Parents/Guardians and Students - Individuals and Households

I1. Student Interview English (Group 2)

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Student Interview

May 2018

Note: The burden associated with Appendix I1 is included in the burden disclosure statement for this appendix, and it is included in the same row as Appendix I1/I2 and I5 in the burden table.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-xxxx. The time required to complete this information collection is estimated to average 12 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. . [If G2: All information collected is authorized under the statutory exception at 20 U.S.C. 1232g(b)(1)(K) and will be kept private under the Privacy Act to the extent allowed by law.]. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-xxxx). Do not return the completed form to this address.

PROGRAMMER:

preload school name, student MPRID, LevelCCD (Child = e and youth = m or h), student name, student dob, student gender, student grade, SECOND DIETARY RECALL FLAG FOR YOUTH (1=FLAGGED and 2 = NOT FLAGGED), PARENT INTERVIEW STATUS (FLAG =1 IF COMPLETE, ELSE FLAG = 0)

LevelCCD = M or H

INTRO1. Okay, now we are going to start the next part of our interview. I’ll be asking about your experiences with school meals as well as your diet and physical activity. Feel free to get up and stretch for a minute or two now if you’d like.

LevelCCD = E

INTRO2. Okay, now we are going to start the next part of our interview. I’ll be asking about your experiences with school meals. Feel free to get up and stretch for a minute or two now if you’d like.

LevelCCD = E, M, or H

INTRO3. I’m going to read a privacy statement to you before we begin:

Authority: Collecting this information is authorized under Section 28(a) of the Richard B. Russell National School Lunch Act.

Purpose: The survey will provide information about students’ experiences with school meals.

Routine Use: A System of Record Notice titled FNS-8 USDA/FNS Studies and Reports describes how your information is protected.

Disclosure: You can choose to take part in the study. Whether or not you take part has no effect on services you receive or may apply for in the future.

ALL

FILL WITH NAME FROM PRELOAD FILE

I1. In order to make sure we have the correct records, can you tell me your full name? Please spell that for me.

INTERVIEWER: MAKE SURE TO REVIEW THE STUDENT’S NAME, DATE OF BIRTH, AND GENDER BEFORE STARTING THE INTERVIEW. YOU WILL CONFIRM THIS INFORMATION WITH THE STUDENT.

INTERVIEWER: IF STUDENT CANNOT SPELL THEIR NAME THEN EXPLAIN TO THE STUDENT THAT IT’S OKAY AND FILL IN MISSING INFORMATION.

[STUDENTFIRSTNAME] [STUDENTMIDDLENAME] [STUDENTLASTNAME]

CONFIRMED 1 GO TO I2

NEEDS CORRECTIONS 2

I1=2

I1a. ENTER CORRECT NAME

(STRING 50)

FIRST NAME

(STRING 50)

MIDDLE INITIAL/NAME

(STRING 50)

LAST NAME

ALL

I2. What is your date of birth?

INTERVIEWER: MAKE SURE TO REVIEW THE STUDENT’S NAME, DATE OF BIRTH, AND GENDER BEFORE STARTING THE INTERVIEW. YOU WILL CONFIRM THIS INFORMATION WITH THE STUDENT.

| | | / | | | / | | | | |

(01-12) (01-31) (1990-2015)

MONTH DAY YEAR

DON’T KNOW d

REFUSED r

SOFT CHECK: IF BORN EARLIER THAN 2002; Can you confirm this answer?

IF LEVELCCD = M OR H AND PARENT INTERVIEW = NOT COMPLETE

I2a. Are you the oldest child who lives in your household?

PROBE: Please answer for the household where you spent the most time in the last 12 months.

PROBE: If you have a twin, please consider yourselves to be the same age.

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

I3. INTERVIEWER: CODE STUDENT’S GENDER

INTERVIEWER: MAKE SURE TO REVIEW THE STUDENT’S NAME, DATE OF BIRTH, AND GENDER BEFORE STARTING THE INTERVIEW. YOU WILL CONFIRM THIS INFORMATION WITH THE STUDENT.

MALE 1

FEMALE 2

OTHER (SPECIFY) 99

ALL

I4. INTERVIEWER: CODE IF SCHOOL BREAKFAST SERVED AT SCHOOL.

YES 1

NO 0

SECTION A

ALL

1. Now I’m going to ask you some questions about what you eat and about what you like and dislike about the meals served at school.

Let me start by asking what grade you are in?

INTERVIEWER: IF STUDENT DOES NOT KNOW HIS OR HER GRADE LEVEL OR REFUSES TO ANSWER THEN YOU SHOULD ENTER THE GRADE LEVEL THAT IS PRINTED ON THE STUDENT CONTACT SHEET.

| | | RECORD GRADE

(1-12)

GRADE IN Q1 = 1-3

2a. Thinking back to the last full week of school, how often did you eat breakfast? That is breakfast anywhere—at home, at school, or somewhere else. Would you say you ate breakfast every day, most days, some days, or never?

EVERY DAY 1 GO TO Q3

MOST DAYS 2 GO TO Q3

SOME DAYS 3 GO TO Q3

NEVER 4 GO TO Q4

DON’T KNOW d GO TO Q3

REFUSED r GO TO Q3

GRADE IN Q1 = 4-12

2b. Thinking back to the last full week of school, how often did you eat breakfast? That is breakfast anywhere—at home, at school, or somewhere else. Would you say you ate breakfast every school day, ate breakfast on 3 or 4 school days, ate breakfast on 1 or 2 school days, or did not eat breakfast on any school days?

EVERY SCHOOL DAY 1

3 TO 4 SCHOOL DAYS 2

1 TO 2 SCHOOL DAYS 3

NO SCHOOL DAYS 4 GO TO Q4

DON’T KNOW d

REFUSED r

PROGRAMMER BOX Q.2A and Q.2b

GO TO Q.13 IF SCHOOL DOES NOT SERVE BREAKFAST (Qi4=0)

QI4=1 and (Q2a AND Q2b NE 4)

FILL ‘TODAY’ IF Levelccd = E, FILL ‘YESTERDAY’ IF LevelCCD = M or H

3. Did you eat the school breakfast (today/yesterday)? By school breakfast we mean a complete breakfast provided by your school, not something from home.

YES 1 GO TO Q6

NO 0

DON’T KNOW d

REFUSED r

Qi4=1 AND Q3 NE 1

4. Do you ever eat a school breakfast?

PROBE: By school breakfast we mean a complete breakfast provided by your school, not something from home.

YES 1 GO TO Q6

NO 0

DON’T KNOW d GO TO Q7

REFUSED r

Qi4=1 AND q4=0 or R

5. Why don’t you eat the school breakfast?

PROBE: Any other reason?

INTERVIEWER: Probe for additional reasons

INTERVIEWER: IF RESPONDENT LISTS MORE THAN THREE REASONS YOU SHOULD CODE ONLY THE FIRST THREE REASONS GIVEN

CODE UP TO THREE REASONS

EAT BREAKFAST AT HOME 1 GO TO Q12

DON’T LIKE SCHOOL BREAKFAST/TASTE IN GENERAL 2 GO TO Q12

NOT CONVENIENT 3 GO TO Q12

I DON’T EAT ANY BREAKFAST 4 GO TO Q12

LONG LINES, NOT ENOUGH TIME 5 GO TO Q12

MONETARY REASONS 6 GO TO Q12

TRANSPORTATION ISSUE 7 GO TO Q12

NOT NUTRITIOUS ENOUGH 8 GO TO Q12

BUSY WITH SCHOOL ACTIVITIES 9 GO TO Q12

NOT HUNGRY, DON’T FEEL LIKE EATING 10 GO TO Q12

NOT ENOUGH VARIETY, TIRED OF WHAT’S OFFERED 11 GO TO Q12

OTHER (SPECIFY) 99 GO TO Q12

DON’T KNOW d GO TO Q12

REFUSED r GO TO Q12

IF OTHER SPECIFY (99): Please specify a reason.

Qi4=1 AND (Q3 = 1 OR Q4 = 1)

6. What is the number one reason you eat school breakfasts?

INTERVIEWER: IF MORE THAN ONE REASON, PROBE FOR MAIN REASON.

EASY/CONVENIENT TO GET 1

LIKE THE FOOD (GENERAL) 2

I AM HUNGRY 3

PARENTS WANT ME TO 4

NO OTHER CHOICE 5

FRIENDS EAT THERE 6

IT’S FREE/PRICES ARE GOOD 7

OTHER (SPECIFY) 99

(STRING 250)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a reason:

Qi4=1 AND (Q3=1 OR Q4=1)

7. What do you think about school breakfast? Do you like it, think it is only okay, or don’t like it?

INTERVIEWER: SHOW HAND CARDS WITH SMILEY FACES FOR STUDENTS IN GRADE 1-3 WHILE READING ANSWER CATEGORIES.

LIKE IT 1

ONLY OKAY 2

DON’T LIKE IT 3

DON’T KNOW d

REFUSED r

Qi4=1 AND (Q7= NOT NULL)

8. Is there enough time to eat the school breakfast before classes begin?

YES 1

NO 0

DON’T KNOW d

REFUSED r

Qi4=1 AND (Q7= NOT NULL)

9. Do you think school breakfast is served too early in the day, too late, or is the time it is served okay?

TOO EARLY 1

TOO LATE 2

OKAY 3

DON’T KNOW d

REFUSED r

Qi4=1 AND Q1 = 1-3 AND Q9=NOT NULL

10. Do you usually eat a school breakfast three or more times a week?

YES 1

NO 0 GO TO 10b

DON’T KNOW d

REFUSED r

Qi4=1 AND Q1 = 4-12 AND Q9=NOT NULL

10a. How many days a week do you usually eat a school breakfast?

NONE-DON’T USUALLY EAT SCHOOL BREAKFAST 0 GO TO 10b

ONE 1 GO TO 10b

TWO 2 GO TO 10b

THREE 3

FOUR 4

FIVE 5

DON’T KNOW d

REFUSED r

Qi4=1 AND (Q10=0 or Q10a = 0, 1, 2)

10b. Why don’t you usually eat the school breakfast?

PROBE: Any other reason?

INTERVIEWER: Probe for additional reasons

INTERVIEWER: IF RESPONDENT LISTS MORE THAN THREE REASONS YOU SHOULD CODE ONLY THE FIRST THREE REASONS GIVEN

CODE UP TO THREE REASONS

EAT BREAKFAST AT HOME 1

LONG LINES, NOT ENOUGH TIME 2

FOODS OFFERED ARE NOT APPEALING/NOT TASTY 3

MONETARY REASONS 4

TRANSPORTATION ISSUE 5

NOT CONVENIENT 6

NOT NUTRITIOUS ENOUGH 7

BUSY WITH SCHOOL ACTIVITIES 8

I DON’T EAT BREAKFAST 9

OTHER (SPECIFY) 99

(STRING 250)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a reason:

Qi4=1 AND (Q10=NOT NULL OR Q10a=NOT NULL) AND Q10a NE 0

11. Where do you usually eat school breakfast?

CAFETERIA 1

CLASSROOM 2 GO TO Q13

GYMNASIUM 3

OUTDOORS 4

OTHER (SPECIFY) 99

(STRING 100)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a location:

ASK IF Q10 =0 OR 10a = 0, 1, 2 AND Q11 NE 2

FILL WITH “MORE OFTEN/MAS SEGUIDO” IF Q10 =0 OR 10a = 0, 1, 2, or 3

12. Would you eat breakfast at school (more often) if it was served in your classroom?

YES 1

NO 0

NO, ALREADY SERVED IN CLASSROOM 2

ALREADY EAT BREAKFAST EVERY DAY 3

DON’T KNOW d

REFUSED r

ALL

FILL ‘TODAY’ IF levelccd = e, FILL ‘YESTERDAY’ IF levelccd = m or h

13. Now I’d like to ask you about lunch. What time is your lunch period?

INTERVIEWER: IF RESPONDENT SAYS IT VARIES BY DAY, ASK FOR [TODAY/YESTERDAY].

| | | HOURS (1-12) : | | | MINUTES (0-59)

AM 1

PM 2

DON’T KNOW d

REFUSED r

SOFT CHECK: IF 3PM TO 5PM OR 8AM TO 10AM: Can you confirm that this time is correct?

HARD CHECK: IF > 5PM OR < 8AM; That time does not appear to be during the school day. Please tell me what time your school lunch period is.

ALL

FILL ‘TODAY’ IF levelccd = e, FILL ‘YESTERDAY’ IF levelccd = m or h

14. Did you eat the school lunch [today/yesterday]? By school lunch, I mean a complete meal—such as salad, soup, a sandwich, or a hot meal—not just milk, snacks, cookies, or ice cream, and not a lunch you brought from home.

YES 1

NO 0 GO TO Q14b

DON’T KNOW d GO TO Q15

REFUSED r GO TO Q15

Q14 = 1

14a. Did you buy any other foods in school to go along with your school lunch, such as snacks, cookies, ice cream, a drink, french fries, pizza, or fruit?

YES 1 GO TO Q17

NO 0 GO TO Q17

DON’T KNOW d GO TO Q17

REFUSED r GO TO Q17

Q14 = 0

14b. Did you stay at school for lunch, go home, go off the school grounds, or did you do something else for lunch?

SCHOOL 1

HOME 2

OFF SCHOOL GROUNDS 3

OTHER (SPECIFY) 99

(STRING 100)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a response:

Q14 = D, R OR Q14b=NOT NULL

15. Do you ever eat the school lunch?

YES 1 GO TO Q17

NO 0

DON’T KNOW d GO TO Q19

REFUSED r GO TO Q19

Q15=0

16. Why don’t you eat the school lunch?

PROBE: Any other reason?

INTERVIEWER: IF RESPONDENT LISTS MORE THAN THREE REASONS YOU SHOULD CODE ONLY THE FIRST THREE REASONS GIVEN.

CODE UP TO 3 REASONS

BRING LUNCH FROM HOME 1

DON’T LIKE SCHOOL LUNCH/TASTE IN GENERAL 2

NOT NUTRITIOUS ENOUGH 3

MONETARY REASONS 4

EAT LUNCH OFF CAMPUS 5

PORTIONS NOT BIG ENOUGH/NOT ENOUGH FOOD 6

NOT ENOUGH VARIETY, TIRED OF WHAT’S OFFERED 7

LONG LINES, NOT ENOUGH TIME 8

NOT HUNGRY, DON’T FEEL LIKE EATING 9

I DON’T EAT ANY LUNCH 10

SPECIAL DIET (VEGETARIAN, RELIGIOUS RESTRICTIONS, WEIGHT LOSS) 11

PARENT PROHIBITS/LIMITS HOW OFTEN EAT SCHOOL LUNCH 12

LEAVE SCHOOL BEFORE LUNCH IS SERVED 13

WANT A LA CARTE ITEM 14

BUSY WITH SCHOOL ACTIVITIES 15

OTHER (SPECIFY) 99

(STRING 100)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a response:

PROGRAMMER BOX Q.16

IF levelccd = m or h AND Q16_14=1 THEN GO TO Q41;

OR IF levelccd = e AND Q16_14=1 GO TO Q59;

IF Q.15=0 then GO TO Q21

ELSE Continue

Q14a =NOT NULL OR Q15 = 1

17. What is the number one reason you eat the school lunch?

INTERVIEWER: IF MORE THAN ONE REASON, PROBE FOR MAIN REASON.

I AM HUNGRY 1

LIKE THE FOOD (GENERAL) 2

EASY/CONVENIENT TO GET 3

PARENTS WANT ME TO 4

NO OTHER CHOICE 5

NO TIME TO MAKE LUNCH 6

NO ONE AT HOME TO MAKE LUNCH 7

LIKE TODAY’S/YESTERDAY’S MEAL 8

IT’S FREE/PRICES ARE GOOD 9

OTHER (SPECIFY) 99

(STRING 100)

DON’T KNOW d

REFUSED r

SOFT CHECK IF Q17=3: What is the number one reason you usually eat the school lunch, not just the lunch today or yesterday? INTERVIEWER: RE-CODE IF STUDENT CHANGES RESPONSE AFTER PROBE.

IF OTHER SPECIFY (99): Please specify a response:

(Q14a =NOT NULL OR Q15 = 1) AND Q1=1-3

18. Do you usually eat a school lunch three or more times a week?

YES 1

NO 0

DON’T KNOW d

REFUSED r

(Q14a =NOT NULL OR Q15 = 1) AND Q1=4-12

18a. How many days a week do you usually eat a school lunch?

NONE-DON’T USUALLY EAT SCHOOL LUNCH 0

ONE 1

TWO 2

THREE 3

FOUR 4

FIVE 5

DON’T KNOW d

REFUSED r

Q15=1

19. What do you think about school lunch? Do you like it, think it is only okay, or don’t like it?

INTERVIEWER: SHOW HAND CARDS WITH SMILEY FACES FOR STUDENTS IN GRADE 1-3 WHILE READING ANSWER CATEGORIES.

LIKE IT 1

ONLY OKAY 2

DON’T LIKE IT 3

DON’T KNOW d

REFUSED r

Q14a =NOT NULL OR Q15 = 1, D, OR R

20. Are you required to take certain foods or put certain foods on your tray such as milk, when you get the school lunch or can you turn down foods you don’t want?

REQUIRED TO TAKE CERTAIN FOODS 1

CAN TURN DOWN FOODS 2

DON’T KNOW d

REFUSED r

SECTION B

ALL

21. Do you think your lunch period is too early in the day, too late, or is your lunch period time about right?

TOO EARLY 1

TOO LATE 2

ABOUT RIGHT 3

DON’T KNOW d

REFUSED r

ALL

22. I want to ask you some questions about the place where you eat your lunch, like the cafeteria, gym, classroom, or wherever you eat your lunch.

Would you say the place you eat your lunch is usually too noisy, too quiet, or about right?

TOO NOISY 1

TOO QUIET 2

ABOUT RIGHT 3

DON’T KNOW d

REFUSED r

ALL

23. Would you say the tables are always, usually, sometimes, or never clean?

ALWAYS 1

USUALLY 2

SOMETIMES 3

NEVER 4

DON’T KNOW d

REFUSED r

ALL

24. Would you say the floor is always, usually, sometimes, or never clean?

ALWAYS 1

USUALLY 2

SOMETIMES 3

NEVER 4

DON’T KNOW d

REFUSED r

ALL

25. Would you say there are usually plenty of seats and tables, or not enough seats and tables?

USUALLY PLENTY 1

NOT ENOUGH 2

DON’T KNOW d

REFUSED r

ALL

26. Would you say most of the time there are long lines, short lines, no lines, or it depends on what is served?

LONG 1

SHORT 2

NO LINES 3

DEPENDS ON WHAT IS SERVED 4

DON’T KNOW d

REFUSED r

ALL

27. Do you have enough time to eat your lunch after you have your food and you are seated?

YES 1

NO 2

SOMETIMES 3

DON’T KNOW d

REFUSED r

Questions 28 and 29 do not appear in this version.

ALL

30. Do you get to pick where you sit and who you can eat with during your lunch period?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

31. Now I’d like to ask you about the food served at lunch by the school.

SHOW CARD #2

INTERVIEWER: SHOW HAND CARD WITH PICTURES OF ADVERBS OF FREQUENCY TO STUDENTS IN GRADES 1-3 WHILE READING ANSWER CATEGORIES.

	ALWAYS	OFTEN	SOMETIMES	NEVER	DON’T KNOW	REFUSED
a. Do you always, often, sometimes, or never like the taste of the food?	1	2	3	4	d	r
b. Do you always, often, sometimes, or never like the smell of the food?	1	2	3	4	d	r
c. Do you always, often, sometimes, or never like the way the food looks?	1	2	3	4	d	r
d. Not counting French fries, do the vegetables on the serving line always, often, sometimes, or never look good?	1	2	3	4	d	r
e. Not counting French fries, do you always, often, sometimes, or never like the vegetables on the serving line?	1	2	3	4	d	r
f. Do the fruits on the serving line always, often, sometimes, or never look good?	1	2	3	4	d	r
g. Do you always, often, sometimes, or never like the fruits on the serving line?	1	2	3	4	d	r
h. Does the serving line always, often, sometimes, or never have the kind of milk you like?	1	2	3	4	d	r

Q14=1 OR Q15=1

IF GRADE IN Q1=1-3, FILL “Whole grains foods are darker in color….”

If grade in q1=4-12, fill “Examples of whole grains are….”

32. FILL IF IN GRADES 1-3: (Whole grain foods are darker in color. Examples are brown bread or brown pizza crust instead of white bread or crust, brown rice instead of white rice, and brown spaghetti instead of white spaghetti.)

FILL IF IN GRADES 4 and ABOVE: (Examples of whole grains are whole wheat bread, pizza crust, or tortillas, whole grain pasta, and brown rice.)

ALL: Do you always, often, sometimes, or never like the whole grain foods in the serving line?

INTERVIEWER: SHOW HAND CARD WITH PICTURES OF ADVERBS OF FREQUENCY TO STUDENTS IN GRADES 1-3 WHILE READING ANSWER CATEGORIES.

ALWAYS 1

OFTEN 2

SOMETIMES 3

NEVER 4

DON’T KNOW d

REFUSED r

Q14=1 OR Q15=1

33. Do you think the amount of food they give you is too much, too little, or about right?

TOO MUCH 1

TOO LITTLE 2

ABOUT RIGHT 3

DON’T KNOW d

REFUSED r

Q14=1 OR Q15=1

33a. Do you think that the food served is too salty, not salty enough, or about right?

TOO SALTY 1

NOT SALTY ENOUGH 2

ABOUT RIGHT 3

DON’T KNOW d

REFUSED r

ALL

34. Does the school menu always, often, sometimes, or never include foods you like?

INTERVIEWER: SHOW HAND CARD WITH PICTURES OF ADVERBS OF FREQUENCY TO STUDENTS IN GRADES 1-3 WHILE READING ANSWER CATEGORIES.

ALWAYS 1

OFTEN 2

SOMETIMES 3

NEVER 4

DON’T KNOW d

REFUSED r

ALL

35. Does the school lunch always, often, sometimes, or never have enough choices of food?

INTERVIEWER: SHOW HAND CARD WITH PICTURES OF ADVERBS OF FREQUENCY TO STUDENTS IN GRADES 1-3 WHILE READING ANSWER CATEGORIES.

ALWAYS 1

OFTEN 2

SOMETIMES 3

NEVER 4

DON’T KNOW d

REFUSED r

Q14=1 OR Q15=1

36. What is your favorite school lunch?

IF NEEDED, PROBE: The main course.

RECORD ANSWER ON NEXT SCREEN 1

NO FAVORITE FOOD 0

DON’T KNOW d

REFUSED r

IF ANSWER (1): Description:

Q14=1 OR Q15=1

37. What is your least favorite school lunch?

IF NEEDED, PROBE: The main course.

RECORD ANSWER ON NEXT SCREEN 1

LIKE ALL THE FOODS, NO LEAST FAVORITE FOOD 0

DON’T KNOW d

REFUSED r

IF ANSWER (1): Description:

ALL

38. Do all kids that get the school lunch pay the same amount for the lunch, or do some kids pay less or get it for free?

ALL PAY THE SAME AMOUNT 1

EVERYONE GETS IT FOR FREE 2

SOME PAY LESS/ SOME GET IT FREE 3 GO TO Q39

DON’T KNOW d

REFUSED r

PROGRAMMER BOX 38.

IF Q38 is 1, 2, d, r AND LevelCCD = M or H GO TO Q41;

IF Q38 is 1, 2, d, r AND LevelCCD = E GO TO Q56;

ELSE GO TO Q39

Q38 = 3

39. Can you tell who is getting the school lunches for free or less than the full price?

YES 1 GO TO Q40

NO 0

DON’T KNOW d

REFUSED r

PROGRAMMER BOX 39.

IF Q39 is 0, d, or r AND LevelCCD = M or H GO TO Q41;

IF Q39 is 0, d, or r AND LevelCCD = E GO Q56;

ELSE GO TO Q40

Q39 = 1

40. How do you know?

AMOUNT PAID TO CASHIER 1

FORM OF PAYMENT (TICKET, TOKEN, ETC.) 2

PERSONAL KNOWLEDGE 3

CASHIER CHECKS LIST OR SAYS SOMETHING TO STUDENT 4

SEPARATE LINE 5

APPEARANCE OR BEHAVIOR 6

CAN SEE ON REGISTER/SCREEN 7

OTHER (SPECIFY) 99

(STRING 100)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a response:

PROGRAMMER BOX 40.

IF LevelCCD = E GO TO Q69;

IF LevelCCD = M or H AND StuFS = 1, CONTINUE TO Q41

IF LevelCCD = M or H AND StuFS = 2 ASK Q50-58, THEN Q41-49, THEN PROCEED TO Q59

SECTION C

Levelccd = M or H

41. The following questions are about the food situation in your home during the last 12 months. Some of the questions might sound similar to each other. Please answer as best you can. Please tell us whether each happened to you a lot, sometimes, or never.

[SHOW CARD]

During the last 12 months, did you worry that food at home would run out before your family got money to buy more? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

42. During the last 12 months, did the food that your family bought run out, and you didn’t have money to get more? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

43. During the last 12 months, did your meals only include a few kinds of cheap foods because your family was running out of money to buy food? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

44. During the last 12 months, how often were you not able to eat a balanced meal because your family didn’t have enough money? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

45. During the last 12 months, did you have to eat less because your family didn’t have enough money to buy food? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

46. During the last 12 months, has the size of your meals been cut because your family didn’t have enough money for food? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

47. During the last 12 months, did you have to skip a meal because your family didn’t have enough money for food? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

48. During the last 12 months, were you hungry but didn’t eat because your family didn’t have enough food? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

49. During the last 12 months, did you not eat for a whole day because your family didn’t have enough money for food? Would you say this happened a lot, sometimes, or never?

A LOT 1

SOMETIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

50. Next, I will read you some statements that children have made about their food situation. For each statement, please say whether this happened to you many times, 1 or 2 times, or never in the last 12 months.

We can’t get the food we want because there is not enough money. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

[SHOW CARD]

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

51. I worry about how hard it is for my parents to get enough food for us. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

52. I worry about not having enough to eat. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

53. I feel hungry, because there is not enough food to eat. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

54. I get really tired, because there is not enough food to eat. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

55. I act ok when we don’t have enough money to buy the foods I want. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

56. I try not to eat a lot so that our food will last. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

57. I bring food home so that there is enough for everyone to eat. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

58. I work to earn money so that we can have enough food. Would you say this happened many times, 1 or 2 times, or never in the last 12 months?

MANY TIMES 1

1 OR 2 TIMES 2

NEVER 3

DON’T KNOW d

REFUSED r

Levelccd = M or H

59. The next questions are about your eating habits.

How many nights a week do you and your family typically sit down together to have dinner as a family?

EVERY NIGHT 1

5 OR 6 NIGHTS A WEEK 2

3 OR 4 NIGHTS A WEEK 3

1 OR 2 NIGHTS A WEEK 4

NEVER 5

DON’T KNOW d

REFUSED r

levelccd = m or h

60. During the past 30 days, did you eat less food, fewer calories, or foods low in fat or carbohydrates to lose weight or to keep from gaining weight?

YES 1

NO 0

DON’T KNOW d

REFUSED r

levelccd = m or h

61. On an average school day, about how many hours do you watch TV or DVDs, use a computer, go online, or play video or computer games for something that is not school work?

PROBE: Count time spent on things such as Xbox, PlayStation, an iPod, an iPad or other tablet, a smartphone, YouTube, Facebook or other social networking tools, and the Internet.

INTERVIEWER: IF RANGE GIVEN, TAKE THE MID POINT. ROUND TO NEAREST HALF HOUR.

| | | . | | HOURS

(HOUR NUMBER RANGE: 0-24; DECIMAL NUMBER: 0 or 5)

DON’T KNOW d

REFUSED r

SOFT CHECK: IF > 12.0 HOURS: Can you confirm this answer?

levelccd = m or h

IF I3 = 1 THEN FILL WITH ‘BOYS.’ IF I3 = 2 THEN FILL WITH ‘GIRLS.’

62. Compared to other [boys/girls] the same age, would you say you are less active, about as active, more active, or much more active?

LESS ACTIVE 1

ABOUT AS ACTIVE 2

MORE ACTIVE 3

MUCH MORE ACTIVE 4

DON’T KNOW d

REFUSED r

levelccd = m or h

63. During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time. Examples of these activities are competitive sports, running, biking, brisk walking, swimming laps, dancing or pushing a lawn mower.

0 days 0

1 day 1

2 days 2

3 days 3

4 days 4

5 days 5

6 days 6

7 days 7

DON’T KNOW d

REFUSED r

PROGRAMMER BOX Q63.

IF PARENT INTERVIEW STATUS = 1 THEN GO TO Q69;

ELSE PROCEED TO Q64.

levelccd = m or h

64. And finally, we would like to follow-up with your parent or guardian in order to better understand their feelings about the meals served at this school. In order to do this, I will need you to give me some contact information.

First, which adult tends to prepare most of the meals in your home?

INTERVIEWER: READ LIST ONLY IF NECESSARY.

MOTHER/FATHER/PARENT 1

PARENT’S SPOUSE OR PARTNER 2

GRANDPARENT 3

OTHER RELATIVE 4

LEGAL GUARDIAN 5

OTHER (SPECIFY) 99

(STRING 100)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a response.

level ccd = m or h

64a. And, what is (HIS/HER/YOUR PARENT OR GUARDIAN’S) first name?

(STRING 100)

FIRST NAME

DON’T KNOW d

REFUSED r

levelccd = m or h

64b. And, what is (HIS/HER) last name?

(STRING 100)

LAST NAME

DON’T KNOW d

REFUSED r

levelccd = m or h

65a. What is (HIS/HER) home phone number?

| | | | - | | | | - | | | | |

(RANGE) (RANGE) (RANGE)

DOESN’T HAVE HOME PHONE NUMBER 0

DON’T KNOW d

REFUSED r

levelccd = m or h

65b. And, what is (HIS/HER) cellular phone number?

| | | | - | | | | - | | | | |

(RANGE) (RANGE) (RANGE)

DOESN’T HAVE CELLULAR PHONE NUMBER 0

DON’T KNOW d

REFUSED r

levelccd = m or h

65d. And, what is (HIS/HER) email address?

(STRING 100)

EMAIL ADDRESS

DOESN’T HAVE EMAIL ADDRESS 0

DON’T KNOW d

REFUSED r

PROGRAMMER BOX 66.

If no PHONE numberS provided (65a, 65b, and 65c are all 0, d, or r) GO TO Q69

levelccd = m or h and (Q65A, Q65B, AND Q65C NE n, d, or r)

66. What is the best language to use when contacting (HIM/HER)? Is it…

English, or 1

Spanish? 2

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a response.

levelccd = m or h and (Q65A, Q65B, AND Q65C NE n, d, or r)

67. What is the best time to reach (HIM/HER)?

TEXT FIELD

DON’T KNOW d

REFUSED r

levelccd = m or h and (Q65A, Q65B, AND Q65C NE n, d, or r) [ONLY SHOW IF MORE THAN 1 NUMBER GIVEN]

PROGRAMMER NOTE: POPULATE RESPONSE FIELDS BASED ON WHAT NUMBERS WERE GIVEN.

68. Finally, which of the phone numbers that you gave me should I use to reach (HIM/HER) when I call?

HOME PHONE 1

CELL PHONE 2

DON’T KNOW d

REFUSED r

SECTION D

ALL

69. Thank you for all of your responses. We are almost finished. Now, I am going to measure your height and your weight. We are going to go over to where we are doing the measurements. Let’s walk there together now.

WEIGHT:

INTERVIEWER: ENTER WEIGHT MEASUREMENT TO THE NEAREST 0.2 POUNDS

INTERVIEWER: ASK STUDENTS TO REMOVE SHOES, HATS, and EXTRA CLOTHES

INTERVIEWER: PLEASE MAKE SURE THE RESPONDENT IS WITH YOU WHILE YOU ARE ENTERING the NUMBERS INTO CAPI. IF THE PROGRAM DOES NOT ALLOW YOU TO PROCEED THEN YOU WILL NEED TO RETAKE THE MEaSUREMENT.

FIRST MEASUREMENT | | | | . | | PoUNDS (RANGE 000.0-308.0) 1

DID NOT COMPLETE MEASUREMENT 0 GO TO 70

REFUSED r GO TO 71

SOFT CHECK: IF LT 30 OR GT 200; Please confirm that the value entered matches your measurement.

Q69 NE 0 OR r

69a. WEIGHT:

INTERVIEWER: ENTER WEIGHT MEASUREMENT TO THE NEAREST 0.2 POUNDS

INTERVIEWER: ASK STUDENTS TO REMOVE SHOES, HATS, EXTRA CLOTHES

INTERVIEWER: PLEASE MAKE SURE THE RESPONDENT IS WITH YOU WHILE YOU ARE ENTERING the NUMBERS INTO CAPI. IF THE PROGRAM DOES NOT ALLOW YOU TO PROCEED THEN YOU WILL NEED TO RETAKE THE MEaSUREMENT.

SECOND MEASUREMENT | | | | . | | POUNDS (RANGE 000.0-308.0) 1

DID NOT COMPLETE MEASUREMENT 0 GO TO 70

REFUSED r GO TO 70

SOFT CHECK: IF LT 30 OR GT 200; Please confirm that the value entered matches your measurement.

	PROGRAMMER BOX 69b. IF DIFFERENCE BETWEEN Q69 AND Q69a IS GREATER THAN 1.0 POUND, GO TO Q69b; ELSE SKIP TO Q70
| Q69 – Q69a | > 1.0

69b. WEIGHT:

INTERVIEWER: ENTER WEIGHT MEASUREMENT TO THE NEAREST 0.2 POUNDS

INTERVIEWER: ASK STUDENTS TO REMOVE SHOES, HATS, EXTRA CLOTHES

INTERVIEWER: THERE IS A MORE THAN 1 POUND DIFFERENCE BETWEEN THE TWO PREVIOUSLY ENTERED WEIGHT MEASUREMENTS. PLEASE TAKE A THIRD MEASUREMENT. DO NOT change your previously entered measurements.

INTERVIEWER: IF YOU ARE NO LONGER ABLE TO COMPLETE THE THIRD MEASUREMENT, MARK “STUDENT DID NOT COMPLETE MEASUREMENt.”

THIRD MEASUREMENT | | | | . | |PoUNDS (RANGE 000.0 – 308.0) 1

DID NOT COMPLETE MEASUREMENT 0

REFUSED r

SOFT CHECK: IF LT 30 OR GT 200; Please confirm that the value entered matches your measurement.

Q69 NE r

70. CONCERNS ABOUT WEIGHT MEASUREMENT:

NO CONCERNS 1

WEARING HEAVY CLOTHING, BRACE, OR CAST 2

WEARING SHOES 3

WEIGHT EXCEEDED SCALE LIMIT 4

PREGNANT 5

DIFFICULTY OBTAINING MEASUREMENT 6

STUDENT OR PARENT REPORT 7 GO TO 70A

OTHER (SPECIFY) 8

(STRING (NUM))

IF OTHER SPECIFY (99): Please specify a response.

Q70=7

70a. INTERVIEWER: DESCRIBE REASON FOR STUDENT OR PARENT REPORT

(STRING 200)

ALL

71. STANDING HEIGHT:

INTERVIEWER: ENTER HEIGHT MEASUREMENT TO THE NEAREST centimeter

INTERVIEWER: ASK STUDENTS TO REMOVE SHOES, HATS, EXTRA CLOTHES

INTERVIEWER: PLEASE MAKE SURE THE RESPONDENT IS WITH YOU WHILE YOU ARE ENTERING the NUMBERS INTO CAPI. IF THE PROGRAM DOES NOT ALLOW YOU TO PROCEED THEN YOU WILL NEED TO RETAKE THE MEaSUREMENT.

FIRST MEASUREMENT | | | | CENTIMETERS (RANGE 0-206) 1

DID NOT COMPLETE MEASUREMENT 0 GO TO PROGRAMMER BOX Q71A

REFUSED r GO TO PROGRAMMER BOX Q72A

SOFT CHECK: IF LT 92 OR GT 196; Please confirm that the value entered matches your measurement.

PROGRAMMER BOX Q71a.

IF Q71=0 OR R AND levelccd = e, GO TO END1;

ELSE IF Q71=0 OR R AND levelccd = m or h AND FLAGGED FOR THE 2nd DIETARY RECALL GO TO SELECTED YOUTH;

ELSE IF Q71=0 OR R AND levelccd = m or h AND NOT FLAGGED FOR THE 2nd DIETARY RECALL GO TO END3;

else go to Q71a

Q71 NE 0 OR r

71a. STANDING HEIGHT:

INTERVIEWER: ENTER Height MEASUREMENT TO THE NEAREST centimeter

INTERVIEWER: ASK STUDENTS TO REMOVE SHOES, HATS, EXTRA CLOTHES

INTERVIEWER: PLEASE MAKE SURE THE RESPONDENT IS WITH YOU WHILE YOU ARE ENTERING the NUMBERS INTO CAPI. IF THE PROGRAM DOES NOT ALLOW YOU TO PROCEED THEN YOU WILL NEED TO RETAKE THE MEaSUREMENT.

SECOND MEASUREMENT | | | |CENTIMETERS (RANGE 0-206) 1

DID NOT COMPLETE MEASUREMENT 0 GO TO Q72

REFUSED r GO TO Q72

SOFT CHECK: IF LT 92 OR GT 196; Please confirm that the value entered matches your measurement.

PROGRAMMER BOX 71B.

IF DIFFERENCE BETWEEN Q71 AND Q71a IS GREATER THAN 2 CENTIMETERS, GO TO Q71b;

ELSE SKIP TO Q72

| Q71 – Q71a | > 2

71b. STANDING HEIGHT:

INTERVIEWER: ENTER Height MEASUREMENT to the nearest CeNtimeter

INTERVIEWER: ASK STUDENTS TO REMOVE SHOES, HATS, EXTRA CLOTHES

INTERVIEWER: IF THERE IS A MORE THAN 2 centimeters DIFFERENCE BETWEEN THE TWO PREVIOUSLY ENTERED MEASUREMENTS. PLEASE TAKE A THIRD MEASUREMENT. DO NOT change your previously entered measurements.

INTERVIEWER: IF YOU ARE NO LONGER ABLE TO COMPLETE THE THIRD MEASUREMENT, MARK “STUDENT DID NOT COMPLETE MEASUREMENt.”

THIRD MEASUREMENT | | | | CENTIMETERS (RANGE 0-206) 1

DID NOT COMPLETE MEASUREMENT 0

REFUSED r

SOFT CHECK: IF LT 92 OR GT 196; Please confirm that the value entered matches your measurement.

Q71 NE r

72. CONCERNS ABOUT HEIGHT MEASUREMENT:

NO CONCERNS 1

WEARING SHOES OR BOOTS 2

HAIR, HAIR PIECE, OR HAT INTERFERED 3

DIFFICULTY OBTAINING MEASUREMENT 4

STUDENT OR PARENT REPORT 5 GO TO 72A

OTHER (SPECIFY) 6

(STRING 250)

IF OTHER SPECIFY (99): Please specify a response.

Q72=5

72a. INTERVIEWER: DESCRIBE REASON FOR STUDENT OR PARENT REPORT

(STRING 200)

PROGRAMMER BOX Q72a.

IF LevelCCD = E GO TO END1;

ELSE IF LevelCCD = M or H AND Dietary2_Recall=1 (from load) GO TO SELECTED YOUTH;

ELSE IF LevelCCD = M or H AND Dietary2_Recall=2 GO TO END3.

LevelCCD = E

END1. Those are all the questions I have today. You’ve done great. Now I’m going to give you a ruler, measuring cups, measuring spoons, and a book to help you describe what you ate. Please give these to your parent to use when someone calls them for the phone interview. You can keep all of them.

Here is a $5 gift card to thank you for all your help. Please sign this gift card receipt.

INTERVIEWER: GIVE CHILD GIFT CARD AND INDICATE PARENT INTERVIEW DATE AND TIME ON COVER OF FOOD DIARY. ASK TO SIGN RECEIPT AND IF CHILD NEEDS A PASS TO GET BACK INTO CLASS.

IF LevelCCD = M or H AND Dietary2_Recall=1 (from load)

SELECTED YOUTH. Thanks for all of your help today. Before we’re done I’d like to schedule a time for one of my team members to call you for a second interview about what you ate. We’d like to call you on the phone in 3 to 5 days to do this. That would be [DAY] to [DAY]. We will mail you an additional $15 gift card for your help. What day and time can we call you to complete the second part of the dietary recall?

INTERVIEWER: THIS INTERVIEW CAN TAKE PLACE ON TUESDAYS THROUGH SATURDAYS ONLY.

INTERVIEWER: IF YOUTH DOES NOT WANT TO OR CAN’T COMMIT TO AN APPOINTMENT, MARK “DON’T KNOW.” IF YOUTH REFUSES SECOND DIETARY RECALL, MARK REFUSED.

RECORD TIME AND DAY 1

DON’T KNOW d GO TO SELECTED PHONE

REFUSED r GO TO END3

SELECTED YOUTH=1

SELECTED YOUTH TIME.

| | | HOURS (1-12) : | | | MINUTES (0-59) [AM/PM]

SELECTED YOUTH=1

ONLY DISPLAY AVAILABLE DAYS THAT ARE 3-5 DAYS FROM THE DATE OF THE INTERVIEW

SELECTED YOUTH DAY.

TUESDAY 3

WEDNESDAY 4

THURSDAY 5

FRIDAY 6

SATURDAY 7

SELECTED YOUTH NE R AND IF LevelCCD = M or H AND Dietary2_Recall=1 (from load)

SELECTED PHONE. What number can we call at that time? If possible, we would prefer to use a landline.

INTERVIEWER: REFER TO THE STUDENT CONTACT SHEET FOR PHONE NUMBERS IF RESPONDENT IS UNABLE TO PROVIDE A PHONE NUMBER.

| | | | - | | | | - | | | | |

(RANGE) (RANGE) (RANGE)

DON’T KNOW d

REFUSED r

SELECTED PHONE IS NOT NULL

SELECTED PHONETYPE. Is the number a home phone or cell phone?

HOME PHONE 1

CELL PHONE 2

DON’T KNOW d

REFUSED r

SELECTED YOUTH NE R

END2. Thanks for your help. Now I’m going to give you a ruler, measuring cups, measuring spoons, and a book to help you describe what you ate. Please have these near you when someone calls you for the phone interview. You can keep all of them.

Those are all the questions I have today. You’ve done great. Thanks for all your help. Here is your gift card. Please sign the receipt and leave it with me.

INTERVIEWER: GIVE RULER, MEASURING CUPS, MEASURING SPOONS, AND PORTION REFERENCE BOOKLET. GIVE GIFT CARD AND ASK YOUTH TO SIGN RECEIPT. ASK IF YOUTH NEEDS A PASS TO GET BACK TO CLASS.

SELECTED YOUTH=R OR (IF LevelCCD = M or H AND Dietary2_Recall=2)

END3. Those are all the questions I have today. You’ve done great. Thanks for all your help. Here is your gift card. Please sign the receipt and leave it with me.

INTERVIEWER: GIVE GIFT CARD AND ASK YOUTH TO SIGN RECEIPT. ASK IF YOUTH NEEDS A PASS TO GET BACK TO CLASS.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	SNMCS CHILD YOUTH INTERVIEW
Subject	CAPI
Author	Mathematica Staff
File Modified	0000-00-00
File Created	2021-01-22