth Cohort


MC03000/(DOC_BRONCH). Had a respiratory illness, such as bronchitis, pneumonia, or bronchiolitis?


Label

Code

Go To

YES

1


NO

2

DOC_GASTRO

REFUSED

-1

DOC_GASTRO

DON'T KNOW

-2

DOC_GASTRO


SOURCE

Early Childhood Longitudinal Program, Birth Cohort


MC04000/(DOC_BRONCH_FREQ). To your knowledge, how many times in the last 12 months did {C_FNAME/the child} have a respiratory illness?

 

|___|___|

TIMES


INTERVIEWER INSTRUCTIONS

  • IF NEEDED, ADD “such as bronchitis, pneumonia, or bronchiolitis.”


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


MC05000/(DOC_GASTRO). Had a severe gastrointestinal illness, as indicated by frequent vomiting, diarrhea, or dehydration?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2

DOC_EAR

REFUSED

-1

DOC_EAR

DON'T KNOW

-2

DOC_EAR


SOURCE

Early Childhood Longitudinal Program, Birth Cohort


MC06000/(DOC_GASTRO_FREQ). To your knowledge, how many times in the last 12 months did {C_FNAME/the child} have a severe gastrointestinal illness?

 

|___|___|

TIMES


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.

  • IF NEEDED, ADD “as indicated by frequent vomiting, diarrhea, or dehydration.”


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


MC07000/(DOC_EAR). Had an ear infection?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2

DOC_STREP

REFUSED

-1

DOC_STREP

DON'T KNOW

-2

DOC_STREP


SOURCE

Early Childhood Longitudinal Program, Birth Cohort


MC08000/(DOC_EAR_FREQ). To your knowledge, how many times in the last 12 months did {C_FNAME/the child} have an ear infection?

 

|___|___|

TIMES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


MC09000/(DOC_STREP). Had strep throat?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2

DOC_UNKN_FEVER

REFUSED

-1

DOC_UNKN_FEVER

DON'T KNOW

-2

DOC_UNKN_FEVER


SOURCE

Early Childhood Longitudinal Program, Birth Cohort


MC10000/(DOC_STREP_FREQ). To your knowledge, how many times in the last 12 months did {C_FNAME/the child} have strep throat?

 

|___|___|

TIMES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


MC11000/(DOC_UNKN_FEVER). Had a fever without a cause?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2

DOC_ASTHMA

REFUSED

-1

DOC_ASTHMA

DON'T KNOW

-2

DOC_ASTHMA


SOURCE

National Children’s Study, Vanguard Phase (Core)


MC12000/(DOC_FEVER_FREQ). To your knowledge, how many times in the last 12 months did {C_FNAME/the child} have a fever without a cause?

 

|___|___|

TIMES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


MC13000/(DOC_ASTHMA). Had asthma?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort 9 Month Parent Interview (modified)


MC14000/(DOC_DELAY). Had a developmental delay?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort Preschool Parent Interview (modified)


MC15000/(DOC_EPILEPSY). Had epilepsy or seizures?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort Kindergarten 07 Parent Interview


MC16000/(DOC_ANEMIA). Had anemia?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort Kindergarten 07 Parent Interview


MC17000/(DOC_ECZEMA). Had eczema?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2007 (modified)


MCXXXXX/(DOC_PINK_EYE). Had pink eye?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MC18000/(DOC_FOOD_ALLERG). Has food allergies or sensitivities?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort 2 Year Parent Interview (modified)


PROGRAMMER INSTRUCTIONS

  • IF DOC_FOOD_ALLERG = 1 GO TO MC18XXX/(DOC_TYPE_ALLERG).


MC18XXX/(DOC_TYPE_ALLERG). What foods is {C_FNAME/the child} allergic to?


SPECIFY: ­­­­­­­­­­­­­­­­­­­­­­ ­­­­________________________


              SOY

              WHEAT

              MILK

              EGG

              FISH

              SHELLFISH

              PEANUT

              OTHER NUTS

              OTHER SPECIFY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MC19000/(DOC_HAYFEVER). Had hay fever or other non-food allergies?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2007 (modified)


MC20000/(DOC_DIABETES). Has diabetes?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort Kindergarten 07 Parent Interview


MC21000/(DOC_OVERWEIGHT). Is overweight?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2007 (modified)


MC22000/(DOC_ADD). Has attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort Kindergarten 07 Parent Interview (modified)


MC23000/(DOC_AUTISM). Has autism, Asperger syndrome, or any other autism spectrum disorder?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (In the past 12 months has a doctor, nurse, or other medical professional told you that {C_FNAME/the child}...) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort Preschool Parent Interview (modified)


MC24000/(FAILURE_THRIVE). Has a doctor ever told you that {C_FNAME/your child} has failure to thrive, or any other concern about proper growth? 


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort


MC25000/(DOC_OTHER_COND). Has any other medical condition or health problem?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_MC_ET

REFUSED

-1

TIME_STAMP_MC_ET

DON'T KNOW

-2

TIME_STAMP_MC_ET


SOURCE

Early Childhood Longitudinal Program, Birth Cohort Kindergarten Parent Interview (modified)


MC26000/(DOC_OTHER_COND_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort Kindergarten Parent Interview (modified)


(TIME_STAMP_MC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



MEDICAL CONDITIONS – ASTHMA & ECZEMA – (EVERY 6M)


(TIME_STAMP_MCZ_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


MCZ01000. Now I would like to ask some questions about asthma and eczema.


MCZ02000/(CHILD_ASTHMA). Has {C_FNAME/the child} had wheezing or whistling in the chest in the past 6 months?  


Label

Code

Go To

YES

1


NO

2

ITCH_RASH_SIX

REFUSED

-1

ITCH_RASH_SIX

DON'T KNOW

-2

ITCH_RASH_SIX


SOURCE

The International Study of Asthma and Allergies in Childhood (ISAAC)


MCZ03000/(NUM_ASTHMA_ATTACK). How many attacks of wheezing has {C_FNAME/the child} had in the past 6 months?

 

|___|___|

NUMBER OF ASTHMA ATTACKS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

The International Study of Asthma and Allergies in Childhood (ISAAC)


MCZ04000/(SLEEP_COUGH). Now I’m going to ask you about the past month.  In the past month, how often, on average, has {C_FNAME/the child}’s sleep been disturbed due to coughing or wheezing?  By coughing I mean a cough not associated with a cold or chest infection. 


Label

Code

Go To

Never

1


Less than one night per week

2


One or more nights per week

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

The International Study of Asthma and Allergies in Childhood (ISAAC) and National Health and Nutrition Examination Study (NHANES)


MCZ05000/(NUM_WHEEZE_WEEK). Now I’m going to ask you about the past week.  How many days of wheezing has {C_FNAME/the child} had in the past week?

 

|___|

DAYS OF WHEEZING


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF NUM_WHEEZE_WEEK ​> 7


MCZ06000/(ITCH_RASH_SIX). Has {C_FNAME/the child} ever had an itchy rash which was coming and going for at least six months? 


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_MCZ_ET

REFUSED

-1

TIME_STAMP_MCZ_ET

DON'T KNOW

-2

TIME_STAMP_MCZ_ET


SOURCE

The International Study of Asthma and Allergies in Childhood (ISAAC)


MCZ07000/(RASH_PAST_SIX). Has {C_FNAME/the child} had this itchy rash at any time in the past 6 months?  


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_MCZ_ET

REFUSED

-1

TIME_STAMP_MCZ_ET

DON'T KNOW

-2

TIME_STAMP_MCZ_ET


SOURCE

The International Study of Asthma and Allergies in Childhood (ISAAC)


MCZ08000. Has this itchy rash at any time affected any of the following places…


SOURCE

Urban Environment and Childhood Asthma: Form 136


MCZ09000/(ELBOW_RASH). Folds of elbows?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Urban Environment and Childhood Asthma: Form 136


MCZ10000/(KNEE_RASH). Behind the knees?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Urban Environment and Childhood Asthma: Form 136


MCZ11000/(ANKLE_RASH). In front of the ankles? 


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Urban Environment and Childhood Asthma: Form 136


MCZ12000/(BUTTOCKS_RASH). Under the buttocks?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Urban Environment and Childhood Asthma: Form 136


MCZ13000/(NECK_RASH). Around the neck?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Urban Environment and Childhood Asthma: Form 136


MCZ14000/(EARS_RASH). Around the ears or eyes?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Urban Environment and Childhood Asthma: Form 136


MCZ15000/(RASH_CLEARED_COMP). Has this rash cleared completely at any time during the past 6 months?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

International Study of Asthma and Allergies in Childhood (modified) 


MCZ16000/(RASH_AWAKE). In the past 6 months, how often, on average, has {C_FNAME/the child} been kept awake at night by this itchy rash? 


Label

Code

Go To

Never

1


Less than one night per week

2


One or more nights per week

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

International Study of Asthma and Allergies in Childhood (modified) 


(TIME_STAMP_MCZ_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • IF EVENT_TYPE = 24, 30, 36, 38, OR XX (54-MONTH EVENT), GO TO TIME_STAMP_WCC_ST.

  • OTHERWISE, GO TO TIME_STAMP_MED_ST.



WELL CHILD CARE/VACCINATIONS - (EVERY 6M, BEGINNING AT 6 M )


(TIME_STAMP_WCC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


WCC01000. Now I would like to ask you about {C_FNAME/the child}’s well-child visits and vaccinations.  It would be helpful if you referred to {C_FNAME/the child}’s shots record, or the Infant and Child Health Care Log that you received as part of this study, or to any other personal record or calendar that you keep that would help you to remember the dates of these shots.  If you have this information available, will you please go and get it now?


SOURCE

National Children’s Study, Vanguard Phase (3M, 6M, 9M, 12M, 18M and 24M) (modified)


INTERVIEWER INSTRUCTIONS

  • IN THE SCHEDULING INSTRUMENT COMPLETED AT THE TIME OF SCHEDULING FOR THIS VISIT, THE DATA COLLECTOR ASKED THE CAREGIVER WHETHER HE/SHE HAS THE INFANT CARE LOG.  IF THE CAREGIVER INDICATED THAT HE/SHE DID NOT HAVE/COULD NOT FIND THE INFANT CARE LOG, THE DATA COLLECTOR SHOULD HAVE MAILED AN INFANT CARE LOG TO THE ADULT CAREGIVER.  THE DATA COLLECTOR SHOULD BRING AN EXTRA INFANT CARE LOG TO GIVE TO THE CAREGIVER IF NECESSARY.

  • IF THE ADULT CAREGIVER DOES NOT HAVE THE LOG OR CHILD’S SHOT RECORD, REASSURE HIM/HER IT IS NOT A PROBLEM AND HE/SHE SHOULD TRY TO RESPOND TO THE NEXT QUESTIONS AS WELL AS POSSIBLE FROM MEMORY.


WCC02000/(WCC_VISIT). In the last 6 months, has {C_FNAME/the child} had a visit to a doctor, nurse or other health care provider for a well care visit or vaccination such as a check-up?  Do not include visits because of illness.  I will ask about those later.


Label

Code

Go To

YES

1


NO

2

ALL_SHOTS

REFUSED

-1

ALL_SHOTS

DON'T KNOW

-2

ALL_SHOTS


SOURCE

Early Childhood Longitudinal Program, Birth Cohort (modified)


WCC03000/(NUM_WELL_CHILD_VISIT). How many well-child visits or check-ups has {C_FNAME/the child} had in the last 6 months?

 

|___|___|

WELL-CHILD VISITS


INTERVIEWER INSTRUCTIONS

  • ENTER “00” IF NONE.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort (modified)


PROGRAMMER INSTRUCTIONS

  • IF NUM_WELL_CHILD_VISIT = 0, -1, OR -2, GO TO ALL_SHOTS.

  • IF NUM_WELL_CHILD_VISIT ≥ 1, LOOP THROUGH WCC04000, LAST_VISIT_DATE_MM, LAST_VISIT_DATE_DD, LAST_VISIT_DATE_YYYY, WCC05000 (IF APPLICABLE), WCC06000, VISIT_WT_LBS, VISIT_WT_OZ, VACCINATION, SHOTS_TYPE, SHOTS_TYPE_OTH (IF APPLICABLE), AND MEDS_WITH_SHOTS UNTIL NUMBER OF LOOPS = ​NUM_WELL_CHILD_VISIT.


WCC04000. What was the date of {C_FNAME/the child}’s {most recent/next most recent} well-child visit or checkup?


INTERVIEWER INSTRUCTIONS

  • ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND FOUR-DIGIT YEAR.


SOURCE

National Children’s Study, Vanguard Phase (3M, 6M, 9M, 12M, 18M and 24M)


(LAST_VISIT_DATE_MM) MONTH:

                 

|___|___|     

 

   M    M


Label

Code

Go To

REFUSED

-1

WCC05000

DON'T KNOW

-2

WCC05000


(LAST_VISIT_DATE_DD) DAY:

  

|___|___|     

 D     D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(LAST_VISIT_DATE_YYYY) YEAR: 

 

|___|___|___|___|

Y      Y     Y      Y


Label

Code

Go To

REFUSED

-1

WCC05000

DON'T KNOW

-2

WCC05000


PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most recent."

  • IF SUBSEQUENT LOOP, DISPLAY "next most recent."

  • IF LAST_VISIT_DATE_YYYY ≠ -1 OR -2, GO TO WCC06000.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most recent."

  • IF SUBSEQUENT LOOP, DISPLAY "next most recent."


WCC07000/(VACCINATION). Was {C_FNAME/the child} given any vaccinations at {his/her} {most recent/next most recent} visit?  Vaccinations are usually injections or shots that strengthen people’s immune systems so that their bodies can fight off serious infectious diseases.  Do not include allergy shots. 


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most recent."

  • IF SUBSEQUENT LOOP, DISPLAY "next most recent."

  • IF VACCINATION = 1, GO TO SHOTS_TYPE.

  • IF VACCINATION = 2, -1 OR -2, AND 

    • IF NUMBER OF LOOPS = NUM_WELL_CHILD_VISIT, AND 

      • IF VACCINATION ≠ 1 FOR ALL LOOPS, GO TO ALL_SHOTS.

      • IF VACCINATION = 1 FOR ANY PREVIOUS LOOP, GO TO RXN_SHOTS.

    • IF NUMBER OF LOOPS < NUM_WELL_CHILD_VISIT, GO TO WCC04000.


WCC08000/(SHOTS_TYPE). Please tell me the name of each vaccination {C_FNAME/the child} received at this visit.  


INTERVIEWER INSTRUCTIONS

  • PROBE: Anything else?

  • SELECT ALL THAT APPLY.  


Label

Code

Go To

DTaP (TETANUS, WHOOPING COUGH, DIPHTHERIA)

1


HepA (HEPATITIS A)

2


HepB (HEPATITIS B)

3


Hib (HAEMOPHILUS INFLUENZA TYPE B)

4


INFLUENZA (INFLUENZA)

5


IPV (POLIO)

6


MMR (MEASLES, MUMPS, RUBELLA)

7


PCV (PNEUMOCOCCUS)

8


RV (ROTAVIRUS)

9


VARICELLA (CHICKENPOX)

10


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


PROGRAMMER INSTRUCTIONS

  • IF SHOTS_TYPE = ANY COMBINATION OF 1 - 10, GO TO MEDS_WITH_SHOTS.

  • IF SHOTS_TYPE = -5, OR ANY COMBINATION OF 1 - 10 AND -5, GO TO SHOTS_TYPE_OTH.

  • IF SHOTS_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO MEDS_WITH_SHOTS.


WCC09000/(SHOTS_TYPE_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children's Study, Vanguard Phase (Core)


WCC10000/(MEDS_WITH_SHOTS). Was {C_FNAME/the child} given acetaminophen, such as Tylenol, or ibuprofen, such as Advil or Motrin, immediately after receiving the vaccination?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF NUMBER OF LOOPS < NUM_WELL_CHILD_VISIT, GO TO WCC04000.

  • OTHERWISE, IF NUMBER OF LOOPS = NUM_WELL_CHILD_VISIT, GO TO RXN_SHOTS.


WCC11000/(RXN_SHOTS). Did the child experience any side effects after receiving any vaccine in the past 6 months?


Label

Code

Go To

YES

1


NO

2

ALL_SHOTS

REFUSED

-1

ALL_SHOTS

DON'T KNOW

-2

ALL_SHOTS


SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


WCC12000/(RXN_SHOTS_TYPE). What was the side effect?


INTERVIEWER INSTRUCTIONS

  • PROBE: Anything else?

  • SELECT ALL THAT APPLY


Label

Code

Go To

ABDOMINAL PAIN

1


BODY ACHES

2


CHILLS

3


DIARRHEA

4


FEVER

5


FUSSINESS

6


HEADACHE

7


HOARSENESS/SORE THROAT/COUGH

8


LOSS OF APPETITE

9


NASAL CONGESTION/RUNNY NOSE

10


MUSCLE/JOINT PAIN

11


NAUSEA/VOMITING

12


RASH/HIVES

13


REDNESS/WARMTH/SWELLING WHERE THE SHOT WAS GIVEN

14


SEIZURE

15


SORENESS/TENDERNESS WHERE THE SHOT WAS GIVEN

16


SORE/RED/ITCHY EYES

17


SWOLLEN GLANDS

18


TEMPORARY LOW PLATELET COUNT

19


TIREDNESS/FATIGUE

20


WEAKNESS

21


WHEEZING/TROUBLE BREATHING

22


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


PROGRAMMER INSTRUCTIONS

  • IF RXN_SHOTS_TYPE = ANY COMBINATION OF 1 - 22, GO TO RXN_SHOTS_DOC.

  • IF RXN_SHOTS_TYPE = -5, OR ANY COMBINATION OF 1 - 22 AND -5, GO TO RXN_SHOTS_TYPE_OTH.

  • IF RXN_SHOTS_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO ​RXN_SHOTS_DOC.





WCC13000/(RXN_SHOTS_TYPE_OTH). SPECIFY: ___________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


WCC14000/(RXN_SHOTS_DOC). Did {C_FNAME/the child} see a physician or health care provider for this side effect?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


WCC15000/(RXN_MEDS). Was the child given any medications for any of the side effects?


Label

Code

Go To

YES

1


NO

2

ALL_SHOTS

REFUSED

-1

ALL_SHOTS

DON'T KNOW

-2

ALL_SHOTS


SOURCE

New


WCC16000/(RXN_MED_NAME). What was the name of the medication?


Label

Code

Go To

TYLENOL (ACETAMINOPHEN)

1


ADVIL/MOTRIN (IBUPROPHEN)

2


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF RXN_MED_NAME = 1 AND/OR 2, GO TO ALL_SHOTS.

  • IF RXN_MED_NAME = -5, OR ANY COMBINATION OF 1 AND/OR 2 AND -5, GO TO RXN_MED_NAME_OTH.

  • IF RXN_MED_NAME = -1 OR -2, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO ​ALL_SHOTS.


WCC17000/(RXN_MED_NAME_OTH). SPECIFY: _________________________________________


INTERVIEWER INSTRUCTIONS

  • ENTER ALL MEDICATIONS IN FIELD SEPARATED BY COMMAS OR “AND”.

  • ENTER UP TO 10 MEDICATIONS; IF MORE THAN 10 MEDICATIONS PROVIDED, ENTER FIRST 10 PROVIDED BY ADULT CAREGIVER.

  • PROBE: “Anything else?”


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


WCC18000/(ALL_SHOTS). In your opinion, has {C_FNAME/the child} received all of the recommended shots for {his/her} age?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2003


WCC19000/(REFUSE_SHOTS). Have you refused to have {C_FNAME/the child} get any vaccinations?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_WCC_ET

REFUSED

-1

TIME_STAMP_WCC_ET

DON'T KNOW

-2

TIME_STAMP_WCC_ET


SOURCE

National Health Interview Survey 2003


WCC20000/(TYPES_SHOTS_REFUSE). Which vaccinations did you refuse to get for {C_FNAME/the child}?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.


Label

Code

Go To

DTaP (TETANUS, WHOOPING COUGH, DIPHTHERIA)

1


HepA (HEPATITIS A)

2


HepB (HEPATITIS B)

3


Hib (HAEMOPHILUS INFLUENZA TYPE B)

4


INFLUENZA (INFLUENZA)

5


IPV (POLIO)

6


MMR (MEASLES, MUMPS, RUBELLA)

7


PCV (PNEUMOCOCCUS)

8


RV (ROTAVIRUS)

9


VARICELLA (CHICKENPOX)

10


ALL

11


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2003


INTERVIEWER INSTRUCTIONS

  • GET INFANT CARE LOG OR CHILD’S SHOT RECORD AND COMPLETE WELL CHILD CARE/VACCINATION GRID WITH INFORMATION FROM THESE RECORDS. 


PROGRAMMER INSTRUCTIONS

  • IF TYPES_SHOTS_REFUSE = ANY COMBINATION OF 1 - 10, GO TO TIME_STAMP_WCC_ET.

  • IF TYPES_SHOTS_REFUSE = -5 OR ANY COMBINATION OF 1 - 10 AND -5, GOT O TYPES_SHOTS_REFUSE_OTH.

  • IF TYPES_SHOTS_REFUSE = 11, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO ​TIME_STAMP_WCC_ET.


WCC21000/(TYPES_SHOTS_REFUSE_OTH). SPECIFY: ______________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2003


(TIME_STAMP_WCC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



EMERGENCY ROOM/URGENT CARE VISITS - (ANNUAL – 12M, 24M, 36M, 48M, 60M)


(TIME_STAMP_ERC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


ERC01000. I am now going to ask some questions about any visits {C_FNAME/the child} may have had to an emergency department or urgent care center.  Include only those visits where the child was treated and released.  Do not include visits where the child was first seen in the emergency department and then admitted to the hospital. 


SOURCE

Early Childhood Longitudinal Program, Birth Cohort (modified)


ERC02000/(ER_VISIT). Has {C_FNAME/the child} ever been taken to an emergency room or urgent care center?


Label

Code

Go To

YES

1


NO

2

FREQ_INJURY

REFUSED

-1

FREQ_INJURY

DON'T KNOW

-2

FREQ_INJURY


SOURCE

Early Childhood Longitudinal Program, Birth Cohort (modified)


ERC03000/(ER_VISIT_NUM). In the last 12 months, how many times has {C_FNAME/the child} been taken to an emergency room or urgent care center?

 

|___|___|

TIMES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2011 (modified)


PROGRAMMER INSTRUCTIONS

  • IF ER_VISIT_NUM = 0, -1 OR -2, GO TO FREQ_INJURY.

  • OTHERWISE, IF ER_VISIT_NUM ≥ 1, LOOP THROUGH ERC04000, ER_VISIT_DATE_MM, ER_VISIT_DATE_DD, ER_VISIT_DATE_YYYY, ERC05000 (IF APPLICABLE), ER_VISIT_DIAG, AND ER_VISIT_DIAG_OTH (IF ER_VISIT_DIAG = -5) UNTIL NUMBER OF LOOPS = ​ER_VISIT_NUM.


ERC04000. What was the date of the {most recent/next most recent} visit to an emergency room or urgent care visit in the last 12 months? 


INTERVIEWER INSTRUCTIONS

  • ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND FOUR-DIGIT YEAR.


SOURCE

National Children’s Study, Vanguard Phase (Core)


(ER_VISIT_DATE_MM) MONTH:

 

|___|___|  

  M    M


Label

Code

Go To

REFUSED

-1

ERC05000

DON'T KNOW

-2

ERC05000


(ER_VISIT_DATE_DD) DAY:

 

|___|___|   

  D     D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(ER_VISIT_DATE_YYYY) YEAR:

 

|___|___|___|___|  

  Y     Y     Y     Y


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most recent."

  • IF SUBSEQUENT LOOP, DISPLAY "next most recent."

  • IF ER_VISIT_DATE_YYYY ≠ -1 OR -2, GO TO ER_VISIT_DIAG.


ERC05000. How old was {C_FNAME/the child} at the {most recent/next most recent} emergency room or urgent care visit in the last 12 months? 


INTERVIEWER INSTRUCTIONS

  • IF NECESSARY, REMIND ADULT CAREGIVER TO REFER TO HEALTH CARE LOG OR OTHER RECORDS IF AVAILABLE.

  • RECORD AGE IN MONTHS IF CHILD YOUNGER THAN 36 MONTHS. 

  • OTHERWISE, RECORD AGE IN YEARS.


SOURCE

National Children’s Study, Vanguard Phase (Core)


(ER_VISIT_AGE)  

|___|___|        

AGE         


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(ER_VISIT_AGE_UNIT)


Label

Code

Go To

MONTHS

1


YEARS

2


REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most recent."

  • IF SUBSEQUENT LOOP, DISPLAY "next most recent."


ERC06000/(ER_VISIT_DIAG). What did the doctor or other health care professional tell you was the reason or diagnosis for {C_FNAME/the child}’s {most recent/next most recent} emergency room or urgent care visit in the last 12 months?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

  • PROBE: “Any others?”


Label

Code

Go To

ABDOMINAL PAIN

1


ACUTE UPPER RESPIRATORY INFECTION

2


ASTHMA

3


CONTUSION (BRUISING)

4


DISLOCATION



FRACTURE(S)

5


OPEN WOUND, HEAD INJURY

6


OPEN WOUND, EXCLUDING HEAD

7


EAR INFECTION OR EARACHE (OTITIS MEDIA)

8


FEVER

9


SORE THROAT (ACUTE PHARYNGITIS)

10


SKIN RASH

11


PNEUMONIA

12


APPENDICITIS

13


DEHYDRATION (FLUID AND ELECTROLYTE IMBALANCE)

14


SEIZURE

15


URINARY TRACT INFECTION

16


VOMITING AND/OR DIARRHEA

17


SKIN INFECTION

18


HEAD INJURY

19


STRAIN/SPRAIN



OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Hospital Ambulatory Care Survey: 2006 Emergency Department Summary (first 11 diagnoses)

H-CUP Statistical Brief #33: Top 20 most common reasons for admission to the ED for children & adolescents, 2004 (remaining diagnoses)


PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most recent."

  • IF SUBSEQUENT LOOP, DISPLAY "next most recent."

  • IF NUMBER OF LOOPS = ER_VISIT_NUM AND

    • IF ER_VISIT_DIAG = ANY COMBINATION OF 1 - 19, GO TO FREQ_INJURY.

    • IF ER_VISIT_DIAG = -5 OR ANY COMBINATION OF 1 - 19 AND -5, GO TO ER_VISIT_DIAG_OTH.

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

  • IF NUMBER OF LOOPS < ER_VISIT_NUM AND

    • IF ER_VISIT_DIAG = ANY COMBINATION OF 1 - 19, GO TO ERC04000.

    • IF ER_VISIT_DIAG = -5 OR ANY COMBINATION OF 1 - 19 AND -5, GO TO ER_VISIT_DIAG_OTH.

    • IF ER_VISIT_DIAG = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO ​ERC04000.


ERC07000/(ER_VISIT_DIAG_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort


PROGRAMMER INSTRUCTIONS

  • IF NUMBER OF LOOPS = ER_VISIT_NUM, GO TO FREQ_INJURY.

  • IF NUMBER OF LOOPS < ER_VISIT_NUM, GO TO ​ERC04000.


PROGRAMMER INSTRUCTIONS

  • IF ER_VISIT_DIAG = X,X,X…GO TO ERC08000/(FREQ_INJURY).



ERC08000/(FREQ_INJURY). What caused the injury?


Label

Code

Go To

FALL

1


STRUCK BY/AGAINST

2


BITES/STINGS

3


CUT/PIERCED WITH SHARP OBJECT

4


SWALLOWING FOREIGN BODY

5


DROWNING

6


NURSEMAID’S ELBOW

7





POISONING (ATE/DRANK/INHALED)

9


FIRE/BURNS

10


MOTOR VEHICLE CRASH

11


SUFFOCATION/INHALATION

12


PEDAL CYCLE

13


OTHER TRANSPORT

14


PEDESTRIAN

15


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort


PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most serious."

  • IF SUBSEQUENT LOOP, DISPLAY "next most serious."

  • IF CAUSE_INJURY = -5 , GO TO CAUSE_INJURY_OTH.

  • IF CAUSE_INJURY = 11, GO TO AUTO_CRASH_SAFE.

  • IF CAUSE_INJURY = 13, GO TO HELMET_BIKE.

  • OTHERWISE, IF CAUSE_INJURY ≠ -5, 11, OR 13, AND

    • IF NUMBER OF LOOPS = FREQ_INJURY, GO TO TIME_STAMP_ERC_ET.

    • IF NUMBER OF LOOPS < FREQ_INJURY, GO TO CAUSE_INJURY.


ERC10000/(CAUSE_INJURY_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort


PROGRAMMER INSTRUCTIONS

  • IF NUMBER OF LOOPS = FREQ_INJURY, GO TO TIME_STAMP_ERC_ET.

  • IF NUMBER OF LOOPS < FREQ_INJURY, GO TO CAUSE_INJURY.


(TIME_STAMP_ERC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



HOSPITALIZATIONS - (ANNUAL – 12M, 24M, 36M, 48M, 60M)


(TIME_STAMP_HOS_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


HOS01000. Now I am going to ask some questions about hospital stays.  


SOURCE

National Children's Study, Vanguard Phase (18M)


HOS02000/(HOSP_VISIT). Has {C_FNAME/the child} ever been hospitalized overnight?  Do not include an overnight stay in the emergency room.


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_HOS_ET

REFUSED

-1

TIME_STAMP_HOS_ET

DON'T KNOW

-2

TIME_STAMP_HOS_ET


SOURCE

National Health Interview Survey 2007 Family Questionnaire (modified)


HOS03000/(HOSP_VISIT_NUM). In the past 12 months, how many different times did {C_FNAME/the child} stay in any hospital overnight or longer?

 

|___|___|

TIMES


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Los Angeles Family and Neighborhood Survey Parent Questionnaire (modified)


PROGRAMMER INSTRUCTIONS

  • IF HOSP_VISIT_NUM = 0, -1, OR -2, GO TO TIME_STAMP_HOS_ET.

  • IF HOSP_VISIT_NUM ≥ 1, LOOP THROUGH HOS04000, HOSP_VISIT_NUM_NIGHTS, HOS06000, HOSP_VISIT_DIAG, AND HOSP_VISIT_DIAG_OTH (IF HOSP_VISIT_DIAG = -5) UNTIL NUMBER OF LOOPS = HOSP_VISIT_NUM.


HOS04000. What was the admission date of the {most recent/next most recent} hospitalization where {C_FNAME/the child} spent at least one night in the hospital? 


INTERVIEWER INSTRUCTIONS

  • ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND FOUR-DIGIT YEAR.


SOURCE

National Children’s Study, Vanguard Phase (Core)


(HOSP_VISIT_DATE_MM) MONTH:

 

|___|___|

  M   M


Label

Code

Go To

REFUSED

-1

HOS06000

DON'T KNOW

-2

HOS06000


(HOSP_VISIT_DATE_DD) DAY:

 

|___|___|

   D    D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HOSP_VISIT_DATE_YYYY) YEAR:

 

|___|___|___|___| 

   Y     Y     Y    Y


Label

Code

Go To

REFUSED

-1

HOS06000

DON'T KNOW

-2

HOS06000


PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most recent."

  • IF SUBSEQUENT LOOP, DISPLAY "next most recent."

  • IF HOSP_VISIT_DATE_MM, HOSP_VISIT_DATE_DD, AND HOSP_VISIT_DATE_YYYY ≠ -1 OR -2, GO TO HOSP_VISIT_NUM_NIGHTS.


HOS06000. How old was {C_FNAME/the child} at the {most recent/next most recent}  hospitalization where {he/she} spent at least one night in the hospital? 


INTERVIEWER INSTRUCTIONS

  • IF NECESSARY, REMIND ADULT CAREGIVER TO REFER TO HEALTH CARE LOGS OR OTHER RECORDS IF AVAILABLE.

  • RECORD AGE IN MONTHS IF CHILD YOUNGER THAN 36 MONTHS. 

  • OTHERWISE, RECORD AGE IN YEARS.


SOURCE

National Children’s Study, Vanguard Phase (Core)


(HOSP_VISIT_AGE)

|___|___|        

AGE         


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(HOSP_VISIT_AGE_UNIT)


Label

Code

Go To

MONTHS

-1


WEEKS

-2



HOS06100/(HOSP_VISIT_NUM_NIGHTS). How many nights did {C_FNAME/your child} stay in the hospital during this hospital stay?

 

|___|___|___|

NUMBER OF NIGHTS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children's Study (PBS 6M)


HOS07000/(HOSP_VISIT_DIAG). What did the doctor or other health care professional tell you was the main reason or diagnosis for {C_FNAME/the child}’s {most recent/next most recent} hospitalization? 


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

  • PROBE: “Any others?”


Label

Code

Go To

ACUTE BRONCHITIS

1


APPENDICITIS

2


ASTHMA

3


BIRTH DEFECT COMPLICATIONS

4


CANCER TREATMENT

5


DEHYDRATION

6


DIABETES

7


EPILEPSY OR SEIZURES

8


FEVER OF UNKNOWN ORIGIN

9


FRACTURES, UPPER LIMB

10


FRACTURES, LOWER LIMB

11


GASTROINTESTINAL INFECTION

12


HEAD INJURY

13


INFLUENZA

14


JAUNDICE (YELLOWNESS OF SKIN)

15


MOOD DISORDER

16


OPEN WOUND



OTHER RESPIRATORY INFECTION

17


OTHER VIRAL INFECTION

18


PNEUMONIA

19


SKIN INFECTION

20


URINARY TRACT INFECTION

21


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


PROGRAMMER INSTRUCTIONS

  • IF FIRST LOOP, DISPLAY "most recent"

  • IF SUBSEQUENT LOOP, DISPLAY "next most recent."

  • IF HOSP_VISIT_DIAG = -5 OR ANY COMBINATION OF 1 - 21 AND -5, GO TO HOSP_VISIT_DIAG_OTH.

  • IF HOSP_VISIT_DIAG = ANY COMBINATION OF 1 - 21, GO TO RECORD_RECALL.

  • IF HOSP_VISIT_DIAG = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND

    • IF NUMBER OF LOOPS = HOSP_VISIT_NUM, GO TO TIME_STAMP_HOS_ET.

    • IF NUMBER OF LOOPS < HOSP_VISIT_NUM, GO TO HOS04000.


HOS08000/(HOSP_VISIT_DIAG_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort


PROGRAMMER INSTRUCTIONS

  • IF HOSP_VISIT_DIAG = X,X,X…GO TO HOS0XXXX /(FREQ_INJURY).



HOS0XXXX /(FREQ_INJURY). What caused the injury?


Label

Code

Go To

FALL

1


STRUCK BY/AGAINST

2


BITES/STINGS

3


CUT/PIERCED WITH SHARP OBJECT

4


SWALLOWING FOREIGN BODY

5


DROWNING

6


NURSEMAID’S ELBOW

7



8


POISONING (ATE/DRANK/INHALED)

9


FIRE/BURNS

10


MOTOR VEHICLE CRASH

11


SUFFOCATION/INHALATION

12


PEDAL CYCLE

13


OTHER TRANSPORT

14


PEDESTRIAN

15


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



HOSXXXXX/(CAUSE_INJURY_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort


HOS09000/(RECORD_RECALL). It is important for the Study to know what type of records you used to help answer these questions.   Which of the following did you use to help you recall {C_FNAME/the child}'s visits to the hospital or emergency room and {his/her} sick visits, well-child visits, and the vaccinations you told me about?  Did you use…


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY


Label

Code

Go To

The Infant and Child Health Care Log

1


A shot or vaccination record (other than the Infant and Child Health Care Log)

2


Your memory

3


Some other type of personal record

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2003


PROGRAMMER INSTRUCTIONS

  • IF RECORD_RECALL = -5 OR ANY COMBINATION OF 1 - 3 AND -5, GO TO RECORD_RECALL_OTH.

  • IF RECORD_RECALL = ANY COMBINATION OF 1 - 3, AND

    • IF NUMBER OF LOOPS = HOSP_VISIT_NUM, GO TO TIME_STAMP_HOS_ET.

    • IF NUMBER OF LOOPS < HOSP_VISIT_NUM, GO TO HOS04000.

  • IF RECORD_RECALL = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND

    • IF NUMBER OF LOOPS = HOSP_VISIT_NUM, GO TO TIME_STAMP_HOS_ET.

    • IF NUMBER OF LOOPS < HOSP_VISIT_NUM, GO TO ​HOS04000.


HOS10000/(RECORD_RECALL_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health Interview Survey 2003


PROGRAMMER INSTRUCTIONS

  • IF NUMBER OF LOOPS = HOSP_VISIT_NUM, GO TO TIME_STAMP_HOS_ET.

  • IF NUMBER OF LOOPS < HOSP_VISIT_NUM, GO TO HOS04000.


(TIME_STAMP_HOS_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



MEDICATIONS – (EVERY 6M)


(TIME_STAMP_MED_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


MED01000. Now I am going to ask some questions about prescription medicines, over-the-counter medicines, and dietary supplements.  If you have them available, please go and get the containers for all the medicines and supplements that have been given to {C_FNAME/the child}.


SOURCE

National Health and Nutrition Examination Survey 2005 (modified)


MED02000/(PRESCR_TAKE). In the past 30 days, has {C_FNAME/the child} used or taken any medication for which a prescription is needed, including vitamins or minerals?  Include only those products prescribed by a health professional such as a doctor or dentist. 


Label

Code

Go To

YES

1


NO

2

MED16000

REFUSED

-1

MED16000

DON'T KNOW

-2

MED16000


SOURCE

National Health and Nutrition Examination Survey 2005 (modified)


MED03000/(PRESCRMED). Please list the name of all prescription medicines taken by {C_FNAME/the child} in the past 30 days:

 

_________________________________


INTERVIEWER INSTRUCTIONS

  • ENTER ALL MEDICATIONS IN FIELD SEPARATED BY COMMAS OR “AND”.

  • ENTER UP TO 10 MEDICATIONS; IF MORE THAN 10 MEDICATIONS PROVIDED, ENTER FIRST 10 PROVIDED BY ADULT CAREGIVER.

  • PROBE: “Anything else?”


Label

Code

Go To

REFUSED

-1

MED16000

DON'T KNOW

-2

MED16000


SOURCE

National Health and Nutrition Examination Survey 2005 (modified)


PROGRAMMER INSTRUCTIONS

  • IF MORE THAN ONE PRESCRIPTION MEDICATION LISTED, LOOP THROUGH MED04000, MED05000, RXMED_COND, PRESCRMED_TIME, PRESCRMED_12MO, RX_BENEFITS, RX_SIDE_EFFECT, RX_SIDE_EFFECT_TYPE, RX_SIDE_EFFECT_TYPE_OTH (IF RX_SIDE_EFFECT_TYPE = -5), RX_MED_SYMP_GONE, RXMED_STOP, AND RXMED_STOP_REAS UNTIL NUMBER OF LOOPS = NUMBER OF PRESCRIPTIONS LISTED IN PRESCRMED.


MED04000. First, let’s talk about {PRESCRMED_1}.


PROGRAMMER INSTRUCTIONS

  • DISPLAY FIRST PRESCRIPTION MEDICATION LISTED IN PRESCRMED AS "PRESCRMED_1."

  • GO TO ​RXMED_COND.


MED05000. Now let’s talk about {PRESCRMED_2_10}.


SOURCE

National Children’s Study, Vanguard Phase (Core)


PROGRAMMER INSTRUCTIONS

  • DISPLAY APPROPRIATE PRESCRIPTION MEDICATION LISTED IN PRESCRMED AS "PRESCRMED_2_10" FOR EACH LOOP (E.G., IF SECOND LOOP, DISPLAY SECOND PRESCRIPTION MEDICATION LISTED IN PRESCRMED).


MED06000/(RXMED_COND). What condition did the health care professional prescribe this medication for?

 

CONDITION: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MED07000/(PRESCRMED_TIME). How long has {C_FNAME/the child} taken this prescription medicine?


Label

Code

Go To

0-14 days

1


15-30 days

2


More than 30 days

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey 2005 (modified)


MED08000/(PRESCRMED_12MO). Is this medication taken for a condition that has lasted or is expected to last for at least 12 months?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey National Survey of Child Health (modified)


MED09000/(RX_BENEFITS). What benefits do you observe from {C_FNAME/the child} taking this medication?

 

BENEFITS: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MED10000/(RX_SIDE_EFFECT). Since taking this medication, has {C_FNAME/the child} experienced any side effects that you believe were caused by this medication?


Label

Code

Go To

YES

1


NO

2

RXMED_STOP

REFUSED

-1

RXMED_STOP

DON'T KNOW

-2

RXMED_STOP


SOURCE

New


MED11000/(RX_SIDE_EFFECT_TYPE). What side effects did {C_FNAME/the child} experience?     


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • PROBE: Any others?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

SKIN RASH

1


ITCHING

2


FEELING/BEING SICK

3


BREATHING DIFFICULTIES

4


EFFECTS ON DIGESTION (E.G. DIARRHEA)

5


BLOOD DISORDER

6


BLEEDING

7


HEADACHES

8


SEVERE ALLERGIC REACTION OR ANAPHYLAXIS

9


JAUNDICE

10


BLURRY VISION

11


CONSTIPATION

12


URINATION PROBLEMS

13


DROOLING/TOO MUCH SALIVA

14


DRY MOUTH

15


SLEEP PROBLEMS

16


HEART FLUTTERS

17


LIGHTHEADEDNESS, DIZZINESS

18


NAUSEA

19


VOMITING

20


WEIGHT GAIN

21


WEIGHT LOSS

22


FEELING RESTLESS OR JITTERY, CANNOT SIT STILL

23


MUSCLE STIFFNESS

24


SHAKING OR MUSCLE TREMBLING

25


SLOWNESS, TROUBLE GETTING MOVING

26


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF RX_SIDE_EFFECT_TYPE = ANY COMBINATION OF 1 - 26, GO TO RX_MED_SYMP_GONE.

  • IF RX_SIDE_EFFECT_TYPE = -5 OR ANY COMBINATION OF 1 - 26 AND -5, GO TO RX_SIDE_EFFECT_TYPE_OTH.

  • IF RX_SIDE_EFFECT_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO ​RX_MED_SYMP_GONE.


MED12000/(RX_SIDE_EFFECT_TYPE_OTH). SPECIFY:  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MED13000/(RX_MED_SYMP_GONE). Have any of the symptoms previously described gone away?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MED14000/(RXMED_STOP). Has {C_FNAME/the child} stopped using this medication?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF RXMED_STOP = 1, GO TO RXMED_STOP_REAS.

  • IF RXMED_STOP = 2, -1 OR -2, AND

    • IF NUMBER OF LOOPS = NUMBER OF PRESCRIPTION MEDICATIONS LISTED IN PRESCRMED, GO TO MED16000.

    • IF NUMBER OF LOOPS < NUMBER OF PRESCRIPTION MEDICATIONS LISTED IN PRESCRMED, GO TO ​MED05000.


MED15000/(RXMED_STOP_REAS). Why has {C_FNAME/the child} stopped using this medication?


Label

Code

Go To

Finished prescribed course

1


I felt the child didn’t need it any longer

2


The health care professional felt that the child didn’t need it any longer

3


I decided to stop because the child was having problems with it

4


The health care professional decided to stop because the child was having problems with it

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF NUMBER OF LOOPS = NUMBER OF PRESCRIPTION MEDICATIONS LISTED IN PRESCRMED, GO TO MED16000.

  • IF NUMBER OF LOOPS < NUMBER OF PRESCRIPTION MEDICATIONS LISTED IN PRESCRMED, GO TO ​MED05000.


MED16000. Now I’d like to ask about non-prescription medications and over-the-counter medications that {C_FNAME/the child} may have taken in the last 30 days.


SOURCE

National Health and Nutrition Examination Survey 2005 (modified)


MED17000/(OTC_TAKE). In the past 30 days, has {C_FNAME/the child} used or taken any non-prescription medicines, including vitamins, minerals, herbals, and dietary supplements?  Include only those products purchased over the counter that do not require a prescription. 


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_MED_ET

REFUSED

-1

TIME_STAMP_MED_ET

DON'T KNOW

-2

TIME_STAMP_MED_ET


SOURCE

National Health and Nutrition Examination Survey 2005 (modified)


MED18000/(OTCMED). Please list the name of all non-prescription medicines taken by {C_FNAME/the child} in the past 30 days:

 

______________________________


INTERVIEWER INSTRUCTIONS

  • ENTER ALL MEDICATIONS IN FIELD SEPARATED BY COMMAS OR “AND”.

  • ENTER UP TO 10 MEDICATIONS; IF MORE THAN 10 MEDICATIONS PROVIDED, ENTER FIRST 10 PROVIDED BY ADULT CAREGIVER.

  • PROBE: “Anything else?”


Label

Code

Go To

REFUSED

-1

TIME_STAMP_MED_ET

DON'T KNOW

-2

TIME_STAMP_MED_ET


SOURCE

National Health and Nutrition Examination Survey 2005 (modified)


PROGRAMMER INSTRUCTIONS

  • IF MORE THAN ONE NON-PRESCRIPTION MEDICATION LISTED, LOOP THROUGH MED19000, MED18000, OTCMED_COND, OTCMED_TIME, OTCMED_12MO, OTC_BENEFITS, OTC_SIDE_EFFECT, OTC_SIDE_EFFECT_TYPE, OTC_SIDE_EFFECT_TYPE_OTH (IF OTC_SIDE_EFFECT_TYPE = -5), OTC_SYMP_GONE, OTC_STOP, AND ​OTC_STOP_REASON UNTIL NUMBER OF LOOPS = NUMBER OF NON-PRESCRIPTION MEDICATIONS LISTED IN OTCMED.


MED19000. First, let’s talk about {OTCMED_1}.


PROGRAMMER INSTRUCTIONS

  • DISPLAY FIRST NON-PRESCRIPTION MEDICATION LISTED IN OTCMED AS "OTCMED_1"

  • GO TO ​OTCMED_COND.


MED20000. Now let’s talk about {OTCMED_2_10}.


PROGRAMMER INSTRUCTIONS

  • DISPLAY APPROPRIATE NON-PRESCRIPTION MEDICATION LISTED IN OTCMED AS "OTCMED_2_10" FOR EACH LOOP (E.G., IF SECOND LOOP, DISPLAY SECOND NON-PRESCRIPTION MEDICATION LISTED IN OTCMED).


MED21000/(OTCMED_COND). What condition is this over-the-counter medication used to treat?

 

CONDITION: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MED22000/(OTCMED_TIME). How long has {C_FNAME/the child} taken this non-prescription medicine?


Label

Code

Go To

0-14 days

1


15-30 days

2


More than 30 days

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey 2005 (modified)


MED23000/(OTCMED_12MO). Is this medication taken for a condition that has lasted or is expected to last for at least 12 months?

  


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey National Survey of Child Health (modified)


MED24000/(OTC_BENEFITS). What benefits do you observe from {C_FNAME/the child} taking this medication?

 

BENEFITS: ________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MED25000/(OTC_SIDE_EFFECT). Since taking this medication, has {C_FNAME/the child} experienced any side effects that you believe were caused by this medication?


Label

Code

Go To

YES

1


NO

2

OTC_STOP

REFUSED

-1

OTC_STOP

DON'T KNOW

-2

OTC_STOP


SOURCE

New


MED26000/(OTC_SIDE_EFFECT_TYPE). What side effects did {C_FNAME/the child} experience?


INTERVIEWER INSTRUCTIONS

  • IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • PROBE: Any others?

  • SELECT ALL THAT APPLY.


Label

Code

Go To

SKIN RASH

1


ITCHING

2


FEELING/BEING SICK

3


BREATHING DIFFICULTIES

4


EFFECTS ON DIGESTION (E.G. DIARRHEA)

5


BLOOD DISORDER

6


BLEEDING

7


HEADACHES

8


SEVERE ALLERGIC REACTION OR ANAPHYLAXIS

9


JAUNDICE

10


BLURRY VISION

11


CONSTIPATION

12


URINATION PROBLEMS

13


DROOLING/TOO MUCH SALIVA

14


DRY MOUTH

15


SLEEP PROBLEMS

16


HEART FLUTTERS

17


LIGHTHEADEDNESS, DIZZINESS

18


NAUSEA

19


VOMITING

20


WEIGHT GAIN

21


WEIGHT LOSS

22


FEELING RESTLESS OR JITTERY, CANNOT SIT STILL

23


MUSCLE STIFFNESS

24


SHAKING OR MUSCLE TREMBLING

25


SLOWNESS, TROUBLE GETTING MOVING

26


OTHER

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF OTC_SIDE_EFFECT_TYPE = ANY COMBINATION OF 1 - 26, GO TO OTC_SYMP_GONE.

  • IF OTC_SIDE_EFFECT_TYPE = -5 OR ANY COMBINATION OF 1 - 26 AND -5, GO TO OTC_SIDE_EFFECT_TYPE_OTH.

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


MED27000/(OTC_SIDE_EFFECT_TYPE_OTH). SPECIFY  _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MED28000/(OTC_SYMP_GONE). Have any of the symptoms previously described gone away?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


MED29000/(OTC_STOP). Has {C_FNAME/the child} stopped using this medication?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF OTC_STOP = 1, GO TO OTC_STOP_REASON.

  • IF OTC_STOP = 2, -1 OR -2, AND

    • IF NUMBER OF LOOPS = NUMBER OF NON-PRESCRIPTION MEDICATIONS LISTED IN OTCMED, GO TO TIME_STAMP_MED_ET.

    • IF NUMBER OF LOOPS < NUMBER OF NON-PRESCRIPTION MEDICATIONS LISTED IN OTCMED, GO TO MED20000.


MED30000/(OTC_STOP_REASON). Why has {C_FNAME/the child} stopped using this medication?


Label

Code

Go To

I felt the child didn’t need it any longer

1


The health care professional felt that the child didn’t need it any longer

2


I decided to stop because the child was having problems with it

3


The health care professional decided to stop because the child was having problems with it

4


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF NUMBER OF LOOPS = NUMBER OF NON-PRESCRIPTION MEDICATIONS LISTED IN OTCMED, GO TO TIME_STAMP_MED_ET.

  • IF NUMBER OF LOOPS < NUMBER OF NON-PRESCRIPTION MEDICATIONS LISTED IN OTCMED, GO TO MED20000.


(TIME_STAMP_MED_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



SLEEP ROUTINE– (EVERY 6M)


(TIME_STAMP_SR_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


SR01000. 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, which is 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. 


SOURCE

National Children’s Study, Vanguard Phase (Core) (modified)


PROGRAMMER INSTRUCTIONS

  • IF SEC_RES ​= 1, DISPLAY BRACKETED TEXT.


PROGRAMMER INSTRUCTIONS

  • IF SEC_RES ​= 1, DISPLAY BRACKETED TEXT.


SR02000/(SLEEP_HRS_NIGHT). Approximately how many hours does {C_FNAME/the child} sleep at night?

 

|___|___|

HOURS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Survey of Parents And Children My Young Baby Girl Questionnaire (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF SLEEP_HRS_NIGHT SLEEP_HRS_DAY ​> 24.


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF SLEEP_HRS_NIGHT SLEEP_HRS_DAY ​> 24.


SR03000/(SLEEP_HRS_DAY). Approximately how many hours does {C_FNAME/the child} sleep during the day?


|___|___|

 HOURS


INTERVIEWER INSTRUCTIONS

  • IF NONE, ENTER "00."


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Survey of Parents And Children My Young Baby Girl Questionnaire (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF SLEEP_HRS_DAY ​> 24.


PROGRAMMER INSTRUCTIONS

  • DISPLAY HARD EDIT IF SLEEP_HRS_DAY ​> 24.



SR04000. On a normal day, what time in the evening does {C_FNAME/the child} go to sleep?


INTERVIEWER INSTRUCTIONS

  • ENTER TIME IN HOURS AND MINUTES.

  • THEN SELECT “AM” OR “PM”.


SOURCE

Avon Longitudinal Survey of Parents And Children My Young Baby Girl Questionnaire (modified)


(SLEEP_TIME_NIGHT)  

|___|___|:|___|___|

            TIME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(SLEEP_TIME_NIGHT_UNIT)


Label

Code

Go To

AM

1


PM

2


REFUSED

-1



SR05000. On a normal day, what time does {C_FNAME/the child} wake up in the morning?


INTERVIEWER INSTRUCTIONS

  • ENTER TIME IN HOURS AND MINUTES.

  • THEN SELECT “AM” OR “PM”.


SOURCE

Avon Longitudinal Survey of Parents And Children My Young Baby Girl Questionnaire (modified)


(SLEEP_TIME_WAKE)  

|___|___|:|___|___|

            TIME


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(SLEEP_TIME_WAKE_UNIT)


Label

Code

Go To

AM

1


PM

2


REFUSED

-1



SR06000/(SLEEP_DIFFICULT). How often is {C_FNAME/the child} difficult when {he/she} is put to bed?


Label

Code

Go To

Most of the time

1


Often

2


Sometimes

3


Rarely

4


Never

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Survey of Parents And Children My Young Baby Girl Questionnaire (modified)


SR07000/(SLEEP_THROUGH). How often does {C_FNAME/the child} wake at night?


Label

Code

Go To

Never

1


Occasionally

2


Most nights

3


Once per night

4


More than once per night

5


REFUSED

-1


DON'T KNOW

-2



SOURCE

Avon Longitudinal Survey of Parents And Children My Young Baby Girl Questionnaire (modified)


(TIME_STAMP_SR_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



CONCERN ABOUT CHILD’S DEVELOPMENT – (EVERY 6M)


(TIME_STAMP_CAC_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.


CAC01000. Now I would like to ask some questions about {C_FNAME/the child}’s development.  Sometimes [parents/caregivers]  have concerns about their children.  Are you concerned about your child’s development? 


INTERVIEWER INSTRUCTIONS

  • USE “parents” OR “caregivers” AS APPROPRIATE.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Core)


PROGRAMMER INSTRUCTIONS

  • IF CAC01000 = 1 THEN GO TO CAC02000/(CONCERN_SPEECH).

  • IF CAC01000 ≠ 1 THEN GO TO (TIME_STAMP_CAC_ET).


CAC02000/(CONCERN_SPEECH). How {C_FNAME/the child} talks and makes speech sounds?


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Early Childhood Health 2011


CAC03000/(CONCERN_UNDERSTAND). How {C_FNAME/the child} understands what you say?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Sometimes parents have concerns about their children. Are you concerned a lot, a little, or not at all about:) AS NEEDED.


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Early Childhood Health 2011


CAC04000/(CONCERN_HANDS). How {C_FNAME/the child} uses {his/her} hands and fingers to do things?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Sometimes parents have concerns about their children. Are you concerned a lot, a little, or not at all about:) AS NEEDED.


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Early Childhood Health 2011


CAC05000/(CONCERN_ARMS). How {C_FNAME/the child} uses {his/her} arms and legs?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Sometimes parents have concerns about their children. Are you concerned a lot, a little, or not at all about:) AS NEEDED.


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

State and Local Area Integrated Telephone Survey (SLAITS) National Survey of Early Childhood Health 2011


CAC06000/(CONCERN_GETALONG). How {C_FNAME/the child} gets along with others?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Sometimes parents have concerns about their children. Are you concerned a lot, a little, or not at all about:) AS NEEDED.


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Survey of Early Childhood Health and the National Survey of Child with Special Health Care Needs


CAC07000/(CONCERN_EAT). {C_FNAME’s/the child} eating habits?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Sometimes parents have concerns about their children. Are you concerned a lot, a little, or not at all about:) AS NEEDED.


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


CAC08000/(CONCERN_GROWTH). C_FNAME’s/the child} growth?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Sometimes parents have concerns about their children. Are you concerned a lot, a little, or not at all about:) AS NEEDED.


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


CAC07000/(CONCERN_HEAR). {C_FNAME’s/the child} hearing?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Sometimes parents have concerns about their children. Are you concerned a lot, a little, or not at all about:) AS NEEDED.


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


CAC07000/(CONCERN_VISION). {C_FNAME’s/the child} vision?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT (Sometimes parents have concerns about their children. Are you concerned a lot, a little, or not at all about:) AS NEEDED.


Label

Code

Go To

A LOT

1


A LITTLE

2


NOT AT ALL

3


REFUSED

-1


DON'T KNOW

-2



SOURCE

New


(TIME_STAMP_CAC_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 18 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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