6 and 12 month - environment - Chinese

Green Housing Study ID# ______________

6-month Follow-up (Environment)

House ID# _____________

Green Housing Study

綠色住房研究

6 and 12-month Follow-up Questionnaire

(Environment)

第六個和第十二個月跟蹤問卷

（住房環境）

Public reporting burden of this collection of information is estimated to average 10 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

這個數據收集所造成的回答負擔大約在１０分鐘左右，其中包括閲讀指示，搜索現有信息庫，集合和保持所需數據，以及完成並檢查收集的數據。任何單位不能進行或贊助，任何人也沒有必要回答沒有國家管理和經費預算辦公室（OMB）批復編號的數據收集問卷。發送有關回答負擔的評論或者建議到美國疾病控制與方中心(CDC/ATSDR)信息收集審查辦公室：1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXX).

Before administering this questionnaire, identify a memorable event that occurred during the previous visit, about 6 months ago, for the participant to use as a reference point for questions regarding the time frame between the current visit and the previous visit. This event should not be recorded for this study, only used for administering this questionnaire.

Interviewer Initials _______ Date: ___________

在進行這個問卷之前，選擇一個在大約六個月前發生的有意義的事件以便于參與人用來作爲參考時間點。 這個事件只用於進行問卷，不應該用於該研究被記錄。

Observation point (Circle One):

1. 6-months follow-up (post-remediation)

2. 12-month follow-up (post-remediation)

跟蹤時間點：

1. 六個月（翻新后）

2. 十二個月（翻新后）

Contact Information

Telephone numbers: Same New

Home ( ) ______________ ( ) ( )

Work ( ) ______________ ( ) ( )

Cellular ( ) ______________ ( ) ( )

Email address __________________ ( ) ( )

聯係方式

電話號碼： 與以前一樣 更新

家裏

工作

手機

電子郵件

Alternate Contacts

Telephone numbers: Same New Relationship to respondent

Home ( ) ______________ ( ) ( ) ____________________

Work ( ) ______________ ( ) ( ) ____________________

Cellular ( ) ______________ ( ) ( ) ____________________

Email address __________________ ( ) ( ) ____________________

其他聯係方式

電話號碼 與以前一樣 更新 跟參與人的關係

家裏

工作

手機

電子郵件

Environment 住房環境

1. Have you changed any carpeting (including rugs) in your home in the past 6 months?

Y N N/A

If YES, circle ALL that apply:

1. Added carpet/ rug

2. Removed carpet/ rug

(Note: replacing carpeting means that both options should be circled)

在過去的六個月中， 你有沒有更換過你家裏的地毯？ 有 沒有 不知道

如果有，選擇所有適用的：

1. １增加了地毯／毛毯

１．２減少了地毯／毛毯

2. Have you added/removed any piece of furniture in your home in the past 6 months?

Y N

If YES, circle ALL that apply:

2.1 Added fabric-covered furniture

2.2 Removed fabric-covered furniture

2.3 Added wood (e.g., solid wood, particle board) furniture

2.4 Removed wood (e.g., solid wood, particle board) furniture

(Note: replacing furniture means that both options for furniture should be circled)

２．在過去的六個月裏，你有沒有增加或減少家裏的家具？ 有 沒有

如果有， 選擇所有適用的

2.1 增加有布料包裹的家具

2.2 減少有不了包裹的家具

2.3 增加木質家具

2.4 減少木質家具

3. Have you added or removed any mattresses in your home in the past 6 months?

Y N

If YES, circle ALL that apply:

3.1 Added child’s mattress

3.2 Removed child’s mattress

3.3 Added mother/primary caregiver’s mattress

3.4 Removed mother/primary caregiver’s mattress

(Note: replacing mattress means that both options for a mattress should be circled)

3．子阿過去的六個月裏，你有增加或減少任何床墊嗎？ 有 沒有

如果有， 選擇所有適用的：

3.1 增加小孩的床墊

3.2 減少小孩的床墊

3.3 增加母親/主要照顧人的床墊

3.4 減少母親/主要照顧人的床墊

4. Have you painted any rooms in your home in the past 6 months? Y N

4.在過去的六個月裏你有粉刷/漆過任何一個房間嗎？ 有 沒有

5. Currently, do you have any pets in your home? Y N

(If NO, then skip to next question)

If YES specify the number of each type of pet(s)

5.1 Cat ______

5.2 Dog ______

5.3 Bird ______

5.4 Other

5. 現在你家裏有任何寵物嗎？ 有 沒有

如果沒有，跳到下一題

如果有， 請説明：

5.1 貓

5.2 狗

5.3 鳥

5.4 其它

6. During the past 6 months, how often have you seen cockroaches in your home?

1. Never

2. Monthly

3. Weekly

4. Daily

6．在過去的六個月裏，你在家裏看到蟑螂的頻率是什麽？

1. 從不

2. 每月

3. 每週

4．每天

7. During the past 6 months, how often have you seen mice in your home?

1. Never

2. Monthly

3. Weekly

4. Daily

7．在過去的六個月裏，你在家裏看到老鼠的頻率是什麽

1. 從不

2. 每月

3. 每週

4．每天

8. During the past 6 months, how often have you seen rats in your home?

1. Never

2. Monthly

3. Weekly

4. Daily

8．在過去的六個月裏，你在家裏看到大老鼠的頻率是什麽？

1. 從不

2. 每月

3. 每週

4．每天

9. During the past 6 months, have you or an exterminator used any pest control measures (pesticides, traps, etc.) to control cockroaches in your home?

Y N

If YES, circle ALL that apply

1. Sticky traps

2. Bait traps (e.g., Combat)

3. Boric acid

4. Gel

5. Spray

6. Exclusion (sealing of cracks, holes, etc.)

7. Chinese Chalk, Tres Pasitos, or Tempo

8. Other

9. 在過去的六個月裏，你或者滅蟲專家有用過任何滅蟲方法（如殺蟲劑，陷阱等）來控制你家裏的蟑螂情況嗎？ 有 沒有

如果有，選擇所有適用的：

9.1 粘蟲板

9.2 有誘餌的陷阱

9.3 硼酸

9.4 凝膠

9.5 噴霧

9.6 隔離（包括封閉裂口，洞口等）

9.7 神奇粉筆，三步死殺蟲劑等

9.8 其它

10. During the past 6 months, have you or an exterminator used any pest control measures (pesticides, traps, etc.) to control mice and/or rats in your home?

Y N

If YES, circle ALL that apply

1. Chemical poison (to be consumed)

2. Sticky traps

3. Snap traps

4. Physical exclusion (e.g., filling holes)

10． 在過去的六個月裏，你或者滅蟲專家有用過任何滅鼠方法（如殺蟲劑，陷阱等）來控制你家裏的老鼠情況嗎？ 有 沒有

如果有，選擇所有適用的：

10.1 （食用的）化學毒品

10.2 粘鼠板

10.3 ???

10.4 凝膠

10.5 隔離（包括封閉裂口，洞口等）

11. During the past 6 months, have you or an exterminator used any pest control measures to control other insects (e.g., ants, silverfish, spiders) in your home?

Y N

If YES, circle ALL that apply

1. Sticky traps

2. Bait traps (e.g., Combat)

3. Boric acid

4. Gel

5. Spray

6. Exclusion (sealing of cracks, holes, etc.)

7. Chinese Chalk, Tres Pasitos, or Tempo

8. Other

11. 在過去的六個月裏，你或者滅蟲專家有用過任何滅蟲方法（如殺蟲劑，陷阱等）來控制你家裏的害蟲情況嗎？ 有 沒有

如果有，選擇所有適用的：

11.1 粘蟲板

11.2 有誘餌的陷阱

11.3 硼酸

11.4 凝膠

11.5 噴霧

11.6 隔離（包括封閉裂口，洞口等）

11.7 神奇粉筆，三步死殺蟲劑等

11.8 其它

12. Was the kitchen floor mopped in the past 3 days? Y N

12．廚房地板在過去的三天中又被打掃過嗎? 有 沒有

13. During the past 6 months, which of these methods has been used to clean the floors of your home? (Circle ALL that apply)

1. Broom

2. Dust mop or dry mop

3. Damp mop (no water poured on floor)

4. Wet mop (involves pouring water on floor)

5. Vacuum

6. None

13．在過去的6個月中，你用了哪些方法清理你家裏的地面？　（選擇所有適用的）

13.1 掃帚

13.2 灰塵用的抹布或者干抹布

13.3 溼潤抹布

13.4 水淋地面后再用抹布

13.5 吸塵器

13.6 都沒用

14. During the last 6 months, has there been water damage to your home?

(Ceilings, floors or walls or dampness from leaks, broken pipes, heavy rain or floods etc)

(Circle answers)

14.1 Kitchen Yes No Don’t Know

14.2 Bathroom Yes No Don’t Know

14.3 Bedroom(s) Yes No Don’t Know

14.4 Living Room Yes No Don’t Know

14.5 Basement Yes No Don’t Know N/A

14.6 Attic Yes No Don’t Know N/A

14．在過去的6個月中， 你家裏有任何的漏水現象嗎？

（房頂，地面或者牆壁，或者由浸水，坏的管道，大雨或漲水等引起的潮濕）

14.1 廚房 有 沒有 不知道

14.2 廁所/洗漱閒 有 沒有 不知道

14.3 臥室 有 沒有 不知道

14.4 客廳 有 沒有 不知道

14.5 地下室 有 沒有 不知道 不適用

14.6 閣樓 有 沒有 不知道 不適用

15. During the past 6 months, have you seen mold in your home? Y N DK

If YES, then ask

1. Was the area larger than a sheet of paper? Y N DK

(show paper, size 8 ½ x 11 inches)

15．在過去的6個月裏， 你在家裏又看到黴嗎？ 有 沒有 不知道

如果有，繼續問：

15.1 黴的大小有這張紙大小嗎？

16. During the past 6 months, have you smelled any mold, mildew, or musty odor in your home? Y N DK

16．在過去的6個月裏，你在家裏聞到過黴，黴菌，或者發黴的味道嗎？ 有 沒有 不知道

17. Do you use a dehumidifier? Y N

17．你用乾燥器嗎？ 有 沒有

If YES, then ask

17.1 Have you used a dehumidifier in the past 6 months? Y N DK

如果有，繼續問

17.1 你在過去的6個月裏使用過乾燥器嗎？ 有 沒有 不知道

18. During the winter, do you add moisture to the air in your home? Y N

18．在冬天裏，你給家裏加溼嗎？ 有 沒有

19. During the winter, what is the primary way your home is heated? (Circle one answer)

1. Radiators

2. Baseboard heater

3. Electric space heater

4. Forced hot air (vents)

5. Open oven

6. Kerosene space heater

7. Fireplace/wood-burning stove

8. Other

19．在冬天裏，你家裏主要取暖的方式是什麽？ （選擇一個答案）

1. 暖氣

2．暖氣片

3. 電暖器

4. 熱風

5. 打開烤箱

6. 煤油暖爐

7. 壁爐/燒木爐

8. 其它

20. In addition to the main source of heat, do you use any other source? Y N

If YES, circle ALL that apply

1. Electric space heater

2. Kerosene space heater

3. Other type of space heater

4. Open oven

5. Fireplace/wood-burning stove

6. Other

20．在主要的取暖方式的基礎上，你還用其他取暖方式嗎？ 有 沒有

如果有，選擇所有適用的

20.1 電暖爐

20.2 煤油爐

20.3 其它種類的暖爐

20.4 打開烤箱

20.5 壁爐/燒木爐

20.6 其它

21. Is an air cleaner or purifier regularly used inside your home? Y N DK

If YES, what type is it? (Circle ALL that apply)

21.1 Ionizer (e.g., Ionic Breeze or similar device)

21.2 Ozone generator

21.3 Filter

21.4 Other

21．你家裏經常使用空氣過濾或者清潔器嗎？ 有 沒有 不知道

如果有，是什麽樣的？ （選擇所有適用的）

21.1 等離子器

21.2 臭氧製造器

21.3 過濾器

21.4 其它

Smoking

吸煙

22. Do visitors to your home ever smoke in your home? Y N

22. 訪客在你家裏抽煙嗎？ 有 沒有

23. Currently, do you or others in your household smoke cigarettes, cigarillos, cigars, pipes or other tobacco products?

Y N DK

現在你或者家裏其他人抽煙，雪茄，管狀煙或者其他煙草產品？ 有 沒有 不知道

If YES, then ask

23.1. Do those who smoke usually smoke indoors, outdoors, or both indoors and outdoors?

1. Indoors

2. Outdoors

3. Both

4. Don’t Know

如果有，繼續問：

23.1 抽煙的人一般在房間裏，房間外，或者裏外都抽？

1．房間裏

2． 房間外

3．裏外都抽

4．不知道

23.2 How often are cigarettes smoked inside the home?

a. Less than once a day

b. 1-3 Times a day

c. 4-10 Times a day

d. More than 10 Times a day

e. Don’t smoke inside the house

f. Don’t know

23．2 在屋裏抽煙的頻率是什麽?

a. 一天少於一次

b. 每天1-3次

c. 每天4-10次

d. 每天大於10次

e. 從不在屋裏抽煙

f. 不知道

23.3 How often are cigars, pipes or other types of tobacco products smoked inside the home?

a. Less than once a day

b. 1-3 Times a day

c. 4-10 Times a day

d. More than 10 Times a day

e. Don’t smoke inside the house

f. Don’t know

23.3 在屋裏抽其它煙草製品的頻率是什麽？

a. 一天少於一次

b. 每天1-3次

c. 每天4-10次

d. 每天大於10次

e. 從不在屋裏抽煙

f. 不知道

Occupational and Other Exposures 職業和其它暴露

24. Are you currently employed outside of the home? Y N

If YES, then are you exposed to these things in your job?

(Please circle all that apply)

24.1 Gasoline or had it on your skin?

24.2 Bug or insect spray or had it on your skin?

24.3 Paint thinner, brush cleaner, or furniture stripper

24.4 Varnish, lacquer, wood stain, or wet paint

24.5 Solid toilet bowl deodorants

24.6 Air freshener/ room deodorizer

24.7 Mothballs or had it on your skin?

24.8 Fingernail polish or remover

24.9 Laboratory mice or rats

24.10 Motor vehicle exhaust

24.11 Other chemicals

24.12 None of the above

24. 你現在在家裏以外工作嗎？ 是 否

如果是， 你在工作時接觸到以下的東西嗎？（選擇所有適用的）

24.1 汽油，沾到你的皮膚上嗎？

24.2 殺蟲劑，沾到你的皮膚上嗎？

24.3 油漆稀釋劑，刷子清潔劑，家具油漆

24.4 油光漆，噴漆，木漆，溼漆

24.5 固體狀的廁所除臭劑

24.6 空氣清新劑/房間除臭劑

24.7 保存劑，沾到你的皮膚上嗎？

24.8 指甲油或者洗甲水

24.9 實驗室的白鼠或者老鼠

24.10 汽車尾氣

24.11 其它化學物

24.12 沒有以上物品

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1/27/2021