Appendix 1b: PRAMS Phase 8 Supplemental Questions and the Rational for their Selection in Red Text
Family History of Cancer
The following questions are about your family history of breast and ovarian cancer.
1. Have any of your close family members who are related to you by blood (parents, full sisters or brothers) had breast OR ovarian cancer?
No
Yes
Rationale: The most prevalent malignant tumor among women is breast cancer (BC), one in four cancers diagnosed in women worldwide. Ovarian cancer is the fifth most deadly cancer in women. Having a positive family history for either one or both is recognized as an indicator for the identification of high-risk, genetically predisposed individuals. For this reason, the PRAMS question, to be asked of women only, focuses on these 2 cancers common and severe among women for which having a positive family history for either one or both is associated with an increased risk for developing the disease.
Other surveys ask about a variety of cancers and structure the questions differently to ask separately about a variety of different types of cancer for each first degree family member. PRAMS is a printed mailed survey that is self-administered by respondents and has strict space limitations. The lengthy enumerate is not practical for this type of survey methodology. Given that the interest is in 2 of the most common and deadly forms of cancer for women, to be asked only of women, this question combines breast and ovarian cancer into a single question, and assesses risk among any first degree relatives in a more efficient manner which aligns with the research interest in assessing genetically predisposed individuals.
2. Has any woman in your family who is related to you by blood (grandmother, aunts, cousins, mother, sisters) had breast cancer before age 50?
No
Yes
Rationale: This question is similar to the National Health Interview Survey (NHIS), but combines first and second degree relatives into a single question. Below is example of second degree relative question from NHIS. An example of the first degree relative question is found in Q1 above. PRAMS has space limitations, and has created this modified version of the question that combines first and second degree relatives into a single question. Combining these relatives into a single question item could result in poorer reporting, however cognitive testing to investigate this potential issue.
3. Has any woman in your family who is related to you by blood (grandmother, aunts, cousins, mother, sisters) had breast AND ovarian cancer?
No
Yes
Rationale: Please see comments above. Other surveys do not combine cancers into a single question or combine first and second degree relatives. Combining these relatives into a single question item could result in poorer reporting, however cognitive testing to investigate this potential issue.
4. Has any man in your family who is related to you by blood (grandfather, uncles, cousins, father or brothers) had breast cancer?
No
Yes
Rationale: Please see comments above. Other surveys do not combine cancers into a single question or combine first and second degree relatives. Combining these relatives into a single question item could result in poorer reporting, however cognitive testing to investigate this potential issue.
5. Have any of your family members related to you by blood (grandparents, aunts, uncles, cousins, parents, sisters, or brothers) had bilateral breast cancer (breast cancer on both sides)?
No
Yes
I don’t know
Rationale: Question not identified on other surveys.
6. Do you have 2 or more relatives with breast and/or ovarian cancer?
No
Yes
Rationale: Please see comments above.
If you answered “Yes” to any of the questions above, go to Question 7. Otherwise, go to Question 10.
7. Have you ever received genetic counseling for cancer risk?
No Go to Question 10
Yes
Rationale: This question is identical to NHIS.
8. What was the MAIN reason you had genetic counseling? Check ONE answer
My doctor recommended it
I requested it
A family member suggested it
I heard or read about it in the news
Other Please tell us: _________________________
Rationale: This question is identical to NHIS.
9. Thinking about your MOST RECENT genetic counseling session for cancer risk, what kind of cancer was it for?
Breast cancer
Ovarian cancer
Other Please tell us: ________________________________________
Rationale: This question is similarly worded to NHIS, however this version combines multiple types of cancer into the response options, with a focus on breast and ovarian cancer. PRAMS has space limitations, and cannot fit questions on each type of cancer separately. Further, this type of list question is used commonly on PRAMS for other topics and works well. The question stem in this newly proposed question was modified given that a list is provided.
Example questions from NHIS:
The only difference is that NHIS asks it in 4 separate questions, by cancer type:
“Please think about your MOST RECENT genetic counseling session for cancer risk. Was it for breast cancer?”
“Please think about your MOST RECENT genetic counseling session for cancer risk. Was it for ovarian cancer?”
“Please think about your MOST RECENT genetic counseling session for cancer risk. Was it for colon or rectal cancer?”
“Please think about your MOST RECENT genetic counseling session for cancer risk. Was it for any other type of cancer?”
10. Do you have Ashkenazi Jewish heritage?
No
Yes
I don’t know
Rationale: Question not identified on other surveys.
Marijuana use questions
Rationale: Changed introductory text to be consistent with National Survey on Drug Use and Health (NSDUH).
The next questions are about marijuana and hashish. Marijuana is also called pot or grass. Marijuana is usually smoked, either in cigarettes, called joints, or in a pipe. It is sometimes cooked in food. Hashish is a form of marijuana that is also called “hash.” It is usually smoked in a pipe. Another form of hashish is hash oil.
1. Have you ever, even once, used marijuana or hashish?
No Go to Question 11
Yes
Rationale: This question is identical to NSDUH.
2. During the 3 months before you got pregnant, how often did you use marijuana products in an average week?
More than once a day
Once a day
2-6 days a week
1 day a week or less
I did not use marijuana products then
3. During the first 3 months of your pregnancy, how often did you use marijuana products in an average week?
More than once a day
Once a day
2-6 days a week
1 day a week or less
I did not use marijuana products then Go to Question 5
4. During the first 3 months of your pregnancy, how did you use marijuana? Check ALL that apply
Smoke it (for example, in a joint, bong, pipe, or blunt)
Eat it (for example, in brownies, cakes, cookies, or candy)
Drink it (for example, in tea, cola, or alcohol)
Vaporize it (for example, in an e-cigarette-like vaporizer device)
Dab it (for example, using waxes or concentrates)
Other Please tell us: _________________
5. During the middle 3 months of your pregnancy, how often did you use marijuana products in an average week?
More than once a day
Once a day
2-6 days a week
1 day a week or less
I did not use marijuana products then Go to Question 7
6. During the middle 3 months of your pregnancy, how did you use marijuana? Check ALL that apply
Smoke it (for example, in a joint, bong, pipe, or blunt)
Eat it (for example, in brownies, cakes, cookies, or candy)
Drink it (for example, in tea, cola, or alcohol)
Vaporize it (for example, in an e-cigarette-like vaporizer device)
Dab it (for example, using waxes or concentrates)
Other Please tell us: _________________
7. During the last 3 months of your pregnancy, how often did you use marijuana products in an average week?
More than once a day
Once a day
2-6 days a week
1 day a week or less
I did not use marijuana products then Go to Question 9
8. During the last 3 months of your pregnancy, how did you use marijuana? Check ALL that apply
Smoke it (for example, in a joint, bong, pipe, or blunt)
Eat it (for example, in brownies, cakes, cookies, or candy)
Drink it (for example, in tea, cola, or alcohol)
Vaporize it (for example, in an e-cigarette-like vaporizer device)
Dab it (for example, using waxes or concentrates)
Other Please tell us: _________________
If you did not use any marijuana products at any time during pregnancy, go to Question 10.
9. Why did you use marijuana products during pregnancy?
No Yes
To relieve nausea
To relieve vomiting
To relieve stress or anxiety
To relieve a chronic condition
To relieve pain
For fun or to relax
Other Please tell us: ________________________
10. Since your new baby was born, how often do you use marijuana products in an average week?
More than once a day
Once a day
2-6 days a week
1 day a week or less
I have not used marijuana products since my new baby was born
11. During any of your prenatal care visits, did a doctor, nurse, or other health care worker do any of the following things? For each item, check No if a health care worker did not do it, or Yes if they did.
No Yes
Ask you if you were using marijuana?
Prescribe marijuana for any reason?
Advise you not to use marijuana?
Advise you not to breastfeed your baby while using marijuana?
12. During any of the following periods, did anyone smoke marijuana products inside your home, including you? For each time period, check No if no one smoked marijuana inside your home then, or Yes if someone did.
|
No |
Yes |
a. In the 3 months before I got pregnant |
□ |
□ |
b. During my most recent pregnancy |
□ |
□ |
c. Since my new baby was born
|
□ |
□ |
|
|
|
13. During any of the following periods, did anyone keep edible marijuana products, such as brownies, cookies, or candy with THC, inside your home? For each time period, check No if no one kept marijuana inside your home then, or Yes if someone did.
|
No |
Yes |
a. In the 3 months before I got pregnant |
□ |
□ |
b. During my most recent pregnancy |
□ |
□ |
c. Since my new baby was born
|
□ |
□ |
|
|
|
14. How much do you think pregnant women harm their own health when they use marijuana? Check ONE answer
a. No harm
b. Slight harm
c. Moderate harm
d. Great harm
15. How much do you think pregnant women harm their unborn baby’s health when they use marijuana during pregnancy? Check ONE answer
a. No harm
b. Slight harm
c. Moderate harm
d. Great harm
Thank you for answering these questions! Your answers will help us understand more about marijuana products and the health of women and babies.
The last questions are about using different drugs during pregnancy. Your answers are strictly confidential.
During your most recent pregnancy, did you use prescription pain relievers such as Vicodin, Percocet or Oxycontin, Demerol, Hydrocodone? Please do not include “over-the-counter” pain relievers such as aspirin, Tylenol, Advil, or Aleve. Check ONE answer
No
Yes, I used them the way my doctor directed me to use thCem
Yes, I used them but not how my doctor directed (e.g., without a prescription of my own, in greater amounts or longer than I was told to take them
Rationale: Added language from NSDUH, combining substances into a single question to reduce burden and because PRAMS does not require specificity for each substance separately.
During your most recent pregnancy, did you use heroin, cocaine, amphetamines, methamphetamine or barbiturates, such as phenobarbital? Check ONE answer
No
Yes
Rationale: Each of these are asked as separate topics on NSDUH. Prevalence of use is low during pregnancy and PRAMS does not require information on each substance separately; therefore, PRAMS is including all of these substances in one question.
During your most recent pregnancy, did you use prescription antidepressants or selective serotonin reuptake inhibitors (SSRIs) such as Sarafem, Zoloft, or Lexapro? Check ONE answer
No
Yes, I used them the way my doctor directed me to use them
Yes, I used them but not how my doctor directed (e.g., without a prescription of my own, in greater amounts or longer than I was told to take them
Rationale: NSDUH does not ask about antidepressants. Added “prescription” to the question for consistency with response options and format used by NSDUH for prescription medications.
During your most recent pregnancy, did you use any prescription benzodiazepines such as diazepam or chlordiazepoxide? Check one answer
No
Yes, I used them the way my doctor directed me to use them
Yes, I used them but not how my doctor directed (e.g., without a prescription of my own, in greater amounts or longer than I was told to take them)
Rationale: Added this question since benzodiazepines have been linked to neonatal abstinence syndrome.
NSDUH asks about “prescription tranquilizers” and includes diazepam, but not chlordiazepoxide; suggest adding prescription to the question for consistency and to match the fact that the responses refer to how a doctor directed the respondent to use the medication.
If you answered “No” to ALL of the last 3 questions, go to the Next Section.
During any of your prenatal care visits, did a doctor, nurse, or other health care worker refer you to treatment because of drug use (prescribed or non-prescribed drugs)?
No
Yes
I didn’t go for prenatal care
Rationale: NSDUH does not ask about healthcare provider referral; question is worded similarly to PRAMS standard question on smoking cessation.
After your baby was born, did a doctor, nurse, or other healthcare worker tell you that your baby had drug withdrawal or neonatal abstinence syndrome?
No
Yes
Rationale: Neonatal abstinence syndrome question not identified on other surveys.
During any of the following time periods, did you use marijuana or hash in any form? For each time period, check No if you did not use then, or Yes if you did.
No Yes
a. During the 12 months before I got pregnant
b. During my most recent pregnancy
c. Since my new baby was born
During the month before you got pregnant, did you take or use any of the following drugs for any reason? Your answers are strictly confidential. For each item, check No if you did not use it in the month before your pregnancy, or Yes if did.
No Yes
Over the counter pain relievers such as aspirin, Tylenol®, Advil®, or Aleve®
Prescription pain relievers such as hydrocodone (Vicodin®), oxycodone (Percocet®), or codeine
Adderall®, Ritalin® or another stimulant
Marijuana or hash
Synthetic marijuana (K2, Spice)
Methadone, naloxone, subutex, or Suboxone®
Heroin (smack, junk, Black Tar, Chiva)
Amphetamines (uppers, speed, crystal meth, crank, ice, agua)
Cocaine (crack, rock, coke, blow, snow, nieve)
Tranquilizers (downers, ludes)
Hallucinogens (LSD/acid, PCP/angel dust, Ecstasy, Molly, mushrooms, bath salts)
Sniffing gasoline, glue, aerosol spray cans, or paint to get high (huffing)
During the your most recent pregnancy, did you take or use any of the following drugs for any reason? Your answers are strictly confidential. For each item, check No if you did not use it during your pregnancy, or Yes if did.
No Yes
Over the counter pain relievers such as aspirin, Tylenol®, Advil®, or Aleve®
Prescription pain relievers such as hydrocodone (Vicodin®), oxycodone (Percocet®), or codeine
Adderall®, Ritalin® or another stimulant
Marijuana or hash
Synthetic marijuana (K2, Spice)
Methadone, naloxone, subutex, or Suboxone®
Heroin (smack, junk, Black Tar, Chiva)
Amphetamines (uppers, speed, crystal meth, crank, ice, agua)
Cocaine (crack, rock, coke, blow, snow, nieve)
Tranquilizers (downers, ludes)
Hallucinogens (LSD/acid, PCP/angel dust, Ecstasy, Molly, mushrooms, bath salts)
Sniffing gasoline, glue, aerosol spray cans, or paint to get high (huffing)
Environmental Exposure Questions
During your most recent pregnancy, how often did you eat largemouth bass, tuna, shark, king mackerel or swordfish?
3 or more times a week
1 to 2 times a week
1 to 3 times a month
Less than once a month
I didn’t eat those fish during my pregnancy Go to question 3
Rationale: The questions on National Health and Nutrition Examination Survey (NHANES) do not have the level of specificity that we need to target mercury exposure caused by fish consumption. The question structure for NHANES is also not conducive to a self-administered questionnaire format like PRAMS.
Where did you get largemouth bass, tuna, shark, king mackerel or swordfish that you ate during your pregnancy? Check ALL that apply
From the grocery store
From a fish market or farmer’s market
From a restaurant
Caught by you or someone else from a local river, stream, lake, or pond
Caught by you or someone else from one of the Great Lakes
Other Please tell us:
Rationale: The questions on NHANES do not have the level of specificity that we need to target mercury exposure caused by fish consumption.
During your most recent pregnancy, did you use any of the following products one or more times per week? For each item, check No if you did not use it one or more times per week, or Yes if you did.
Cockroach or other bug sprays and baits
Insect repellents for personal use
Rat poison or other rodent poisons
Weed killers
Flea and tick sprays, powders, or pet collars
Rationale: This question not identified on other surveys.
During your most recent pregnancy, did you use or have contact with any of the following things on a daily basis (every day)? For each item, check No if you did not use it every day, or Yes if you did.
Strong degreasers such as oven cleaner or heavy duty degreaser
Furniture or shoe polish
Bleach products without good ventilation
Clothes that were freshly dry-cleaned
Air fresheners, plug-ins or incense
Strong smelling perfume or deodorant
Strong smelling nail polish
Rationale: This question not identified on other surveys.
During your most recent pregnancy, on average, how often did you eat food that was microwaved in a plastic container?
More than once a day
Once a day
2 to 6 times a week
Once a week
Less than once a week
Never
Rationale: This question not identified on other surveys.
Are the bottles that you use to feed your new baby BPA free?
No
Yes, sometimes
Yes, all the time
I don’t know
I don’t use plastic bottles when feeding my baby
Rationale: This question not identified on other surveys.
Was the house or apartment you live in now built before 1977?
No Go to Question 10
Yes
Rationale: We will use the current AHS question.
Has the house or apartment you live in now been tested for lead?
No
Yes
I don’t know
Rationale: We will use the current AHS question.
Do you have a working carbon monoxide detector inside your home?
No
Yes
Rationale: We will use the current AHS question. This question has been updated.
Has your home’s air been tested for the presence of radon, a gas that is found in the air in some homes?
No
Yes
I don’t know
Rationale: We will use the current AHS question. This question has been updated.
During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? Please count only discussions, not reading materials or videos. For each item, check No if no one talked with you about it, or Yes if someone did.
No Yes
How eating fish with high levels of mercury during pregnancy could affect my baby
How me being exposed to lead could affect my baby
Medicines that are safe to take during pregnancy
How using pesticides, which are chemicals to kill insects, rodents or weeds during pregnancy, could affect my baby
How using water bottles or other bottles made of polycarbonate plastic (BPA, recycle #7) during pregnancy could affect my baby
Rationale: This question not identified on other surveys.
During your most recent pregnancy, did you do any of the following things? For each thing, check No if you did not do it or Yes if you did.
No Yes
a. Eat fish with high levels of mercury
b. Come in contact with fumes from fresh paint
c. Come in contact with lead paint dust from house remodeling.
d. Eat food microwaved in plastic containers………………………..
e. Take medicines that are not recommended by my doctor
f. Drink out of plastic bottles like those made of polycarbonate
(BPA, recycle #7)
Rationale: This question not identified on other surveys.
Was your doctor, nurse, or other health care provider able to answer any questions about environmental exposures that you had during your pregnancy?
No
Yes
I didn’t have any concerns about environmental exposures
Rationale: This question not identified on other surveys.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Whitaker, Karen R. (CDC/OPHSS/NCHS) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |