1 54M Questionnaire Adult

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

Attach 4. 54M Questionnaire Adult

54-Month Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 6/30/2017

54M Questionnaire– Adult, Phase 2g

OMB Specification


54M Questionnaire - Adult


Event Category:

Time-Based

Event:

54M

Administration:

N/A

Instrument Target:

Primary Caregiver

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:

5 minutes

Multiple Child/Sibling Consideration:

Per Event

Special Considerations:

N/A

Version:

1.0

MDES Release:

4.0


*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.


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54M Questionnaire - Adult



TABLE OF CONTENTS





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54M Questionnaire - Adult



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.





PARENTING (PARENTAL MODERNITY SCALE)


(TIME_STAMP_PPM_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

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


PPM01000. These next questions include some statements other parents have made about rearing and educating children. For each statement, please tell me how you feel in general, not just about your own child.  


PPM02000/(PARENT_PRETEND). Parents should go along with the game when their child is pretending something.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


PPM03000/(OBEY_TEACHER). Children should always obey the teacher.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


PPM04000/(FORCE_CORRECT). Children will not do the right thing unless they must.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.
Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


PPM05000/(TEACH_OBEDIENCE). The most important thing to teach children is absolute obedience to whoever is in authority.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.
Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


PPM06000/(OBEY_PARENTS). Children should always obey their parents.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


PPM07000/(TEACH_RIGHT). Children will be bad unless they are taught what is right.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


PPM08000/(PERMIT_DISAGREE). Children should be allowed to disagree with their parents if they feel their own ideas are better.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


PPM09000/(PERSPEC_RIGHT). Children have a right to their own point of view and should be allowed to express it.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


PPM10000/(OK_DISAGREE_PARENT). It’s all right for a child to disagree with his or her parents.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.) (modified)


PPM11000/(CONSIDER_IDEAS). A child’s ideas should be seriously considered in making family decisions.


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.


Label

Code

Go To

STRONGLY DISAGREE

1


MILDLY DISAGREE

2


NOT SURE

3


MILDLY AGREE

4


STRONGLY AGREE

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)


(TIME_STAMP_PPM_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP





RELIGIOUS AFFILIATION


(TIME_STAMP_RA_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


RA01000. These next questions are about your religious faith.


RA02000/(CURRENT_REL_PREF). What is your religious preference?


Label

Code

Go To

PROTESTANT

1

PROTEST_DENOM

CATHOLIC

2

TIME_STAMP_RA_ET

MORMON

3

TIME_STAMP_RA_ET

JEHOVAH’S WITNESS

4

TIME_STAMP_RA_ET

GREEK/RUSSIAN/EASTERN ORTHODOX

5

TIME_STAMP_RA_ET

JEWISH

6

TIME_STAMP_RA_ET

BUDDHIST

7

TIME_STAMP_RA_ET

MUSLIM

8

TIME_STAMP_RA_ET

HINDU

9

TIME_STAMP_RA_ET

AGNOSTIC

10

TIME_STAMP_RA_ET

ATHEIST

11

TIME_STAMP_RA_ET

OTHER

-5


NONE

-7

TIME_STAMP_RA_ET

REFUSED

-1

TIME_STAMP_RA_ET

DON’T KNOW

-2

TIME_STAMP_RA_ET


SOURCE

Panel Study of Income Dynamics 2013


RA02100/(CURRENT_REL_PREF_OTH). SPECIFY: ________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Panel Study of Income Dynamics 2013


RA03000/(PROTEST_DENOM). What denomination is that?


Label

Code

Go To

BAPTIST

1

TIME_STAMP_RA_ET

LUTHERN

2

TIME_STAMP_RA_ET

METHODIST/AFRICAN METHODIST

3

TIME_STAMP_RA_ET

PRESBYTERIAN

4

TIME_STAMP_RA_ET

EPISCOPALIAN

5

TIME_STAMP_RA_ET

PROTESTANT, UNSPECIFIED

6

TIME_STAMP_RA_ET

PENTECOSTAL/ASSEMBLY OF GOD

7

TIME_STAMP_RA_ET

OTHER

-5


REFUSED

-1

TIME_STAMP_RA_ET

DON’T KNOW

-2

TIME_STAMP_RA_ET


SOURCE

Panel Study of Income Dynamics 2013


RA04000/(PROTEST_DENOM_OTH). SPECIFY    __________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Panel Study of Income Dynamics 2013


(TIME_STAMP_RA_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 5 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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