Study Questionnaire - Burmese Immigrants and their Desce

Biomonitoring of Great Lakes Populations Program III

7d.StudyQuestionnaire_Burm

Study Questionnaire - Burmese Immigrants and Descendants

OMB: 0923-0056

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Biomonitoring of Great Lakes Populations Program III

Form Approved

OMB No. 0923-17IY

Exp. Date xx/xx/201x

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Attachment 7d. Study Questionnaire for Burmese Immigrants and their Descendants


Interviewer instructions: Please record the date of the interview and the participant’s ID number below before beginning the interview. Please confirm completion of the Contact Information Form.


DATE (MM/DD/YYYY): __ / __ / ____


STUDY ID: ______________________


Mark this box to confirm that the Contact Information Form has been completed. If not, complete this form with the participant now.




SEX, AGE, RACE, ETHNICITY

I will start by asking you some questions about your sex, age, race and ethnicity.

  1. What is your sex/gender?

Male

Female


  1. What is your birthdate?

____ / _____/ _______

mm dd yyyy


Unknown 2a. What is your age? ________ years


  1. In what country were you born?

United States

Burma/Myanmar

Thailand

Malaysia

Other country 3a. Specify: _________________________

Don’t know

Prefer not to answer



ATSDR estimates the average public reporting burden for this collection of information as 40 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 (0923-17IY).

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  1. What is your ethnicity or tribe?

Burman

Chin

Kachin

Karenni

Karen

Mon

Rakhine
Rohingya

Other, 4a. Specify: _________________________

Don’t Know

Prefer not to answer


RESIDENTIAL HISTORY

Now we will ask you some questions about where you have lived.

  1. How long have you lived in the United States?

_____ years

Don’t know

Prefer not to answer

  1. How long have you lived in the Milwaukee, Wisconsin area?

_____ years

Don’t know

Prefer not to answer


  1. How long have you lived at your current address?

_____ years

Don’t know

Prefer not to answer


  1. When was this home built?

Approximate year: __________


  1. Have you lived anywhere outside the Milwaukee area?

Yes

No Skip to #11

Don’t know Skip to #11

Prefer not to answer Skip to #11


  1. Where did you live before coming to Milwaukee?


10a. Location #1 (specify city, state, country): ________________________

Was this a Refugee Camp? Yes No
How long did you live there
? _____ years

Interviewer: please round to the nearest year

Don’t know

Prefer not to answer


10b. Location #2 (specify city, state, country): ________________________

Was this a Refugee Camp? Yes No
How long did you live there
? _____ years

Interviewer: please round to the nearest year

Don’t know

Prefer not to answer



FISH AND SHELLFISH

I will now ask you about the fish and shellfish you eat. I will ask you about fish and shellfish that you may have bought at a store or restaurant, as well as fish and shellfish that you or someone you know caught from lakes, rivers, or streams in Wisconsin. First, I will ask several questions on fish and shellfish eaten in the last 30 days.

  1. In the last 30 days, how many times did you eat SHELLFISH, such as shrimp, oysters, lobster, clams, crab, or crayfish?

_______ total number of shellfish meals eaten in the last 30 days

Don’t know

Prefer not to answer

  1. In the last 30 days, how many times did you eat FISH such as fresh, canned, or frozen fish, fish fillets, fish sticks, fish sandwiches, and tuna fish?

    _______ total number of fish meals eaten in the last 30 days

Don’t know Skip to #14

Prefer not to answer Skip to #14

13. In the last 30 days, how many of these fish meals were caught by you or someone you know from any lakes, rivers, and streams in Wisconsin? These are sometimes called ‘sport-caught fish’.

_______ number of locally-caught fish meals eaten in the last 30 days

Don’t know Skip to #14

Prefer not to answer Skip to #14



FISH EATEN IN THE LAST 12 MONTHS

Now I will ask you some questions about fish you ate that were caught by you or someone you know. These fish are sometimes called ‘sport-caught fish’ or ‘sportfish’. I will be asking you to estimate how many fish meals you have eaten in the last 12 months. I understand that you might need a few minutes to think about these questions, so please take your time.

14. In the last 12 months, how many times have you eaten fish caught by you or someone you know?
__________ total number of meals in the last 12 months

Don’t know Answer Question 16, then SKIP to #18

Prefer not to answer Answer Question 16, then SKIP to #18

15. Please look at this picture of lakes, rivers, and streams near Milwaukee. Thinking about the last year, how many times have you eaten fish caught by you or someone you know from the lakes, rivers, and streams shown here? Please think about these locations only. (Will include an image of the MKE AOC water bodies)
__________ total number of meals in the last 12 months

Don’t know Answer Question 16, then SKIP to #18

Prefer not to answer Answer Question 16, then SKIP to #18

  1. Please look at the picture of lakes, rivers, and streams near Milwaukee. For fish caught in any of the lakes, rivers, and streams in the picture, how has the total amount of fish you eat changed during the past five years? (Will include map/picture of water bodies)

Eat less

Same or about the same

Eat more

Don’t know

Prefer not to answer

  1. Please look at this picture of lakes, rivers, and streams near Milwaukee. The following questions are about types of fish you have eaten that were caught by you or someone you know. When answering these questions, please think only about fish caught in the lakes, rivers, and streams pictured and listed here. (Will include map/picture of water bodies)


In the last 12 months, have you eaten:


Yes

No

Don’t know

Prefer not to answer

If YES, approximately how many times did you eat it in the last 12 months?

Black crappie





Number: ______

Don’t know how many

Bluegill





Number: ______

Don’t know how many

Bullhead





Number: ______

Don’t know how many

Carp





Number: ______

Don’t know how many

Channel catfish





Number: ______

Don’t know how many

Chubs





Number: ______

Don’t know how many

Salmon





Number: ______

Don’t know how many

Northern pike





Number: ______

Don’t know how many

Redhorse





Number: ______

Don’t know how many

Rockbass





Number: ______

Don’t know how many

Largemouth bass





Number: ______

Don’t know how many

Smallmouth bass





Number: ______

Don’t know how many

Smelt





Number: ______

Don’t know how many

Walleye





Number: ______

Don’t know how many

White sucker





Number: ______

Don’t know how many

Yellow perch





Number: ______

Don’t know how many

Brown trout





Number: ______

Don’t know how many

Lake trout





Number: ______

Don’t know how many

Rainbow trout





Number: ______

Don’t know how many

Other fish types (please specify):





Number: ______

Don’t know how many

Other fish types (please specify):





Number: ______

Don’t know how many

Other fish types (please specify):





Number: ______

Don’t know how many




PURCHASED FISH EATEN IN THE LAST 12 MONTHS

Now I will ask you to think about fish and shellfish you have bought in store, restaurant or market. I will be asking you to estimate how many fish meals you have eaten in the last 12 months. I understand that you might need a few minutes to think about these questions, so please take your time.

  1. These next questions will ask you about fish you have eaten which came from a store, restaurant, fish vendor, market, or supermarket. Will include a picture of each type of fish)

Thinking about the last 12 months, have you eaten:


Yes

No

Don’t know

Prefer not to answer

If YES, approximately how many times did you eat it in the last 12 months?

King mackerel






Number: ______

Don’t know how many

Tilefish





Number: ______

Don’t know how many

Shark





Number: ______

Don’t know how many

Swordfish





Number: ______

Don’t know how many

Salmon (including canned)





Number: ______

Don’t know how many

Canned light tuna





Number: ______

Don’t know how many

Canned white or albacore tuna





Number: ______

Don’t know how many

Fresh or frozen tuna





Number: ______

Don’t know how many

Tilapia





Number: ______

Don’t know how many

Halibut





Number: ______

Don’t know how many

Cod





Number: ______

Don’t know how many

Shellfish (such as shrimp, mussels, etc.)





Number: ______

Don’t know how many

Other fish not listed here, please specify:






Number: ______

Don’t know how many


FISH PASTE

  1. Do you eat fish paste, sometimes called “nya u” or “ngape”?
    Yes How often?______ times per (circle one) week month year

No SKIP to #24

Don’t know SKIP to #24

Prefer not to answer SKIP to #24

  1. Where do you get your fish paste? (check all that apply)
    Homemade

Purchased in a store or market SKIP to #24
Don’t know SKIP to #24

Prefer not to answer SKIP to #24

  1. Is the homemade fish paste made from fish caught in nearby waters?
    Yes
    No
    SKIP to #24
    Don’t know
    SKIP to #24
    Prefer not to answer
    SKIP to #24

  1. What kinds of fish are used to make homemade fish paste? (check all that apply) (There will be a picture to help identify each type of fish. The picture will have common and translated fish names).

Black crappie Northern pike Walleye

Bluegill Redhorse White sucker

Bullhead Rock bass Yellow perch

Carp Largemouth bass Brown trout

Channel catfish Smallmouth bass Lake trout

Chubs Smelt Rainbow trout

Chinook salmon Coho salmon

Other species, specify: ________________________________________
Don’t know

Prefer not to answer

  1. What parts of the fish are used to make homemade fish paste? (check all that apply) (There will be a picture to help identify parts of the fish)

Whole fish

Flesh/muscle and skin only

Flesh only

Whole fish with head and tail removed

Other: (specify) ___________________________

Don’t know

Prefer not to answer

FISH CLEANING AND COOKING PRACTICES

I will now ask you some questions about how you typically clean and cook the fish you eat.


  1. These next questions will ask you about how you clean and prepare the fish you eat. Here is a picture to show you the different parts of the fish we are asking about. (Will include picture of each fish part)

When preparing fish, how often do you eat or prepare meals using:

Never

Sometimes

Always

Don’t know

Prefer not to answer

The skin of the fish






The head of the fish






The guts, organs, or other innards of the fish






The belly fat of the fish







  1. The next questions will ask you about how you cook fish.

When cooking fish, how often do you:

Never

Sometimes

Always

Don’t know

Prefer not to answer

Smoke or dry fish






Pickle fish






Use fish to make fish paste






Pan fry






Grill, or roast fish






Deep fry fish






Boil or poach fish






Use fish or fish parts to make broth/stock, curry, or soup







  1. Please look at this picture of a 6 ounce serving of cooked fish. Compared to this model, would you say that a typical meal of fish you eat is usually: (Will include picture to illustrate serving size)

Less (smaller than the picture)

Same or about the same

More (larger than the picture)

Don’t know

Prefer not to answer


  1. During which season(s) do you eat fish? (check all that apply)
    Spring (March, April, May)
    Summer
    (June, July, August)
    Fall
    (September, October, November)
    Winter
    (December, January, February)
    Don’t know
    Prefer not to answer


  2. During which season(s) do you catch fish? (check all that apply)
    Spring (March, April, May)
    Summer
    (June, July, August)
    Fall
    (September, October, November)
    Winter
    (December, January, February)
    I do not catch fish
    Don’t know
    Prefer not to answer


ADVISORY AWARENESS

Now we will be asking you a few questions about the safe-eating guidelines for fish caught in Wisconsin. We are not asking you about the regulations on what size of fish and how many fish you can keep from a water body. These questions are about the health-based advisories written to protect you from contaminants like mercury and PCBs.

  1. Have you heard about the safe-eating guidelines for fish caught in Wisconsin?

Yes

No Skip to #32

Don’t know Skip to #32
Prefer not to answer Skip to #32


  1. How much would you say that you know about these guidelines?
    Nothing
    A little bit
    Some
    Quite a bit
    A great deal
    Prefer not to answer


  2. How closely do you follow the advice provided in these guidelines?
    Not at all
    A little bit
    Somewhat
    Very
    Extremely
    Prefer not to answer

  3. Have you ever heard about the safe-eating guidelines for fish caught in the Milwaukee River and harbor mouth at Lake Michigan, Menomonee River, Lincoln Creek, or Cedar Creek?
    Yes
    No
    Skip to #35
    Don’t know
    Skip to #35
    Prefer not to answer
    Skip to #35

  4. How much would you say that you know about these guidelines?
    Nothing
    A little bit
    Some
    Quite a bit
    A great deal
    Prefer not to answer


  5. How closely do you follow the advice provided in these guidelines?
    Not at all
    A little bit
    Somewhat
    Very
    Extremely

    Prefer not to answer

  6. Have you ever made any of the following changes to avoid contaminants such as mercury and PCBs? (check all that apply)

Eaten fewer fish meals
Eaten different types or species of fish

Avoided eating certain parts of fish (head, fat, belly, skin)
Avoided eating fish from some fishing locations

None of these
Prefer not to answer


  1. The next questions will ask you about how you get information about fish consumption advice, and how useful you think these sources are. Remember, we are asking you about the safe-eating guidelines, NOT any regulations about size and number of fish you can keep.

Do you get information about Wisconsin fish consumption advice from:

If yes:

How useful is this source of information

Do you find this source easy to understand?

Do you use this source when making decisions about eating fish?

Fishing club newsletters or websites or other sports club publications

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Wisconsin Department of Natural Resources website or publications

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Wisconsin Department of Health Services website or publications

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Federal agencies, such as the Environmental Protection Agency (EPA) or the Food and Drug Administration (FDA)

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Friends or family members

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Fishing regulations booklet distributed with fishing license, pictured here

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Choose Wisely – a health guide for eating fish in Wisconsin, pictured here

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Tackle or sporting goods stores

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

County health office or website

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Grocery store or food market

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Fish eating guidelines posted near waters that I fish (see example picture)

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Television, radio and/or newspaper messages/reports

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

My health care provider

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

Charter boat operators or guides

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer

iPhone/Smartphone apps (e.g., DNR Pocket Ranger Fish and Wildlife app), pictured here

Yes

No

Prefer not to

answer

Not useful

Somewhat useful

Very useful

Prefer not to

answer

Yes

No

Prefer not to

answer

Yes

No

Prefer not to answer




WILD BIRDS AND ANIMALS

Now I will ask you about any wild birds or animals you may have eaten in the last 12 months.


  1. These next questions will ask you about the types of wild animals and waterfowl you have eaten, which were harvested near areas identified in this picture. (Will include map/picture of locations, and picture of each bird/animal)

Thinking about the last 12 months, have you eaten:


Yes

No

Don’t know

Prefer not to answer

If YES, approximately how many times did you eat it in the last 12 months?

Waterfowl (ducks, geese, or seagulls)





Number: ______

Don’t know how many

Crows or other scavenger birds





Number: ______

Don’t know how many

Deer





Number: ______

Don’t know how many

Frogs or toads





Number: ______

Don’t know how many

Rats or mice





Number: ______

Don’t know how many

Rabbits





Number: ______

Don’t know how many

Groundhogs





Number: ______

Don’t know how many

Squirrels





Number: ______

Don’t know how many


  1. In the past 12 months, have you eaten waterfowl (such as ducks or geese) that were harvested in any other locations not listed/pictured here?

YES: Specify location:_________________

NO

Don’t know

Prefer not to answer


LIFESTYLE AND ACTIVITIES

Now I will ask you some questions about your lifestyle and some activities you might do in your free-time.

  1. The following question is about any supplements you may take.

On most days, do you take or use:

Yes

No

Don’t know

Prefer not to answer

Herbal medicine or supplements





Fish oil





Store-bought Betel nut





Natural or hand-made Betel nut






  1. Do you use a homemade or store-bought yellow powder/cream called Thanakar or Thanakha?

Yes, Homemade

Yes, Store bought

No Skip to #42

Don’t know Skip to #42

Prefer not to answer Skip to #42


  1. How often do you use Thanakar?

_____ times per (circle one) week month year

Don’t know

Prefer not to answer

  1. Have you smoked at least 100 cigarettes (or 5 packs) in your lifetime?

Yes (Ever smoker)

No (Never smoker) Skip to #45

Don’t know Skip to #45

Prefer not to answer Skip to #45

  1. Do you smoke cigarettes now?

Yes

No Skip to #45

Don’t know Skip to #45

Prefer not to answer Skip to #45


  1. How many cigarettes do you smoke per day? (1 pack=20 cigarettes)

1-5 per day

6-10 per day

11-20 per day (>1/2 and <1 pack per day)

>20 per day (>1 pack per day)

Don’t know

Prefer not to answer


  1. Do you use chewing tobacco or snuff?

Yes

No Skip to #47

Don’t know Skip to #47

Prefer not to answer Skip to #47


  1. How often do you use chewing tobacco or snuff?

Daily

Weekly

Monthly

Don’t know

Prefer not to answer


  1. Please look at this picture of lakes, rivers, and streams in the Milwaukee area. Do you swim, dive, or wade in any of these local bodies of water? (Will include map/picture of water bodies)

Yes 47a. How many times in the past year? ______

No

Don't know

Prefer not to answer


  1. Have you or anyone else in your household done any of the following activities in the last 12 months?

Activity:

Yes

No

Don’t know

Prefer not to answer

Dyeing material





Electronics assembly





Gardening or farming





Glass crafting, metal work, painting or glazing,





Metal work





Painting and glazing





Packing ammunition





Print making





Wood working





Home renovation/repair







HOUSEHOLD INFORMATION

Now we will ask you a few questions about your household, including how many people live in your home with you.

  1. Including yourself, how many people currently live at your address?

Total number: _____________

Live alone SKIP to #52

Don’t know SKIP to #52

Prefer not to answer SKIP to #52

  1. How many people who live with you are women between 15 and 45 years old?

Number: _____ (If 0, SKIP to #51)

Don’t know SKIP to #51

Prefer not to answer SKIP to #51


50a. Do any of these women eat locally caught fish?
Yes

No

Don’t know

Prefer not to answer


  1. How many children who live with you are under the age of 15?

Number under 15 years: _____ (if 0 SKIP to #52)

Don’t know SKIP to #52

Prefer not to answer SKIP to #52


51a. Do any of these children eat locally caught fish?

Yes

No

Don’t know

Prefer not to answer



EDUCATION, MARITAL STATUS, WORK HISTORY, AND INCOME

Now we will ask some questions about your work history, education, income, and marital status.

  1. What is the highest grade level of school or degree you have completed?

8th grade or less

Some high school, no diploma or GED

High school diploma or GED

Some college, no diploma

Associate degree

Bachelor’s degree

Postgraduate, professional, or doctoral degree

Don’t know

Prefer not to answer


  1. What is your current marital status?

Married

Living with someone in a marriage-like relationship

Separated

Divorced

Widowed

Never married
Prefer not to answer


  1. Do you currently work outside the home?

Yes, Full-time

Yes, Part-time

No SKIP to #55

Don’t know SKIP to #55

Prefer not to answer SKIP to #55


54a. What is your current job?

Title_______________________________

Who is your employer? ___________________________________________

How many hours a week do you work? _____ hours per week

What are your usual activities or duties? _________________________________



54b. Do you have a second job?

Yes

No SKIP to #55

Don’t know SKIP to #55

Prefer not to answer SKIP to #55


54bi. What is your second job?

Title_______________________________

Who is your employer? ___________________________________________

What are your usual activities or duties?_________________________________


54c. Have you worked at any (other) job in the past year?

Yes, Full-time

Yes, Part time

No SKIP to #55

Don’t know SKIP to #55

Prefer not to answer SKIP to #55


54ci. What was this other job?

Title_______________________________

Who is your employer? ___________________________________________

What are your usual activities or duties? ________________________________



  1. Does anyone in your household receive SNAP or WIC services (such as food stamps)?

Yes

No

Don’t know

Prefer not to answer


  1. Can you tell me your total family income in 2016 before taxes? (check one only)

Less than $15,000

$15,000 to less than $25,000

$25,000 to less than $35,000

$35,000 to less than $50,000

$50,000 to less than $75,000

$75,000 to less than $100,000

$100,000 or more

Don’t know

Prefer not to answer


HEALTH HISTORY

These next questions will ask you about any health conditions you have or have had.

Have you ever been told by a doctor that you had/have any of the following health conditions:

  1. Heart/Circulatory Conditions:

Yes

If yes: year of diagnosis

No

Don’t know

Prefer not to answer

Coronary heart disease


Heart attack


Angina (pain from coronary heart disease)


Hypertension or high blood pressure


Stroke


High fat or cholesterol in your blood


Aneurysm


  1. Thyroid conditions:

Yes

If yes: year of diagnosis

No

Don’t know

Prefer not to answer

Benign (non-cancerous) thyroid tumor


Hashimoto’s Disease


Grave’s Disease


An underactive thyroid or hypothyroidism


An overactive thyroid or hyperthyroidism


A goiter or enlarged thyroid gland


Some other thyroid or endocrine problem : __________________


  1. Liver conditions:

Yes

If yes: year of diagnosis

No

Don’t know

Prefer not to answer

Hepatitis


Cirrhosis of the liver


Yellow jaundice


Fatty liver disease, not caused by drinking alcohol)


Some other type of liver condition: _________________


  1. Other health conditions:

Yes

If yes: year of diagnosis

No

Don’t know

Prefer not to answer

Diabetes


Pre-diabetes (impaired fasting glucose, impaired glucose tolerance, borderline diabetes or higher blood sugar than normal but not high enough to be called diabetes or sugar diabetes)


Chronic kidney disease (CKD; chronic renal insufficiency)


Porphyria (decreased red blood cell production due to abnormal porphyrin metabolism)


Cancer

Type 1:


Type 2:


Type 3:




PRESCRIPTION MEDICATIONS

These next questions will ask you about medications you may currently be taking.


Are you currently taking prescription medications for:

Yes

No

Don’t know

Prefer not to answer

  1. A thyroid condition

  1. Diabetes

YES

IF YES, What kind?

Insulin

Oral medication

Both

  1. High blood pressure

  1. High cholesterol

  1. Other health conditions



REPRODUCTIVE HISTORY – FEMALE ONLY

If male, skip to END SURVEY

These next questions will ask you about any children you have given birth to and breastfed.

  1. Have you ever been pregnant?

Yes, If yes, 66a. How many times? _______

No END INTERVIEW

Don’t know END INTERVIEW

Prefer not to answer End survey


  1. How many of these pregnancies resulted in a live birth?

Number of live births ______

Never

Don’t know

Prefer not to answer

  1. Have you ever breastfed any children?

Yes

No END INTERVIEW

Don’t know END INTERVIEW

Prefer not to answer END INTERVIEW


68b. Tell me about the children you have breastfed from the first to the most recent child, including any children you are breastfeeding now.



Birth Year (YYYY)

Birthplace

(city/state/country)

Number of months breastfeeding?

If number of months is unknown ask:

At what age did they stop breast feeding?

1st





2nd





3rd





4th





5th





6th





7th





8th





9th





10th








END OF INTERVIEW

Interviewer script:

Thank you for participating in this project. Before you leave today, we would like to know if you would be willing to invite 3 people from your community to participate in this project. Please DO NOT invite people who live in your home. We would give you 3 invitations and spend a few minutes today giving you some instructions on who to give these invitations to. The people you invite will need to bring the letter with them if they decide to participate in the project. We will give you an additional $15 gift card as a token of appreciation for each person that brings in this invitation and participates in this project like you did today.


1. Would you be willing to invite 3 people from your community to participate in this project?

NO -> thank the participant for their time and let them know they may leave.

YES -> Record serial numbers on the invitations and give them to the participant.
Coupon 1 serial number: ____________________________

Coupon 2 serial number: ____________________________

Coupon 3 serial number: ____________________________




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