1 60M Questionaire Child

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

Attach 5. 60M Questionnaire Child

60-Month Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 6/30/2017

60M Questionnaire - Child, Phase 2g

OMB Specification


60M Questionnaire - Child


Event Category:

Time-Based

Event:

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:

15 minutes

Multiple Child/Sibling Consideration:

Per Child

Special Considerations:

N/A

Version:

1.0

MDES Release:

4.0


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


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60M Questionnaire - Child



TABLE OF CONTENTS





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60M 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.









NOISE EXPOSURE




(TIME_STAMP_NE_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 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 AND IF = 1, DISPLAY "he", him" AND "his" IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

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


NE10000. We would now like to ask you some questions about noise in and around the child’s home.


NE11000/(NOISE_OUTSIDE). When inside {C_FNAME/the child}’s home, how much would you say noise from outdoor sources bothers, disturbs, or annoys {CHILD’s Name}? 


Label

Code

Go To

Extremely

1


Very much

2


Moderately

3


Slightly

4


Not at all

5

NOISE_INSIDE

REFUSED

-1

NOISE_INSIDE

DON'T KNOW

-2

NOISE_INSIDE


SOURCE

The International Commission on Biological Effects of Noise’s (ICBEN’s) Community Response to Noise Team, Cohen/Bronzaft airport studies (Modified) 


NE13000/(NOISE_OUTSIDE_TYPE). What types of outdoor noise bother, disturb or annoy {C_FNAME/the child} when {he/she} is inside?


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

AIRPLANE

1


CAR/TRUCK

2


GARDEN EQUIPMENT

3


DOGS BARKING

4


LOUD MUSIC

5


NEIGHBOR VOICES

6


ROWDY PASSERBY VOICES

7


NO PARTICULAR SOURCE

8


SOME OTHER SOURCE

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

The International Commission on Biological Effects of Noise's Cohen/Bronzaft airport studies (Modified) 


PROGRAMMER INSTRUCTIONS

  • IF NOISE_OUTSIDE_TYPE = ANY COMBINATION OF 1 THROUGH 7, GO TO NOISE_INSIDE.

  • IF NOISE_OUTSIDE_TYPE = -5 OR ANY COMBINATION OF 1 THROUGH 7 AND -5, GO TO NOISE_OUTSIDE_OTH.

  • IF NOISE_OUTSIDE_TYPE = 8, -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES, AND GO TO NOISE_INSIDE.


NE14000/(NOISE_OUTSIDE_OTH). What other type of outdoor noise?

 

SPECIFY: ___________________________________


INTERVIEWER INSTRUCTIONS

  • PROBE “Anything else?” 

  • LIST ALL OTHER OUTDOOR NOISE SOURCES SEPARATED BY COMMAS. 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

The International Commission on Biological Effects of Noise's Cohen/Bronzaft airport studies (Modified) 


NE15000/(NOISE_INSIDE). At {C_FNAME/the child}’s home, how much would you say noise from indoor sources bothers, disturbs, or annoys {C_FNAME/the child}?


Label

Code

Go To

Extremely

1


Very much

2


Moderately

3


Slightly

4


Not at all

5

NOISE_INTERFERE

REFUSED

-1

NOISE_INTERFERE

DON'T KNOW

-2

NOISE_INTERFERE


SOURCE

The International Commission on Biological Effects of Noise’s (ICBEN’s) Community Response to Noise Team (Modified) 


NE17000/(NOISE_INSIDE_TYPE). What types of indoor noise would you say bother, disturb or annoy {C_FNAME/the child}?


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

BUILDING/MECHANICAL NOISE SUCH AS – FAN, AIR CONDITIONING, ETC

1


LOUD MUSIC

2


LOUD TALKING, CRYING, ETC. BY HOUSEHOLD MEMBERS, INCLUDING CHILDREN

3


DOGS BARKING

4


SOME OTHER SOURCE

-5


REFUSED

-1


DON'T KNOW

-2



SOURCE

The International Commission on Biological Effects of Noise’s (ICBEN’s) Community Response to Noise Team (Modified) 


DATA COLLECTOR INSTRUCTIONS

  • IF NOISE_INSIDE_TYPE = ANY COMBINATION OF 1 THROUGH 4, GO TO NOISE_INTERFERE.

  • IF NOISE_INSIDE_TYPE = -5, OR ANY COMBINATION OF 1 THROUGH 4 AND -5, GO TO NOISE_INSIDE_OTH.

  • IF NOISE_INSIDE_TYPE = -1 OR -2, DO NOT ALLOW ANY OTHER RESPONSES, AND GO TO NOISE_INTERFERE.


NE18000/(NOISE_INSIDE_OTH). What other type of indoor noise?

 

SPECIFY: ___________________________________


INTERVIEWER INSTRUCTIONS

  • PROBE “Anything else?” 

  • LIST ALL OTHER INDOOR NOISE SOURCES SEPARATED BY COMMAS. 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

The International Commission on Biological Effects of Noise’s (ICBEN’s) Community Response to Noise Team (Modified) 


(TIME_STAMP_NE_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP.



SCHOOL EXPERIENCES


(TIME_STAMP_SEZ_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


SEZ01000/(ATTEND_SCHOOL). Is {C_FNAME/the child} attending or enrolled in school?


Label

Code

Go To

YES

1

SCHOOL_GRADE

NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ02000/(REAS_NO_SCHOOL). Why is {C_FNAME/the child} not attending school this year?


Label

Code

Go To

NOT OLD ENOUGH

1

TIME_STAMP_SEZ_ET

NOT READY SOCIALLY

2

TIME_STAMP_SEZ_ET

NOT READY ACADEMICALLY

3

TIME_STAMP_SEZ_ET

OTHER

-5


REFUSED

-1

TIME_STAMP_SEZ_ET

DON’T KNOW

-2

TIME_STAMP_SEZ_ET


SOURCE

New


SEZ02100/(REAS_NO_SCHOOL_OTH). SPECIFY: ______________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

New 


PROGRAMMER INSTRUCTIONS

  • GO TO ​TIME_STAMP_SEZ_ET.


SEZ03000/(SCHOOL_GRADE). What grade is {he/she} in?


Label

Code

Go To

PRESCHOOL

1

SEZ05000

KINDERGARTEN

2

SEZ05000

FIRST GRADE

3

SEZ05000

UNGRADED

4

SEZ05000

OTHER

-5


REFUSED

-1

SEZ05000

DON'T KNOW

-2

SEZ05000


SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ04000/(SCHOOL_GRADE_OTH). SPECIFY: ___________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ05000. What month and year did {C_FNAME/the child} start in their current class?


SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


(BEGIN_SCHOOL_MM)

|___|___|

MONTH


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(BEGIN_SCHOOL_YYYY)  

|___|___|___|___|

         YEAR


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SEZ06000/(HRS_SCHOOL). How many hours each day does {he/she} spend in school?

 

|___|___|

HOURS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ07000/(DAYS_SCHOOL). How many days each week does {he/she} spend in school?

 

|___|

DAYS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ08000/(NAME_SCHOOL). What is the name of the school where {C_FNAME/the child} attends school?

 

NAME: _____________________________________


INTERVIEWER INSTRUCTIONS

  • VERIFY SPELLING.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ09000. What is the address of {SCHOOL NAME}?


INTERVIEWER INSTRUCTIONS

  • VERIFY SPELLING.


SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


(SCHOOL_STREET_ADDRESS_1) ​STREET ADDRESS 1: ____________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(SCHOOL_STREET_ADDRESS_2) ​STREET ADDRESS 2: _____________________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(SCHOOL_CITY) CITY: _____________________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(SCHOOL_STATE) STATE: |___|___|


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(SCHOOL_ZIPCODE) ZIP CODE: |___|___|___|___|___|


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • DISPLAY RESPONSE PROVIDED IN NAME_SCHOOL AS ​"SCHOOL NAME".


SEZ10000/(SCHOOL_PRIVATE). Is the school public or private?


Label

Code

Go To

PUBLIC

1


PRIVATE

2


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ11000/(SCHOOL_VOUCHER). Did you use a voucher provided by the government to attend this school? 


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ12000/(NUM_STUDENTS_CLASS). How many students are in {C_FNAME/the child}'s class? 

 

|___|___|___|

NUMBER


SOURCE

New


SEZ13000/(NUM_TEACHERS_CLASS). How many teachers and teacher’s assistants usually work in {C_FNAME/the child}'s classroom? 

 

|___|___|

NUMBER


SOURCE

New 


SEZ14000/(TRANS_SCHOOL). How does {C_FNAME/the child} usually get to school? Does (he/she)…


Label

Code

Go To

Walk or ride a bike

1


Ride a bus

2


Is {he/she} dropped off by a parent, relative, or adult friend

3


Is {he/she} dropped off by {his/her} day care provider

4


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Spring Parent Interview 


SEZ15000/(COMMUTE_LENGTH_SCH). How many minutes does it usually take {C_FNAME/the child} to get to school?

 

l___l___l

MINUTES


SOURCE

New


SEZ16000/(DISTANCE_SCHOOL). About how far would you say it is from your home to the school {C_FNAME/the child} attends?


Label

Code

Go To

LESS THAN 1/8TH MILE (LESS THAN 3 BLOCKS)

1


1/8TH MILE TO ¼ MILES (3-5 BLOCKS

2


MORE THAN ¼ MILE, BUT LESS THAN ½ MILE (6-9 BLOCKS)

3


½ MILE TO LESS THAN 1 MILE (10-19 BLOCKS)

4


ONE MILE TO 2.5 MILES (LESS THAN 5 MINUTE DRIVE)

5


2.6 MILES TO 5 MILES (BETWEEN 5-10 MINUTE DRIVE)

6


5.1 MILES TO 7.5 MILES (BETWEEN 11 AND 15 MINUTE DRIVE)

7


7.6 MILES TO 10 MILES (BETWEEN 16 AND 20 MINUTE DRIVE), OR

8


11 MILES OR MORE (MORE THAN A 20 MINUTE DRIVE)?

9


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ17000/(SPEC_ED). When a child with a disability or developmental delay receives special education and/or related services sponsored through your local education agency – that is, the school system – these services are initiated after a diagnosis of condition, or professional evaluation of the child, and development of an Individualized Education Program or "IEP" or an Individualized Family Service Program or "IFSP", which is discussed with and signed by the parent.

 

Is {C_FNAME/the child} receiving special education services related to either an IEP or an IFSP? 


Label

Code

Go To

YES

1


NO

2

SEZ21000

REFUSED

-1

SEZ21000

DON'T KNOW

-2

SEZ21000


SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


PROGRAMMER INSTRUCTIONS

  • IF SPEC_ED = 1, GO TO SPEC_EQUIP_SCHOOL.

  • IF SPEC_ED = 2, -1 OR -2, AND

    • IF SCHOOL_GRADE = 2, GO TO SEZ21000.

    • IF SCHOOL_GRADE ≠ 2, GO TO INVITE_PARTY.


SEZ18000/(SPEC_EQUIP_SCHOOL). Does {C_FNAME/the child} currently use special equipment for children with special needs such as a wheelchair, communication board, or other assistive device?  


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview 


SEZ19000/(WRITTEN_SPEC_NEEDS). Does {C_FNAME/the child} have a written accommodations plan for any special needs, as described under Section 504 of the Vocational Rehabilitation Act usually called a 504 plan? 


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Longitudinal Transition Study – 2 Parent Interview


SEZ20000/(SPEC_SERVICES). Were you the one who first asked for special services for {C_FNAME/the child} in school, or did school staff first suggest that {he/she} might need services?


Label

Code

Go To

PARENT ASKED

1


SCHOOL STAFF RECOMMENDED

2


SOMEONE ELSE RECOMMENDED

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

National Longitudinal Transition Study – 2 Parent Interview 


PROGRAMMER INSTRUCTIONS

  • IF SCHOOL_GRADE = 2, GO TO SEZ21000.

  • IF SCHOOL_GRADE ≠ 2, GO TO INVITE_PARTY.


SEZ21000. Starting school can be a big change for children. These next few items are about how well that transition to school went for {C_FNAME/the child}, and how ready you thought {he/she} was for school.


SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ22000/(ACAD_PREP_SCHOOL). How academically prepared do you think {C_FNAME/the child} was for kindergarten?  By academically prepared, we mean knowing things like letters and numbers, and being ready to learn. Would you say…


Label

Code

Go To

Very prepared

1


Somewhat prepared

2


Not at all prepared

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ23000/(SOC_PREP_SCHOOL). How socially prepared do you think {C_FNAME/the child} was for kindergarten?  By socially prepared, we mean being ready for the classroom environment, including being able to listen to and follow instructions, express {his/her} needs verbally, and play well with other children. Would you say…


Label

Code

Go To

Very prepared

1


Somewhat prepared

2


Not at all prepared

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ24000. Children sometimes have trouble adjusting to kindergarten. On average, {since this school year began/during the first two months of this school year}…


PROGRAMMER INSTRUCTIONS

  • IF CURRENT MONTH AND YEAR < 2 MONTHS FROM BEGIN_SCHOOL_MM AND BEGIN_SCHOOL_YYYY DISPLAY FIRST BRACKETED PHRASE.

  • OTHERWISE, DISPLAY SECOND BRACKETED PHRASE.


SEZ25000/(FREQ_COMPLAIN_SCH). How often did {C_FNAME/the child} complain about school?  Would you say more than once a week, once a week or less, or not at all?


Label

Code

Go To

MORE THAN ONCE A WEEK

1


ONCE A WEEK OR LESS

2


NOT AT ALL

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ26000/(FREQ_RELUCT_SCHOOL). How often was { C_FNAME/the child } reluctant to go to school?


Label

Code

Go To

MORE THAN ONCE A WEEK

1


ONCE A WEEK OR LESS

2


NOT AT ALL

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ27000/(FREQ_PRETEND_SICK). How often did {he/she} pretend to be sick to stay home from school?


Label

Code

Go To

MORE THAN ONCE A WEEK

1


ONCE A WEEK OR LESS

2


NOT AT ALL

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ28000/(FREQ_SAY_GOOD). How often did {he/she} say good things about school?


Label

Code

Go To

MORE THAN ONCE A WEEK

1


ONCE A WEEK OR LESS

2


NOT AT ALL

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ29000/(FREQ_SAY_LIKE_TEACH). How often did {C_FNAME/the child} say {he/she} liked {his/her} teacher?


Label

Code

Go To

MORE THAN ONCE A WEEK

1


ONCE A WEEK OR LESS

2


NOT AT ALL

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ30000/(FREQ_LOOK_FORWARD_SCH). How often did {he/she} look forward to going to school?


Label

Code

Go To

MORE THAN ONCE A WEEK

1


ONCE A WEEK OR LESS

2


NOT AT ALL

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview 


SEZ31000/(INVITE_PARTY). During the past 12 months, has {he/she} been invited by friends to social activities like over to their home or to a party?  


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Longitudinal Transition Study – 2 Parent Interview 


SEZ32000/(NUM_FRIENDS). How many friends does {C_FNAME/the child} have? Would you say...


Label

Code

Go To

None

1


1 or 2 friends

2


3 to 5 friends

3


More than 5 friends

4


REFUSED

-1


DON’T KNOW

-2



SOURCE

Fragile X Survey 


SEZ33000/(BULLY_SCHOOL). Has {C_FNAME/the child} been bullied [in school] this year?  By bullied, we mean has there been a time when someone else has done things like called {C_FNAME/the child} names, teased or laughed at {him/her}, left {him/her} out, threatened, or physically hurt {him/her}?  


Label

Code

Go To

YES

1


NO

2

MET_TEACHER

REFUSED

-1

MET_TEACHER

DON'T KNOW

-2

MET_TEACHER


SOURCE

New 


SEZ34000/(BULLY_FREQ). How often has this happened?  Would you say…


Label

Code

Go To

Once or twice

1


Three to ten times

2


More than ten times

3


REFUSED

-1


DON’T KNOW

-2



SOURCE

New 


SEZ35000/(MET_TEACHER). Have you met {C_FNAME/the child}’s teacher yet? 


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Birth Cohort Kindergarten 2006 Parent Interview (modified)


SEZ36000. Since the beginning of this school year, have you or the other adults in your household…


SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview 


SEZ37000/(ATTEND_OPEN_HOUSE). Attended an open house or a back-to-school night?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview 


SEZ38000/(ATTEND_PTA_MTG). Attended a meeting of a PTA, PTO, or Parent-Teacher Student Organization?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview 


SEZ39000/(ATTEND_ADVIS_GRP). Gone to a meeting of a parent advisory group or policy council?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview


SEZ40000/(ATTEN_PAR_TEAC_CONF). Gone to a regularly-scheduled parent-teacher conference with {C_FNAME/the child}'s teacher or meeting with {C_FNAME/the child}'s teacher?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview 


SEZ41000/(ATTEND_SCH_EVENT). Attended a school or class event, such as a play, sports event, or science fair?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview 


SEZ42000/(VOLUNTEER_SCHOOL). Acted as a volunteer at the school or served on a committee?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview 


SEZ43000/(FUNDRAISE_SCHOOL). Participated in fundraising for (C_FNAME/the child)'s school?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, 1998-99 Kindergarten Cohort Fall Parent Interview 


(TIME_STAMP_SEZ_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



CHILD DEMOGRAPHICS


(TIME_STAMP_CD_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


CD01000. These next questions ask about {C_FNAME/the child}.


CD02000/(BABY_ETHNIC_ORIGIN). Is {C_FNAME/the child} of Hispanic, Latino/a or Spanish origin?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


PROGRAMMER INSTRUCTIONS

  • IF BABY_ETHNIC_ORIGIN=1, GO TO  BABY_EHTNIC_ORIGIN_1.

  • IF BABY_EHTNIC_ORIGIN≠1, AND

    • IF MODE=CAPI,GO TO BABY_RACE_NEW.

    • IF MODE=CATI, GO TO BABY_RACE_1​.


CD03000/(BABY_ETHNIC_ORIGIN_1). Is {C_FNAME/the child} one or more of the following?


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

  • PROBE: Anything else?


Label

Code

Go To

Mexican, Mexican American, Chicano/a

1


Puerto Rican

2


Cuban

3


Another Hispanic, Latino/a, or Spanish origin

4


OTHER

-5


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


PROGRAMMER INSTRUCTIONS

  • IF BABY_ETHNIC_ORIGIN_1=ANY COMBINATION OF 1 THROUGH 4, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING BABY_EHTNIC_ORIGIN_1.

  • IF BABY_ETHNIC_ORIGIN_1=-5 OR ANY COMBINATION OF 1 THROUGH 4 AND-5, GO TO BABY_EHTNIC_ORIGIN_1_OTH.

  • IF BABY_EHTNIC_ORIGIN_1=-1 OR-2, DO NOT ALLOW ANY OTHER RESPONSES AND GO TO PROGRAMMER INSTRUCTIONS FOLLOWING BABY_EHTNIC_ORIGIN_1​.


CD04000/(BABY_ETHNIC_ORIGIN_1_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


PROGRAMMER INSTRUCTIONS

  • IF MODE=CAPI, GO TO BABY_RACE_NEW​.

  • IF MODE=CATI, GO TO BABY_RACE_1.


CD05000/(BABY_RACE_NEW). What is {C_FNAME/the child}’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

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

  • IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

  • SELECT ALL THAT APPLY.

  • CODE “SOME OTHER RACE” ONLY IF VOLUNTEERED.

  • PROBE: Anything else?


Label

Code

Go To

WHITE

1


BLACK OR AFRICAN AMERICAN

2


AMERICAN INDIAN OR ALASKA NATIVE

3


ASIAN INDIAN

4


CHINESE

5


FILIPINO

6


JAPANESE

7


KOREAN

8


VIETNAMESE

9


OTHER ASIAN

10


NATIVE HAWAIIAN

11


GUAMANIAN OR CHAMORRO

12


SAMOAN

13


OTHER PACIFIC ISLANDER

14


SOME OTHER RACE

-5


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


PROGRAMMER INSTRUCTIONS

  • IF BABY_RACE_NEW=ANY COMBINATION OF 1 THROUGH 14, GO TO ​ENGLISH_WELL_CHILD.

  • IF BABY_RACE_NEW=-5 OR ANY COMBINATION OF 1 THROUGH 14 AND -5, GO TO BABY_RACE_NEW_OTH.

  • IF BABY_RACE_NEW=-1 OR -2, DO NOT ALLOW ANY OTHER RESONSES AND GO TO ENGLISH_WELL_CHILD


CD06000/(BABY_RACE_NEW_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


PROGRAMMER INSTRUCTIONS

  • GO TO ENGLISH_WELL_CHILD​.


CD07000/(BABY_RACE_1). What is {C_FNAME/the child}’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • SELECT ALL THAT APPLY.

  • CODE “SOME OTHER RACE” ONLY IF VOLUNTEERED.

  • PROBE: Anything else?


Label

Code

Go To

White

1


Black or African American

2


American Indian or Alaska native,

3


Asian

4


Native Hawaiian or other Pacific Islander

5


SOME OTHER RACE

-5


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


PROGRAMMER INSTRUCTIONS

  • IF BABY_RACE_1=ANY COMBINATION OF 1 THROUGH 3, GO TO ENGLISH_WELL_CHILD.

  • IF BABY_RACE_1=4 OR ANY COMBINATION OF 4 AND 1, 2, 3 AND/OR 5, GO TO BABY_RACE_2.

  • IF BABY_RACE_1=5 OR ANY COMBINATION OF 5 AND 1 THORUGH 3, GO TO BABY_RACE_3.

  • IF BABY_RACE_1=-5 OR ANY COMBINATION OF 1 THROUGH 5 AND -5, GO TO BABY_RACE_1_OTH.

  • IF BABY_RACE_1=-1 OR -2, DO NOT ALLOW OTHER RESPONSES AND GO TO ENGLISH_WELL_CHILD.  


CD08000/(BABY_RACE_1_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


PROGRAMMER INSTRUCTIONS

  • IF BABY_RACE_1=4 OR 4 AND ANY COMBINATION OF 1, 2, 3, AND/OR 5, GO TO BABY_RACE_2

  • IF BABY_RACE_1=5 OR 5 AND ANY COMBINATION OF 1 THROUGH 3, GO TO BABY_RACE_3.

  • OTHERWISE, GO TO ENGLISH_WELL_CHILD.


CD09000/(BABY_RACE_2). What is {C_FNAME/the child}’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

Asian Indian

1


Chinese

2


Filipino

3


Japanese

4


Korean

5


Vietnamese

6


Other Asian

7


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


PROGRAMMER INSTRUCTIONS

  • IF BABY_RACE_1=ANY COMBINATION WITH 4 AND 5 ,GO TO BABY_RACE_3.

  • OTHERWISE, GO TO ENGLISH_WELL_CHILD.


CD10000/(BABY_RACE_3). What is {C_FNAME/the child}’s race? (One or more categories may be selected).


INTERVIEWER INSTRUCTIONS

  • PROBE FOR ANY OTHER RESPONSES

  • SELECT ALL THAT APPLY. 


Label

Code

Go To

Native Hawaiian

1


Guamanian or Chamorro

2


Samoan

3


Other Pacific Islander

4


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Office of Minority Health Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status


CD11000/(ENGLISH_WELL_CHILD). How well does {C_FNAME/the child} speak English? Would you say…


Label

Code

Go To

Very well

1


Well

2


Not well

3


Not at all

4


REFUSED

-1


DON’T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD12000/(HH_NONENGLISH_NEW_CHILD). Does{C_FNAME/the child} speak a language other than English at home?


Label

Code

Go To

YES

1


NO

2

DIFF_HEAR_CHILD

REFUSED

-1

DIFF_HEAR_CHILD

DON'T KNOW

-2

DIFF_HEAR_CHILD


SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD13000/(OTHER_LANG_CHILD). What is this language?


Label

Code

Go To

Spanish

1

DIFF_HEAR_CHILD

Other Language

-5


REFUSED

-1

DIFF_HEAR_CHILD

DON’T KNOW

-2

DIFF_HEAR_CHILD


SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD14000/(OTHER_LANG_CHILD_OTH ). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD15000/(DIFF_HEAR_CHILD). Is {C_FNAME/the child} deaf or does {he/she} have serious difficulty hearing?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD15100/(DIFF_SEE_CHILD). Is {C_FNAME/the child} blind or does {he/she} have serious difficulty seeing, even when wearing glasses?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD16000/(DIFF_CONCENTRATE_CHILD). Because of a physical, mental, or emotional condition, does {C_FNAME/the child} have serious difficulty concentrating, remembering, or making decisions?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD17000/(DIFF_WALK_CHILD). Does {C_FNAME/the child} have serious difficulty walking or climbing stairs?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD18000/(DIFF_DRESS_CHILD). Does {C_FNAME/the child} have difficulty dressing or bathing?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

U.S. Department of Health and Human Services Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status required by Section 4302 of the Affordable Care Act


CD19000/(PARTICIPANT_SEX). WHAT IS THE SEX OF THE CHILD?


INTERVIEWER INSTRUCTIONS

  • DO NOT ADMINISTER THIS QUESTION TO THE RESPONDENT


Label

Code

Go To

MALE

1


FEMALE

2


REFUSED

-1


DON'T KNOW

-2



(TIME_STAMP_CD_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 15 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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