12 2018 MCH Survey Core_MarshallIslands_Marshallese_Formatt

Section A.Screener

1. Ewōr ke jabrewōt 0-17 iiō ko rettan me eke an jokwe ak pād ilo mweo?

   1. ☐ Jab [elaññe jab, BWIJRAK IJIN. Enin ej jemlok in bwinbwin in]

   2. ☐ Aet

2. Jete ajri ro 0-17 iiō ko rettair ekka air jokwe ak pād ilo mweo?

Nomba in ajri ro rej jokwe ak pād ilo atreej in

3. Kajin ta eo elap kojerbale ilo mweo?

   1. ☐ Kajin belle

   2. ☐ Kajin Spain

   3. ☐ Bar juon kajin, jouij im kwalok

Uaake kajjitōk kein ñan kajojo iaan ajri rein 0-17 iiō ko rettan eo ekke an jokwe ak pād ilo atreej in.

Jino jān eo EDIK TATA, eo jenaaj nae etan, "AJRI 1" im wonmanlok wōt ippān eo erittolok mae iien ededelok am uaake kajjitōk ko ñan aolep ajri ro ekke air jokwe im pād ilo atreej.

4. AJRI 1

Etab ajri eo, inijel ko an in etan, riab in etan?

5. Ewōr ke nememein ajri in Rispan, Rilatino, ak lukkun Rispan?

   1. ☐ Aet, bar Rihispanic, Rilatino, ak lukkun Rispain

   2. ☐ Aet, Rimexican, Rimexican America, Richicano

   3. ☐ Aet, Ripuerto Rican

   4. ☐ Aet, Ricuban

   5. ☐ Aet, bar Rihispanic, Rilatino, ak lukkun Rispain, jouij im kwalok

6. Ta kadkad (race) eo an ajri eo? Kokkaleik eo ejimwe. Please select one or more from the following list.

1. ☐ Ribelle

2. ☐ Black or Ak Rikilmej in Amerka

3. ☐ American Indian or Alaska Native

4. ☐ Asian Indian

5. ☐ Richina

6. ☐ Rifilipin

7. ☐ Rijapan

8. ☐ KRikorea

9. ☐Rivietnam

10. ☐ Bar jet Riasia, jouij im kwalok

11. ☐ RiHawaii

12. ☐ Richamorro

13. ☐ American Samoan/Samoan

14. ☐ Ricreole

15. ☐ Rimicronesia

16. ☐ Ricarolinia

17. ☐ Ripalau

18. ☐ Ripohnpe

19. ☐ Rirussia

20. ☐ RiYap

21. ☐ RiChuuk

22. ☐ Rimarshall

23. ☐ Kosraen

24. ☐ RiPacific Island, jouij im kwalok

25. ☐ Ripuerto Rican

26. ☐ Ridomincan

27. ☐ Ricuban

7. Ta ajjri eo, sex?

   1. ☐ ladik (ladik)

   2. ☐ ledik (Leddik)

8. Ewi rettan ajri in? Elaññe ajri eo is diklok janjuon alloñ rettan, round age in alloñ ko to 1.

Iiō ko (ak) Alloñ ko

Elaññe ajri in is DIKLOK JAN4 IIŌ KO RETTAN, Etal ñan A10.

9. Ripuerto Rico: Ekijkan an eman an ajri eo konono Kajin Spain?

All Jikin jo jet: Ekijkan an eman an ajri eo konono Kajin belle?

1. ☐ elap an eman

2. ☐ Eman

3. ☐ Jab eman

4. ☐ Jab ñan jidikl

1. Aajri in ej ke ilo TERRE in Kojerbal uno litok jān taktō eo an, ijelokin vitamen ko?

   1. ☐ Aet

   2. ☐ Jab [Etal ñan A11]

[Elaññe aet] Ajri eo ej aikuij ke uno ko letok jān taktō ro konke jabrewōt IAN wawein ko rejelet taktō, mwil, ak bar jekjek ko rejelet ejmour?

1. ☐ Aet

1. ☐ Jab [Etal ñan A11]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

11. Ajri eo ej ke pād ilo aikuij ak kojebal elaplok katak ko kin kejparok ejmourim, ejmour an kemalij elaplok jan enañin aolep ajri ro rettan wōt

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A12]

[Elaññe aet] Ajri eo ej aikuij ke aktō, keejmour in komelij, ak jerbal in katakin ko konke JABREWŌT nañinmij, mwil ak bar wāwein ko jet rejelet iejmour?

1. ☐ Aet

3. ☐ Jab [Etal ñan A12]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

12. Ajri in rej ke bobrae lilo jabrewōt wawein jan maroñ kmmaneō men ko ajri ro jet rettan rej maroñ kmmaneō?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A13]

[Elaññe aet] ej ajri, ewōr ke an mojno ak maroñ ko kon wōt utam, mwilin, akbar bar jekjek o jet ikijien ejmour?

1. ☐ Aet

5. ☐ Jab [Etal ñan A13]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

13. Ajri eo ej ke aikuij jipañ ikijien kokkajurlok enbwinin, jerbal eo an, ak kilen kenono?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A14]

[Elaññe aet] ta kinke ewōr jabrewōt kain utame ñaninmj, mwil, akjekjek ko jet?

1. ☐ Aet

7. ☐ Jab [Etal ñan A14]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

14. Ewōr ke an ajri in jabrewōt kain utame ikijien an jaje control enjake (ilulu/ejanjan), eoklok, ak jorren mwilin joñan ejaikuij bōk jipañ ek kennaan kake ippān counselor ro?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A15]

[Elaññe aet] eloñ ke an eñjake jaje kantrol (ilulu/ejanñjañ), eddōklok, ak ilo mwil lasted or is it expected to last 12 alloñ ko ak aetoklok?

1. ☐ Aet

9. ☐ Jab

If respondent has another child, continue with A15. Else continue with Section B.

15. AJRI 2

Etab ajri eo, inijel ko an in etan, riab in etan?

16. Ewōr ke nememein ajri in Rispan, Rilatino, ak lukkun Rispan?

    1. ☐ Aet, bar Rihispanic, Rilatino, ak lukkun Rispain

    2. ☐ Aet, Rimexican, Rimexican America, Richicano

    3. ☐ Aet, Ripuerto Rican

    4. ☐ Aet, Ricuban

    5. ☐ Aet, bar Rihispanic, Rilatino, ak lukkun Rispain, jouij im kwalok

17. Ta kadkad (race) eo an ajri eo? Kokkaleik eo ejimwe. Please select one or more from the following list.

1. ☐ Ribelle

2. ☐ Black or Ak Rikilmej in Amerka

3. ☐ American Indian or Alaska Native

4. ☐ Asian Indian

5. ☐ Richina

6. ☐ Rifilipin

7. ☐ Rijapan

8. ☐ KRikorea

9. ☐Rivietnam

10. ☐ Bar jet Riasia, jouij im kwalok

11. ☐ RiHawaii

12. ☐ Richamorro

13. ☐ American Samoan/Samoan

14. ☐ Ricreole

15. ☐ Rimicronesia

16. ☐ Ricarolinia

17. ☐ Ripalau

18. ☐ Ripohnpe

19. ☐ Rirussia

20. ☐ RiYap

21. ☐ RiChuuk

22. ☐ Rimarshall

23. ☐ Kosraen

24. ☐ RiPacific Island, jouij im kwalok

25. ☐ Ripuerto Rican

26. ☐ Ridomincan

27. ☐ Ricuban

18. Ta ajjri eo, sex?

    1. ☐ ladik (ladik)

    2. ☐ ledik (Leddik)

19. Ewi rettan ajri in? Elaññe ajri eo is diklok janjuon alloñ rettan, round age in alloñ ko to 1.

Iiō ko (ak) Alloñ ko

Elaññe ajri in is DIKLOK JAN4 IIŌ KO RETTAN, Etal ñan A21.

20. Ripuerto Rico: Ekijkan an eman an ajri eo konono Kajin Spain?

All Jikin jo jet: Ekijkan an eman an ajri eo konono Kajin belle?

1. ☐ elap an eman

2. ☐ Eman

3. ☐ Jab eman

4. ☐ Jab ñan jidikl

1. Aajri in ej ke ilo TERRE in Kojerbal uno litok jān taktō eo an, ijelokin vitamen ko?

   1. ☐ Aet

   2. ☐ Jab [Etal ñan A22]

[Elaññe aet] Ajri eo ej aikuij ke uno ko letok jān taktō ro konke jabrewōt IAN wawein ko rejelet taktō, mwil, ak bar jekjek ko rejelet ejmour?

1. ☐ Aet

10. ☐ Jab [Etal ñan A22]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

22. Ajri eo ej ke pād ilo aikuij ak kojebal elaplok katak ko kin kejparok ejmourim, ejmour an kemalij elaplok jan enañin aolep ajri ro rettan wōt

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A23]

[Elaññe aet] Ajri eo ej aikuij ke aktō, keejmour in komelij, ak jerbal in katakin ko konke JABREWŌT nañinmij, mwil ak bar wāwein ko jet rejelet iejmour?

1. ☐ Aet

12. ☐ Jab [Etal ñan A23]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

13. ☐ Jab

23. Ajri in rej ke bobrae lilo jabrewōt wawein jan maroñ kmmaneō men ko ajri ro jet rettan rej maroñ kmmaneō?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A24]

[Elaññe aet] ej ajri, ewōr ke an mojno ak maroñ ko kon wōt utam, mwilin, akbar bar jekjek o jet ikijien ejmour?

1. ☐ Aet

14. ☐ Jab [Etal ñan A24]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

24. Ajri eo ej ke aikuij jipañ ikijien kokkajurlok enbwinin, jerbal eo an, ak kilen kenono?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A25]

[Elaññe aet] ta kinke ewōr jabrewōt kain utame ñaninmj, mwil, akjekjek ko jet?

1. ☐ Aet

16. ☐ Jab [Etal ñan A25]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

25. Ewōr ke an ajri in jabrewōt kain utame ikijien an jaje control enjake (ilulu/ejanjan), eoklok, ak jorren mwilin joñan ejaikuij bōk jipañ ek kennaan kake ippān counselor ro?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A26]

[Elaññe aet] eloñ ke an eñjake jaje kantrol (ilulu/ejanñjañ), eddōklok, ak ilo mwil lasted or is it expected to last 12 alloñ ko ak aetoklok?

1. ☐ Aet

18. ☐ Jab

[If respondent has another child, continue with A26. Else continue with Section B.]

26. AJRI 3

Etab ajri eo, inijel ko an in etan, riab in etan?

27. Ewōr ke nememein ajri in Rispan, Rilatino, ak lukkun Rispan?

19. ☐ Aet, bar Rihispanic, Rilatino, ak lukkun Rispain

1. ☐ Aet, Rimexican, Rimexican America, Richicano

2. ☐ Aet, Ripuerto Rican

3. ☐ Aet, Ricuban

4. ☐ Aet, bar Rihispanic, Rilatino, ak lukkun Rispain, jouij im kwalok

28. Ta kadkad (race) eo an ajri eo? Kokkaleik eo ejimwe. Please select one or more from the following list.

1. ☐ Ribelle

2. ☐ Black or Ak Rikilmej in Amerka

3. ☐ American Indian or Alaska Native

4. ☐ Asian Indian

5. ☐ Richina

6. ☐ Rifilipin

7. ☐ Rijapan

8. ☐ KRikorea

9. ☐Rivietnam

10. ☐ Bar jet Riasia, jouij im kwalok

11. ☐ RiHawaii

12. ☐ Richamorro

13. ☐ American Samoan/Samoan

14. ☐ Ricreole

15. ☐ Rimicronesia

16. ☐ Ricarolinia

17. ☐ Ripalau

18. ☐ Ripohnpe

19. ☐ Rirussia

20. ☐ RiYap

21. ☐ RiChuuk

22. ☐ Rimarshall

23. ☐ Kosraen

24. ☐ RiPacific Island, jouij im kwalok

25. ☐ Ripuerto Rican

26. ☐ Ridomincan

27. ☐ Ricuban

29. Ta ajjri eo, sex?

    1. ☐ ladik (ladik)

    2. ☐ ledik (Leddik)

30. Ewi rettan ajri in? Elaññe ajri eo is diklok janjuon alloñ rettan, round age in alloñ ko to 1.

Iiō ko (ak) Alloñ ko

Elaññe ajri in is DIKLOK JAN4 IIŌ KO RETTAN, Etal ñan A32.

31. Ripuerto Rico: Ekijkan an eman an ajri eo konono Kajin Spain?

All Jikin jo jet: Ekijkan an eman an ajri eo konono Kajin belle?

1. ☐ elap an eman

2. ☐ Eman

3. ☐ Jab eman

4. ☐ Jab ñan jidikl

1. Aajri in ej ke ilo TERRE in Kojerbal uno litok jān taktō eo an, ijelokin vitamen ko?

   1. ☐ Aet

   2. ☐ Jab [Etal ñan A33]

[Elaññe aet] Ajri eo ej aikuij ke uno ko letok jān taktō ro konke jabrewōt IAN wawein ko rejelet taktō, mwil, ak bar jekjek ko rejelet ejmour?

1. ☐ Aet

20. ☐ Jab [Etal ñan A33]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

33. Ajri eo ej ke pād ilo aikuij ak kojebal elaplok katak ko kin kejparok ejmourim, ejmour an kemalij elaplok jan enañin aolep ajri ro rettan wōt

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A34]

[Elaññe aet] Ajri eo ej aikuij ke aktō, keejmour in komelij, ak jerbal in katakin ko konke JABREWŌT nañinmij, mwil ak bar wāwein ko jet rejelet iejmour?

1. ☐ Aet

22. ☐ Jab [Etal ñan A34]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

34. Ajri in rej ke bobrae lilo jabrewōt wawein jan maroñ kmmaneō men ko ajri ro jet rettan rej maroñ kmmaneō?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A35]

[Elaññe aet] ej ajri, ewōr ke an mojno ak maroñ ko kon wōt utam, mwilin, akbar bar jekjek o jet ikijien ejmour?

1. ☐ Aet

24. ☐ Jab [Etal ñan A35]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

35. Ajri eo ej ke aikuij jipañ ikijien kokkajurlok enbwinin, jerbal eo an, ak kilen kenono?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A36]

[Elaññe aet] ta kinke ewōr jabrewōt kain utame ñaninmj, mwil, akjekjek ko jet?

1. ☐ Aet

26. ☐ Jab [Etal ñan A36]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

36. Ewōr ke an ajri in jabrewōt kain utame ikijien an jaje control enjake (ilulu/ejanjan), eoklok, ak jorren mwilin joñan ejaikuij bōk jipañ ek kennaan kake ippān counselor ro?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A37]

[Elaññe aet] eloñ ke an eñjake jaje kantrol (ilulu/ejanñjañ), eddōklok, ak ilo mwil lasted or is it expected to last 12 alloñ ko ak aetoklok?

1. ☐ Aet

28. ☐ Jab

[If respondent has another child, continue with A37. Else continue with Section B.]

37. AJRI 4

Etab ajri eo, inijel ko an in etan, riab in etan?

38. Ewōr ke nememein ajri in Rispan, Rilatino, ak lukkun Rispan?

1. ☐ Aet, bar Rihispanic, Rilatino, ak lukkun Rispain

1. ☐ Aet, Rimexican, Rimexican America, Richicano

2. ☐ Aet, Ripuerto Rican

3. ☐ Aet, Ricuban

4. ☐ Aet, bar Rihispanic, Rilatino, ak lukkun Rispain, jouij im kwalok

39. Ta kadkad (race) eo an ajri eo? Kokkaleik eo ejimwe. Please select one or more from the following list.

1. ☐ Ribelle

2. ☐ Black or Ak Rikilmej in Amerka

3. ☐ American Indian or Alaska Native

4. ☐ Asian Indian

5. ☐ Richina

6. ☐ Rifilipin

7. ☐ Rijapan

8. ☐ KRikorea

9. ☐Rivietnam

10. ☐ Bar jet Riasia, jouij im kwalok

11. ☐ RiHawaii

12. ☐ Richamorro

13. ☐ American Samoan/Samoan

14. ☐ Ricreole

15. ☐ Rimicronesia

16. ☐ Ricarolinia

17. ☐ Ripalau

18. ☐ Ripohnpe

19. ☐ Rirussia

20. ☐ RiYap

21. ☐ RiChuuk

22. ☐ Rimarshall

23. ☐ Kosraen

24. ☐ RiPacific Island, jouij im kwalok

25. ☐ Ripuerto Rican

26. ☐ Ridomincan

27. ☐ Ricuban

40. Ta ajjri eo, sex?

    1. ☐ ladik (ladik)

    2. ☐ ledik (Leddik)

41. Ewi rettan ajri in? Elaññe ajri eo is diklok janjuon alloñ rettan, round age in alloñ ko to 1.

Iiō ko (ak) Alloñ ko

Elaññe ajri in is DIKLOK JAN4 IIŌ KO RETTAN, Etal ñan A43.

42. Ripuerto Rico: Ekijkan an eman an ajri eo konono Kajin Spain?

All Jikin jo jet: Ekijkan an eman an ajri eo konono Kajin belle?

1. ☐ elap an eman

2. ☐ Eman

3. ☐ Jab eman

4. ☐ Jab ñan jidikl

1. Aajri in ej ke ilo TERRE in Kojerbal uno litok jān taktō eo an, ijelokin vitamen ko?

   1. ☐ Aet

   2. ☐ Jab [Etal ñan A44]

[Elaññe aet] Ajri eo ej aikuij ke uno ko letok jān taktō ro konke jabrewōt IAN wawein ko rejelet taktō, mwil, ak bar jekjek ko rejelet ejmour?

1. ☐ Aet

29. ☐ Jab [Etal ñan A44]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

44. Ajri eo ej ke pād ilo aikuij ak kojebal elaplok katak ko kin kejparok ejmourim, ejmour an kemalij elaplok jan enañin aolep ajri ro rettan wōt

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A45]

[Elaññe aet] Ajri eo ej aikuij ke aktō, keejmour in komelij, ak jerbal in katakin ko konke JABREWŌT nañinmij, mwil ak bar wāwein ko jet rejelet iejmour?

1. ☐ Aet

31. ☐ Jab [Etal ñan A45]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

45. Ajri in rej ke bobrae lilo jabrewōt wawein jan maroñ kmmaneō men ko ajri ro jet rettan rej maroñ kmmaneō?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A46]

[Elaññe aet] ej ajri, ewōr ke an mojno ak maroñ ko kon wōt utam, mwilin, akbar bar jekjek o jet ikijien ejmour?

1. ☐ Aet

33. ☐ Jab [Etal ñan A46]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

46. Ajri eo ej ke aikuij jipañ ikijien kokkajurlok enbwinin, jerbal eo an, ak kilen kenono?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A47]

[Elaññe aet] ta kinke ewōr jabrewōt kain utame ñaninmj, mwil, akjekjek ko jet?

1. ☐ Aet

35. ☐ Jab [Etal ñan A47]

[Elaññe aet] Ej jekjek eo in me emōj an jemlok ak ewōr kotmene bwe enaaj jemlok 12 alloñ ko ak aetoklok?

1. ☐ Aet

1. ☐ Jab

47. Ewōr ke an ajri in jabrewōt kain utame ikijien an jaje control enjake (ilulu/ejanjan), eoklok, ak jorren mwilin joñan ejaikuij bōk jipañ ek kennaan kake ippān counselor ro?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan A48]

[Elaññe aet] eloñ ke an eñjake jaje kantrol (ilulu/ejanñjañ), eddōklok, ak ilo mwil lasted or is it expected to last 12 alloñ ko ak aetoklok?

1. ☐ Aet

37. ☐ Jab

If there are no other children, continue to Section B.

Elaññe elon lok jan emen nejum ajri ro 0-17 iiō ko rettaier eo ekke air mour ak jokwe ilo atreej in, kolajrak iiō kab kain rot (sex) kjojo iaer. Jab alij melele kake ajri ro ededelok aunwōt AJRI 1ñan ajrI 4.

48. AJRI 5

Etab ajri eo, inijel ko an in etan, riab in etan?

49. Ewi rettan ajri in?

Iiō ko (or) Alloñ ko

50. Ajri rot??

    1. ☐ Ladik

    2. ☐ Leddik

51. AJRI 6

Etab ajri eo, inijel ko an in etan, riab in etan?

52. Ewi rettan ajri in?

Iiō ko (or) Alloñ ko

53. Ajri rot??

    1. ☐ Ladik

    2. ☐ Leddik

54. AJRI 7

Etab ajri eo, inijel ko an in etan, riab in etan?

55. Ewi rettan ajri in?

Iiō ko (or) Alloñ ko

56. Ajri rot??

    1. ☐ Ladik

    2. ☐ Leddik

57. AJRI 8

Etab ajri eo, inijel ko an in etan, riab in etan?

58. Ewi rettan ajri in?

Iiō ko (or) Alloñ ko

59. Ajri rot??

    1. ☐ Ladik

    2. ☐ Leddik

60. AJRI 9

Etab ajri eo, inijel ko an in etan, riab in etan?

61. Ewi rettan ajri in?

Iiō ko (or) Alloñ ko

62. Ajri rot??

    1. ☐ Ladik

    2. ☐ Leddik

63. AJRI 10

Etab ajri eo, inijel ko an in etan, riab in etan?

64. Ewi rettan ajri in?

Iiō ko (or) Alloñ ko

65. Ajri rot??

    1. ☐ Ladik

    2. ☐ Leddik

Section B.Ejmour an Ajri

Ewōr kio kajjitōk ko ñan eliji im kajjitōk kaki [KWALOK AJRI]. Kajjitok kein renaj aiin elaplok melele kake kake jabrewōt laamlamin ejmour eo an ajri ekoba ejmour eo an, lolok ko an ñan taktō ro, wonaan an taktō, im health insurance eo an. Emōj ad kelet juon ajri wōt ilo juon em ilo ad kate kij ñan kadiklik iien aikuijiñan kadedelok kajjitōk kein jej bar aliji.

66. Ilo tudibakbak inekijkan am kemleleik jmour eo an ajri eo?

    1. ☐ Elap an lukkun eman

    2. ☐ Lukkunin eman

    3. ☐ Eman

    4. ☐ Epwe an eman

    5. ☐ Ejjab eman

    6. ☐ Ijab jela

    7. ☐ Ijab kōnaan uaak

67. Ewi wāwein am kamelele kake jekjek in ñiin ajri ajri in?

    1. ☐ Elap an lukkun eman

    2. ☐ Lukkunin eman

    3. ☐ Eman

    4. ☐ Epwe an eman

    5. ☐ Ejjab eman

    6. ☐ AJRI does not have teeth

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

68. ILOWAN WŌT ALLOÑ KO 12, Emōj ke an ajri in bōk ilo an IKUTKUT im AETOK an bōke im ebin ñane iaan wawein kein?

    	AET	JAB	Ijab jela	Ijab kōnaan uaak
    B3a. Emenono ak barabañin emenono ko jet ainwōt majje ak kadu tok menkwan an menono)	1 ☐	2 ☐	77 ☐	99 ☐
    B3b. Mōña ak oronlok kinke ewōr utame ippān	1 ☐	2 ☐	77 ☐	99 ☐
    B3c. Meik mōña ko, ekoba abanko ilo lojen/ mwejnal, bin kubwen, ak pidodo loje	1 ☐	2 ☐	77 ☐	99 ☐
    B3d. Metak in Anbwin ko rekutkut im aetok air pād, ekoba ko an metak bar ak metak in rileb ak jikin ko jet ilo anbwinin	1 ☐	2 ☐	77 ☐	99 ☐
    B3e. Kojerbal pa ko pein	1 ☐	2 ☐	77 ☐	99 ☐
    B3f. Komakitkit anbwinin	1 ☐	2 ☐	77 ☐	99 ☐
    B3g. Metak ni	1 ☐	2 ☐	77 ☐	99 ☐
    B3h. Bōtōkōk nad	1 ☐	2 ☐	77 ☐	99 ☐
    B3i. Nimak	1 ☐	2 ☐	77 ☐	99 ☐
    B3j. Jorran in lojilni	1 ☐	2 ☐	77 ☐	99 ☐

69. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ewōr ke ippān ajri eo jekjek kein?

	AET	JAB	Ijab jela	Ijab kōnaan uaak
B4a. Jaroñroñ ak jorren ilo an ronjake	1 ☐	2 ☐	77 ☐	99 ☐
B4b. Bilo ak jab lolokijen, mene ej ekkonak mejen bilo	1 ☐	2 ☐	77 ☐	99 ☐

70. Emōj ke an juon taktō ak ro rej taktō ro jet ñanin ke jiroñ eok bwe ajri in ewōr ippān wawein kein? Elaññe aet, ewōr ke ippān ILO TERRE in jekjek kein?

    	Enañin ke?	Ilo terre in?	Ijab jela	Ijab konaan uaak
    B5a. Kajjinok ak ikijelok	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5b. Nañinmi in tonal	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5c. Widbwebwe	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5d. Ikutkut an lap anmetak bar	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5e. Jorren kemlij, kinijnij bar	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5f. jab monono	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5g. Ñana an mour	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5h. Jidbwebwe (Autism, ASD, Autism Spectrum Disorder (ASD), Asperger’s Disorder, ak Pervasive Developmental Disorder (PDD)	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5i. Kijon im jaje tot wōt)Attention Deficit Disorder (ADD ) or Attention Deficit/Hyperactivity Disorder(ADHD)	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5j. Rumij an rittolok	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5k. Ñana mwil	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5l. Utame in komelij ak tano)	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5m. jaje kenono	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5n. Bwebwe	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐
    B5o. Annen etao	1 ☐ Yes 2 ☐ No	1 ☐ Yes 2 ☐ No	77 ☐	99 ☐

71. ILOWAN WŌT ALLOÑ KO 12, ewi ikutkut in an abañkein walok im jelet e ilo an maroñ kōmmani men ko ajri ro jet rettan wōt remaroñ kōmmani?

    1. ☐ Ajri in ejjelok an jekjek rot kein [Etal ñan B8]

    2. ☐ Ejjelok ñan jidik [Etal ñan B8]

    3. ☐ Jet iien

    4. ☐ Ekke

    5. ☐ Aolep iien

⁷⁷ ☐ Ijab jela

⁹⁹ ☐ Ijab kōnaan uaak

72. Ewi joñan an jekjek ak abañkein io ejmour eo an ajri jepete ilo an maroñ kōmmani men ko?

    1. ☐ Elukkun dik

    2. ☐ Ejapwe

    3. ☐ Elapl

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

73. [ONLY ASK THIS QUESTION IF CHILD IS 6-17 YEARS OLD]

Emōj ke an juon taktō ak (provider ro) RENAÑIN KE KAR jiroñ eok that ajri eo ewōr an utame jan an jiñan lap an kojerbal den in kadōk? Utame rot in ewj walok ne ej ikutkut ak ejb bojrak jan an kojerbal den in kadōk ak uno ko rekajur when the frequent or im rej kōmman jorren ñan ejmour, im kōmman bwe en jab maroñ kmmaneō eddo ko an ilo jikin jerbal, jikuull,ak ilo mweo.

1. ☐ Aet

2. ☐ Jab [Etal ñan B9]

77. ☐ Ijab jela [Etal ñan B9]

99. ☐ Ijab konaan uaak [Etal ñan B9]

[Elaññe aet] Ajri eo ej ke pād ilo jekjek in?

1. ☐ Aet

38. ☐ Jab [Etal ñan B9]

77. ☐ Ijab jela [Etal ñan B9]

99. ☐ Ijab konaan uaak [Etal ñan B9]

[Elaññe aet] ej et:

1. ☐ Edik

1. ☐ Eman joñan

2. ☐ Elukkun ñana

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

74. [ONLY ASK THIS QUESTION IF CHILD IS 6-17 YEARS OLD]

Ewōr ke ippān ajri eo jekjek kein?

	AET	JAB	Ijab jela	Ijab kōnaan uaak
B9a. Elukun bib an kolmenlokijen, kakememej, ak kōmman bebe ko kon wōt jekjek kein io anbwinin,kolmenlokijen, ak jekjek koi lo an enjake	1 ☐	2 ☐	77 ☐	99 ☐
B9b. Elap an bin ñan etetal ak talon jikinwe ko	1 ☐	2 ☐	77 ☐	99 ☐
B9c. Ebin ñan an ekkonak nuknuk	1 ☐	2 ☐	77 ☐	99 ☐
B9d. Ebin ñan an jerbal dikdik, ainwōt lolok opij eo an taktō ak kaikujkuj, kon wōt jekjek kein ilo anbwinin, kolmenlokijen, ak enjake	1 ☐	2 ☐	77 ☐	99 ☐
B9e. Jaroñroñ ak jorren lojilnin	1 ☐	2 ☐	77 ☐	99 ☐
B9f. Bilo ak jablolokijen mene ej ekoñan mejen bilo	1 ☐	2 ☐	77 ☐	99 ☐

75. Emōj ke an juon taktō ak bar ro jet rej RENAÑIN KAR ke jiroñ eok ke ajri ewōr an …

	AET	JAB	Ijab jela	Ijab kōnaan uaak
B10a. Jorren in kijñeñe in menono	1 ☐	2 ☐	77 ☐	99 ☐
B10b. Nañinmi in fever	1 ☐	2 ☐	77 ☐	99 ☐
B10c. Jorren ilo kilin (ak emmed ilo kil)	1 ☐	2 ☐	77 ☐	99 ☐

[Elaññe aetewōr jorren in kijñeñe in menono kabr fever] rej ke bōk uno ko ñan jekjek kein?

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe aet] Rej bōk uno batin ak wa?

1. ☐ Uno batin [Etal ñan B11]

41. ☐ Wa [Etal ñan B11]

[Elaññe jab] Etkejab? Kokkaleik eo ejimwe.

1. ☐ Elap wonaan.

1. ☐ Ejjelok ial.

2. ☐ Ejjelok ej bōk ajri eo neju ñan hospital.

3. ☐ Ejjelok tokjen

4. ☐ Bar un ko jet: jouij im kwalok

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

76. Has a taktō ak bar rijerbal ro jet an ejmour care renanin ke jiron eok bwe ajri in ewor an nañinmij ilo botoktok ainewot leukemia, anemia or sickle cell disease? Jouij im jab koba botoktok eo eib jekjekin.

[Riit bwe elaññe emenin aikuij]: Ajri ro ewor ajr nañinmij in anemia, edik botoktok im renaj kanuij mokaj air emokmok.

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Kio Inaj kajjitōk ippam jet kajjitōk ko ikijienkejparok ajri eo nejum jān jorren.

77. Emoj ke am akritto rojet kennaan ippān ajri eo nan an jab kepaak jikinjorren ko ak bōbrae jān ajri eo nejum?

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

78. Emoj ke am kenaan ippān ajri eo nejum kake kon an kauwatata ikkure iloial eo, talōn wōjke ko im aōō ilojet?

    1. ☐ Aet

    2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

79. Kwoj keetal ippān ajri eo nejum ilo iien an ikkureaineot aoo ak ikkureko jet naboj?

    1. ☐ Aet

    2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

80. [ONLY ASK THIS QUESTION IF CHILD IS 6-17 YEARS OLD]

Ne ajri eo nejum ej iuwe ilo juon bajikol, ewi kutkut in an ekonaak elmet?

1. ☐ Ajri eo neju ejab bajikol

2. ☐ Jañin ej ekonak helmet

3. ☐ Ejejja ej ekonak helmet

4. ☐ Jet iien ej ekonak helmet

5. ☐ Enañin aolep iien ej ekonak helmet

6. ☐ Aolep iien ej ekonak helmet

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. [ONLY ASK THIS QUESTION IF CHILD IS 0-11 YEARS OLD]

Ewi ikutkut in an ajri eo nejum iuwe ilo jea eo an ajri ko?

1. ☐ Aolep iien

2. ☐ Nearly aolep iien

3. ☐ Jet iien

4. ☐ Ejeja

5. ☐ Ejañin r [If ajri 0-11 iiō ko old, etal ñan B18]

6. ☐ Ajri eo neju ejab iuwe ilo cars [If ajri 0-11 iiō ko rettan, etal ñan B18]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. [ONLY ASK THIS QUESTION IF CHILD IS 0-11 YEARS OLD]

Ia eo safety jea eo a ajri eo nejum ej pād ilo wan ettōr eo?

1. ☐ Imaan pajinjea eo

2. ☐ Tulikin pajinjea eo

3. ☐ Tulikin rikattor eo

4. ☐ Iolap in jea eo lokon

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ededelok ke an ajri eo nejum' bōk wa ko an ajri?

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Section C.Ajri in as an Infant

81. Ajri in ear lotak 3 wiik ko mokta lok jan raan eo en kar lotak?

    1. ☐ Aet

    2. ☐ Jab

    3. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

82. Jetkar pound in eddo in ke ear lotak? Uak ilo pound im ounce AK kilograms and grams. Letok joñan eo koj kememej.

paun IM aunji

kilogram IM grams

1. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

83. Jete am iiō ke ajri eo ear lotak?

Iiō ko

84. [ONLY ASK THIS QUESTION IF CHILD IS 0-1 YEAR OLD, ELSE GO TO I3]

Tu ia ilo anbwinin ekka am kakaki ninnin eo kio?

1. ☐ katin

2. ☐ likin (jedtak)

3. ☐ lojen (peddo)

4. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

85. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD. ELSE GO TO SECTION D]

Ajri in ENAÑIN ke kar ninnin milk jan ittin jinen?

1. ☐ Aet

2. ☐ Jab [Etal ñan C7]

77. ☐ Ijab jela [Etal ñan C7]

99. ☐ Ijab konaan uaak [Etal ñan C7]

[Elaññe aet] Jete rettan ajri in ke ear LUKKUN kabwijrak an ninnin akkabwijrak jān an nininin jān ittin jinan?

raan ko (ak)

wiik ko (ak)

alloñ ko (ak)

iiō ko

Ajri ej ninnin wōt

3. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

86. Ewi rettan kar ajri eo keear JINO an mōña ijelokin an ninnin jan an ittin ippān jinen ak bōk formula? Ekoba juice, milk in cow, den in juka, mōña kijen ninnin, ak jabrwōt men ko kwar leok ñan ajri eo, ekoba den borenwōt.

raan ko (ak) wiik ko (ak) alloñ ko

bōk Iien lotak

Kokaleik box in elaññe ajri eo ejañin kar mōña ijelokin wōt an niñniñ milk ippān jiñan ak bōk formula

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Section D.Jerbal in Kojbarok Ejmour Ko

87. ILOWAN 12 ALLOÑ KO REMOTLOK, Ajri eo ear ke loelok juon taktō, nurse, ak bar rijerbal ro jet rej lale ajri ro rej ninmij, jeeke ajri ro, kakkilene anbwininier, delon ilo jilo imon taktō ko kon jabrewōt nañinmij?

    1. ☐ Aet

    2. ☐ Jab [Etal ñan D2]

77. ☐ Ijab jela [Etal ñan D2]

99. ☐ Ijab konaan uaak [Etal ñan D2]

[Elaññe aet] ILOWAN 12 ALLOÑ KO REMOTLOK, jete allen an ajri lolok juon taktō, nurse, ak rijerbal ro jet ikijien BOBRAE JAN AN BŌK NAÑINMI ñan air jeeke ak kakkilene ilo an nañinmi ak jab, ainwōt juon lolok eo ej kmmaneō ñan ajri eo aolep iiō.

1. ☐ 0 lolok kdoo

1. ☐ 1 alenlolok

2. ☐ 2 ak elonlok lolok ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

88. Kwoj ke inebata kin anajri in eddo?

    1. ☐ Aet, elap an lap

    2. ☐ Aet, elap an dik

    3. ☐ Jab, Ij jab inebata kake

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

89. Jete joñan aetok in ajri in ilo TERRE in? Jouij imuaak joñan wōt am maroñ.

feet IM inches

meters IM centimeters

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

90. Jete eddo in ajri iloTERRE in? Jouij im kwalok joñan wōt am maroñ.

pounds IM ounces

kilograms IM grams

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

91. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

ILOWAN WŌT ALLOÑ KO 12, Taktō eo an and provider ro ilo jikin ejmour eo raar ke kajjitōk elaññe ewōr am inebata kake an ajri eo katak, eddōklok, ak mwilin?

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

92. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

[If this child is YOUNGER THAN 9 MONTHS, GO TO D7]

ILOWAN WŌT ALLOÑ KO 12Ewōr ke taktō ak rijerbal ro jet rar ke kanne pepa in kajjitok ko kake abañko ak jerbal in etale ko am kake anajri eo eddōklok, an kenono, ak mwilin ilo an iaieo ? Jet iien juon taktō eo an ajri ak provider ro jet jān jikin ejmour eo renaj kajjitōk ippān jiñan im jemān ñan kmmaneō ilo mweo ak io iien an ajri eo lolok.

1. ☐ Aet

2. ☐ No [Etal ñan D7]

77. ☐ Ijab jela [Etal ñan D7]

99. ☐ Ijab konaan uaak [Etal ñan D7]

[If this child is 9-23 Months]

Pepa in kajjitōk eo ej ke kajjitōk kake abañk oak jerbal in etale ko kake ask: Kokkaleikeo ejimwe.

1. ☐ Ekijkan an ajri in kenono ak kōmman ainikien ñe ej keroro?

48. ☐ Ekijkan an ajri in iiaeo ippam im ro jet?

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[If this child is 2-5 Years]

Pepa in kajjitōk eo (questionnaire) ej ke kajjitōk kake abañk oak jerbal in etale ko am kake: Kokkaleik eo ejimwe.

1. ☐ Naan ko ajri in ej kojerbaliim ej melele?

1. ☐ Ej et mwilin ajri eo ilo an emakitkit ippam im ro jet?

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

93. Ewōr ke juon jikin eo ajri in EKKE an etal ñane ñe ej nañinmij ak kwe im bar taktō ro jet rej aikuij lelok kakabiloklok kake ejmour eo an?

    1. ☐ Aet

    2. ☐ Jab [Got to D8]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe aet] ia eo ajri in EKKE an etal ñane?

1. ☐ Opij eo an taktō

2. ☐ Ruum ilo Aujpitol

3. ☐ Aujpital ijo jikiin ro rej jokwe likin

4. ☐ Clinic akjikin ejmour

5. ☐ Opij eo an jikuul in (Nōōj, Athletic Trainer's Office)

6. ☐ Jikin taktō eo an jikin jidikdik eo

7. ☐ Bar jet jikin, jouij im kwalok

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

94. Ewōr ke juon jikin eo ajri in EKKE an etal ñane kakkolkol nañinmi, ainwōt kakkilene anbwinin ak jeeke - check-up?

    1. ☐ Aet

    2. ☐ Jab [Elaññe ajriis 0-5 iiō ko rettan, etal ñan D9; else elaññe ajri 6-17 iiō ko rettan, etal ñan D10]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe aet] ejja jikin eo in ajri eoej etal ñe ej nañinmij ke?

1. ☐ Aet

1. ☐ Jab

95. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Emōj ke etale akjeeke mejen ajri in kin an lolokijen?

1. ☐ Aet

2. ☐ Jab [Etal ñan D10]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe aet] Jikin rot eoajri eo ej etal bwe ren etale im jeeke mejen? Kokkaleik uaak eo am ejimwe.

1. ☐ Opij ko an Taktō in mej ro

1. ☐ Opijn ko an taktō in ajri

2. ☐ Jikin aktō jidik ko oakjijikin kejmour ko

3. ☐ Jikuull

4. ☐ Bar jikin ko jet, jouij im kwalok

96. ILOWAN WŌT ALLOÑ KO 12, ajri in ear ke lolok juon taktō in ñi (dentist) akbar jikin ejmour ko kake jerbal in kejbarok ñiin?

    1. ☐ Aet, kar loe juon taktō in ñi (dentist)

    2. ☐ Aet, kar loe bar jet taktō iñejmour

    3. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

97. ILOWAN WŌT ALLOÑ KO 12, emōj ke an ajri in bōk jabrewōt madmōd ak bōk melele jān rijerbal ro ilo jikin ejmour ko kin kemalij? Rijerbal ro ainwōt, aktō in komelij ro, nōōj rijipan aktō in kemlij rein, rijerbal jojel ro, im kounjel ro an jikuul.

    1. ☐ Aet

    2. ☐ Jab, ijoke ajri in ejaikuij oejuon rijerbal jan jikin ejmour eo kin komeij eo

    3. ☐ Jab, ajri in ear jab aikuij in loe rijerbal in ejmour in komelij ro

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

98. ILOWAN WŌT ALLOÑ KO 12, ajri in uear ke kojerbale jabrewōt madmōd ko jet ñan an ejour? Madmōd ko jet ekoba aktō kon niitol, chiropractic care, relaxation therapies, herbal supplements,im ko jet. Jet madmōd kein ñan kamouur ekoba loelok juon taktō ak health care provider, ak ko jet kwo maroñ make kōmmani.

    1. ☐ Aet

    2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

99. ILOWAN WŌT ALLOÑ KO 12, ear ke wor juon iien ajri in ear aikuij taktō ijoke ear jab bōke bwe ejjelok? Melein ad ba hkejbarok ejmour, ej ainwōt ko an taktō in ñi, vtaktō in mej, im ko rejelet ejmour in komelijj.

    1. ☐ Aet

    2. ☐ Jab [Etal ñan D15]

77. ☐ Ijab jela [Etal ñan D15]

99. ☐ Ijab konaan uaak [Etal ñan D15]

[Elaññe aet] Kainjerbal in ejmour rot ko ear jab bōki bwe ear ejjelok? Kokkaleik eoejimwe.

1. ☐ Taktō in anbwin

1. ☐ Taktō in ñi

2. ☐ Taktō in mej

3. ☐ Taktō in lojilni

4. ☐ Taktō in ejmour ilo komelij

5. ☐ Bar ko jet, jouij im kwalok

1. Ta eo ian men kein rej bōbrae an ajri eo bōk jerbal ko elap aikuij ñan an ejmour:

   	AET	JAB	Ijab jela	Ijab kōnaan uaak
   D14a. Ajri in ear jab maroñ bōk madmōd ko?	1 ☐	2 ☐	77 ☐	99 ☐
   D14b. Kain madmōd ko ajri in ear aikuiji ear ejjelok ilo jikin eo ej pād ie?	1 ☐	2 ☐	77 ☐	99 ☐
   D14c. Ear wor abañko ñan etal ñan appointment ko an ñe ajri ejaikuijjuon?	1 ☐	2 ☐	77 ☐	99 ☐
   D14d. Ear worabañkoikijien ial ak ñan an taktō?	1 ☐	2 ☐	77 ☐	99 ☐
   D14e. Ear jab bellok opij eo an taktō (clinic/doctor’s) ke ajri in ñejaikuiji in taktō?	1 ☐	2 ☐	77 ☐	99 ☐
   D14f. Ewōr kar abañkoikijien wonaan?	1 ☐	2 ☐	77 ☐	99 ☐

2. ILOWAN WŌT ALLOÑ KO 12, jete alen an ajri in lolok juon ruum inidib ilo aujpitol?

   1. ☐ Ejjelok lolok ko

   2. ☐ 1 lolok

   3. ☐ 2 ak elon lolok ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Section E.Mōttan E. Experience with Ajri in’s Health Care Providers

102. Ewōr ke juon ak eloñlok armij ro kwoj lomnak rej an ajri eotaktō ak nōōj? Juon armij eo ejtaktō ak nōōj ej juon eo ej rijerbal in ejmour eo ejela kake ajri in eman im ej ewōr an jela kake bwebwenato in mour eo an ajri in. Emaroñ juon taktō, juon taktō in ajri, juon specialist taktō, juon nōōj, ak juon taktō in rijipan.

     1. ☐ Aet, juon armij

     2. ☐ Aet, elonlok jan juon armij

     3. ☐ Ejjelok

103. ILOWAN WŌT ALLOÑ KO 12, Ajri in ear ke aikuij in jilikinok bwe en bar lolok jet taktō ak bōk jabrewōt madmōd?

     1. ☐ Aet

     2. ☐ Jab [Etal ñan E3]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe aet] ewi joñanabañilo iien eo rar jilikinlok (referrals) ñan loe taktō rojet?

1. ☐ Ejab juon aban

1. ☐ Abañjidikdik

2. ☐ Abañkileplep

104. [Answer the following questions only if this child had a health care visit IN THE PAST 12 MONTHS. Otherwise, go to E4.]

ILOWAN WŌT ALLOÑ KO 12, ewiikutkut in anajri in’lolok taktō ak bar rijerbal ro jet an jikin ejmour:

	Aolep iien	Ekke	Jet iien	Jamin	Ijab jela	Ijab konaan uaak
E3a. Jolok ebwe iien ippān ajri eo?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐
E3b. Lukkun ronjake eok?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐
E3c. Kwalok an jela manit im tiriamo?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐
E3d. Lewaj melele ko kwar aikuiji kake ajri in?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐
E3e. Jipan kōmman bwe kwon enjake ainwōt juon ej kojbarok an ajri in ejmour?	1 ☐	2 ☐	3 ☐	4 ☐	77 ☐	99 ☐

105. Ewōr ke ejnjipan eo karōk ñan makitkit ko an ajri inñan taktō iubwilijin elon taktō reoktak kab madmōd ko ajri eo naj bōki?

     1. ☐ Aet

     2. ☐ Jab

     3. ☐ Ear jab loe elon ok jan juon health care provider ilo 12 ALLOÑ KO remotlok [Etal ñan E7]

106. ILOWAN WŌT ALLOÑ KO, emōj ke am kar enjake bwe kwo maroñ kar kojerbal elaplok jipañ kōmman karōk ak komakitkit an ajri in taktō ilubwilijin elon taktō ro reoktak im kilen madmōd ko air?

     1. ☐ Aet

     2. ☐ Jab [Etal ñan E6]

[Elaññe aet] ILOWAN WŌT ALLOÑ KO 12, Ewiikutkut in am bōk jipañ ñe kwoj konaan ikijien kōmman karōk im makitkit ko ñan kejbarok ejmour eo an ajri in?

1. ☐ Ekke

1. ☐ Jet iien

2. ☐ Jañin

107. Ilo lale lok, kwoj ke monon kake melele ko ilubwilijin taktō ro an ajri in kab bar health care provider ro?

     1. ☐ Lukkun monono

     2. ☐ Monono jidik

     3. ☐ Jab monono jidik

     4. ☐ Lukkun jab monono

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

2. [ONLY ASK THIS QUESTION IF CHILD IS 12-17 YEARS OLD]

Elon ke an ajri eo taktō in ak bar rijerbal eo in jikin ejmour rej taktō in ajriro wōt?

1. ☐ Aet

2. ☐ Jab [Etal ñan E8]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe aet] emōj ke air kenono ippam kake anon ajri ro eke air oe taktō ro ak bar rijerbal in ejmourro ro rej bar taktō ak ñan retto ro?

1. ☐ Aet

1. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

108. [ONLY ASK THIS QUESTION IF CHILD IS 12-17 YEARS OLD]

Emōj ke an taktō ak bar rijerbal ro jet an ejmour (care provider) ajri I n lap air bōk kunair rim jerbal ippān ajri in ñan:

	AET	JAB	Ijab jela	Ijab kōnaan uaak
E8a. Lomnak kake karōk ko an ñan tokaik. Ñan waanjonok, bōk an iien im kenono kake karōk ko tokaik kon jelalokijen, jerbal, kotaan ñan rojet, im eddklok iokabel in imour?	1 ☐	2 ☐	77 ☐	99 ☐
E8b. Kōmmankele5 ko ewōrtokjeir kake ejmoureo an. Ñan wanjonok, mōña in ejmour ko, kamourour aoep iien, jab kojerba tabacco, den inkaddok ak bar un ko rekajur jet, ak karumij an beru (sex activity)?	1 ☐	2 ☐	77 ☐	99 ☐
E8c. Bōk kabe ko ñan ejmour. Ñan wanjonok, io an melele kake aikuij ko an ejmour, jela ta eo en kmmaneō ilo iien ko reidin ikijien taktu, ak bōk uno ko emaroñ aikuiji?	1 ☐	2 ☐	77 ☐	99 ☐
E8d. Melee kake oktak ko ikijien ejmour ñe jej 18 iiō rettam. Ñan wanjonok, ilo am melele kake men ko am make, kwalok uaak eo am, tobar elon melele ko, ak maroñ kōmman am bebe?	1 ☐	2 ☐	77 ☐	99 ☐

109. [ONLY ASK THIS QUESTION IF CHILD IS 12-17 YEARS OLD]

Emōj kuaake aikuij kein e an taktō ro ak rijerbal ro jet an jikin ejmour eo an ajri in jerbal ippam im ajri in ñan ejaake juon plan ñan jibadbad kottobar ñan aikuij ko an?

1. ☐ Aet

2. ☐ Jab [Etal ñan E10]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe aet] plan 9in ej ke kwalok kadkad inkotobar ko ñan ajri in im jabrewōt aikuij akabañkoikijien ejmour me emaroñ wor anajri eo im ekijkan an maroñ bukot mejlan aikuij kein anajri in?

1. ☐ Aet

65. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Kwe im ajri eo komro kar ke bōke juon amiro kape eo emōj je kon karōk ak plan in taktō in?

1. ☐ Aet

66. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Plan in emōj an kokeel koppan ILO TERRE in ñan ajri eo ke?

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

110. Maroñ bwe en lon am health insurance ekka an kōmman oktak ko ippān ñe reitto. Kwoj jela ke ekijkan an ajri in naj insured ainwōt ne enaj erom juon ritto?

     1. ☐ Aet [Etal ñan F]

     2. ☐ Jab

[Elaññe jab] ewōr ke en emōj an kenono ippam kon wāwein bōk ak kejbarok jet kain insurance taktoainwōt an ajri in ñe enaj erom juon ritto?

1. ☐ Aet

1. ☐ Jab

Section F.Ajri in’s Health Insurance Coverage

111. ILOWAN WŌT ALLOÑ KO 12, ajri in ENAÑIN kekar lon an insurance in taktō?

     1. ☐ Aet, ajri in was covered all 12 alloñ ko or, if under 1 year rettan, since birth [Etal ñan F4]

     2. ☐ Aet, but ajri in had a gap in coverage

     3. ☐ Jab

112. Jouij im kwalok eanne kajojo ian wāwein keinej juon un eo ajri in ear ejjelok an insurance in taktō ILOWAN WŌT ALLOÑ KO 12:

     	AET	JAB
     F2a. Oktakin jikinjerbal ak rijerbal	1 ☐	2 ☐
     F2b. Kabwijrak bwe ejjān kolle wonen insurance	1 ☐	2 ☐
     F2c. Jako konke ejab maroñ wonaan	1 ☐	2 ☐
     F2d. Jako bwe edik tobrak ko jāni	1 ☐	2 ☐
     F2e. Jako konke kelet eo kin taktō ro ear jabwe	1 ☐	2 ☐
     F2f. Abañ ikijien pepa in taktō ak bar kokkeal	1 ☐	2 ☐
     F2g. Bar unko jet, jouij im kwalok	1 ☐	2 ☐

113. Ajri in ej ke ILO TERRE IN wor an jabrewōt insurance in taktō?

     1. ☐ Aet

     2. ☐ Jab [Etal ñan Mōttan G]

77. ☐ Ijab jela [Etal ñan Mōttan G]

99. ☐ Ijab konaan uaak [Etal ñan Mōttan G]

1. Ajri in ej ke libobo iumin jabrewōt iaan insurance in taktō?

   	AET	JAB
   F4a. Insurance cjan jikin jerbal eo an ak union	1 ☐	2 ☐
   F4b. Insurance kar wia jān juon insurance kompani	1 ☐	2 ☐
   F4c. Medicaid, Jipan nan taktō, ak jabrewōt ko an kien ñan jipañ roedik wonai utame ilo anbwinier	1 ☐	2 ☐
   F4d. TRICARE ak bar health care ko an ritarinae	1 ☐	2 ☐
   F4e. Indian Health Service	1 ☐	2 ☐
   F4f. Bar ko jet, jouij im kwalok	1 ☐	2 ☐

2. Ewi ikutkut in an insurance in taktō eo lelok an ajri in lelok jipañ ak jerbal ko ñan aikuijko an ajri in?

   1. ☐ Aolep iien

   2. ☐ Ekke

   3. ☐ Jet iien

   4. ☐ Jañin

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. Ewi ikutkut an health insurance eo an ajri inkotolok bwe en oe talto ro health care provider ñe ej aikuij ir?

   1. ☐ Aolep iien

   2. ☐ Ekke

   3. ☐ Jet iien

   4. ☐ Jañin

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Section G.Mōttan G. Lelok Nan Ejmour Eo An Ajri In

117. Koba co-pay koi m joñan ko jān Health Savings Accounts (HSA) im Flexible Spending Accounts (FSA), jete jaan eo kwoj kolla ñan ajri uno, taktō,taktō in ñi, im mej ILOWAN WŌT ALLOÑ KO 12? Kwoj ke kobaik wonāān eo ñan insurance in taktō me rar ak renaj kolle waj jān insurance ak jikin ko jet.

     1. ☐ $0 (Ejjelok muri jokok nan taktō) [Etal ñan G4]

     2. ☐ $1-$249

     3. ☐ $250-$499

     4. ☐ $500-$999

     5. ☐ $1,000-$5,000

     6. ☐ Eap jan $5,000

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. EWi ekka in an wonaan kein pād io joñan eo eman?

   1. ☐ Aolep iien

   2. ☐ Ekke

   3. ☐ Jet iien

   4. ☐ Jañin

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. ILOWAN WŌT ALLOÑ KO 12, ear ke wor an baaṃḷe eo am abañikijien kolleik bill in taktō ko an jabrewōt ian ajri ro?

   1. ☐ Aet

   2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. ILOWAN WŌT ALLOÑ KO 12, emōj ke am ak ro ilo baaṃḷe eo am:

   	AET	JAB	Ijab jela	Ijab kōnaan uaak
   G4a. Ar bwojrak an jerbal konke ejmour im jekjek ko jet rejelete ajri in?	1 ☐	2 ☐	77 ☐	99 ☐
   G4b. Jolok jet awa ko in amjerbal konke ejmour im jekjek ko jet rejelete ajri in?	1 ☐	2 ☐	77 ☐	99 ☐
   G4c. Jab janij jikin jerbal ko koke iñebata eo ñan kejbarok health insurance eo an ajri in?	1 ☐	2 ☐	77 ☐	99 ☐
   G4d. Kar bōk jipañ jan ro uan baaṃḷe eo?	1 ☐	2 ☐	77 ☐	99 ☐

2. ILO ENAÑIN JUON WIIK, jete awa kwe im ro ilo baamle rej kau ilo mweo ñan ajri in? Kau ekoba jenij korak, ak lelok uno im jerbal in kokajur ñe ej aikuij.

   1. ☐ Ajri in ej jab aikuij bōk health care bedbed ion juon wiik

   2. ☐ Jab kau ej kōmman jan na ak rouan baaṃḷe eo

   3. ☐ Diklok jan 1 awa ilo juon wiik

   4. ☐ 1-4 awa ko ilo juon wiik

   5. ☐ 5-10 awa ko ilo juon wiik

   6. ☐ 11 ak eonlok awa ko ilo juon wiik

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. ILO ENAÑIN JUON WIIK, jete awa kwe im ro ilo baamle ej karōk ikijien ejmour ak taktō ñan ajri in, ainwōt kōmman an iien taktō ko (appointments) ak kwalok jikin ko jerbal ko jet rej pād ie?

   1. ☐ Ajri in ej jab aikuij bōk health care bedbed ion juon wiik

   2. ☐ Jab kau ej kōmman jan na ak rouan baaṃḷe eo

   3. ☐ Diklok jan1 awa ilo juon wiik

   4. ☐ 1-4 awa ko ilo juon wiik

   5. ☐ 5-10 awa ko ilo juon wiik

   6. ☐ 11 ak eonlok awa ko ilo juon wiik

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Section H.Ajri Ej Katak

123. ENAÑIN JUON RAAN ILO JUON WIIK, enañin jete alen an ajri in jolok an iien an jijit iman TV eo im im alouj TV pirokiramko, videos, ak ikkure video game ko?

     1. ☐ Ejjelok

     2. ☐ Diklok jan 1 awa

     3. ☐ 1 awa

     4. ☐ 2 awa ko

     5. ☐ 3 awa ko

     6. ☐ 4 ak eonlok awa ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

124. ENAÑIN JUON RAAN ILO JUON WIIK, enañin jete alen an ajri injolok an iien ippān computer ko, cell phone ko, video game ko, im bar electronic ko, kōmmani men ko ijelokin ankōmman an katak?

     1. ☐ Ejjelok

     2. ☐ Diklok jan1 awa

     3. ☐ 1 awa

     4. ☐ 2 awa ko

     5. ☐ 3 awa ko

     6. ☐ 4 ak eonlok awa ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

125. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ewi emanin an ajri in katak kmmaneō men ko ñan e-make?

1. ☐ Elap an lukkun eman

2. ☐ Somewhat

3. ☐ Ejjab emanly

4. ☐ Jab ñan jidikl

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

126. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ewi joñan lōke eo am bwe ajri in tobrak im kadedelok elementere ak piraimeri jikuul?

1. ☐ Lukkiun lōke

2. ☐ Elap lōke

3. ☐ Ebwe ao lōke

4. ☐ Ij jab lōke ñan jidik

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

127. [ONLY ASK THIS QUESTION IF CHILD IS 6-17 YEARS OLD]

ILOWAN WŌT ALLOÑ KO 12, enañin wor jet raan koajri in ear jab jikuul kon an nañinmij ak jorren im kinejnej?

1. Ear jab jako jan raan in jikuul

2. ☐ 1-3 raan ko

3. ☐ 4-6 raan ko

4. ☐ 7-10 raan ko

5. ☐ 11 or more raan ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

128. [ONLY ASK THIS QUESTION IF CHILD IS 6-17 YEARS OLD]

ILOWAN WŌT ALLOÑ KO 12, ewōr jete iien jikuul eo an ajri in emōj an kepaake eok an bar juon ritto ilo mweo imom kin jabrewōt jorren ko ej kōmmani ilo jikuul?

1. ☐ EJJELOK iien

2. ☐ 1 iien

3. ☐ 2 ak elonlok iien ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

129. [ONLY ASK THIS QUESTION IF CHILD IS 6-17 YEARS OLD]

JĀN JINOIN AN KINTER KARTON, emōj ke an ajriin elji jabrewōt kilaaj ko?

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

130. [ONLY ASK THIS QUESTION IF CHILD IS 6-17 YEARS OLD]

ILOWAN WŌT WIIK EO EJ JEMLOK, ewōr jete raan ko ajri in ear kamourur, ikkure, ak bōk kuñan ilo makitkit ko añanbwinin me rar diktata 60 minutes in air jemlok?

1. ☐ 0 raan ko

2. ☐ 1-3 raan ko

3. ☐ 4-6 raan ko

4. ☐ Kajojo raan

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Section I.Kon Kwe im Ajri in

131. Jete alen an ajri in emakit ñan bar juon atreej keal akjikin jan ke ear lotak?

Nomba in alen

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

132. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

ILOWAN WŌT WIIK EO EJ JEMLOK, jete raan ko kwe ak ro ilo baaṃḷe eo kar riit ñan ajri in?

1. ☐ 0 raan ko

2. ☐ 1-3 raan ko

3. ☐ 4-6 raan ko

4. ☐ Kajojo raan

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

133. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

ILOWAN WŌT WIIK EO EJ JEMLOK, jete raan ko kwe im rouan baaṃḷe eokar bwebwenato ak al ñan ajri in?

1. ☐ 0 raan ko

2. ☐ 1-3 raan ko

3. ☐ 4-6 raan ko

4. ☐ Kajojo raan

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

134. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD]

Ajri in ej ke pād ilo kejparok iumin diktata 10 awa ko ilo juon wiik janjuon ijelokin jiñan im jeñan ak eo ej rilale ak bōk eddoin (guardian)? Emaroñ juon day care center, preschool, Head Start pirokram, baaṃḷe ilo mweo, ñanny, au pair, babysitter ak ro nukun.

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Section J.Kake Baamle Eo Am im Ro Ilo Mweo

135. Jete alen an ajri in emakit ñan bar juon atreej keal akjikin jān ke ear lotak?

     1. ☐ Aet

     2. ☐ Jab [Etal ñan J3]

77. ☐ Ijab jela [Etal ñan J3]

99. ☐ Ijab kōnaan uaak [Etal ñan J3]

136. Elon ke ej kobatbat ilowan mweo imom?

     1. ☐ Aet

     2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

137. Emōj ke an ajri eo nejum meme betel nut?

     1. ☐ Aet

     2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

138. Kwoj melele ke kon ta ko remaroñ walok jan ad meme betel nut?

     1. ☐ Aet

     2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Kajjitok kein jilu rej kinjaan.

139. JĀN KE AJRI IN EAR LOTAK, ekka ke an bin mour kin joñan wonāān ro ilo baame eo – ebin ñan kollaik mōña im on jokwe?

     1. ☐ Jañin

     2. ☐ Ejeja

     3. ☐ Ekka jet iien

     4. ☐ Lukkun ekka

1. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. Kajjitok in tok ej ne kwar maroñwiaik mōñan kom ar aikuij. Ewi wōt iaan naan (statements) ko eman an kwalok kake jekjek in mōña eo ilo mweo ILO 12 ALLOÑ KO REMOTLOK?

   1. ☐ Kimij maroñejab aolep iien wiaik mōña ko reman im elap air iiōne.

   2. ☐ Kikij maroñ wiaik ebwe ñan mōña ijoke aolep iien kain mōña ko kim aikuij in mōña.

   3. ☐ Jet iien kimij jab maroñ kapwe am mōña.

   4. ☐ Ekka amjab maroñ wia ebwe ñan am mōña.

   5. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. Ilo jabrewōt ILOWAN WŌT ALLOÑ KO 12, mene juon wōt alloñ, elon ke ilo baaṃḷe eo am ear bōk:

	AET	JAB	Ijab jela	Ijab kōnaan uaak
J7a. Jaan in jipañ jan pirokiram ko an kie ainwōt welfare?	1 ☐	2 ☐	77 ☐	99 ☐
J7b. Food Stamps ak benefits SNAP pirokiram eo?	1 ☐	2 ☐	77 ☐	99 ☐
J7c. Mōña in jipon ak raeeb ko ejjelok ak edik wonair at school?	1 ☐	2 ☐	77 ☐	99 ☐
J7d. Jipan ko jan pirokram ko an kora, ninnin im ajri roe tan in WIC?	1 ☐	2 ☐	77 ☐	99 ☐

Section K.Mōttan K. Kake Eok

Complete the questions for each of the two adults in the household who are this child’s primary caregivers. If there is just one adult, provide answers for that adult.

142. Ritto 1

Enaj ewi kdkad eo am ñan o ajri in?

1. ☐ Lukkun ro jiñan im jemān rej kokkajriri

2. ☐ Riab in jemān

3. ☐ Jimman

4. ☐ Armij eo kien ar lelok bwe en lale (foster parent)

5. ☐ Aunt ak rikorean

6. ☐ Bar jet: Nukun

7. ☐ Bar jet: Ej jab nukun

1. Kain rot kwe (sex)?

   1. ☐ Ladik

   2. ☐ Leddik

2. Ta iio ne am?

Rettan iiō ko

145. Kilaaj ak iiō in jikuul eo emōj am kar kadedelok? Kokkaleik JUON wōt.

     1. ☐ 8th kilaaj ak etta lok

     2. ☐ 9th-12th kilaaj; EJJELOK diploma

     3. ☐ Kadoujlok jān High School ak kadedelok GED

     4. ☐ Kadedelok juon vocational, trade, or business school pirokiram

     5. ☐ Jet College Credit, ak ejjelok Degree

     6. ☐ Associate Degree (AA, AS)

     7. ☐ Bachelor’s Degree (BA, BS, AB)

     8. ☐ Master’s Degree (MA, MS, MSW, MBA)

     9. ☐ Doctorate (PhD, EdD) or Professional Degree (MD, DDS, DVM, JD))

146. Ta jekjek in am belele?

     1. ☐ Emōj mare [Etal ñan K7]

     2. ☐ Jañin mare

     3. ☐ Kojemlok mare eo

     4. ☐ Jibel

     5. ☐ Ej make wōt bwe emij rimare eo an

99. ☐ Ijab kōnaan uaak [Etal ñan K7]

147. Kwoj ke ILO TERRE IN jokwe ippān juon eo kwoj jeraik?

     1. ☐ Aet

     2. ☐ Jab

99. ☐ Ijab kōnaan uaak

148. Ilo lalelok, ej et am ejmour?

     1. ☐ Elap an lukkun eman

     2. ☐ Lukkunin eman

     3. ☐ Eman

     4. ☐ Epwe an eman

     5. ☐ Ejjab eman

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

149. Ilo lale lok, ej et am kolmenlokijen ak ejmour ilo am enjake?

     1. ☐ Elap an lukkun eman

     2. ☐ Lukkunin eman

     3. ☐ Eman

     4. ☐ Epwe an eman

     5. ☐ Ejjab eman

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

150. Ritto 2 ear ke ke jerbal diktata 50 jan 52 wiik ko?

     1. ☐ Aet

     2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

151. Wor ke ritto ilo mweo eoej rilale akrikejparok ñan ajri in?

     1. ☐ Aet

     2. ☐ Jab [Etal ñan Mōttan L]

99. ☐ Ijab kōnaan uaak [Etal ñan Mōttan L]

Rikejbarok in bar juon ak Rilale in enaj likit bwe ej Ritto 2.

152. Rilale akrikejparok enaj itto 2.

     1. ☐ Lukkun ro jiñan im jemān rej kokkajriri

     2. ☐ Riab in jemān

     3. ☐ Jimman

     4. ☐ armij eo kien ar lelok bwe en lale (foster parent)

     5. ☐ Aunt ak rikorean

     6. ☐ Bar jet: Nukun

     7. ☐ Bar jet: Ej jab nukun

153. Kainrot Ritto 2 eo?

     1. ☐ Emman

     2. ☐ Kora

154. Jete an Ritto 2 iiō?

Rettan iiō ko

155. Ta kilaaj ta eo ilon tata ak iiō in jikuul eo Ritto Adult 2 emōj an kar kadedelok? Kokkaleik JUON wōt.

     1. ☐ 8th kilaaj ak etta lok

     2. ☐ 9th-12th kilaaj; EJJELOK diploma

     3. ☐ Kadoujlok jān High School ak kadedelok GED

     4. ☐ Kadedelok juon vocational, trade, or business school pirokiram

     5. ☐ Jet College Credit, ak ejjelok Degree

     6. ☐ Associate Degree (AA, AS)

     7. ☐ Bachelor’s Degree (BA, BS, AB)

     8. ☐ Master’s Degree (MA, MS, MSW, MBA)

     9. ☐ Doctorate (PhD, EdD) or Professional Degree (MD, DDS, DVM, JD)

156. Ta jekjek in an Ritto 2’s belele?

     1. ☐ Emōj mare [Etal ñan K7]

     2. ☐ Jañin mare

     3. ☐ Kojemlok mare eo

     4. ☐ Jibel

     5. ☐ Ej make wōt bwe emij rimare eo an

99. ☐ Ijab kōnaan uaak

1. Kwoj ke ILO TERRE IN jokwe ippān juon eo kwoj jeraik?

   1. ☐ Aet

   2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. Ilo lalelok, ej et am ejmour?

   1. ☐ Elap an lukkun eman

   2. ☐ Lukkunin eman

   3. ☐ Eman

   4. ☐ Epwe an eman

   5. ☐ Ejjab eman

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. Ilo lale lok, ej et am kolmenlokijen ak ejmour ilo am enjake??

   1. ☐ Elap an lukkun eman

   2. ☐ Lukkunin eman

   3. ☐ Eman

   4. ☐ Epwe an eman

   5. ☐ Ejjab eman

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

1. Ritto 2 earke jerbal diktata 50 jan past 52 wiik ko?

   1. ☐ Aet

   2. ☐ Jab

77. ☐ Ijab jela

1. ☐ Ijab kōnaan uaak

Section L.EJMOUR EO AM

161. Juon iien kakkolkol im jeek anbwinin, ejjab juon kakkokol jorren ko il anbwinin, nañinmij, ak jekjek in. ej ñan lale alkin jan kar juon emotlok juon kar taktō loe im kar kakkilene ak jeeke?

     1. ☐ Ilowan wōt iiō emotok diklok jan12 alloñ ko)

     2. ☐ Ilowan 2 iiō ko (1 iiō ak ediklok jan but diklok jan2 iiō ko lok)

     3. ☐ Ilowan wōt 5 iiō ko (2 iiō ko ijoke diklok jan 5 iiō ko lok)

     4. ☐ 5 ak elonlok iiō ko ok

     5. ☐ Jañin

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

162. ILOWAN WŌT ALLOÑ KO 12, emōj ke am kar taktō akbōk koeo kkabiloklok jān juon rijerbal eo ekabeel kake ejmoue in kemelij? Rijerbal inejmour eo ekabeel ekoba psychiatrists, psychologists, psychiatric nōōjs, im rijerbal ro an jojiel.

     1. ☐ Aet

     2. ☐ Jab, ijoke iar aikuij in loe juon rijerba kabeel kin komelij

     3. ☐ Jab, Iar jab aikuij in loe rijerbak kabeel inmkomelij [Etal ñan L4]

77. ☐ Ijab jela [Etal ñan L4]

99. ☐ Ijab kōnaan uaak [Etal ñan L4]

163. Ewi joñan aba neo ñan bōk madmōd ko jan juon ikijienkomelij akbōk kokkabiloklok bwe kwar aikuiji?

     1. ☐ Ejab juon aban

     2. ☐ Jidik aban

     3. ☐ Abañkileplep

164. Ilo kar iien in kio kekwar bororo, kwar ke kareoik niim ippānjuon taktō in ñi ak juon rikareo ni?

     1. ☐ Aet

     2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

165. Won eo ej kōmman bebe ñan eok ikijienejmour eo am?

     1. ☐ Kwe

     2. ☐ Beleem

     3. ☐ Kwe im beleem/komro jimor

     4. ☐ jinam im jamom

     5. ☐ Bar juon, jouij im kwalok

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

166. Won eo ej kōmman bebe ñan eok ikijienejmour eo an ajri ro nejum)?

     1. ☐ Kwe

     2. ☐ Beleem

     3. ☐ Kwe im beleem/komro jimor

     4. ☐ jinam im jamom

     5. ☐ Bar juon, jouij im kwalok

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Kajittok kein rej kajjitōk kake kobatat, idak kadok, I'm kojerbal uno ko rekajur.

167. Ilo 30 raan ko remotlok, jete raan ko dkwar kobatat jika ko?

     1. ☐ 0 raan ko

     2. ☐ 1 or 2 raan ko

     3. ☐ 3 to 5 raan ko

     4. ☐ 6 to 9 raan ko

     5. ☐ 10 to 19 raan ko

     6. ☐ 20 to 29 raan ko

     7. ☐ All 30 raan ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

168. Kwoj ke idak den in kadōk ak alrkool, ekoba den in kadōk ko kwoj ioke ak kōmman lio mweo?

     1. ☐ Aet

     2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

169. Ilo terre in our eo am, emōj ke am kojerbal men kein:

	AET	JAB	Ijab jela	Ijab kōnaan uaak
L9a. Betel nut	1 ☐	2 ☐	77 ☐	99 ☐
L9b. Vape or e-cigarette	1 ☐	2 ☐	77 ☐	99 ☐
L9c. Funta	1 ☐	2 ☐	77 ☐	99 ☐
L9d. Marijuana (also called grass, pot, weed, or reefer)	1 ☐	2 ☐	77 ☐	99 ☐
L9e. Cocaine, including powder, crack, or freebase	1 ☐	2 ☐	77 ☐	99 ☐
L9f. Heroin (also called smack, junk, or China White)	1 ☐	2 ☐	77 ☐	99 ☐
L9g. Methamphetamines (also called speed, crystal, crank, or ice)	1 ☐	2 ☐	77 ☐	99 ☐
L9h. Ecstasy (also called MDMA)	1 ☐	2 ☐	77 ☐	99 ☐
L9i. Synthetic marijuana (also called K2, Spice, fake weed, King Kong, Yucatan Fire, Skunk, or Moon Rocks)	1 ☐	2 ☐	77 ☐	99 ☐
L9j. Steroid pills or shots without a doctor's prescription	1 ☐	2 ☐	77 ☐	99 ☐
L9k. Prescription pain medicine without a doctor's prescription or differently than how a doctor told you to use it? (Count drugs such as codeine, Vicodin, OxyContin, Hydrocodone, and Percocet)	1 ☐	2 ☐	77 ☐	99 ☐

If respondent never chewed betel nut, go to L11.

170. Ilo 30 raan ko, jete ia raan ko kwar meme betel nut?

     1. ☐ 0 raan ko

     2. ☐ 1 or 2 raan ko

     3. ☐ 3 to 5 raan ko

     4. ☐ 6 to 9 raan ko

     5. ☐ 10 to 19 raan ko

     6. ☐ 20 to 29 raan ko

     7. ☐ All 30 raan ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

171. Emōj ke air lelok kwe, ak kwar ke, ilo jabrewōt/ bōk kunam ak /bōk kokkabiloklok/taktō kon pirablem ko am ilo am kojerbal uno kein?

     1. ☐ Aet

     2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

172. Emōj ke an eo taktō eo am ak ro il ojikin ejmour eo jiroñ eok ke type in nañinmij in tonal eo am epād ilo type 1 or type 2 nañinmi in tonal?

     1. ☐ Kain nañinmi in tonal

     2. ☐ Kain 2 nañinmi in tonal

     3. ☐ Ejjelok [Etal ñan L14]

77. ☐ Ijab jela [Etal ñan L14]

99. ☐ Ijab kōnaan uaak [Etal ñan L14]

173. Kwoj ke bōk uno kon nañinmij in?

     1. ☐ Wa in tonal (Insulin)

     2. ☐ Pills

     3. ☐ Insulin kab batin (pills)

     4. ☐ Ij jab ebbōk uno

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

174. Emōj ke an bar juon taktō jan jikin taktō jet RENAÑIN KE ba ñan kwe ewōr kain jekjek kein ippam?

     	AET	JAB	Ijab jela	Ijab kōnaan uaak
     L14a. Kokale in jorren an menono	1 ☐	2 ☐	77 ☐	99 ☐
     L14b. Kokale in piipa	1 ☐	2 ☐	77 ☐	99 ☐
     L14c. kanjer in kod	1 ☐	2 ☐	77 ☐	99 ☐
     L14d. Jabwe bōtōkōk	1 ☐	2 ☐	77 ☐	99 ☐

175. EWi wawein am kwalok kon eedo eoam?

     1. ☐ Lukkun mera

     2. ☐ Mera jidik wōt

     3. ☐ Eedo en ejimwe joñan

     4. ☐ Elaplok jidik eddo

     5. ☐ Lukkun lap jan joñan an edo

176. Ta iian men kein kwoj kajeon in kmman eō ikijien am eddo?

     1. ☐ Kadiklok eddo

     2. ☐ Kollaplok eddo

     3. ☐ pād wōt ilo joñan eddo in

     4. ☐ Ejjelok men en ij kajjeon kake eddoin ao

177. Ilowan 7 raan ko remotlok, jete raan ko kwar lukkun komakitkiti anbwinin ilo am etor ak eetal diktata 60 minuteko ilo juon raan? Kobaik aolep iien eo kwoj jolok ñan kain makitkit rot in bwe menono en laplok an pump im kōmman bwe kajurlok am emenono jet iien.

     1. ☐ 0 raan ko

     2. ☐ 1 day ko

     3. ☐ 2 raan ko

     4. ☐ 3 raan ko

     5. ☐ 4 raan ko

     6. ☐ 5 raan ko

     7. ☐ 6 raan ko

     8. ☐ 7 raan ko

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

178. Kim kōnaan kamool, ewōr ke juon nejum ninnin12-alloñ ko ak ediklok im/ak kwoj Bororo ke ilo terre in.

     1. ☐ Ewōr juon neju ninnin eo rettan ej 12-alloñ ko ak diklaok im Ij jab Bororo iloterre in

     2. ☐ Ewōr juon neju ninnin jidikdik im ij Bororo ilo terre in

     3. ☐ Ij Bororo ilo terre in ijoke ejjelok bar neju ninnin [Etal ñan Mōttan M]

     4. ☐ Jab [Etal ñan M]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Kajjitok kein tokalik rej kake Zika virus. Nañinmi eo ej walok janZika virus eke an ajeded jan nam ko rej kij koj ak rebar maroñ ajed ilo amlajikmed ippān armij eo ewōr Zika virus in.

179. Ilo kar Bororo eo am ko epaak, ewi joñan inebaqte eo am ne kwo naj bōk nañinmij in Zika virus? Kokkaleik JUON uaak.

     1. ☐ Lukkun inebata

     2. ☐ iInebata jidik

     3. ☐ Jab ñan jidik inebata

     4. ☐ Ij jañin kar ron kake Zika virus ilo terre eo kio ke ij Bororo

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

180. Ilo jabrewōt iien ke kwar bororo, kwar ke kennaan ippān juon taktō, nurse, ak rijerbal ro jet ilo jikin ejmour eo kake Zika virus?

     1. ☐ Jab

     2. ☐ Aet, juon rijerbal in jikin ejour eo ear kennaan ippamene iarjab kajjitōk kake

     3. ☐ Aet, juon rijerbal in jikin ejmour eo eaar kennaan kake, ijoke ALKIN WŌT ao kajjitōk kake

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

181. Ilo iien in ke kwar bororo kio, kwar ke bōk test in bōtōkōk ñan lale ewōr ke Zika virus ippam?

     1. ☐ Aet

     2. ☐ Jab [Etal ñan L23]

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

182. Kwar ke kakkolkol im rar ke elolo Zika Ilo iien in ke kwar bororo kio?

     1. ☐ Aet

     2. ☐ Jab [Etal ñan M1]

77. ☐ Ijab jela [Etal ñan M1]

99. ☐ Ijab kōnaan uaak [Etal ñan M1]

[Elaññe aet] AJRI ta eo kwar Bororo kake?

Kajjitok kein tok ilal rej kake Ilo iien in ke kwar bororo.

183. Ilo iien in ke kwar bororo kio, kwar ke itotak ñan jikin ewōr Zika virus?

     1. ☐ Aet

     2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe aet] Ilo kar iien in kio kekwar bororo, kwar ke jela kake melele ko bwe kora ro rebororo ren jab itotak ñan jikin ko ewōr Zika virus ie?

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

[Elaññe jab] Ilo kar iien in kio kekwar bororo, kwar ke eitotak ñan jikin ko ewōr the Zika virus konke melele bwe kora ro rebororo rej aikuij jab itotak ñan jikin kein?

1. ☐ Aet

2. ☐ Jab

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Section M.Mōttan M. MELELE KON RO ILO MWEO

184. Jete armij rej jokwe io atreej in? Ekoba jabrewōt eo ekka an kijon jokwe ilo atreej eo. JAB kadeloñe jabrewōt eo ej jokwe joko jet eloñlok jan ruo alloñ ko, ainwōt rijikuul in college ro rej jokwe ettolok akjuon eo ilo jikin tarinas an Armed Forces.

Nomba in armij

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

185. Jete armij ilo mweo rej uaan baaṃḷe eo? Baamle ej melelein jabrewōt ro nukum kin bōtōkōk einwōt ajri, kinmare, kokkajriri, kwoj foster care kake ir.

Nomba in armij

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

186. Kio jenaj kajjitokin kake wōnaam ilo income ILO IIŌ EO LOK yiio (January 1 - December 31, 2017) Ñan kajojo in wōnaam, jouij kwalok elaññe baame eo ear bōke ne kwoj letok AOLEPEN JOÑAN TOTAL EO ANTOONE IIŌ EO LOK.

     	AET	JAB	Elaññe aet, total joñan eo emōj bōke	Ijab jela	Ijab kōnaan uaak
     M3a. Wōnaam, commissions, bonej ko, or tip kojan jerbal ko?	1 ☐	2 ☐	, ,	77 ☐	99 ☐
     M3b. Wōnaam jan amjerbal ippam make busineaa in jikin kallip eo am make ak koewōr mottam?	1 ☐	2 ☐	, ,	77 ☐	99 ☐
     M3c. Interest, dividends, wonaan ren, royalty income,wonaan ko jan kien im trust ko?	1 ☐	2 ☐	, ,	77 ☐	99 ☐
     M3d. Social security or railroad retirement; retirement, survivor, ak armij ro ewor utame ilo anbwinier?	1 ☐	2 ☐	, ,	77 ☐	99 ☐
     M3e. Supplemental security income (SSI); any public assistance or jaan in jipañ jan pirokiram ko an kien jan kien ak opij ko jet?	1 ☐	2 ☐	, ,	77 ☐	99 ☐
     M3f. Jabrewōt jikin ko kwojbōk jan Veterans’ (VA) kolla ko, jaan ko ne jako jerbal, jaan jnn ajri?	1 ☐	2 ☐	, ,	77 ☐	99 ☐

187. Kajjitok kein rej kake wōnaam im elap an aurok. Lomnak kake total aolepen wōnaami ilo 2017 eo ñan aolepen ro rej uaan baaṃḷe eo. Ta kar joñan eo mokta jān tax? Ekoba jān jerbal kos, jipañ ko ñan ajri, social security, jaan ko janretirement, kola ko n ej jako ad jerbal, jipañ jan kien, and so forth. Bar ainwōt ekoba interest, dividends, ñet wōnaam jān business, jikin kallip,ak r rent, im ebar lon money income emōj bōki.

, , Total amount ($)

77. ☐ Ijab jela

99. ☐ Ijab kōnaan uaak

Komool kon am bōk kunam.

Ilo etan U.S. Department of Health and Human Services, kemij amolol eok kon iien kein kwar maroñ jolok in am letok amiien im kwalok meele ko kake ajri in, kwe im ro ilo baaṃḷe eo am.

Uaak ko am elap ai and will help rr aurok ñan kim esearcherro, rikōmman kakien ko, imrorej jipañ baaṃḷe ko ñan kokkmanmanlok melele kon ejmour im aikuij ko ane ajri ro ilo lubwilijinarmij rein reoktak jan doon.w

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