WIC Participant

OMB Approval No. 0584-0580

Approval Expires: XX/XX/20XX

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APPENDIX D.1

AGE 3 EXTENSION WIC INFANT AND TODDLER FEEDING PRATICES STUDY – II

24-MONTH INTERVIEW (INCLUDES CONTACT MODULE) - ENGLISH

WIC ITFPS-2 Participant Interview

24 Month

Revised September 2014

SOCIODEMOGRAPHICS AND BACKGROUND

Respondent still Caregiver?

1, 3, 5, 7, 9, 11, 13, 15, 18, 24

SD12. (1 mo.: Before we go any further/ All other: Before we begin today), I need to ask whether you are still {CHILD's} caregiver. [Source: New Development]

Yes 01

No 02

(If no, go to a)

a. Does {CHILD} still live with you?

Yes 01

No 02

b. (If a is Yes): Can you please tell me who in your household is now {CHILD's} caregiver? Can I speak with that person?

Name of New Caregiver______________________________________________

c. (If a is No): Can you please tell me who is caring for {CHILD} now, and how I could reach that person?

Name of New Caregiver______________________________________________

Phone of New Caregiver______________________________________________

Address of New Caregiver____________________________________________

Relation of New Caregiver to Child_____________________________________

OK, I’m going to start by asking you some questions about yourself and your household.

Household size

Enrollment, 7, 13, 24

SD18. How many people live in your household? By household I mean people who live together and share living expenses. Please include yourself in this count, and (If PN enrollment: please add 1 to the total for your pregnancy, too/If postnatal enrollment or 7, 13, or 24 months: If you are pregnant right now please add 1 to the total for your pregnancy. [Source: FITS 2002, modified]

Number of people in household [number]

Household income

Enrollment, 7, 13, 24

SD19. During [PREVIOUS MONTH], what was your household income before taxes? Please include any income in the past month from you, your family members who live with you, and any other people who live with you and share living expenses with you [Source: WIC IFPS-1, modified]

Income [amount]

(OR if respondent cannot provide specific amount): I’ll read some ranges, and you can stop me when I get to the one that is your best estimate of your household income before taxes for [PREVIOUS MONTH]

$500 or less 01

$501-$1000 02

$1001-$1500 03

$1501-$2000 04

$2001-$2500 05

$2501-$3000 06

$3001-$3500 07

$3501-$4000 08

$4001-$4500 09

$4501-$5000 10

$5001+ 11

Don’t know 98

Refused 99

Next I’d like to ask you some questions about WIC.

Continuation/discontinuation of WIC participation (timing, reasons, location)

1, 3, 5, 7, 9, 11, 13, 15, 18, 24

SD31. Are you currently getting WIC food or checks for yourself or {CHILD}? [Source: FDA IFPS-2; modified]

Yes 01

No 02

(if no for the first time go to SD34, if no previously go to next applicable module)

SD32. The last time we talked with you, you were going to WIC at [fill in location]. Do you still go there, or do you go to a new location? [Source: FDA IFPS-2 modified]

Yes, still that location 01

No, new location 02

SD33. (If SD32 is no) Please tell me where you go now

Record location _______________________________________

Ask SD34 and SD35 only if SD31 is 'no'

SD34. How old was {CHILD} when you stopped going to WIC? [Source: LA WIC Survey; modified]

Age [weeks/months]

SD35. I'm going to read some reasons why you might have stopped going to WIC. Please tell me if each one is a reason you stopped going to WIC: [Source: LA WIC Survey; modified]

You no longer qualify for WIC 01

It was inconvenient for you 02

You no longer need WIC 03

Other reason (record response) 04

WIC PROGRAM AWARENESS, SATISFACTION, UTILIZATION

Perceptions of Impact of Nutrition Education

3, 13, 24

Administer WC20 only if respondent indicated in SD31 that they are still on WIC. If not on WIC, skip to WC21.

WC20. Your WIC benefits include both education and food. Which is more important to you—the food you get from WIC, the education you get from WIC, or are they equally important? [Source: New Development]

Food is more important 01

Education is more important 02

They are equally important 03

Don’t know 98

Refused 99

If no longer on WIC, say: I’d like to ask you about how you used WIC education.

WC21. Have you changed how you feed yourself or your family because of something you learned at WIC? [Source: New Development]

Yes 01

No 02

Don’t Know 98

WC22. (If YES to WC21) What is the most important change you have made based on education you received from WIC? (Open-ended; Interviewer record response) [Source: New Development]

I/we eat more fruits and vegetables 01

I/we eat more whole grains 02

I/we drink more reduced fat/low-fat/non-fat milk 03

I am breastfeeding/breastfed 04

I know how to prepare formula/feed the right amount of formula 05

We have more family meals/eat together 06

We don’t watch TV when eating meals 07

We drink/buy fewer sugar sweetened beverages 08

I/we offer the right amount of foods (portion) 09

I know how to choose more healthy foods for myself/my family 10

Other (specify____________________________________) 11

Don’t know 98

Refused 99

CURRENT FEEDING PRACTICES

AMPM Module (Asking child’s food intake in past 24 hours)

24-HR Recall for Food Intake

1, 3, 5, 7, 9, 11, 13, 15, 18, 24

Nutrition intake

Number of breastmilk/formula feedings per day

Type of formula used

Adherence to formula dilution instructions

Use/timing of supplemental formula for breastfeeding mothers

Addition of anything other than human milk/formula to child’s bottle

Specific food item intake

Use of jarred baby foods

Meal and snack pattern

Eating locations (eating on the go)

Use of dietary supplements for infants (direct administration)

Supplemental Foods Initiation (asked all interviews 1-24 until all endorsed)

Fed other than breastmilk or formula

1, 3, 5, 7, 9, 11, 13, 15, 18, 24

Ask CF32 at every interview until mother answers yes, then drop from later interviews.

CF32. Has {CHILD} been given anything to eat or drink besides formula or breastmilk? [Source: WIC IFPS-1, modified]

Yes 01

No 02

Time to introduction of supplemental foods

1, 3, 5, 7, 9, 11, 13, 15, 18, 24

Only ask CF33 if CF32 = YES now or at a previous interview

Next I’m going to ask you some questions about when you first started feeding {CHILD} different types of foods.

Ask each food until answer is affirmative, then stop asking that food in subsequent interviews

CF33. For each of the following, please tell me if {CHILD} has been given this food or drink, and if so, how old {CHILD} was when he/she first had that food. [Sources: FITS 2008; IFPS-1; WHO Toolkit 1996]

a. Has [HE/SHE] been given plain bottled or tap water?

Yes 01

No 02

b. (If yes) How old was {CHILD} when [HE/SHE] was first fed plain bottled or tap water?

Age [weeks/months]

Don’t know 98

Refused 99

c. Has [HE/SHE] been given soda or soft drinks?

Yes 01

No 02

d. (If yes) How old was {CHILD} when [HE/SHE] was first fed soda or soft drinks?

Age [weeks/months]

Don’t know 98

Refused 99

e. Has [HE/SHE] been given other sweetened beverages (such as Kool Aid, Hi-C, Fruit Punch, sweetened juice, sweetened or flavored water, Gatorade, or sweet tea)?

Yes 01

No 02

f. (If yes) How old was {CHILD} when [HE/SHE] was first fed other sweetened beverages?

Age [weeks/months]

Don’t know 98

Refused 99

g. Has [HE/SHE] been given 100% fruit juice such as apple juice, orange juice, or other types of 100% juice. Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to?

Yes 01

No 02

h. (If yes) How old was {CHILD} when [HE/SHE] was first fed 100% fruit juice?

Age [weeks/months]

Don’t know 98

Refused 99

i. Has [HE/SHE] been given other drinks and liquids, including teas and broths?

Yes 01

No 02

j. (If yes) How old was {CHILD} when [HE/SHE] was first fed Other drinks and liquids, including teas and broths?

Age [weeks/months]

Don’t know 98

Refused 99

k. Has [HE/SHE] been given Cow’s milk, including whole milk, 2%, 1%, or skim? Please include milk you add to other foods such as cereal.

Yes 01

No 02

l. (If yes) How old was {CHILD} when [HE/SHE] was first fed cow’s milk?

Age [weeks/months]

Don’t know 98

Refused 99

m. Has [HE/SHE] been given dairy products other than cow’s milk including cheese, yogurt, or goat’s milk? Please include any dairy products other than cow’s milk that you add to other foods.

Yes 01

No 02

n. (If yes) How old was {CHILD} when [HE/SHE] was first fed dairy products other than cow’s milk?

Age [weeks/months]

Don’t know 98

Refused 99

o. Has [HE/SHE] been given baby cereal, either with a spoon or by adding it to a bottle of breastmilk or formula?

Yes 01

No 02

p. (If yes) How old was {CHILD} when [HE/SHE] was first fed baby cereal?

Age [weeks/months]

Don’t know 98

Refused 99

q. Has [HE/SHE] been given other cereal besides baby cereal?

Yes 01

No 02

r. (If yes) How old was {CHILD} when [HE/SHE] was first fed other cereal besides baby cereal?

Age [weeks/months]

Don’t know 98

Refused 99

s. Has [HE/SHE] been given eggs?

Yes 01

No 02

t. (If yes) How old was {CHILD} when [HE/SHE] was first fed eggs?

Age [weeks/months]

Don’t know 98

Refused 99

u. Has [HE/SHE] been given fruit, including baby food or regular fruit?

Yes 01

No 02

v. (If yes) How old was {CHILD} when [HE/SHE] was first fed fruit?

Age [weeks/months]

Don’t know 98

Refused 99

w. Has [HE/SHE] been given vegetables, including baby food or regular vegetables?

Yes 01

No 02

x. (If yes) How old was {CHILD} when [HE/SHE] was first fed vegetables?

Age [weeks/months]

Don’t know 98

Refused 99

y. Has [HE/SHE] been given beans, such as black beans, pinto beans, or chick peas?

Yes 01

No 02

z. (If yes) How old was {CHILD} when [HE/SHE] was first fed beans?

Age [weeks/months]

Don’t know 98

Refused 99

aa. Has [HE/SHE] been given peanut butter

Yes 01

No 02

bb. (If yes) How old was {CHILD} when [HE/SHE] was first fed peanut butter?

Age [weeks/months]

Don’t know 98

Refused 99

cc. Has [HE/SHE] been given meats,, chicken, or fish, including baby food and baby food combination dinners containing these foods?

Yes 01

No 02

dd. (If yes) How old was {CHILD} when [HE/SHE] was first fed meat, chicken, or fish?

Age [weeks/months]

Don’t know 98

Refused 99

ee. Has [HE/SHE] been given salty snacks, such as chips, pretzels, crackers, or other snack foods including baby snacks?

Yes 01

No 02

ff. (If yes) How old was {CHILD} when [HE/SHE] was first fed salty snacks?

Age [weeks/months]

Don’t know 98

Refused 99

gg. Has [HE/SHE] been given sweets, such as cake, cookies, candy, or jam

Yes 01

No 02

hh. (If yes) How old was {CHILD} when [HE/SHE] was first fed sweets?

Age [weeks/months]

Don’t know 98

Refused 99

Next I’m going to ask you some questions about the types of food you buy or make for {CHILD}, how you prepare those foods and feed them to {CHILD}, and what foods you get through WIC.

Time to cessation of bottle feeding

7, 9, 11, 13, 15, 18, 24 (until affirmative)

CF34. Is {CHILD} still drinking anything from a bottle? [Source: New Development]

Yes 01

No 02

CF35. (If no, ask:) How old was {CHILD} when he/she stopped using a bottle? [Source: New Development]

Age [weeks/months/years]

Infant/child food package – does child eat foods from WIC food package?

7, 13, 15, 18, 24

For 13, 15, 18, 24 mo:

CF43. Which of the following WIC foods does {CHILD} eat? Does [HE/SHE] eat: [Source: FITS 2008, modified]

a. Breakfast cereal, either hot or cold from WIC

Yes 01

No 02

Don’t Know 98

b. Cheese from WIC

Yes 01

No 02

Don’t Know 98

c. Eggs from WIC

Yes 01

No 02

Don’t Know 98

d Does {CHILD} eat fruits from WIC

Yes 01

No 02

Don’t Know 98

e. 100% juice from WIC

Yes 01

No 02

Don’t Know 98

f. Milk from WIC, including cow’s milk, soy milk, or other milk

Yes 01

No 02

Don’t Know 98

g. Peanut butter from WIC

Yes 01

No 02

Don’t Know 98

h. Does {CHILD} eat vegetables from WIC

Yes 01

No 02

Don’t Know 98

i. Whole grain bread or other whole grains, such as brown rice, bulgur, barley, or tortillas from WIC

Yes 01

No 02

Don’t Know 98

j. Does {CHILD} eat other food from WIC (specify ________________________________________)

Yes 01

No 02

Don’t Know 98

Practices for introducing new foods to toddlers

15, 18, 24

CF49. How many times do you offer a new food before you decide {CHILD} does not like it? [Source: FITS 2002, 2008, modified]

Once 01

Twice 02

Three to five times 03

Six to ten times 04

More than ten times 05

LIKES EVERYTHING 06

DON’T KNOW 98

REFUSED 99

Toddler feeding rules

15, 24

CF51. I am going to read some things that parents may do. Please tell me how often each statement is true for you and {CHILD}. [Source: Thompson et al., 2009]

a. I keep track of what food {CHILD} eats

Always 01

Usually 02

About half of the time 03

Occasionally 04

Never 05

b. I try to get {CHILD} to finish his/her food

Always 01

Usually 02

About half of the time 03

Occasionally 04

Never 05

c. I try to get {CHILD} to eat even if she/he seems not hungry

Always 01

Usually 02

About half of the time 03

Occasionally 04

Never 05

d. I carefully control how much {CHILD} eats

Always 01

Usually 02

About half of the time 03

Occasionally 04

Never 05

e. I am very careful not to feed {CHILD} too much

Always 01

Usually 02

About half of the time 03

Occasionally 04

Never 05

MATERNAL HEALTH AND LIFESTYLE

Now I’d like to change topics and ask you some questions about your health, and about work, school, and child care.

Maternal weight

1, 3, 13, 24

MH13. Right now, about how much do you weigh, without shoes? [Source: PHFE WIC Postpartum Questionnaire 2010]

Pounds [number]

Educational attainment

Baseline, 24 months

SD26. What is the highest year or grade you finished in school? [Source: FITS 2002; modified]

(do not read – endorse based on participant response, probe if needed)

NEVER ATTENDED SCHOOL 01

GRADES 1 TO 11, ENTER NUMBER 02

High school diploma or GED 03

Some college/some postsecondary vocational courses 04

2-year or 3-year college degree (AA degree)

or vocational school diploma 05

4-year college degree (BA, BS degree) 06

Some graduate work/no graduate degree 07

Doctoral or graduate degree (MA, MBA, PhD, JD, MD) 08

DON’T KNOW 98

REFUSED 99

Educational status

3, 7, 13, 18, 24

SD27. As of today, are you in school or college? [Source: WIC IFPS-1]

Yes 01

No 02

Current employment status

3, 7, 13, 18, 24

SD29. Are you currently working for pay full time, part time, or not at all? [Source: LA WIC Survey]

Full time (35 hours or more) 01

Part time 02

Not at all 03

Ask SD30 first time answer to SD 27 or SD29 is ‘yes’ then discontinue

SD30. How old was {CHILD} when you started going to school or working? [Source: New Development]

Age [weeks, months]

Ever used regular non-maternal child care?

3, 7, 13, 24 (once answered affirmative, stop asking for subsequent interviews)

The next few questions are about childcare. By childcare, we mean any kind of arrangement where someone other than you or {CHILD’S} other parent takes care of {CHILD} on a regular basis, while you go to work or school.

Please include care provided by a relative or non-relative, either in your home or someone else’s home, as well as in a childcare center or family daycare home. Do not include care provided by you or {CHILD’S} other parent. [Source: PHFE WIC Survey 2010 modified]

MH18. Have you ever used a regular childcare arrangement for {CHILD}?

Yes 01

No 02

When did child first start non-maternal child care?

3, 7, 13, 24 (asked only if ever used is yes, then stop asking once answered)

MH19. At what age did {CHILD} first start a regular childcare arrangement? [Source: New Development]

Age [months]

Current use of non-maternal child care (and what kind)

3, 7, 13, 24

MH20. Which type of regular childcare arrangement are you currently using the most for {CHILD}? [Source: PHFE WIC Survey 2011, modified]

A child care center 01

A family daycare home 02

Early Head Start 03

Someone cares for {CHILD} in their home 04

Someone cares for {CHILD} in your home 05

Some other kind of childcare 06

Not currently using childcare 07

Contact info for child care (for CACFP status)

3, 7, 13, 24

MH21. (If center or family daycare from MH20) Can we get the official name and address of the child care? We won’t contact them without your permission, we just need it to for our records. [Source: New Development]

Name ___________________________________________________

Address _________________________________________________

Who provides food to child care location (provided by mother, or by facility)

3, 7, 13, 24

Ask only if indicated current child care use in MH20

MH23. Who provides most of the food {CHILD} eats at childcare – the child care provider, you, or is the food divided about equally between you and the childcare provider? [Source: PHFE WIC Survey 2011]

Child care provider 01

Parent 02

Equally divided 03

EXPERIENCE, KNOWLEDGE, ADVICE, BELIEFS

Now I’m going to ask you about your beliefs about feeding toddlers.

Toddler period knowledge, attitudes, beliefs about nutrition

15, 24

KA11. It’s ok for a toddler to walk around while eating as long as he or she eats. [Source: Thompson, 2009, modified]. Would you say that you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree?

Strongly agree 01

Agree 02

Neither agree nor disagree 03

Disagree 04

Strongly disagree 05

KA12. It’s important for a toddler to finish all the food on his or her plate. [Source: Thompson, 2009, modified]. Would you say that you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree?

Strongly agree 01

Agree 02

Neither agree nor disagree 03

Disagree 04

Strongly disagree 05

KA13. The best way to make a toddler stop crying is to feed him or her. [Source: Thompson, 2009, modified]. Would you say that you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree?

Strongly agree 01

Agree 02

Neither agree nor disagree 03

Disagree 04

Strongly disagree 05

KA14. It’s important that the parent decides how much a toddler should eat. [Source: Thompson, 2009, modified]. Would you say that you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree?

Strongly agree 01

Agree 02

Neither agree nor disagree 03

Disagree 04

Strongly disagree 05

KA15. People feel differently about what their toddlers eat. Which of the following best describes your opinion about toddlers eating fast food: [Source: Thompson, 2009, modified]

Toddlers should be allowed to eat fast food whenever they want to 01

Toddlers should be allowed to eat fast food occasionally 02

Toddlers should never eat fast food 03

KA16. There are many kinds of sugary foods like candy, ice cream, cakes or cookies. Which of the following best describes your opinion about toddlers eating sugary foods: [Source: Thompson, 2009, modified]

Toddlers should be allowed to eat sugary foods whenever they want to 01

Toddlers should be allowed to eat sugary foods occasionally 02

Toddlers should never eat sugary foods 03

KA17. There are many kinds of snack foods like potato chips, regular or flavored tortilla chips, and cheese puffs. Which of the following best describes your opinion about toddlers eating snack foods: [Source: Thompson, 2009, modified]

Toddlers should be allowed to eat snack foods whenever they want to 01

Toddlers should be allowed to eat snack foods occasionally 02

Toddlers should never eat snack foods 03

Caregiver understanding of infant nonverbal satiety cues and crying; toddler satiety cues.

3, 13, 24

13 and 24 months:

KA27. I’m going to read you some statements about when {CHILD} is hungry or full. Please tell me how much you agree or disagree with these statements. [Source: First Steps Survey, modified]

a. My child knows when he or she is full. Would you say that you:

Strongly agree 01

Agree 02

Neither agree nor disagree 03

Disagree 04

Strongly disagree 05

b. I let my child decide how much to eat. Would you say that you:

Strongly agree 01

Agree 02

Neither agree nor disagree 03

Disagree 04

Strongly disagree 05

Perceptions of infant/toddler size and role in feeding decisions

3, 13, 24

At 3, 13, 24:

KA29. Does your child’s weight influence your decisions about how and what to feed [HIM/HER]? [Source: New Development]

Yes 01

No 02

Don’t know 98

At 24 months only:

KA30. Currently, would you describe your child as overweight, normal weight or thin? [Source: UCLA/PHFE CHIRP Study]

Overweight 01

Normal 02

Thin 03

CHILD HEALTH, BEHAVIOR, AND CHILD REARING

Finally, I’m going to ask you some questions about {CHILD’S} health and behavior, and your family’s routines and habits.

Health status/conditions

Actions to rectify health conditions

1, 3, 5, 7, 9, 11, 13, 15, 18, 24

CH2. Has the doctor told you that {CHILD} has any long-term medical problems or conditions that may affect what or how (he/she) eats? [Source: FITS 2008, modified]

(Interviewer, if necessary add) These medical problems or conditions may be things like food allergies, diabetes, metabolic disorders such as PKU or galactosemia, gastrointestinal problems such as gastric reflux, other problems like cleft palate or other mouth or facial conditions – any long-term problems that affect the baby’s ability to eat and swallow.

Yes 01

No 02

Don’t Know 98

(If yes) What medical problem or condition does {CHILD} have?

Specify ______________________________________________

CH3. (If yes to health status/conditions in CH2): What are you currently doing to treat this medical problem? [Source: New Development] (Open-ended, Interviewer check all that apply)

Taking her/him to the doctor for treatment 01

Treating him/her at home with medicine 02

Treating him/her at home with something other than

medicine (such as herbal remedies, special teas, or other

forms of treatment) 03

Changing his/her diet 04

Other 05

Don’t Know 98

Refused 99

Child is a picky eater

18, 24

CH4. Do you consider [CHILD] a very picky eater, a somewhat picky eater, or not a picky eater? [FITS 2008]

A very picky eater 01

A somewhat picky eater 02

Or, not a picky eater? 03

Don’t Know 98

Refused 99

Child physical activity indoors

5, 13, 15, 24

At 13, 15, 24 only:

CH6. I am going to read you a list of activities you or someone in your home may have done with {CHILD} in the past week. How often did you or someone in your home do: [Source: MacDonald & Parke, 1986, modified]

a. Wrestling. This is when someone gently and playfully pushes the child around on the ground or a bed, and the child playfully pushes back. In the past week, how often did you or someone in your home wrestle with {CHILD}?

Every day 01

Several times a week 02

Once a week 03

Not at all 04

Don’t Know 98

Refused 99

b. Tumbling. This is when a child rolls around, does somersaults, or climbs over things. In the past week, how often did you or someone in your home play tumbling with {CHILD}?

Every day 01

Several times a week 02

Once a week 03

Not at all 04

Don’t Know 98

Refused 99

c. Playing chase. This is when someone playfully runs or crawls after a child. In the past week, how often did you or someone in your home play chase with {CHILD}?

Every day 01

Several times a week 02

Once a week 03

Not at all 04

Don’t Know 98

Refused 99

d. Playing ball. This includes placing a ball in front of a child so he has to go after it by crawling, walking, or grabbing. In the past week, how often have you or someone in your home played ball with {CHILD}?

Every day 01

Several times a week 02

Once a week 03

Not at all 04

Don’t Know 98

Refused 99

Child physical activity outdoors

18, 24

CH7. Think for a moment about a typical weekday, that is Monday through Friday, for your child. In the past month, how much time would you say your child spent playing outdoors on a typical weekday? This can include playing in your yard or neighborhood, or playing in a park or other outdoor recreation area, such as a zoo or amusement park. This does not include time spent in a stroller outside. [Source: Parental report of outdoor playtime Burdette, 2004, modified]

Time [hours/minutes]

CH8. Now, think about a typical weekend day, that is Saturday or Sunday, for your child. In the past month, how much time would you say your child spent playing outdoors on a typical weekend day? [Source: Parental report of outdoor playtime Burdette, 2004, modified]

Time [hours/minutes]

Child sleep duration/patterns

5, 11, 24

CH9. On a typical day, how much time does your child spend sleeping during the NIGHT, between 7 in the evening and 7 in the morning? [Source: Brief Infant Sleep Questionnaire (BISQ), Sadeh, 2004, modified]

Amount of time [hours, minutes]

CH10. On a typical day, how much time does your child spend sleeping during the DAY, between 7 in the morning and 7 in the evening? [Source: Brief Infant Sleep Questionnaire (BISQ), Sadeh, 2004, modified]

Amount of time [hours, minutes]

CH11. How many times does your child usually wake up during the night, between 7 in the evening and 7 in the morning? [Source: Brief Infant Sleep Questionnaire (BISQ), Sadeh, 2004, modified]

Number of wakings [number]

Child television/video exposure

15, 18, 24

CH17 . On an average day, how many hours does {CHILD} watch television? Only include time when [HE/SHE] is actually watching TV, and just give your best estimate. [Source: PHFE WIC survey 2011, modified]

Less than one hour 01

Number of hours(1 or more) [number 1-18]

Don't know 98

Refused 99

At 18 and 24 only:

CH18. On an average day, how many hours does {CHILD} play video or computer games, including games on handheld devices like a cell phone? Just give your best estimate. [Source: PHFE WIC survey 2011, modified]

Less than one hour 01

Number of hours (1 or more) [number 2-18]

Don't know 98

Refused 99

TV on during meals

15, 18, 24

CH19. When you and your child eat meals or snacks at home, how often is a television on while you are eating? [Source: CDC 2010 Youth Physical Activity and Nutrition Survey, modified]

Most of the time 01

Sometimes 02

Rarely 03

Never 04

Don’t know 98

Refused 99

Family eats together

15, 18, 24

CH20. During the past week, including weekdays and weekends, how many times did all or most of your family sit down and eat a meal together? [Source: NHANES Flexible Consumer Behavior Survey (CBQ) 2009-2010, modified]

7 or more times each week 01

5-6 times during the week 02

3-4 times/week 03

1-2 times/week 04

Never 05

Don’t know 98

Refused 99

24-MONTH BONUS MODULE

6-Item Food Security

24 bonus module

These next questions are about the food eaten in your household in the last 12 months, since (current month) of last year and whether you were able to afford the food you need.

SD36. I’m going to read you several statements that people have made about their food situation. For these statements, please tell me whether the statement was often true, sometimes true, or never true for your household in the last 12 months—that is, since last (name of current month). [Source: USDA food security 6-item]

The first statement is, “The food that (I/we) bought just didn’t last, and (I/we) didn’t have money to get more.” Was that often, sometimes, or never true for your household in the last 12 months?

Often true 01

Sometimes true 02

Never true 03

Don’t know 98

Refused 99

SD37. “We couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true for your household in the last 12 months?

Often true 01

Sometimes true 02

Never true 03

Don’t know 98

Refused 99

SD38. In the last 12 months, since last (name of current month), did you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food?

Yes 01

No 02 (skip SD38a)

Don’t Know 98 (skip SD38a)

a. [if yes to SD38, ask] How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months?

Almost every month 01

Some months but not every month 02

Only 1 or 2 months 03

Don’t know 98

SD39. In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money for food?

Yes 01

No 02

Don’t Know 98

SD40. In the last 12 months, were you ever hungry but didn't eat because there wasn't enough money for food?

Yes 01

No 02

Don’t Know 98

Receipt of Public Assistance

Baseline, 13, 24

SD21. Are you or your family currently receiving any of the following: [Source: WIC IFPS-1; modified; HIP, modified]

a. Supplemental nutrition assistance benefits, sometimes called SNAP or Food Stamps?

Yes 01

No 02

Don’t know 98

b. Temporary assistance to needy families, sometimes called TANF or welfare?

Yes 01

No 02

Don’t know 98

c. Medicaid or [state specific name for medicaid]?

Yes 01

No 02

Don’t know 98

d. Are any children in your household receiving free or reduced price meals from the National School Lunch or School Breakfast Program, or the Summer Foods Program?

Yes 01

No 02

Don’t know 98

Maternal Dietary Intake Questions

24 month bonus module

MH28. These questions are about the different kinds of foods you ate or drank during the past month, that is, the past 30 days. When answering, please include meals and snacks eaten at home, at work or school, in restaurants, and anyplace else. [Source: NHANES]

a. During the past month, how often did you drink regular soda or pop that contains sugar? Do not include diet soda. You can tell me per day, per week or per month.

Interviewer instruction:

Include: manzanita and peñafiel sodas.

Do not include: diet or sugar-free fruit drinks. do not include juices or tea in cans.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record Unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 2 times per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question a)

Don’t know 98

Refused 99

b. (During the past month), how often did you drink 100% pure fruit juice such as orange, mango, apple, grape and pineapple juices? Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to. (You can tell me per day, per week or per month.)

Interviewer instruction:

Include: only 100% pure juices.

Do not include: fruit-flavored drinks with added sugar, like cranberry cocktail, hi-c, lemonade, kool-aid, gatorade, tampico, and sunny delight.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question b)

Don’t know 98

Refused 99

c. (During the past month), how often did you drink coffee or tea that had sugar or honey added to it? Include coffee and tea you sweetened yourself and presweetened tea and coffee drinks such as Arizona Iced Tea and Frappuccino. Do not include artificially sweetened coffee or diet tea. (You can tell me per day, per week or per month.)

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 1 time per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question c)

Don’t know 98

Refused 99

d. (During the past month), how often did you drink sweetened fruit drinks, sports or energy drinks, such as Kool-aid, lemonade, Hi-C, cranberry drink, Gatorade, Red Bull or Vitamin Water? Include fruit juices you made at home and added sugar to. Do not include diet drinks or artificially sweetened drinks. (You can tell me per day, per week or per month.)

Interviewer instruction:

Include: drinks with added sugar, tampico, sunny delight, and twister.

Do not include: 100% fruit juices or soda, yogurt drinks, carbonated water or fruit-flavored teas.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question d)

Don’t know 98

Refused 99

e. (During the past month), how often did you eat fruit? Include fresh, frozen or canned fruit. Do not include juices. (You can tell me per day, per week or per month.)

Interviewer instructions:

Do not include: dried fruits.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 1 time per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question e)

Don’t know 98

Refused 99

f. (During the past month), how often did you eat a green leafy or lettuce salad, with or without other vegetables? (You can tell me per day, per week or per month.)

Interviewer instructions:

Include: spinach salads.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 1 time per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question f)

Don’t know 98

Refused 99

g. (During the past month), how often did you eat any kind of potatoes other than fried potatoes, such as baked, boiled, mashed potatoes, sweet potatoes, or potato salad? (You can tell me per day, per week or per month.)

Interviewer instructions:

Include: all types of potatoes except fried. Include potatoes au gratin, scalloped potatoes.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 1 time per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question g)

Don’t know 98

Refused 99

h. (During the past month), how often did you eat refried beans, baked beans, beans in soup, pork and beans or any other type of cooked dried beans? Do not include green beans. (You can tell me per day, per week or per month.)

Interviewer instructions:

Include: soybeans, kidney, pinto, garbanzo, lentils, black, black-eyed peas, cow peas, and lima beans.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 1 time per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question h)

Don’t know 98

Refused 99

i. (During the past month), not including what you just told me about (lettuce salads, potatoes, cooked dried beans), how often did you eat other vegetables? (You can tell me per day, per week or per month.)

Interviewer instructions:

Include any form of the vegetable (raw, cooked, canned, or frozen). Examples of other vegetables include: tomatoes, green beans, carrots, corn, cabbage, bean sprouts, collard greens, and broccoli.

Do not include: rice

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 2 times per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question i)

Don’t know 98

Refused 99

j. (During the past month), how often did you have Mexican-type salsa made with tomato? (You can tell me per day, per week or per month.)

Interviewer instructions:

Include: all tomato-based salsas.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 1 time per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question j)

Don’t know 98

Refused 99

k. During the past month, how often did you eat pizza? Include frozen pizza, fast food pizza, and homemade pizza. You can tell me per day, per week or per month.

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 1 time per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question k)

Don’t know 98

Refused 99

l. (During the past month), how often did you have tomato sauces such as with spaghetti or noodles or mixed into foods such as lasagna? {If indicated eats pizza in l, add: Please do not count tomato sauce on pizza.} (You can tell me per day, per week or per month.)

Record quantity:

Quantity [number]

Never 00

Don’t know 98

Refused 99

Record unit (per):

Day 01

Week 02

Month 03

Don’t know 98

Refused 99

Interviewer Instruction:

If more than 1 time per day

OR more than 14 times per week

OR more than 60 times per month

Ask:

You said {quantity} per {unit}. Is that correct?

Yes 01

No 02 (if no, re-ask question l)

Don’t know 98

Refused 99

PARTICIPANT CONTACT INFORMATION UPDATE

Thank you for taking the time to speak with me today. Because we’ll be calling you again for your next interview when your child is {AGE – next interview}), I’d like to be sure we have all the right ways to contact you.

CM1. Is your full name still {NAME}?

Yes 01

No 02

(If no, go to a)

a. Can you please tell me what your full legal name is now?

_____________________________________________

Ask only if still on WIC:

CM3. I reached you today at {FILL #}. Will that still be the best number to call you at for your next interview?

Yes (if yes, go to b) 01

No (if no, go to a) 02

a. What is the best number to call you at for your next interview?

Number (specify ---/---/----)

NO PHONE (go to CM4) 97

Is that number home, work, cell, or something else?

Home 01

Work 02

Cell 03

Other (specify__________________) 04

b. Is there another number we could try in case we have trouble reaching you?

Number (specify ---/---/----)

Is that number home, work, cell, or something else?

Home 01

Work 02

Cell 03

Other (specify__________________) 04

We’d like to keep in touch with you even if we can’t get you by phone or your phone number changes, so I’m going to ask you about a few additional ways we might be able to contact you.

CM5. If mailing address on file: We have your current mailing address as {FILL}. Is that correct? If no mailing address on file: Can I get a mailing address we could use to contact you if necessary?

Address is the same (fill below) 01

New address (specify below) 02

Don’t know/don’t have address 98

Refused address 99

a. Can you please tell me what your current mailing address is?

Street/Apt#________________________________________

City______________________________________________

State_____________________________________________

ZIP______________________________________________

b. (If CM3a is 97 – no phone): Earlier you indicated that you do not have a phone. Since we need to speak with you by phone we will mail you a study phone. You will receive the phone before your next interview. The package will contain instructions on how to use the phone. Should we mail the phone to the mailing address you just provided?

Address is the same (fill below) 01

New address (specify below) 02

Don’t know/don’t have address 98

Refused address 99

Can you please provide the address where the phone should be mailed?

Street/Apt#________________________________________

City______________________________________________

State_____________________________________________

ZIP______________________________________________

CM4. If have email on file: We have your email address as {FILL}, is that correct?/If no email: Do you have an email address we could use to contact you if necessary?

Email is the same (fill below) 01

New Email (specify below) 02

Don’t know Email 98

Refused Email 99

Email___________________________________

CM6. Do you have a Facebook account we could use to contact you?

YES 01

NO 02

(IF YES): [What is your Facebook name?]

[SPECIFY:___________________________________________]

CM7. (If contacts on file: Earlier you provided the names and contact information for two people who would always know how to find you. Can I read that information back to you and check that it’s still up to date?/If no contacts on file: Just in case we can’t get in touch with you using the information you just gave me, I’d like to ask you for the names and contact information for two people who would always know how to find you.

Person #1 (If contacts on file, read fill info and correct as needed)

Name

Who is this person to you?

Phone

Address

Email

Person #2 (If contacts on file, read fill info and correct as needed)

Name

Who is this person to you?

Phone

Address

Email

HEALTH CARE PROVIDER INFORMATION UPDATE

Ask at 7, 13, 24 months only if core sample. Ask once and then confirm at interview prior to when the next height/weight measure is needed:

CM9. As we mentioned when you first joined the study, we’d like to get information from {CHILD}’s doctor, and you gave us permission to do that. Can I please have the name of your child’s doctor, the doctor’s phone number if you have it, and the city and state where the doctor’s office is?

Doctor’s name

Location

Phone

Child hasn’t seen a doctor 97

Don’t know 98

Refused 99

If CM9 = 97, 98, 99 refer case for home health service.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB number.  The valid OMB control number for this information collection is 0584-0580.  The time required to complete this information collection is estimated to average 33 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.