AI/AN FACES 2019 Head Start parent survey
OPRE Evaluation: Head Start Family and Child Experiences Survey (FACES 2019) [Nationally representative studies of HS programs]
Attachment 17. AIAN FACES 2019 PARENT SURVEY_20200401_CLEAN
AI/AN FACES 2019 Head Start parent survey
OMB: 0970-0151
O
MB
#: 0970-0151
American Indian and Alaska Native Head Start Family and Child Experiences Survey 2019 (AI/AN FACES 2019)
Parent Survey
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Fall 2019 – Spring 2020
Welcome to the American Indian and Alaska Native Head Start Family and Child Experiences Survey (AI/AN FACES 2019) parent survey. Please refer to the instructions you received to find your login ID and password. To begin the survey, enter your login ID and password in the fields below, and then click OK. If you do not have your login ID and password, please call 877-523-4651. You can also email us at [email protected].
Username:
Password:___________________________
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Paperwork Reduction Act Statement: This collection of information is voluntary. 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. The valid OMB control number for this information collection is 0970-0151 which expires 04/30/2022. The time required to complete this collection of information is estimated to average 30 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the collection of information. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: Mathematica, 1100 1st Street, NE, 12th Floor, Washington, DC 20002, Attention: Lizabeth Malone.
SCREENER
intro1= continue |
Intro2.
SURVEY INFORMATION
Mathematica is conducting the American Indian and Alaska Native Head Start Family and Child Experiences Survey (AI/AN FACES) for the Administration for Children and Families (ACF). ACF is part of the U.S. Department of Health and Human Services.
We are inviting you to complete a survey about you and your child, because he or she is in a Head Start program that is taking part in AI/AN FACES. This study aims to learn more about families in Head Start and the services Head Start provides. By completing this survey, you will help Head Start serve all children and their families. The survey will take about 30 minutes to complete.
Your answers to this survey will be kept private to the extent permitted by law. No one from your child’s Head Start program will see your answers. Using the login ID and password ensures that your answers will only be seen by the study team. The next page will tell you how to complete the survey.Please click the button below to continue or close this webpage to exit.
SCREENER |
WEB ONLY |
Intro3.
How to Complete the Survey
Thank you for taking the time to complete this survey.
There are no right or wrong answers.
To answer a question, click the box to choose your response.
To continue to the next webpage, click the “Next” button.
To go back to the previous webpage, click the “Back” button. Please note that this command is only available in certain sections.
If you need to stop before you have finished, close out of the webpage. The data you provide prior to logging out will be securely stored and available when you return to complete the survey.
For security purposes, you will be timed out of the survey if you are idle for longer than 30 minutes.
Please click on the button below to begin the survey or close this webpage to exit.
PREVIOUS INTERVIEW BOX IF Wave=1 (Fall 2019), CONTINUE AT SC1_w IF Wave=2 (Spring 2020) AND PrevInt=0 (No Fall interview), CONTINUE AT SC1_w IF Wave=2 (Spring 2020) AND PrevInt=1 (Fall interview completed), CONTINUE AT SC0_w. |
PROGRAMMER NOTE: ITEMS SC0_W THROUGH C17_EXIT_W ARE ALSO FOUND IN THE CATI SHELL AS [ITEM]_C. |
IF Wave=2 (SPRING 2020) AND PrevInt=1 (PREVIOUS INTERVIEW COMPLETED) |
FILL [FallRespondent_FullName] FROM PRELOAD |
SC0_w. In the fall we completed an interview with [FallRespondent_FullName]. Is that you?
Yes 1
No 0
NO RESPONSE M
WEB SOFT CHECK: IF SC0_w =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
Wave=1 or 2 (ALL) |
FILL [CHILD] FROM PRELOAD |
IF SC0_w = 1, FILL still |
SC1_w. The person most responsible for [CHILD]’s care should complete this survey. Are you [still] that person?
Yes 1 GO TO SC1a
No 0 GO TO NewNameRep_w
NO RESPONSE M GO TO NewNameRep_w
WEB SOFT CHECK: IF SC1_w =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
sc1_w = 1 |
FILL [CHILD] FROM PRELOAD |
SC1a_w. Do you live in the same household as [CHILD]?
Yes 1 GO TO SKIP BOX SC0d
No 0 GO TO NewNameRep_w
NO RESPONSE M GO TO NewNameRep_w
WEB SOFT CHECK: IF SC1a_w =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF SC1_w OR SC1a_w = 0, D, R, OR M |
FILL [CHILD] FROM PRELOAD |
IF SC1a = 0, D, R, OR M, FILL Among the people that live with [CHILD], please ELSE, FILL Please |
NewNameRep_w and NewRepPhone_w.
[Among the people that live with [CHILD], please/Please] enter the name, address, and phone number of the person most responsible for [CHILD]’s care.
First Name:
Middle Initial:
Last Name:
Street Address 1:
Street Address 2:
City:
State:
Zip:
(___) ___-____
Telephone:
NO RESPONSE M GO TO THANKS
WEB SOFT CHECK: IF (NewNameRep_w is missing First Name AND Last Name) AND (NewRepPhone_w is missing Telephone); Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
Newnamerep_w HAS PHONE PROVIDED |
NewNameRepTZ_w. What time zone are you in?
Eastern Time (US & Canada) [(FILL CURRENT TIME)] 62
Indiana (East) [(FILL CURRENT TIME)] 63
Central Time (US & Canada) [(FILL CURRENT TIME)] 65
ARIZONA [(FILL CURRENT TIME)] 68
MOUNTAIN TIME (US & CANADA) [(FILL CURRENT TIME)] 70
PACIFIC TIME (US & CANADA) [(FILL CURRENT TIME)] 71
ALASKA [(FILL CURRENT TIME)] 72
HAWAII [(FILL CURRENT TIME)] 73
BAJA CALIFORNIA [(FILL CURRENT TIME)] 93
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PROGRAMMER NOTE NEWNAMEREP_W
IF (NEWNAMEREP_W FIRST NAME AND LAST NAME) NE D, R, OR M, GO TO THANKS AND SET DISP = 36 (CALL BACK).
IF (NEWNAMEREP_W FIRST NAME AND LAST NAME) = D, R, OR M, GO TO THANKS AND SET DISP = 45 (NO PROXY).
.
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SKIP BOX SC0d
IF HEADSTART=1 (CHILD IS IN HEAD START, BASED ON PRELOAD), GO TO SC2b_2_w.
ELSE, GO TO SC2c_2_w.
HEADSTART=1 (CHILD IS HEAD START, BASED ON PRELOAD) |
FILL [CHILD] FROM PRELOAD |
SC2b_2_w. According to our records [CHILD] is still attending Head Start. Is that correct?
Yes 1 GO TO SampMemb_w
No 0 GO TO SC2c_2_w
NO RESPONSE M GO TO SC2c_2_w
WEB SOFT CHECK: IF SC2b_2_w =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF HEADSTART NE 1 OR SC2b_2 = 0, D, R, OR M |
FILL [CHILD] FROM PRELOAD |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
SC2c_2_w. What grade or year of school is [CHILD] attending?
(Click here for more information about the grades or years below.)
Head Start is closed due to coronavirus (COVID-19) outbreak…………………..12 GO TO SampMemb_w
Head Start 1 GO TO SampMemb_w
Nursery/Preschool/Prekindergarten 8 SC2c_2Exit_w
Kindergarten 2 SC2c_2Exit_w
Transitional Kindergarten (Before Kindergarten) 3 SC2c_2Exit_w
Pre-first Grade (After Kindergarten) 4 SC2c_2Exit_w
First Grade 5 SC2c_2Exit_w
Un-graded or Home Schooled 6 SC2C_2new_w
Special Education 7 SC2c_2Exit_w
Something else 99 SC2c_2Specify_w
Not enrolled in school 11 SC2c_2Exit_w
NO RESPONSE M SC2c_2Exit_w
[PROGRAMMER: CREATE A HELP SCREEN (TO POP UP IN A SEPARATE WINDOW) WITH THE FOLLOWING DEFINITIONS:] Nursery/preschool/pre-kindergarten: Programs that offer classes prior to kindergarten, primarily serving 3 and 4 year-old children. These may be offered by public and private organizations. Transitional (or readiness) kindergarten: Extra year of school for kindergarten-age eligible children who are judged not ready for kindergarten. Kindergarten: Traditional year of school primarily for 5-year-olds prior to first grade. Pre-first (transitional first) grade (after k): Extra year of school for children who have attended kindergarten but have been judged not ready for first grade. Un-graded: A classroom containing kindergarten-aged students (possibly in combination with other ages), not formally identified as a "kindergarten" class. |
WEB SOFT CHECK: IF SC2c_2_w =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
SC2c_2_w = 99 |
SC2c_2Specify_w. Please enter the grade your child is in.
GRADE
(STRING 50)
NO RESPONSE M
WEB SOFT CHECK: IF SC2c_2Specify_w =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
SC2C_2_w =6 |
FILL [CHILD] FROM PRELOAD |
IF CHILD’S PRELOADED SEX = M, FILL he; IF CHILD’S PRELOADED SEX = F, FILL she; IF NO PREVIOUS INTERVIEW, FILL he or she |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
SC2C_2new_w. What grade would [CHILD] be in if [he/she/he or she] were attending a school with regular grades?
(Click here for more information about the grades or years below.)
Head Start 1 GO TO SampMemb_w
Nursery/Preschool/Prekindergarten 8 SC2c_2Exit_w
Kindergarten 2 SC2c_2Exit_w
Transitional Kindergarten (Before Kindergarten) 3 SC2c_2Exit_w
Pre-first Grade (After Kindergarten) 4 SC2c_2Exit_w
First Grade 5 SC2c_2Exit_w
Special Education 7 SC2c_2Exit_w
NO RESPONSE M SC2c_2Exit_w
[PROGRAMMER: CREATE A HELP SCREEN (TO POP UP IN A SEPARATE WINDOW) WITH THE FOLLOWING DEFINITIONS:] Nursery/preschool/pre-kindergarten: Programs that offer classes prior to kindergarten, primarily serving 3 and 4 year-old children. These may be offered by public and private organizations. Kindergarten: Traditional year of school primarily for 5-year-olds prior to first grade. Transitional (or readiness) kindergarten: Extra year of school for kindergarten-age eligible children who are judged not ready for kindergarten. Pre-first (transitional first) grade (after k): Extra year of school for children who have attended kindergarten but have been judged not ready for first grade. Un-graded: A classroom containing kindergarten-aged students (possibly in combination with other ages), not formally identified as a "kindergarten" class. |
WEB SOFT CHECK: IF SC2c_2New_w =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(SC2c_2_w = 2-8, 99, 11, D, R, OR M) OR (SC2c_2new_w = 2-8, D, R, or m) |
SC2c_2Exit_w : Right now we are only looking at children attending Head Start. We do not have any more questions for you now.
PROGRAMMER SKIP BOX SC2c_2EXIT SET DISP = 50 (INELIGIBLE) AND GO TO THANKS. |
sc2b_2_w =1 or sc2c_2_w =1 or sc2c_2new_w =1 |
IF SC0_w =1 (PREVIOUS INTERVIEW WITH THIS RESPONDENT), FILL As you may remember, the ELSE, FILL The |
IF Wave=2 AND PrevInt=0, FILL When we spoke to parents from [CHILD]’s Head Start program last fall we were unable to interview you. |
IF CHILD’S PRELOADED SEX = M, FILL his; IF CHILD’S PRELOADED SEX = F, FILL her; IF NO PREVIOUS INTERVIEW, FILL his or her |
SampMemb_w.
Thank you for agreeing to complete this survey. [As you may remember, the/The] purpose of this study is to learn more about families in the Head Start Program. [When we spoke to parents from [CHILD]’s Head Start program last fall we were unable to interview you.]
We also want to learn more about the program [CHILD] attends. This will help us understand Head Start from a parent’s point of view, including some information about your child’s home environment. Information from this study will be used to help Head Start better serve all children and their families.
In this survey we’ll want to learn more about the activities you do with your child, including the language you speak with [him/her] regularly. We will use the term Native to refer to American Indian or Alaska Native culture or language.
Your answers to the survey questions are private to the extent permitted by law. Neither your name nor [CHILD]’s name will be attached to any of the information you give us. All of the study results will be reported for groups of parents; no results will be analyzed or reported for individuals. If you are uncomfortable answering any questions, you may skip them and move on to the next question.
Your participation is completely voluntary. If you choose not to complete this survey, it will not affect you or your child’s participation in the Head Start Program or any of the services that you or your child receives. Your answers are very important, so please be as accurate as possible. Occasionally, you may be asked a question that does not apply to you or that you may not want to answer. If that happens, you can move on to the next question.
Given the likely disruption to your family’s typical schedule due to the coronavirus (COVID-19), when answering questions that ask about activities done within the last month or week please consider a typical month or week.
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PROGRAMMER BOX INTRO2
IF Wave=1 (FALL 2019): GO TO SC3_INTRO
IF Wave=2 (SPRING 2020): GO TO C2
If wave=2 (SPRING 2020) |
FILL CHILD’S NAME FROM PRELOAD. |
FILL ProgramName FROM PRELOAD. |
FILL ProgramCity AND ProgramState FROM PRELOAD. |
IF CHILD’S PRELOADED SEX = M, FILL he; IF CHILD’S PRELOADED SEX = F, FILL she; IF NO PREVIOUS INTERVIEW, FILL he or she |
C2_w. Is [CHILD] still enrolled in [ProgramName] in [ProgramCity], [ProgramState] or has [he/she/he or she] stopped going to that program?
Yes, [CHILD] is still going to same program 1 GO TO MODE-1
No, [CHILD] stopped going to that Head Start program 0 GO TO C9B
WEB HARD CHECK: IF C2_w =NO RESPONSE; You must answer this question to continue with the rest of the survey. |
C2_w = 0 |
FILL CHILD’S NAME FROM PRELOAD. |
FILL PROGRAM/CENTER NAME FROM PRELOAD. |
C9b_w. When did [CHILD] stop going to [PROGRAM]?
| | | / | | | / | | | | |
MONTH DAY YEAR
(1-12) (1-31) (2018-2020)
WEB SOFT CHECK: IF C9b_w =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
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BOX C17
IF C2_w =0, GO TO C17_exit_w AND SET DISP=50
C2_w = 0 |
FILL CHILD’S NAME FROM PRELOAD; |
FILL [FallInt_MonthYear] FROM PRELOAD. |
C17_exit_w. This spring we are only looking at children attending the Head Start program [CHILD] attended as of [FallInt_MonthYear]. We do not have any more questions for you now, but thank you for your time.
NO RESPONSE M GO TO THANKS (DISP=50)
ALL |
SC3_intro. CATI: Before we get started, I would like to make sure we have your name recorded correctly.
WEB: We would like to make sure we have your name recorded correctly.
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BOX SC3a
IF (WAVE=1 OR (Wave=2 AND PrevInt=0)) AND ((Consent_Parent_FirstName OR Consent_Parent_LastName) NE EMPTY), GO TO SC3. PRELOAD Consent_Parent_FirstName AND Consent_Parent_LastName.
IF WAVE=2 AND PrevInt=1 AND ((RespondentFirstName OR RespondentLastName) NE EMPTY), GO TO SC3. PRELOAD RespondentFirstName AND RespondentLastName.
ELSE, IF ((WAVE=1 OR (Wave=2 AND PrevInt=0)) AND (Consent_Parent_FirstName OR Consent_Parent_LastName=M)) OR (WAVE=2 AND PrevInt=1 AND (RespondentFirstName OR RespondentLastName=M)), GO TO SC3a.
if RESPONDENT PRELOADED NAME NE EMPTY (SEE BOX SC3A) |
IF WAVE=1 OR (WAVE=2 AND PREVINT=0), FILL Consent_Parent_FirstName, CONSENT_PARENT_mIDDLE, Consent_Parent_LastName IF WAVE=2 AND PREVINT=1, FILL FALLRESPONDENT_FIRSTNAME, FALLRESPONDENT_MIDDLE, FALLRESPONDENT_LASTNAME |
SC3. CATI: INTERVIEWER INSTRUCTION: READ NAME TO RESPONDENT AND VERIFY SPELLING.
WEB: Is the correct spelling of your name below?
[DISPLAY PRELOADED FIRST NAME, MIDDLE NAME/INITIAL, LAST NAME]
Yes, my name is spelled correctly 1 GO TO SC7
This is my name, but it is misspelled 2
No, this is not my name 3
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC3=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
SC3 = 2, 3, M OR RESPONDENT PRELOADED NAME = EMPTY (SEE BOX SC3A) |
SC3a. CATI: May I have the correct spelling of your name?
WEB: Please enter the correct spelling of your name.
First Name:
Middle Initial:
Last Name:
WEB HARD CHECK: IF SC3a FIRST OR LAST NAME=NO RESPONSE; You must answer this question to continue with the rest of the survey. |
WEB ONLY |
SC3 = 3, M |
SC3b. What is your telephone number?
PROGRAMMER: INSERT PHONE MASK
(___) ___-____
Do not have a telephone number 0
NO RESPONSE M
WEB ONLY |
SC3 = 3, M |
SC3c. What is your email address?
(STRING 50)
Do not have email 0
NO RESPONSE M
IF (Wave=1 or (Wave=2 AND PrevInt=0)) OR (SC0=0) OR (Sc0=1 AND FallRespondent_DOB=D, R, M or blank) |
SC7. What is your birth date?
WEB ONLY: Please enter it below.
| | | / | | | / | | | | |
MONTH DAY YEAR
(RANGE 1923-2003)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC7=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF SC0=1 (PREVIOUS INTERVIEW WITH THIS RESPONDENT) AND FallRespondent_DOB NE M |
FILL FallRespondent_DOB |
SC7a. CATI: Now, I would like to confirm we have your birth date recorded correctly.
NOTE: READ BIRTH DATE TO THE RESPONDENT AND VERIFY WHETHER CORRECT.
[DISPLAY FallRespondent_DOB, MM/DD/YYYY]
WEB: Now, we would like to confirm your birth date. Is your birth date [FallRespondent_DOB]?
Yes, birth date is correct 1
No, birth date is incorrect 2
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC7a=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
sc7a = 2 |
SC7b. What is your birth date?
WEB ONLY: Please enter it below.
| | | / | | | / | | | | |
MONTH DAY YEAR
(RANGE 1923-2003)
IF Wave=1 OR (Wave=2 and prevint=0) |
IF WAVE=1 OR (WAVE=2 AND PrevInt=0), FILL Consent_Child_FirstName, Consent_Child_Middle, Consent_LastName IF WAVE=2 AND PrevInt=1, FILL Fall_Child_FirstName, Fall_Child_Middle, Fall_Child_LastName |
SC8. CATI: Now, I would like to make sure we have [CHILD]’s name recorded correctly.
INTERVIEWER INSTRUCTION: READ NAME TO RESPONDENT AND VERIFY SPELLING
WEB: Now, we would like to make sure we have the correct spelling of your child’s name. Is the information below correct?
First Name: [FILL]
Middle Name/Initial: [FILL]
Yes, name is correct 1 GO TO SC9
No, name is incorrect 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC8=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
sc8 = 0 or M |
SC8a. CATI: May I have the correct spelling of [CHILD]’s name?
WEB: What is the correct spelling of your child’s name? Please enter it below.
First Name:
Middle Initial:
Last Name:
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC8a FIRST OR LAST NAME =NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (Wave=1 OR (Wave=2 and PrevInt=0)) OR (IF WAVE=2 AND PREVINT=1 AND Fall_Sc9=M) or (if wave=2 and prevint=1 and sc0=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
SC9. What is your relationship to [CHILD]?
(Click here for definitions of relationship options.)
Biological mother 11
Biological father 12
Adoptive mother 13
Adoptive father 14
Stepmother 15
Stepfather 16
Grandmother 17
Grandfather 18
Great grandmother 19
Great grandfather 20
Sister/stepsister 21
Brother/stepbrother 22
Other relative or in-law (female) 23
Other relative or in-law (male) 24
Foster parent (female) 25
Foster parent (male) 26
Other non-relative (female) 27
Other non-relative (male) 28
Parent’s partner (female) 29
Parent’s partner (male) 30
DON’T KNOW d
REFUSED r
NO RESPONSE M
[PROGRAMMER: MAKE TEXT AVAILABLE ON HELP SCREEN THAT OPENS IN SEPARATE WINDOW:] Biological Mother: Child's female biological parent. This may be the birth mother, but could also apply to a mother who used a surrogate mother to have her biological child. Biological Father: Child's male biological parent. This could also apply to a father who used a surrogate mother to have his biological child. Adoptive Mother: The female who has taken the child into her own family by legal process to raise as her own child. Adoptive Father: The male who has taken the child into his own family by legal process to raise as his own child. Step Mother: The female other than the child's mother who is married to the child's father. Step Father: The male other than the child's father who is married to the child's mother. Foster Parent (Female): The female with whom the child is placed temporarily, usually through a social service agency and/or a court. Foster Parent (Male): The male with whom the child is placed temporarily, usually through a social service agency and/or a court. Parent’s Partner (Female): The female who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship. Parent’s Partner (Male): The male who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship. |
WEB SOFT CHECK: IF SC9=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
SC9 = 23, 24, 27, OR 28 |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
SC9_1. How are you related to [CHILD]?
(Click here for definitions of relationship options.)
Select one only
Girlfriend or female partner of [CHILD]’s parent/guardian 1
Boyfriend or male partner of [CHILD]’s parent/guardian 2
Female guardian 3
Male guardian 4
Daughter/Son of [CHILD]'s parent’s partner 5
Other relative of [CHILD]'s parent’s partner 6
DON’T KNOW d
REFUSED r
NO RESPONSE M
[PROGRAMMER: HELP SCREEN SHOULD OPEN IN A SECOND WINDOW.] Girlfriend or Female Partner of CHILD's Parent/Guardian: The female who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship. Boyfriend or Male Partner of CHILD's Parent/Guardian: The male who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship. Female Guardian: The female legally placed in charge of the affairs of the child. Male Guardian: The male legally placed in charge of the affairs of the child. Daughter/son of CHILD's Parent's Partner: The child of the person who has a "partner-like" relationship with one of the child's parents or guardians. Other Relative of CHILD's Parent's Partner: Some other relative of the person who has a "partner-like" relationship with one of the child's parents or guardians. |
WEB SOFT CHECK: IF SC9_1=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (WAVE=1 AND SC9 = 12, 16-30, OR M) OR (Wave=2 and prevint=0 and sc9 = 12, 16-30, or M) OR ((WAve=2 and prevint=1) AND FALL_SC9a=M) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
SC9a. What is the first name of [CHILD]’s biological mother?
FIRST NAME
(STRING 50)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC9a=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (WAVE=1 AND SC9 = 11, 15-30, OR M) OR (Wave=2 and prevint=0 and sc9 = 11, 15-30, or M) OR ((WAve=2 and prevint=1) AND FALL_SC9b=M) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
SC9b. What is the first name of [CHILD]’s biological father?
FIRST NAME
(STRING 50)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC9b=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF ((Wave=1) OR (Wave=2 and PrevInt=0)) AND (SC9 = 17-30, M) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
SC10. Are you [CHILD]’s legal guardian?
Yes 1 GO TO VERSION BOX A
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC10=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
SC10 = 0, D, R, or m |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
SC11. CATI: Who is [CHILD]’s legal guardian?
WEB: Please enter the name, address, and phone number of [CHILD]’s legal guardian.
First Name:
Middle Initial:
Last Name:
Street Address 1:
Street Address 2:
City:
State:
Zip:
(___) ___-____
TELEPHONE
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF SC11=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
A. ABOUT YOUR CHILD |
PROGRAMMER VERSION BOX A IF WAVE=1 OR (WAVE=2 AND PREVINT=0), ASK A1-A11. IF (Wave=2 AND PrevInt=1), CHECK MISSING FLAGS:
|
If (Wave=1 OR (Wave=2 and Prevint=0)) and sampmembsex=0 or blank |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
A1. Is [CHILD] a boy or a girl?
Boy 2
Girl 1
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF A1=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (Wave=1 or (Wave=2 and prevint=0)) and Sampmembdob=blank |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
A2. What is [CHILD]’s birth date?
WEB ONLY: Please enter it below.
| | | / | | | / | | | | |
MONTH DAY YEAR
(YEAR RANGE 2013-2017)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF A2=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and prevint=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
A3. Is [CHILD] of Spanish, Hispanic, or Latino origin?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF A3=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and prevint=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
A5. CATI: What is [CHILD]’s race? You may name more than one if you like.
IF PARENT ANSWERS ‘Hispanic,’ PROBE: Would that be white Hispanic or black Hispanic?
IF PARENT ANSWERS ‘Hispanic’ AGAIN, PUT RESPONSE IN OTHER CATEGORY.
WEB: What is [CHILD]’s race?
Select one or more
White 11
Black or African American 12
American Indian or Alaska Native 13
Asian 27
Native Hawaiian, or other Pacific Islander 26
Another race (SPECIFY) 25
Please specify other race. STRING 50
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF A5=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and prevint=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
A8.
Early Head Start is a program designed to provide services to enhance development of children from birth to three years of age.
Did [CHILD] participate in Early Head Start?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF A8=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
B. ABOUT HOUSEHOLD |
PROGRAMMER NOTE: THE FOLLOWING POINTS PROVIDE AN OVERVIEW OF HOW THE HOUSEHOLD GRID LOOPS OPERATES: 1. THE GRID LOOPS OPERATE IDENTICALLY FOR FIRST AND LATER ADMINISTRATIONS. 2. THE FIRST “ROW” (b3_1) IS ALWAYS FOR THE FOCUS CHILD and second (b3_2) is for the respondent. THE DATA ARE IMPUTED FROM THE SCREENER as follows: a. child: First name = sc8 or sc8a; age = a2; relationship = n/a b. r: first name = sc3 or sc3a; age = sc7 or sc7a; relationship = sc9 3. AT BOTH ADMINISTRATIONS, INTERVIEWERS WILL ASK FOR AND ENTER INFORMATION ABOUT ALL HOUSEHOLD MEMBERS OTHER THAN A FEW PIECES OF PRELOADED INFORMATION ABOUT THE CHILD AND RESPONDENT. 4. LOOP RANGE UP 15. |
ALL |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
B3a. Besides yourself and [CHILD], does anyone normally live in your household? This would include anyone who usually lives there who is temporarily away from home for work or military duty, or living in a dorm in school. Please do not include anyone staying there temporarily who usually lives somewhere else.
Yes 1 GO TO B3_FN
No 0 GO TO D1
WEB HARD CHECK: IF B3A=NO RESPONSE; You must answer this question to continue with the rest of the survey. |
LOOP 1: HOUSEHOLD NAMES
IF WAVE=1 OR 2
PROGRAMMER: Please add WEB SOFT CHECK: IF MoreHH1 OR MoreHH2=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button.
|
PERSON |
PROGRAMMER: FOR WEB, IF B3_FN_3, FILL “FIRST”; IF B3_FN_4-15, FILL “NEXT” PROGRAMMER: GRAY QUESTION TEXT AFTER B3_3 (OR AFTER FIRST LOOP, SINCE CHILD AND R ARE B3_1 AND _2)
B3_FN. CATI: Please tell me the first names of all the other people, besides yourself and [CHILD], who normally live in your household.
PROBE: Please do not include anyone staying there temporarily who usually lives somewhere else.
PROBE: Please tell me who else lives here.
PROBE: IF B3 NAME REPORTED MATCHES RESPONDENT’S NAME, CONFIRM WHO IS BEING DISCUSSED: Just to clarify, are we talking about you, or someone else?
WEB: Please enter the first name of the [first/next] person, besides yourself and [CHILD], who normally lives in your household. Please enter only one name in the box below. Please do not include anyone staying there temporarily who usually lives somewhere else.
PROGRAMMER: WEB: [SOFT EDIT] IF B3_#_NAME = B3_2_NAME (REPSONDENT NAME): This name is the same as yours. Please do not include yourself in the list.
WEB/CATI: [HARD CHECK] IF B3_#_NAME = BLANK: Please provide an answer to this question so we can refer to this person later. If you’d prefer, you can use this person’s initials.
|
_______________ FIRST NAME (STRING 50)
|
PROGRAMMER: CATI ONLY: GRAY QUESTION TEXT AFTER MoreHH1_3 (OR AFTER FIRST LOOP, SINCE CHILD AND R ARE SPOTS _1 AND _2)
MoreHH1. Is there anyone else in your household? This could be your spouse or partner, another relative, or any babies or small children.
[List all B3_3_Name reported] |
Yes… 1 No… 0 DON’T KNOW… d REFUSED… r NO RESPONSE… M
IF MoreHH1 = 1, LOOP B3 NAMES UNTIL MOREHH1 = 0, D, R, OR M. WHEN MOREHH1= 0, D, R, OR M. GO TO MOREHH2.
|
MoreHH2. Have we missed anyone who usually lives here who is temporarily away from home for work or military duty, or living in a dorm at school? |
Yes… 1 No… 0 DON’T KNOW… d REFUSED… r NO RESPONSE… M
IF MOREHH2 = 1, LOOP B3 NAMES UNTIL MOREHH2 = 0. WHEN MOREHH2 = 0, D, R, OR M, GO TO B4.
|
LOOP 2: HOUSEHOLD AGES AND RELATIONSHIPS
IF WAVE=1 OR 2
PROGRAMMER: Please add WEB SOFT CHECK: IF B4, B5, B5a1, B5a2, OR B5a3=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button.
|
PERSON |
IF B3_#_Name NE 0, d, r, or m (name reported at B3)
IF Wave=1, fill [Fall_B3_#_Name] IF Wave=2, fill [Spring_B3_#_Name]
B4. How old is [Fall_B3_#_Name/Spring_B3_#_Name]?
CATI: INTERVIEWER NOTE: IF CHILD IS LESS THAN ONE YEAR OLD, RECORD AS 0.
WEB: If a child is less than one year old, please enter “0” for the age.
|
_______ YEARS (RANGE 0-110) DON’T KNOW… d REFUSED… r NO RESPONSE… M
|
IF (B3_#_Name NE 0, d, r, or m) AND (B4 GT or = 18)
IF Wave=1, fill [Fall_B3_#_Name] IF Wave=2, fill [Spring_B3_#_Name] FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB. See Help Text Box below Loop 2 table.
B5. What is [Fall_B3_#_Name/Spring_B3_#_Name]’s relationship to [CHILD]?
(Click here for definitions of relationship options.)
|
Select one only
Biological or adoptive mother ………… 1 GO TO B5a1 Biological or adoptive father …………… 2 GO TO B5a2 Stepmother ……………………………… 3 Stepfather ………………………………… 4 Grandmother …………………………… 5 Grandfather ……………………………… 6 Great grandmother ……………………… 7 Great grandfather ……………………… 8 Sister/stepsister ………………………… 9 Brother/stepbrother ……………………… 10 Other relative or in‑law (female) ……… 11 Other relative or in‑law (male) ………… 12 Foster parent (female) ………………… 13 Foster parent (male) …………………… 14 Other non-relative (female) …………… 15 GO TO B5a3 Other non-relative (male) ……………… 16 GO TO B5a3 Parent’s partner (female) ……………… 17 Parent’s partner (male) ………………… 18
DON’T KNOW………………………… D REFUSED …………………………… r NO RESPONSE ………………………M
IF ((B5=3-14, 17-18, d, r, m) AND (NEXT B3_#_NAME slot NE 0, d, r, m)), GO TO B4. IF ((B5=3-14, 17-18, d, r, m) AND (NEXT B3_#_NAME slot = 0, d, r, m)), GO TO B8a.
|
IF B5=1
IF Wave=1, fill [Fall_B3_#_Name] IF Wave=2, fill [Spring_B3_#_Name] FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB. See Help Text Box below Loop 2 table.
B5a1. Is [Fall_B3_#_Name/Spring_B3_#_Name] [CHILD]’s…
CATI: INTERVIEWER INSTRUCTION: IF THE RESPONDENT STATES SOMETHING OTHER THAN BIOLOGICAL, BIRTH, OR ADOPTIVE MOTHER GO BACK TO B5 AND UPDATE RELATIONSHIP.
(Click here for definitions of biological or birth mother and adoptive mother.)
|
Select one only
biological or birth mother or ………… 1 adoptive mother? ……………………… 2
DON’T KNOW………………………… D REFUSED …………………………… r NO RESPONSE ………………………M
IF NEXT B3_#_NAME slot NE 0, d, r, m, GO TO B4. IF NEXT B3_#_NAME slot = 0, d, r, m, GO TO B8a.
|
IF B5=2
IF Wave=1, fill [Fall_B3_#_Name] IF Wave=2, fill [Spring_B3_#_Name] FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB. See Help Text Box below Loop 2 table.
B5a2. Is [Fall_B3_#_Name/Spring_B3_#_Name] [CHILD]’s…
CATI: INTERVIEWER NOTE: IF THE RESPONDENT STATES SOMETHING OTHER THAN BIOLOGICAL, BIRTH, OR ADOPTIVE FATHER GO BACK TO B5 AND UPDATE RELATIONSHIP.
(Click here for definitions of biological or birth father and adoptive father.)
|
Select one only
biological or birth father or ………… 1 adoptive father? ……………………… 2
DON’T KNOW………………………… D REFUSED …………………………… r NO RESPONSE ………………………M
IF NEXT B3_#_NAME slot NE 0, d, r, m, GO TO B4. IF NEXT B3_#_NAME slot = 0, d, r, m, GO TO B8a.
|
IF B5=15 or 16
IF Wave=1, fill [Fall_B3_#_Name] IF Wave=2, fill [Spring_B3_#_Name] FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB. See Help Text Box below Loop 2 table.
B5a3.
CATI: INTERVIEWER NOTE: CODE NON-RELATIVE RELATIONSHIP BELOW IF MORE DESCRIPTIVE.
How is [B3_NAME] related to [CHILD]?
(Click here for more information about the relationships listed below.)
|
Select one only
Girlfriend or female partner of [CHILD]’s parent/guardian ……………………………… 1 Boyfriend or male partner of [CHILD]’s parent/guardian ……………………………… 2 Female guardian …………………………… 3 Male guardian ……………………………… 4 Daughter/Son of [CHILD]'s parent’s partner ………………………………………… 5 Other relative of [CHILD]'s parent’s partner ………………………………………… 6
DON’T KNOW………………………… D REFUSED …………………………… r NO RESPONSE ………………………M
IF NEXT B3_#_NAME slot NE 0, d, r, m, GO TO B4. IF NEXT B3_#_NAME slot = 0, d, r, m, GO TO B8a.
|
B5: HELP TEXT BOX PROGRAMMER: MAKE TEXT AVAILABLE ON HELP SCREEN THAT OPENS IN SEPARATE WINDOW: Biological Mother: Child's female biological parent. This may be the birth mother, but could also apply to a mother who used a surrogate mother to have her biological child. Biological Father: Child's male biological parent. This could also apply to a father who used a surrogate mother to have his biological child. Adoptive Mother: The female who has taken the child into her own family by legal process to raise as her own child. Adoptive Father: The male who has taken the child into his own family by legal process to raise as his own child. Step Mother: The female other than the child's mother who is married to the child's father. Step Father: The male other than the child's father who is married to the child's mother. Foster Parent (Female): The female with whom the child is placed temporarily, usually through a social service agency and/or a court. Foster Parent (Male): The male with whom the child is placed temporarily, usually through a social service agency and/or a court. Parent’s Partner (Female): The female who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship. Parent’s Partner (Male): The male who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship. |
B5A1: HELP TEXT BOX PROGRAMMER: HELP SCREEN SHOULD POP UP IN A SEPARATE WINDOW. Biological or Birth Mother: Child's female biological parent. This may be the birth mother, but could also apply to a mother who used a surrogate mother to have her biological child. Adoptive Mother: The female who has taken the child into her own family by legal process to raise as her own child. |
B5A2: HELP TEXT BOX PROGRAMMER: HELP SCREEN SHOULD POP UP IN A SEPARATE WINDOW. Biological or Birth Father: Child's male biological parent. This could also apply to a father who used a surrogate mother to have his biological child. Adoptive Father: The male who has taken the child into his own family by legal process to raise as his own child. |
B5A3: HELP TEXT BOX PROGRAMMER: HELP SCREEN SHOULD OPEN IN A SECOND WINDOW. Girlfriend or Female Partner of CHILD's Parent/Guardian: The female who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship. Boyfriend or Male Partner of CHILD's Parent/Guardian: The male who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship. Female Guardian: The female legally placed in charge of the affairs of the child. Male Guardian: The male legally placed in charge of the affairs of the child. Daughter/son of CHILD's Parent's Partner: The child of the person who has a "partner-like" relationship with one of the child's parents or guardians. Other Relative of CHILD's Parent's Partner: Some other relative of the person who has a "partner-like" relationship with one of the child's parents or guardians. Other Non-relative: If one of the codes for non-relative above does not better describe the relationship of the person to the child, and there is no family relationship through blood, marriage, adoption, or partnership (i.e., living together as married), use this code. |
PROGRAMMER NOTE: LOAD NAMES OF ALL ADULTS IN THE HOUSEHOLD
PROGRAMMER NOTE: CALCULATE AGE OF ALL RESPONDENTS IN HOUSEHOLD. BUILD VARIABLES:
1. OnlyChild: If the focal child is the only child in the HH (where no other members are less than or equal to 18), OnlyChild=1. If there are additional children in the HH, where other HH members (beside focal child) age is less than or equal to 18, OnlyChild=0.
2. OnlyAdult: If the respondent is the only adult in the HH (where no other members are greater than 17), OnlyAdult=1. If there are additional adults in the HH, where other HH members (beside respondent) age is greater than 17, OnlyAdult=0.
If (B3_3_Name OR HIGHER NE EMPTY) AND (B4 GT or = 18) |
B8a. Do you have a spouse or partner who lives in this household?
[List of B3_#_Name, NOT including B3_1_Name (child) and B3_2_Name (respondent)]
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF B8a = 1 |
B8b. Who in the household is your spouse or partner?
[List of B3_#_Name, NOT including B3_1_Name (child) and B3_2_Name (respondent)]
CATI ONLY: INTERVIEWER NOTE: SELECT NAME OF PERSON WHO IS [RESPONDENT]'S SPOUSE/PARTNER.
BOX B9
ONLY ASK B9 AND B10 IF RESPONDENT IS BIO/ADOPTIVE/STEP PARENT AND THERE IS ANOTHER BIO/ADOPTIVE/STEPPARENT IN THE HOUSEHOLD, REGARDLESS OF GENDER. FILL WITH NAME OF OTHER PARENT IN HOUSEHOLD. |
IF (B8b ne blank) and (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND (SC9=11-16) AND (ANY b5_3-15=1, 2, 3, or 4) |
FILL [B3_#_Name] with B8b selection |
B9. Are you and [B3_#_Name]…
Select one only
married, 1 GO TO D1
in a registered domestic partnership or civil union, 5 GO TO D1
divorced, 2 GO TO B10
separated, 3 GO TO B10
not married, or 4 GO TO B10
living as partners in a committed relationship? 6 GO TO D1
DON’T KNOW d GO TO B10
REFUSED r GO TO B10
NO RESPONSE M GO TO B10
WEB SOFT CHECK: IF B9=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF b9 = 2, 3, 4, M, D OR R |
FILL [B3_#_Name] where B5=1, 2, 3, or 4 |
B10. Which of the following statements best describes your current relationship with [B3_#_Name]? Would you say…
Select one only
we are romantically involved on a steady basis, 1
we are involved in an on-again and off-again relationship, 2
we are just friends, or 3
we are not in any kind of relationship? 4
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF B10=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
D. ACTIVITIES WITH YOUR CHILD |
IF WAVE=1 or 2 (all) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
D1. CATI: Now I have some questions about you and [CHILD] at home.
How many times have you or someone in your family read to [CHILD] in the past week?
By family, I mean the people living together in your household.
Would you say...
WEB: The next questions are about you and [CHILD] at home.
How many times have you or someone in your family read to [CHILD] in the past week?
By family, we mean the people living together in your household.
Would you say…
not at all, 1
once or twice, 2
three or more times, but not every day, or 3
every day? 4
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF D1=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
wave=1 or 2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF web DO NOT SHOW DK OR REF |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL her IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL him ELSE, FILL him or her |
PROGRAMMER: GRAY QUESTION TEXT AFTER D3_A |
D3. In the past week, have you or someone in your family done the following things with [CHILD]?
The following activities can be done in your Native language or in English. By Native language we mean an American Indian or Alaska Native language.
|
|
|
Select one per row |
|||
|
Never |
One or two days |
Three or four days |
Most days |
DK |
R |
a. Told [him/her/him or her] a story? |
0 |
1 |
2 |
3 |
D |
R |
b. Taught [him/her/him or her] letters, words, or numbers? |
0 |
1 |
2 |
3 |
D |
R |
c. Taught [him/her/him or her] songs or music, including traditional or ceremonial songs? |
0 |
1 |
2 |
3 |
D |
R |
d. Worked on arts and crafts (such as painting or jewelry making) with [him/her/him or her]? |
0 |
1 |
2 |
3 |
D |
R |
e. Played with toys or games indoors? |
0 |
1 |
2 |
3 |
D |
R |
f. Danced, played a game, sport, or exercised together? |
0 |
1 |
2 |
3 |
D |
R |
g. Took [him/her/him or her] along while doing errands like going to the post office, store, Tribal Center or office, doctor, or to check on elderly family members? |
0 |
1 |
2 |
3 |
D |
R |
h. Involved [him/her/him or her] in household chores like cooking, cleaning or picking up after him/herself, setting the table, caring for animals such as pets or livestock, or helping with planting or chopping wood? |
0 |
1 |
2 |
3 |
D |
R |
i. Talked about what happened in Head Start? |
0 |
1 |
2 |
3 |
D |
R |
j. Talked about TV programs or videos? |
0 |
1 |
2 |
3 |
D |
R |
k. Played counting games like singing songs with numbers or reading books with numbers with [him/her/him or her]? |
0 |
1 |
2 |
3 |
D |
R |
l. Played a board game or a card game with [him/her/him or her]? |
0 |
1 |
2 |
3 |
D |
R |
m. Played with blocks with [him/her/him or her]? |
0 |
1 |
2 |
3 |
D |
R |
n. Counted different things with [him/her/him or her], like twigs, stones, grapes, or stars? |
0 |
1 |
2 |
3 |
D |
R |
WEB SOFT CHECK: IF ANY D3a-n=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
D3a = 1, 2 or 3 (TOLD STORIES IN PAST WEEK) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
D3a1. How many times have you or someone in your family told stories to [CHILD] in the past week? Would you say…
once or twice, 2
three or more times, but not every day, or 3
every day? 4
DON’T KNOW d
REFUSED r
NO RESPONSE M
PROGRAMMER VERSION BOX D4 IF Wave=1 OR (Wave=2 and PrevInt=0) CONTINUE, ELSE GO TO SECTION E. |
IF Wave=1 OR (Wave=2 and prevint=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
D5. About how many children’s books does [CHILD] have in your home now, including library books? Please only include books that are for children.
CATI: PROBE: Your best estimate is fine.
WEB: Your best estimate is fine.
NUMBER
(RANGE 0-300)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF D5=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and prevint=0) |
if web don’t show dk or ref |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: GRAY QUESTION TEXT AFTER D5B_A |
D5b. In the past 12 months, has [CHILD] done the following with someone in your community (outside of your family)?
|
Select one per row |
||||
|
Yes |
No |
Not appropriate for this age |
DK |
R |
a. Listened to Elders tell stories? |
1 |
0 |
2 |
D |
R |
b. Participated in traditional ways, including carving, harvesting, collecting, hunting, and fishing? |
1 |
0 |
2 |
D |
R |
c. Danced, sang, or drummed at a pow-wow or other community cultural activity? |
1 |
0 |
2 |
D |
R |
d. Worked on traditional arts and crafts, such as beading, blanket weaving, or making jewelry, a basket, a painting, or pow-wow regalia? |
1 |
0 |
2 |
D |
R |
e. Participated in traditional ceremonies? |
1 |
0 |
2 |
D |
R |
f. Played American Indian or Alaska Native games? |
1 |
0 |
2 |
D |
R |
g. Other cultural activities? (SPECIFY) ____________________________________ (STRING 100) |
|
||||
WEB SOFT CHECK: IF ANY D5b_a-g=NO RESPONSE OR (D5b_g=1 AND specify left blank); Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and prevint=0) |
D6a. Is English spoken in your home?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF D6a=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and prevint=0) |
D7. Is any language other than English spoken in your home? This includes an American Indian or Alaska Native language that may be spoken in your home.
Yes 1 GO TO D8
No 0 GO TO D10a
DON’T KNOW d GO TO D10a
REFUSED r GO TO D10a
NO RESPONSE M GO TO D10a
WEB SOFT CHECK: IF D7=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
D7 = 1 |
D8. What other languages are spoken in your home?
CATI: PROBE: Any other langauges?
Select all that apply
Your Native language (SPECIFY) 33
Specify (STRING 50)
Other Native language(s) (SPECIFY) 34
Specify (STRING 50)
French 11
Spanish 12
Another language (SPECIFY) 21
Specify (STRING 50)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF D8=NO RESPONSE OR ANY SPECIFY SELECTED BUT LEFT BLANK; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
D7 = 1 |
D10. What language do you usually speak to [CHILD] at home?
Select one only
English 25
Your Native language 33
Other Native language(s) 34
French 11
Spanish 12
Another language (SPECIFY) 21
Specify (STRING 50)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF D10=NO RESPONSE OR SPECIFY SELECTED BUT LEFT BLANK; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and prevint=0) |
IF WEB DON’T SHOW DK OR REF |
IF OnlyChild=0 (MORE THAN 1 CHILD IN HOUSEHOLD), FILL children; children were IF OnlyChild=1 (JUST FOCAL CHILD IN HOUSEHOLD), FILL child; child was |
PROGRAMMER: PLEASE GRAY QUESTION TEXT AFTER D10A_A. |
D10a. CATI: Please indicate how often you did each of the following things in the past month. By Native language we mean an American Indian or Alaska Native language.
Would you say, very often, often, sometimes, rarely, or never?
WEB: Please indicate how often you did each of the things below in the past month. By Native language we mean an American Indian or Alaska Native language.
-
SELECT ONE PER ROW
Very often
Often
Sometimes
Rarely
Never
DK
R
a. I spoke our Native language with my [child/children].
1
2
3
4
5
D
R
b. I made sure my [child/children] heard our Native language spoken by others.
1
2
3
4
5
D
R
c. I encouraged my [child/children] to learn our Native language (for example, take classes in school).
1
2
3
4
5
D
R
d. I used our Native language in prayers or songs with my [child/children].
1
2
3
4
5
D
R
e. I used our Native language in everyday life with my [child/children].
1
2
3
4
5
D
R
f. I spoke our Native language with other adults when my [child was/children were] around.
1
2
3
4
5
D
R
WEB SOFT CHECK: IF ANY D10a_a-f=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
IF OnlyChild=0 (MORE THAN 1 CHILD IN HOUSEHOLD), FILL children learn IF OnlyChild=1 (JUST FOCAL CHILD IN HOUSEHOLD), FILL child learns |
D10a1. How important is it for you that your [child learns/children learn] your Native language? Would you say…
Select one only
very important, 1
somewhat important, or 2
not at all important? 3
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF D10A1=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and prevint=0) |
D10b. What languages are spoken at your child’s Head Start center?
Select all that apply
English 25
Your Native language 33
Other Native language(s) 34
French 11
Spanish 12
Another language (SPECIFY) 21
Specify (STRING 50)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF D10B=NO RESPONSE OR (D10B_21=1 AND SPECIFY LEFT BLANK); Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
D7 = 1 AND D10 = 11-21, 33-34, D, R, M |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL her IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL him ELSE, FILL him or her |
FILL RESPONSE(S) SELECTED AT D8 IF TWO RESPONSES SELECTED AT D8, fill “[first D8 language] or [second D8 language]?” IF THREE RESPONSES SELECTED AT D8, fill “[first], [second,] or [third]?” REPEAT PATTERN UP TO SIX POSSIBLE LANGUAGES. IF D8=D, R, OR M, FILL “the language spoken in your home” |
D19. How often is there someone in [CHILD]’s Head Start classroom available to talk to [him/her/him or her] in [[D8]/the language spoken in your home]? Would you say it is…
Select one only
always, 1
sometimes, or 2
never? 3
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF D19=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
E. CHILD’S ACTIVITIES |
e_INTRO.
The next questions are about some of [CHILD]’s activities.
If wave=2 |
if web, don’t show dk or ref |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL she IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL he ELSE, FILL he or she |
PROGRAMMER: GRAY QUESTION TEXT AFTER E4_A |
E4. About how much time does [CHILD] spend doing each of the following activities on a typical weekday?
Would you say more than 2 hours, 1 to 2 hours, less than one hour, or [he/she/he or she] never spends time on that on a typical weekday?
Select one per row
|
More than two hours |
One to two hours |
Less than one hour |
Never |
DK |
R |
a. Watching programs on TV |
1 |
2 |
3 |
0 |
D |
R |
b. Watching a video or DVD on the TV or computer/laptop/iPad/tablet |
1 |
2 |
3 |
0 |
D |
R |
e. Playing video games on a gaming console like X-Box, PlayStation, Wii or GameBoy |
1 |
2 |
3 |
0 |
D |
R |
g. Using a computer/laptop, Smartphone, iPad, or other tablet for playing games |
1 |
2 |
3 |
0 |
D |
R |
h. Using a computer/laptop, Smartphone, iPad, or other tablet for something other than videos or games |
1 |
2 |
3 |
0 |
D |
R |
H. HOUSEHOLD ROUTINES |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
H1. CATI: My next questions are about routines in your household.
In a typical week, please tell me the number of days at least some of the family eats the evening meal together.
PROBE: IF VARIES: On average, how many days?
WEB: The next questions are about routines in your household.
In a typical week, about how many days does at least some of the family eat the evening meal together with [CHILD]?
If it changes each week, please think about a typical week.
NUMBER
(RANGE 0-7)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF H1=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL she IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL he ELSE, FILL he or she |
PROGRAMMER: ON WEB, ONLY DISPLAY 98. |
H8. When is [CHILD]’s regular bedtime?
CATI: PROBE: We are interested in what time [he/she/he or she] usually goes to bed, not what time [he/she/he or she] actually falls asleep.
NOTE: IF VARIES, PROBE: On an average night?
NOTE: IF BEDTIME IS AFTER MIDNIGHT, TYPE IN 11:59
WEB: We are interested in what time [he/she/he or she] usually goes to bed, not what time [he/she/he or she] actually falls asleep.
If your child’s bedtime is after midnight, please enter 11:59PM.
HH:MM AM PM
(HR RANGE1 -12) (MIN RANGE 0-59)
[CHILD] does not have a usual bedtime 98 GO TO H10
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF H8=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
WEB HARD CHECK: IF H8=98 AND TIME ALSO ENTERED; You entered a time and also selected that your child does not have a usual bedtime. Please either enter a time or select that your child does not have a usual bedtime to continue. |
CATI HARD CHECK: IF (H8=98, D OR R) AND TIME ALSO ENTERED; INTERVIEWER CHECK: You entered a time and also selected that the child does not have a usual bedtime. Please either enter a time or select that the child does not have a usual bedtime to continue. |
IF (Wave=1 OR (Wave=2 and PrevInt=0)) AND H8 NE 98 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
H9. How many times in the last week, Monday through Friday, was [CHILD] put to bed at that time?
NUMBER
(RANGE 0-5)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF H9=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL she IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL he ELSE, FILL he or she |
PROGRAMMER: ON WEB, ONLY DISPLAY 98. |
H10. About what time does [CHILD] usually wake up on a weekday?
NOTE: IF VARIES, PROBE: On average?
HH:MM AM PM
(HR RANGE1-12) (MIN RANGE 0-59)
[CHILD] does not wake up at a usual time 98
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF H10=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
WEB HARD CHECK: IF H10=98 AND TIME ALSO ENTERED; You entered a time and also selected that your child does not wake up at a usual time. Please either enter a time or select that your child does not wake up at a usual time to continue. |
CATI HARD CHECK: IF (H10=98, D OR R) AND TIME ALSO ENTERED; INTERVIEWER CHECK: You entered a time and also selected that the child does not wake up at a usual time. Please either enter a time or select that the child does not wake up at a usual time to continue. |
J. ABOUT CHILD’S MOTHER |
PROGRAMMER VERSION BOX J2 IF (WAVE=1 OR (WAVE=2 and PrevInt=0)) AND (ANY B5_2-15 = 1 (BIOLOGICAL OR ADOPTIVE MOTHER IN HOUSEHOLD)) AND (SC9 = 11 OR 13 (RESPONDENT IS BIOLOGICAL OR ADOPTIVE MOTHER)), GO TO J10.
IF (WAVE=1 OR (WAVE=2 and PrevInt=0)) AND (ANY B5_2-15 = 1 (BIOLOGICAL OR ADOPTIVE MOTHER IN HOUSEHOLD)) AND (SC9 = 12, 14-30 (RESPONDENT IS NOT BIOLOGICAL OR ADOPTIVE MOTHER)), GO TO J8.
IF (WAVE=1 OR (WAVE=2 and PrevInt=0)) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1 (MOTHER NOT IN HOUSEHOLD))), ASK J1.
IF (WAVE=2 AND PREVINT=1) AND (FALL_MOMHH = 1) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)), ASK J1 (IF SPRING 2020 AND MOTHER LEFT HOUSEHOLD SINCE FALL 2019 INTERVIEW).
IF (WAVE=2 AND PREVINT=1) AND (FALL_MOMHH = 0, D, R, M) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)), GO TO VERSION BOX J3 (BIOLOGICAL OR ADOPTIVE MOTHER IS NOT IN HOUSEHOLD, AND WAS NOT IN HOUSEHOLD AT FALL INTERVIEW).
IF (WAVE=2 AND PREVINT=1) AND (FALL_MOMHH = 0) AND ((SC9 = 11 OR 13) OR (ANY B5_2-15 = 1)), GO TO BOX J14A (IF SPRING 2020 AND MOTHER WAS NOT PREVIOUSLY IN HOUSEHOLD BUT NOW IS).
IF (WAVE=2 AND PREVINT=1) AND (FALL_MOMHH = 1) AND ((SC9 = 11 OR 13) OR (ANY B5_2-15 = 1)), GO TO BOX J14A (IF SPRING 2020 AND MOTHER IS STILL IN HOUSEHOLD). |
IF WAVE = 1 OR 2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF SC9= 11 OR 13, FILL you IF SC9 NE 11 OR 13, FILL [CHILD]’s mother |
J_Intro:
The next questions are about [you/[CHILD]’s mother].
((ALL B5_2-15 NE 1) AND (SC9 NE 11 or 13)) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL her; Her; she; She IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL his; him; Him; he; He ELSE, FILL his or her; him or her; His or her; his or her |
J1. CATI: There are many reasons for children not living with their parents. Please tell me why [CHILD] is not living with [her/his/his or her] mother.
PROBE: Are there any other reasons?
WEB: There are many reasons for children not living with their parents. Please select why [CHILD] is not living with [her/his/his or her] mother.
Select all that apply
[Her/His/His or her] mother is deceased 11
[Her/His/His or her] mother did not have enough money to raise [her/him/him or her] 12
[Her/His/His or her] mother got too sick to take care of [her/him/him or her] 13
[Her/His/His or her] mother had a drinking problem and could not take care of [her/him/him or her] 14
[Her/His/His or her] mother had a drug problem and could not take care of [her/him/him or her] 15
[Her/His/His or her] mother is in a residential treatment program for substance abuse and could not bring [her/him/him or her] 24
[Her/His/His or her] mother had a mental or emotional problem and could not take care of [her/him/him or her]. 16
[Her/His/His or her] mother was in trouble with the law or had to go to jail 17
[She/He/He or she] was neglected or abused while living with [her/his/his or her] mother. 18
Someone at the child welfare office said [she/he/he or she] could not live with [his/her/his or her] mother any more. 19
[Her/His/His or her] family is homeless. 25
[Her/His/His or her] parents are divorced/separated 22
Mother and [CHILD] are currently living together 26
Something else (SPECIFY) 21
Specify (STRING 100)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J1=NO RESPONSE OR (J1_21=1 AND SPECIFY LEFT BLANK); Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J1 NE 11, 26, D, OR R |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
J7a. Is there anyone else who is like a mother to [CHILD]?
Yes 1 GO TO J7B
No 0 GO TO BOX J3
DON’T KNOW d GO TO BOX J3
REFUSED r GO TO BOX J3
NO RESPONSE M GO TO BOX J3
WEB SOFT CHECK: IF J7a=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J7a = 1 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
If SC9 = 11, 13, 15, 17, 19, 21, 23, 25, 27, 29 (R IS FEMALE), display option 1 and fill you, ELSE, DO NOT DISPLAY OPTION 1 |
J7b. Who is this person? Is she . . .
Select one only
[you,] 1
your spouse or partner, 2
a relative of [CHILD], 3
a friend of the family, or 4
someone else? (SPECIFY) 5
Specify (STRING 50)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J7b=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
VERSION BOX J3 IF Wave=1 OR (Wave=2 AND PrevInt=0), GO TO J8 IF Wave=2 AND PrevInt=1 AND FALL_NEEDMOTHERDOB=1, GO TO J8. IF WAVE=2 AND PREVINT=1 AND FALL_NEEDMOTHERDOB=0 (MOTHER DOB COLLECTED AT PREVIOUS INTERVIEW)) AND J1 ≠ 11, SKIP TO J29, ELSE GO TO J8. |
IF SC9 =12, 14-30 AND ((Wave=1 OR (Wave=2 AND PrevInt=0)) OR (Wave=2 AND PrevInt=1 AND FALL_NEEDMOTHERDOB = 1)) |
CATI: IF ANY J1=11, FILL I am sorry to hear about [CHILD]’s mother passing. I would like to ask you a few questions about her. ELSE, FILL Now I’m going to ask you some questions about [CHILD]’s mother. WEB: IF ANY J1=11, FILL We are sorry to learn about [CHILD]’s mother passing. The next few questions are about her. ELSE, FILL The next questions are about [CHILD]’s mother. |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF ANY J1=11, FILL was; IF ANY J1 NE 11, FILL is |
J8. CATI: [I am sorry to hear about [CHILD]’s mother passing. I would like to ask you a few questions about her./Now I’m going to ask you some questions about [CHILD]’s mother.]
What [is/was] her birth date?
WEB: [We are sorry to learn about [CHILD]’s mother passing. The next few questions are about her./The next questions are about [CHILD]’s mother].
What [is/was] her birth date?
MM/DD/YYYY
(RANGE 1923-2003)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J8=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
IF SC9=11 OR 13, FILL Are you IF J1=11, FILL Was she IF (SC9 NE 11 OR 13) AND (J1 NE 11), FILL Is she |
J10. [Are you/Is she/Was she] of Spanish, Hispanic, or Latino origin?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J10=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
IF J1=11, FILL was ELSE, FILL is |
IF SC9=11 OR 13, FILL your ELSE, FILL her |
J12. CATI: What [is/was] [your/her] race? You may name more than one if you like.
IF R ANSWERS ‘Hispanic,’ PROBE: Would that be white Hispanic or black Hispanic?
IF R ANSWERS ‘Hispanic’ AGAIN, PUT RESPONSE IN OTHER CATEGORY.
WEB: What [is/was] [your/her] race?
Select one or more
White 11
Black or African American 12
American Indian or Alaska Native 13
Asian 27
Native Hawaiian, or other Pacific Islander 26
Another race (SPECIFY) 25
Specify STRING 50
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J12=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
PROGRAMMER SKIP BOX J13a IF SC9 = 11 OR 13 (RESPONDENT IS BIRTH OR ADOPTIVE MOTHER), CONTINUE. IF SC9 NE 11 OR 13 (NOT BIRTH MOTHER) AND J1 = 12-25 (BIRTH MOTHER IS ALIVE), CONTINUE. IF SC9 NE 11 OR 13 (NOT BIRTH MOTHER) AND J1=11 (BIRTH MOTHER IS DECEASED), GO TO BOX K1. |
PROGRAMMER SKIP BOX j14a IF SC9 NE 11 (NOT BIOLOGICAL MOTHER) AND SC9 NE 12 (NOT BIOLOGICAL FATHER) AND J1 NE 11 (MOTHER NOT DECEASED), CONTINUE. OTHERWISE, GO TO BOX J16A |
IF (Wave=1 OR (Wave=2 and PrevInt=0)) AND (SC9 = 13-30, M (R IS NOT BIO PARENT)) AND J1 NE 11 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
J15. The next questions are about [CHILD]’s biological parents.
Are they…
Select one only
married, 1 GO TO J17
in a registered domestic partnership or civil union, 5 GO TO J17
divorced, 2 GO TO J16
separated, 3 GO TO J16
not married, or 4 GO TO J16
living as partners in a committed relationship? 6 GO TO J17
DON’T KNOW d GO TO J16
REFUSED r GO TO J16
NO RESPONSE M GO TO J16
WEB SOFT CHECK: IF J15=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J15 = 2, 3, 4, M, D, OR R |
J16. Which of the following statements best describes their current relationship?
Select one only
They are romantically involved on a steady basis, 1
they are involved in an on-again and off-again relationship, 2
they are just friends, or 3
they are not in any kind of relationship. 4
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J16=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
PROGRAMMER SKIP BOX j16a IF ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)) (MOTHER IS NOT LIVING IN HOUSEHOLD), GO TO VERSION BOX J33. |
IF (Wave=1 OR (Wave=2 and PrevInt=0)) AND ((SC9 = 11 OR 13) OR (ANY B5_2-15 = 1)) |
IF SC9=11 OR 13, FILL you ELSE, FILL [CHILD]’s mother |
IF SC9=11 OR 13, FILL I am ELSE, FILL [CHILD]’s mother is |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
J17. During the past week (that is, the past 7 days), did [you/[CHILD]’s mother] work at a job for pay or income, including self-employment?
Select one only
Yes 1 GO TO J21
No, [I am/[CHILD]’s mother is] retired 2 GO TO J24
No, [I am/[CHILD]’s mother is] disabled and unable to work 3 GO TO J24
No (for reason other than retirement or disability) 0 GO TO J18
DON’T KNOW d GO TO J24
REFUSED r GO TO J24
NO RESPONSE M GO TO J24
WEB SOFT CHECK: IF J17=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J17=0 |
IF SC9=11 OR 13, FILL Were you ELSE, FILL Was she |
J18. [Were you/Was she] on leave or vacation from a job for the past week (that is, the past 7 days)?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J18=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J17=0 |
IF SC9=11 OR 13, FILL Have you ELSE, FILL Has she |
J19. [Have you/Has she] actively been looking for work in the past four weeks?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J19=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J17=0 |
IF SC9=11 OR 13, FILL you ELSE, FILL [CHILD]’s mother |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF Wave=1 OR (Wave=2 AND PrevInt=0), FILL In the last 12 months ELSE, FILL Since [FallInt_MonthYear] |
J20. [In the last 12 months/Since [FallInt_MonthYear]], did [you/[CHILD]’s mother] work at a job for pay or income, including self-employment?
Yes 1 GO TO J21
No 0 GO TO J24
DON’T KNOW d GO TO J24
REFUSED r GO TO J24
NO RESPONSE M GO TO J24
WEB SOFT CHECK: IF J20=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(J17=1) OR (J20=1) |
IF (SC9=11 OR 13) AND J17=1, FILL do you IF (SC9=11 OR 13) AND J17 NE 1, FILL did you IF (SC9 NE 11 OR 13) AND J17=1, FILL does she IF (SC9 NE 11 OR 13) AND J17 NE 1, FILL did she |
J21. About how many total hours per week [do you/did you/does she/did she] usually work for pay or income, counting all jobs?
CATI: INTERVIEWER NOTE: IF HOURS VARY, AVERAGE HOURS PER WEEK.
CATI: PROBE: Your best estimate is fine.
WEB: If hours vary, please enter the average hours per week.
(Your best estimate is fine.)
HOURS
(RANGE 0-99)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J21=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 = 11 OR 13) OR (ANY B5_2-15 = 1)) |
IF SC9=11 OR 13, FILL you ELSE, FILL she |
J24. What is the highest grade or year of school that [you/she] completed?
CATI ONLY: NOTE: If ‘high school’, PROBE: What is the last grade [you/she] completed?
CATI ONLY: NOTE: If ‘college’, PROBE: Did [you/she] receive a degree? If yes, what type of degree?
Select one only
8th grade or lower 1
9th to 11th grade 2
12th grade but no diploma 3
High school diploma or equivalent 4
Vocational/technical program after high school but no vocational/technical diploma 5
Vocational/technical diploma after high school 6
Some college but no degree 7
Associate’s degree 8
Bachelor’s degree 9
Graduate or professional school but no degree 10
Master’s degree (MA, MS) 11
Doctorate degree (Ph.D, EdD) 12
Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J24=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 = 11 OR 13) OR (ANY B5_2-15 = 1)) |
IF SC9=11 OR 13, FILL Are you ELSE, FILL Is she |
J26. [Are you/Is she] now attending or enrolled in any courses, classes, or workshops for work-related reasons or personal interest? Some examples include college or university degree or certificate programs, computer courses, job training courses, basic reading or math classes, family literacy classes or GED preparation classes.
Yes 1 GO TO J27
No 0 GO TO J28
DON’T KNOW d GO TO J28
REFUSED r GO TO J28
NO RESPONSE M GO TO J28
WEB SOFT CHECK: IF J26=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J26 = 1 |
IF SC9=11 OR 13, FILL Are you ELSE, FILL Is she |
J27. [Are you/Is she] currently taking courses full-time or part-time?
Select one only
Full-time 1
Part-time 2
Not currently taking 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J27=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J26 = 0, D, R, OR M |
IF SC9=11 OR 13, FILL Are you ELSE, FILL Is she |
J28. [Are you/Is she] currently participating in a job-training or on-the-job-training program?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J28=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF WAVE=2 AND ((SC9 = 11 OR 13) OR (ANY B5_2-15 = 1)) |
IF SC9=11 OR 13, FILL Have you ELSE, FILL Has she |
IF NO PREVIOUS INTERVIEW, FILL in the last 12 months ELSE, FILL since [FallInt_MonthYear] |
J29. [Have you/Has she] received a certificate, diploma, or degree [in the last 12 months/since [FallInt_MonthYear]]?
Yes 1 GO TO J30
No 0 GO TO BOX J33
DON’T KNOW d GO TO BOX J33
REFUSED r GO TO BOX J33
NO RESPONSE M GO TO BOX J33
J29 = 1 |
IF SC9=11 OR 13, FILL you ELSE, FILL she |
J30. What kind of certificate, diploma, or degree did [you/she] receive?
Select one only
Trade license or certificate 1
GED certificate or equivalent 2
High school diploma 3
Associate’s degree 4
Child Development Associate (CDA) 5
Bachelor’s degree 6
Graduate degree 7
Credential for Family Service Worker 9
Other (SPECIFY) 8
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
J33 BOX IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1 (IF CHILD'S BIOLOGICAL MOTHER DOES NOT LIVE IN THE HOUSEHOLD))) AND (J1 NE 11 (MOTHER NOT DECEASED)), GO TO J33.
ELSE GO TO SECTION K. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)) AND (J1 NE 11) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL her IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL him ELSE, FILL him or her |
J33. The next questions are about how far away [CHILD]'s mother lives and the amount of contact she has with [him/her/him or her].
How many minutes away does [CHILD]'s mother live from [him/her/him or her]?
Select one only
10 minutes or less 1
11 to 30 minutes 2
31 to 59 minutes 3
1 to 2 hours 4
More than 2 hours 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J33=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)) AND (J1 NE 11) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: PLEASE DISPLAY DK OPTION ON WEB. |
J35. CATI: How long has it been since she last saw [CHILD]?
IF SHE SAW [CHILD] TODAY, ENTER 1 DAY.
WEB: How long has it been since she last saw [CHILD]?
If she saw [CHILD] today, enter 1 Day.
Enter number:
NUM
(RANGE 0-100)
Days 1
Weeks 4
Months 2
Years 3
Mother has never seen [CHILD]. 0 GO TO J37
Don’t know d GO TO J39
REFUSED r GO TO J39
NO RESPONSE M GO TO J39
PROGRAMMER: Using J35, calculate length of time since mother saw child (MomLastSawChild). |
J35 BOX IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND IF MomLastSawChild (LENGTH OF TIME SINCE BIOLOGICAL MOTHER SAW CHILD) IS LESS THAN OR EQUAL TO 3 MONTHS/90 DAYS/12 WEEKS, GO TO J36. ELSE IF MomLastSawChild (LENGTH OF TIME SINCE BIOLOGICAL MOTHER SAW CHILD) IS GREATER THAN 3 MONTHS/90 DAYS/12 WEEKS, GO TO J36 BOX.IF J35 = 0, GO TO J37. ELSE IF J35 = D, R, OR M, GO TO J39. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND (Momlastsawchild < 3 months) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL her IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL him ELSE, FILL him or her |
[90DaysAgo]: Current date minus 3 months/90 days |
PROGRAMMER: PLEASE DISPLAY DK OPTION ON WEB. |
J36. In the last 3 months, that is since [90DaysAgo], on how many days has [CHILD]’s mother seen [him/her/him or her]?
Your best guess is fine.
NUMBER OF DAYS
(RANGE 0-100)
Don’t know. d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J36=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J36 BOX IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND MomLastSawChild (LENGTH OF TIME SINCE BIOLOGICAL MOTHER SAW CHILD) IS GREATER THAN ONE MONTH/30 DAYS/4 WEEKS OR ANY NUMBER OF YEARS ENTERED, GO TO J37. ELSE, GO TO J39. |
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND (Momlastsawchild > 1 mONTH/30 DAYS/4 WEEKS or any number of years ENTERED) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
FILL more recently if j35 NE 0. |
J37. Why hasn't she seen [CHILD] [more recently]? Is it because...
Select one only
you do not want her to see [CHILD], 1 GO TO J43
she does not want to see [CHILD], or 2 GO TO J43
she has been unable to see [CHILD]? 3 GO TO J38
DON’T KNOW d GO TO J43
REFUSED r GO TO J43
NO RESPONSE M GO TO J43
WEB SOFT CHECK: IF J37=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
J37 = 3 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
J38. Why has she been unable to see [CHILD]? Is it because.…
Select one only
she lives too far away, 1
she is sick or disabled, 2
she is in the military, 3
she is in jail or prison, or 4
some other reason? (SPECIFY) 99
Specify (STRING 50)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J38=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
-
PROGRAMMER BOX J39
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND IF (J35 = D, R, or M), THEN GO TO J39.
ELSE, GO TO TO J43.
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND (J35 = D, R, or M) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
J39. In the last 3 months, how often have you been in touch with [CHILD]’s mother, either by phone, letter, or other means? Is it…
Select one only
Every day or almost every day, 1
Several times a week, 2
About once a week, 3
Two or three times a month, 4
About once a month, or 5
Less often? 6
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J39=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)) AND (J1 NE 11) |
WEB DO NOT SHOW DK OR R |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: Please gray question text after J43_a |
J43. CATI: Mothers who do not live with their children sometimes help out with them in other ways. Please tell me whether [CHILD]'s mother has done these things often, sometimes, or never.
[FILL J43a-d.]
WEB: Mothers who do not live with their children sometimes help out with them in other ways. Please indicate whether [CHILD]'s mother has done these things often, sometimes, or never. How often has she done any of the following for [CHILD]?
Select one per row
|
Often |
Sometimes |
Never |
DK |
R |
a. Bought clothes, toys, or presents for [CHILD]? |
1 |
2 |
3 |
D |
R |
b. Paid for [CHILD]'s medical insurance, doctor bills, or medicines? |
1 |
2 |
3 |
D |
R |
c. Helped pay for [CHILD]’s child care expenses? |
1 |
2 |
3 |
D |
R |
d. Not including child support, given you extra money to help out? |
1 |
2 |
3 |
D |
r |
|
|
|
|
|
|
WEB SOFT CHECK: IF ANY J43 a-d=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)) AND (J1 NE 11) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
J44. Thinking about child support, do you have a legal agreement, an informal agreement, or no arrangement at all with [CHILD]'s mother?
Select one only
Legal agreement 1
Informal agreement 2
No arrangement 3
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J44=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)) AND (J1 NE 11) |
J45. Do you receive child support from the mother on a regular basis?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 11 OR 13) AND (ALL B5_2-15 NE 1)) AND (J1 NE 11) |
J46. Do you receive financial support from the mother’s family?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF J46=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K. ABOUT CHILD’S FATHER |
PROGRAMMER VERSION BOX K1 IF (WAVE=1 OR (WAVE=2 and PrevInt=0)) AND (ANY B5_2-15 = 2 (BIOLOGICAL OR ADOPTIVE FATHER IN HOUSEHOLD) AND (SC9 = 12 OR 14 (RESPONDENT IS BIOLOGICAL OR ADOPTIVE FATHER), GO TO BOX K9.
IF (WAVE=1 OR (WAVE=2 and PrevInt=0)) AND (ANY B5_2-15 = 2 (BIOLOGICAL OR ADOPTIVE FATHER IN HOUSEHOLD), AND (SC9 = 11, 13, OR 15-30 (RESPONDENT IS NOT BIOLOGICAL OR ADOPTIVE FATHER), GO TO K8.
IF (WAVE=1 OR (WAVE=2 and PrevInt=0)) AND ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2 (BIOLOGICAL OR ADOPTIVE FATHER NOT IN HOUSEHOLD))), ASK K1.
IF (WAVE=2 AND PREVINT=1) AND (FALL_DADHH = 1) AND ((SC9 NE 12 OR 14) OR (ALL B5_2-15 NE 2)), ASK K1 (IF SPRING 2020 AND FATHER LEFT HOUSEHOLD SINCE FALL 2019 INTERVIEW).
IF (WAVE=2 AND PREVINT=1) AND (FALL_DADHH = 0, D, R, M) AND ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2)), GO TO VERSION BOX K2 (BIOLOGICAL OR ADOPTIVE FATHER IS NOT IN HOUSEHOLD, AND WAS NOT IN HOUSEHOLD AT FALL INTERVIEW).
IF (WAVE=2 AND PREVINT=1) AND (FALL_DADHH = 0) AND ((SC9 = 12 OR 14) OR (ANY B5_2-15 = 2)), GO TO BOX K16A (IF SPRING 2020 AND FATHER WAS NOT PREVIOUSLY IN HOUSEHOLD BUT NOW IS).
IF (WAVE=2 AND PREVINT=1) AND (FALL_DADHH = 1) AND ((SC9 = 12 OR 14) OR (ANY B5_2-15 = 2)), GO TO BOX K16A (IF SPRING 2020 AND FATHER IS STILL IN HOUSEHOLD).
|
IF WAVE = 1 OR 2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF SC9= 12 OR 14, FILL you IF SC9 NE 12 OR 14, FILL [CHILD]’s father |
K_Intro:
The next questions are about [you/[CHILD]’s father].
(ALL B5_2-15 NE 2) AND (SC9 NE 12 OR 14)) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL her; Her; she; She IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL his; him; His; he; He ELSE, FILL his or her; him or her; His or her; He or she; he or she |
K1. CATI: There are many reasons for children not living with their fathers. Please tell me why [CHILD] is not living with [her/his/his or her] father.
PROBE: Are there any other reasons?
WEB: There are many reasons for children not living with their fathers. Please enter why [CHILD] is not living with [her/his/his or her] father.
Select all that apply
[Her/His/His or her] father is deceased 11
[Her/His/His or her] father did not have enough money to raise [her/him/him or her] 12
[Her/His/His or her] father got too sick to take care of [her/him/him or her] 13
[Her/His/His or her] father had a drinking problem and could not take care of [her/him/him or her] 14
[Her/His/His or her] father had a drug problem and could not take care of [her/him/him or her] 15
[Her/His/His or her] father is in a residential treatment program for substance abuse and could not bring [her/him/him or her] 24
[Her/His/His or her] father had a mental or emotional problem and could not take care of [her/him/him or her] 16
[Her/His/His or her] father was in trouble with the law or had to go to jail 17
[He/She/He or she] was neglected or abused while living with [her/his/his or her] father 18
Someone at the child welfare office said [he/she/he or she] could not live with [his/her/his or her] father any more. 19
[Her/His/His or her] family is homeless. 25
[Her/His/His or her] parents are divorced/separated 22
Father left/did not want child 23
Father and [CHILD] currently live together 26
Something else (SPECIFY) 21
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K1=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K1 = NE 11, 26, D, OR R |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
K7a. Is there anyone else who is like a father to [CHILD]?
Yes 1 GO TO K7B
No 0 GO TO BOX K2
DON’T KNOW d GO TO BOX K2
REFUSED r GO TO BOX K2
NO RESPONSE M GO TO BOX K2
WEB SOFT CHECK: IF K7a=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K7a=1 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
If SC9 = 12, 14, 16, 18, 20, 22, 24, 26, 28, 30 (R IS MALE), display option 1 and fill you, ELSE, DO NOT DISPLAY OPTION 1 |
K7b. Who is this person? Is he…
Select one only
[you,] 1
your spouse or partner, 2
a relative of [CHILD], 3
a friend of the family, or 4
someone else? (SPECIFY) 5
Specify:
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K7b=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
PROGRAMMER version BOX K2 IF Wave=1 OR (Wave=2 AND PrevInt=0), GO TO K8. IF Wave=2 AND PrevInt=1 AND FALL_NEEDFATHERDOB=1, GO TO K8. IF Wave=2 AND PrevInt=1 AND FALL_NEEDFATHERDOB=0 (FATHER DOB COLLECTED AT PREVIOUS INTERVIEW) AND K1 ≠ 11, SKIP TO K29. ELSE CONTINUE. |
SC9 = 11, 13, 15-30, M AND ((Wave=1 OR (Wave=2 AND PrevInt=0)) OR (Wave=2 AND PrevInt=1 AND FALL_NEEDFATHERDOB=1)) |
CATI: IF ANY K1=11, FILL I am sorry to hear about [CHILD]’s father passing. I would like to ask you a few questions about him ELSE, FILL Now I’m going to ask you some questions about [CHILD]’s father WEB: IF ANY K1=11, FILL We are sorry to learn about [CHILD]’s father passing. The next few questions are about him ELSE, FILL The next questions are about [CHILD]’s father |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF ANY K1=11, FILL was ELSE, FILL is |
K8. CATI: [I am sorry to hear about [CHILD]’s father passing. I would like to ask you a few questions about him/Now I’m going to ask you some questions about [CHILD]’s father].
What [is/was] his birth date?
WEB: [We are sorry to learn about [CHILD]’s father passing. The next few questions are about him/The next questions are about [CHILD]’s father].
What [is/was] his birth date?
MM/DD/YYYY
(RANGE 1923-2003)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K8=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
IF SC9 = 12 or 14, FILL Are you IF K1=11, FILL Was he IF (SC9 NE 12 OR 14) AND (K1 NE 11), FILL Is he |
K10. [Are you/Is he/Was he] of Spanish, Hispanic, or Latino origin?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K10=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
IF K1=11, FILL was ELSE, FILL is |
IF SC9=12 or 14, FILL your ELSE, FILL his |
K12. CATI: What [is/was] [your/his] race? You may name more than one if you like.
IF R ANSWERS ‘Hispanic,’ PROBE: Would that be white Hispanic or black Hispanic?
IF R ANSWERS ‘Hispanic’ AGAIN, PUT RESPONSE IN OTHER CATEGORY.
WEB: What [is/was] [your/his] race?
Select one or more
White 11
Black or African American 12
American Indian or Alaska Native 13
Asian 27
Native Hawaiian, or other Pacific Islander 26
Another race (SPECIFY) 25
Please specify other race. STRING 50
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K12=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
PROGRAMMER SKIP BOX K13a IF SC9 = 12 OR 14 (RESPONDENT IS BIRTH OR ADOPTIVE FATHER), CONTINUE. IF SC9 NE 12 OR 14 (NOT BIRTH FATHER) AND K1 = 12-25 (BIRTH FATHER IS ALIVE), CONTINUE. IF SC9 NE 12 OR 14 (NOT BIRTH FATHER) AND K1 = 11 (BIRTH FATHER IS DECEASED), GO TO BOX L. |
PROGRAMMER SKIP BOX =k16a IF ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2 (FATHER IS NOT LIVING IN HOUSEHOLD)), GO TO VERSION BOX K33. |
IF (Wave=1 OR (Wave=2 and PrevInt=0)) AND ((SC9 = 12 OR 14) OR (ANY B5_2-15 = 2)) |
IF SC9 = 12 OR 14, FILL you; I am ELSE, FILL [CHILD]’s father; [CHILD]’s father is |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
K17. During the past week (that is, the past 7 days), did [you/[CHILD]’s father] work at a job for pay or income, including self-employment?
Select one only
Yes 1 GO TO K21
No, [I am/[CHILD]’s father is] retired 2 GO TO K24
No, [I am/[CHILD]’s father is] disabled and unable to work 3 GO TO K24
No (for reason other than retirement or disability) 0 GO TO K18
DON’T KNOW d GO TO K24
REFUSED r GO TO K24
NO RESPONSE M GO TO K24
WEB SOFT CHECK: IF K17=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K17=0 |
IF SC9 = 12 OR 14, FILL Were you ELSE, FILL Was he |
K18. [Were you/Was he] on leave or vacation from a job for the past week (that is, the past 7 days)?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K18=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K17=0 |
IF SC9 = 12 OR 14, FILL Have you ELSE, FILL Has he |
K19. [Have you/Has he] actively been looking for work in the past four weeks?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K19=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K17=0 |
IF SC9 = 12 OR 14, FILL you ELSE, FILL [CHILD]’s father |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF Wave=1 OR (Wave=2 AND PrevInt=0), FILL in the last 12 months ELSE, FILL since [FallInt_MonthYear] |
K20. [In the last 12 months/Since [FallInt_MonthYear]], did [you/[CHILD]’s father] work at a job for pay or income, including self-employment?
Yes 1 GO TO K21
No
0 GO TO K24
DON’T KNOW d GO TO K24
REFUSED r GO TO K24
NO RESPONSE M GO TO K24
WEB SOFT CHECK: IF K20=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(K17=1) OR (K20=1) |
IF SC9 = 12 OR 14 AND K17 = 1, FILL do you IF SC9 = 12 OR 14 AND K17 NE 1, FILL did you IF SC9 NE 12 OR 14 AND K17=1, FILL does he IF SC9 NE 12 OR 14 AND K17 NE 1, FILL did he |
K21. About how many total hours per week [do you/did you/does he/did he] usually work for pay or income, counting all jobs?
CATI: INTERVIEWER NOTE: IF HOURS VARY, AVERAGE HOURS PER WEEK.
CATI PROBE: Your best estimate is fine.
WEB: If hours vary, please enter the average hours per week. (Your best estimate is fine.)
HOURS
(RANGE 0-99)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K21=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 = 12 OR 14) OR (ANY B5_2-15 = 2)) |
IF SC9 = 12 OR 14, FILL you ELSE, FILL he |
K24. What is the highest grade or year of school that [you/he] completed?
CATI ONLY: NOTE: If ‘high school’, PROBE: What is the last grade [you/he] completed?
CATI ONLY: NOTE: If ‘college’, PROBE: Did [you/he] receive a degree? If yes, what type of degree?
Select one only
8th grade or lower 1
9th to 11th grade 2
12th grade but no diploma 3
High school diploma/equivalent 4
Vocational/technical program after high school but no vocational/technical diploma 5
Vocational/technical diploma after high school 6
Some college but no degree 7
Associate’s degree 8
Bachelor’s degree 9
Graduate or professional school but no degree 10
Master’s degree (MA, MS) 11
Doctorate degree (Ph.D, EdD) 12
Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K24=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 = 12 OR 14) OR (ANY B5_2-15 = 2)) |
IF SC9=12 or 14, FILL Are you ELSE, FILL Is he |
K26. [Are you/Is he] now attending or enrolled in any courses, classes, or workshops for work-related reasons or personal interest? Some examples include college or university degree or certificate programs, computer courses, job training courses, basic reading or math classes, family literacy classes or GED preparation classes.
Yes 1 GO TO K27
No 0 GO TO K28
DON’T KNOW d GO TO K28
REFUSED r GO TO K28
NO RESPONSE M GO TO K28
WEB SOFT CHECK: IF K26=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K26 = 1 |
IF SC9=12 or 14, FILL Are you ELSE, FILL Is he |
K27. [Are you/Is he] currently taking courses full-time or part-time?
Select one only
Full-time 1
Part-time 2
Not currently taking 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K27=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K26 = 0, D, R, or M |
IF SC9=12 or 14, FILL Are you ELSE, FILL Is he |
K28. [Are you/Is he] currently participating in a job-training or on-the-job-training program?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K28=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF WAVE=2 AND ((SC9 = 12 OR 14) OR (ANY B5_2-15 = 2) |
IF SC9 = 12 OR 14, FILL Have you ELSE, FILL Has he |
IF NO PREVIOUS INTERVIEW, FILL in the last 12 months ELSE, FILL since [FallInt_MonthYear] |
K29. [Have you/Has he] received a certificate, diploma, or degree [in the last 12 months/since [FallInt_MonthYear]?
Yes 1 GO TO K30
No 0 GO TO BOX K33
DON’T KNOW d GO TO BOX K33
REFUSED r GO TO BOX K33
NO RESPONSE M GO TO BOX K33
K29 = 1 |
IF SC9 = 12 OR 14, FILL you ELSE, FILL he |
K30. What kind of certificate, diploma, or degree did [you/he] receive?
Select one only
Trade license or certificate 1
GED certificate or equivalent 2
High school diploma 3
Associate’s degree 4
Child Development Associate (CDA) 5
Bachelor’s degree 6
Graduate degree 7
Credential for Family Service Worker 9
Other (SPECIFY) 8
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
K33 BOX IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2 (IF CHILD'S BIOLOGICAL FATHER DOES NOT LIVE IN THE HOUSEHOLD))) AND (K1 NE 11 (FATHER NOT DECEASED)), GO TO K33. ELSE GO TO SECTION L. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2)) AND (K1 NE 11) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL her IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL him ELSE, FILL him or her |
K33. The next questions are about how far away [CHILD]'s father lives and the amount of contact he has with [him/her/him or her].
How many minutes away does [CHILD]'s father live from [him/her/him or her]?
Select one only
10 minutes or less 1
11 to 30 minutes 2
31 to 59 minutes 3
1 to 2 hours 4
More than 2 hours 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K33=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2)) AND (K1 NE 11) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: PLEASE DISPLAY DK OPTION ON WEB. |
K35. CATI: How long has it been since he last saw [CHILD]?
NOTE: IF HE SAW [CHILD] TODAY, ENTER 1 DAY.
WEB: How long has it been since he last saw [CHILD]?
If he saw [CHILD] today, enter 1 Day.
Enter number:
NUM
(RANGE 0-100)
Days 1
Weeks 4
Months 2
Years 3
Father has never seen [CHILD]. 0 GO TO K37
Don’t know d GO TO K39
REFUSED r GO TO K39
NO RESPONSE M GO TO K39
PROGRAMMER: Using K35, calculate length of time since father saw child (DadLastSawChild).
|
K35 BOX IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND IF DadLastSawChild (LENGTH OF TIME SINCE BIOLOGICAL FATHER SAW CHILD) IS LESS THAN OR EQUAL TO 3 MONTHS/90 DAY/12 WEEKS, GO TO K36. ELSE IF DadLastSawChild (LENGTH OF TIME SINCE BIOLOGICAL FATHER SAW CHILD) IS GREATER THAN 3 MONTHS/90 DAYS/12 WEEKS, GO TO K36 BOX. IF K35 = 0, GO TO K37. ELSE IF K35 = D, R, or M, GO TO K39. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND Dadlastsawchild < 3 months |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL her IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL him ELSE, FILL him or her |
90DaysAgo: Current date minus 3 months/90 days |
PROGRAMMER: PLEASE DISPLAY DK OPTION ON WEB. |
K36. In the last 3 months, that is since [90DaysAgo], on how many days has [CHILD]’s father seen [him/her/him or her]?
Your best guess is fine.
NUMBER OF DAYS
(RANGE 0-100)
Don’t know d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K36=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K36 BOX IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND IF DadLastSawChild (LENGTH OF TIME SINCE BIOLOGICAL FATHER SAW CHILD) IS GREATER THAN ONE MONTH/30 DAYS/4 WEEKS OR ANY NUMBER OF YEARS ENTERED, GO TO K37. ELSE, GO TO K39. |
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND Dadlastsawchild > 1 MONTH/30 DAYS/4 WEEKS OR ANY NUMBER OF YEARS ENTERED |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
if K35 NE 0, fill more recently. |
K37. Why hasn't he seen [CHILD] [more recently]? Is it because...
Select one only
You do not want him to see [CHILD], 1 GO TO K43
He does not want to see [CHILD], or 2 GO TO K43
He has been unable to see [CHILD]? 3 GO TO K38
DON’T KNOW d GO TO K43
REFUSED r GO TO K43
NO RESPONSE M GO TO K43
WEB SOFT CHECK: IF K37=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
K37 = 3 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
K38. Why has he been unable to see [CHILD]? Is it because.…
Select one only
He lives too far away, 1
He is sick or disabled, 2
He is in the military, 3
He is in jail or prison, or 4
Some other reason? (SPECIFY) 99
Specify (STRING 50)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K38=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
-
PROGRAMMER BOX K39
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND IF (K35 = D, R, or M), THEN GO TO K39.
ELSE, GO TO TO K43.
IF (WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND (K35 = D, R, or M) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
K39. In the last 3 months, how often have you been in touch with [CHILD]’s father, either by phone, letter, or other means? Is it…
Select one only
every day or almost every day, 1
several times a week, 2
about once a week, 3
two or three times a month, 4
about once a month, or 5
less often? 6
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K39=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2)) AND (K1 NE 11) |
WEB DO NOT SHOW DK OR R |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: Please gray question text after J43_a |
K43. CATI: Fathers who do not live with their children sometimes help out with them in other ways. Please tell me whether [CHILD]'s father has done these things often, sometimes, or never.
[FILL K43a-d.]
WEB: Fathers who do not live with their children sometimes help out with them in other ways. Please indicate whether [CHILD]'s father has done these things often, sometimes, or never. How often has he done any of the following for [CHILD]?
Select one per row
|
Often |
Sometimes |
Never |
DK |
R |
a. Bought clothes, toys, or presents for [CHILD]? |
1 |
2 |
3 |
D |
R |
b. Paid for [CHILD]'s medical insurance, doctor bills, or medicines? |
1 |
2 |
3 |
D |
R |
c. Helped pay for [CHILD]’s child care expenses? |
1 |
2 |
3 |
D |
R |
d. Not including child support, given you extra money to help out? |
1 |
2 |
3 |
D |
r |
WEB SOFT CHECK: IF K43=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 12 OR 14) AND(ALL B5_2-15 NE 2)) AND (K1 NE 11) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
K44. Thinking about child support, do you have a legal agreement, an informal agreement, or no arrangement at all with [CHILD]'s father?
Select one only
Legal agreement 1
Informal agreement 2
No arrangement 3
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K44=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2)) AND (K1 NE 11) |
K45. Do you receive child support from the father on a regular basis?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K45=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (WAVE=2 AND PREVINT=0)) AND ((SC9 NE 12 OR 14) AND (ALL B5_2-15 NE 2)) AND (K1 NE 11) |
K46. Do you receive financial support from the father’s family?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF K46=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
L. ABOUT RESPONDENT |
PROGRAMMER VERSION BOX L IF SC9 = 11-14 (RESPONDENT IS [CHILD]’S BIOLOGICAL OR ADOPTIVE MOTHER OR FATHER), GO TO SECTION M. IF (WAVE=1 OR (Wave=2 AND PrevInt=0)) AND (SC9 NE 11-14 (RESPONDENT IS NOT BIOLOGICAL OR ADOPTIVE MOTHER OR FATHER)), CONTINUE. ELSE GO TO L17. |
(WAVE=1 OR (Wave=2 AND PrevInt=0)) AND SC9 = 15-30, d, r, m |
L10. These next questions are about you.
Are you of Spanish, Hispanic, or Latino origin?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L10=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (Wave=2 AND PrevInt=0)) AND SC9 = 15-30, d, r, m |
L12. CATI: What is your race? You may name more than one if you like.
IF PARENT ANSWERS ‘Hispanic,’ PROBE: Would that be white Hispanic or black Hispanic?
IF PARENT ANSWERS ‘Hispanic’ AGAIN, PUT RESPONSE IN OTHER CATEGORY.
WEB: What is your race?
Select one or more
White 11
Black or African American 12
American Indian or Alaska Native 13
Asian 27
Native Hawaiian, or other Pacific Islander 26
Another race (SPECIFY) 25
Specify STRING 50
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L12=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (Wave=2 AND PrevInt=0)) AND SC9 = 15-30, M, d , r |
If L10 = L (logical skip), fill These next questions are about you. |
L17. [These next questions are about you.]
During the past week (that is, the past 7 days), did you work at a job for pay or income, including self-employment?
Select one only
Yes 1 GO TO L21
No, I am retired 2 GO TO L24
No, I am disabled and unable to work 3 GO TO L24
No (for reason other than retirement or disability) 0 GO TO L18
DON’T KNOW d GO TO L24
REFUSED r GO TO L24
NO RESPONSE M GO TO L24
WEB SOFT CHECK: IF L17=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
L17 = 0 |
L18. Were you on leave or vacation from a job for the past week?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L18=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
L17 = 0 |
L19. Have you actively been looking for work in the past four weeks?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L19=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
L17 = 0 |
IF NO PREVIOUS INTERVIEW , FILL in the last 12 months ELSE, FILL since [FallInt_MonthYear] |
L20. [In the last 12 months/Since [FallInt_MonthYear]], did you work at a job for pay or income, including self-employment?
Yes 1 GO TO L21
No 0 GO TO L24
DON’T KNOW d GO TO L24
REFUSED r GO TO L24
NO RESPONSE M GO TO L24
WEB SOFT CHECK: IF L20=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
L17 = 1 OR L20 = 1 |
IF L17=1, FILL do ELSE, FILL did |
L21. About how many total hours per week [do/did] you usually work for pay or income, counting all jobs?
CATI: INTERVIEWER NOTE: IF HOURS VARY, PROBE FOR AVERAGE HOURS PER WEEK.
CATI PROBE: Your best estimate is fine.
WEB: If hours vary, please enter the average hours per week. (Your best estimate is fine.)
HOURS
(RANGE 0-99)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L21=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (Wave=2 AND PrevInt=0)) AND SC9 = 15-30, M, d, r |
L24. What is the highest grade or year of school that you completed?
CATI ONLY: NOTE: If ‘high school’, PROBE: What is the last grade you completed?
CATI ONLY: NOTE: If ‘college’, PROBE: Did you receive a degree? If yes, what type of degree?
Select one only
8th grade or lower 1
9th to 11th grade 2
12th grade but no diploma 3
High school diploma or equivalent 4
Vocational/technical program after high school but no vocational/technical diploma 5
Vocational/technical diploma after high school 6
Some college but no degree 7
Associate’s degree 8
Bachelor’s degree 9
Graduate or professional school but no degree 10
Master’s degree (MA, MS) 11
Doctorate degree (Ph.D, EdD) 12
Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L24=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (Wave=2 AND PrevInt=0)) AND SC9 = 15-30, M, d, r |
L26. Are you now attending or enrolled in any courses, classes, or workshops for work-related reasons or personal interest? Some examples include college or university degree or certificate programs, computer courses, job training courses, basic reading or math classes, family literacy classes or GED preparation classes.
Yes 1 GO TO L27
No 0 GO TO L28
DON’T KNOW d GO TO L28
REFUSED r GO TO L28
NO RESPONSE M GO TO L28
WEB SOFT CHECK: IF L26=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
L26 = 1 |
L27. Are you currently taking courses full-time or part-time?
Select one only
Full-time 1
Part-time 2
Not currently taking 3
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L27=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(WAVE=1 OR (Wave=2 AND PrevInt=0)) AND SC9 = 15-30, M, d, r |
L28. Are you currently participating in a job-training or on-the-job-training program?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L28=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF WAVE=2 AND SC9 = 15-30, M, D, OR R |
IF PrevInt=0 (NO PREVIOUS INTERVIEW), FILL in the last 12 months ELSE, FILL since [FallInt_MonthYear] |
L29. Have you received a certificate, diploma, or degree [in the last 12 months/since [FallInt_MonthYear]?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF L29=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button.
|
L29 = 1 |
L30. What kind of certificate, diploma, or degree did you receive?
Select one only
Trade license or certificate 1
GED certificate or equivalent 2
High school diploma 3
Associate’s degree 4
Child Development Associate (CDA) 5
Bachelor’s degree 6
Graduate degree 7
Credential for Family Service Worker 9
Other (SPECIFY) 8
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
M. INCOME AND HOUSING |
IF WAVE=1 OR 2 (ALL) |
WEB DO NOT DISPLAY DK OR R |
Fill Consent_State |
PROGRAMMER: GRAY QUESTION TEXT AFTER M1_A |
M1. In the past six months, did you or anyone in your household receive any income or support from…
Select one per row
|
Yes |
No |
DK |
R |
a. [Consent_State] or welfare? |
1 |
2 |
D |
R |
b. Unemployment insurance? |
1 |
2 |
D |
R |
c. Food Stamps or SNAP benefits? |
1 |
2 |
D |
R |
d. WIC or the Special Supplemental Nutrition Program for Women, Infants, and Children? |
1 |
2 |
D |
R |
e. Child support? |
1 |
2 |
D |
R |
f. SSI or Social Security Retirement, Disability, or Survivor’s benefits? |
1 |
2 |
D |
R |
g. Payments for providing foster care, guardianship subsidies, or adoption assistance? |
1 |
2 |
D |
R |
h. Energy assistance? |
1 |
2 |
D |
R |
i. Food assistance from a Native or tribal community source, such as commodities, tribal community food bank or the Food Distribution Program Indian Reservation (FDPIR)? |
1 |
2 |
d |
R |
WEB SOFT CHECK: IF ANY M1a-i=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
BOX M1a STATE WELFARE AGENCIES |
|||
Alabama |
FA (Family Assistance Program) |
Nebraska |
Employment First |
Alaska |
ATAP (Alaska Temporary Assistance Program) |
Nevada |
TANF |
Arizona |
EMPOWER (Employing and Moving People Off Welfare and Encouraging Responsibility) |
New Hampshire |
FAP (Family Assistance Program), financial aid for work exempt families NHEP (New Hampshire Employment Program), financial aid for work-mandated families |
Arkansas |
TEA (Transitional Employment Assistance) |
New Jersey |
WFNJ (Work First New Jersey) |
California |
CALWORKS (California Work Opportunity and Responsibility for Kids) |
New Mexico |
NM Works |
Colorado |
Colorado Works |
New York |
FA (Family Assistance Program), SNA (Safety Net Assistance) |
Connecticut |
JOBS FIRST |
North Carolina |
Work First |
Delaware |
ABC (A Better Chance) |
North Dakota |
TEEM (Training, Employment, Education Management) |
District of Columbia |
TANF |
Ohio |
OWF (Ohio Works First) |
Florida |
Welfare Transition Program |
Oklahoma |
TANF |
Georgia |
TANF |
Oregon |
JOBS (Job Opportunities and Basic Skills) |
Hawaii |
TANF |
Pennsylvania |
Pennsylvania TANF |
Idaho |
Temporary Assistance For Families in Idaho |
Rhode Island |
FIP (Family Independence Program) |
Illinois |
TANF |
South Carolina |
Family Independence |
Indiana |
TANF, cash assistance, IMPACT (Indiana Manpower Placement and Comprehensive Training, TANF work program |
South Dakota |
TANF |
Iowa |
FIP (Family Investment Program) |
Tennessee |
Families First |
Kansas |
Kansas Works |
Texas |
Texas Works (Department of Human Services), cash assistance Choices (Texas Workforce Commission, TANF work program) |
Kentucky |
K-TAP (Kentucky Transitional Assistance Program) |
Utah |
FEP (Family Employment Program) |
Louisiana |
FITAP (Family Independence Temporary Assistance Program) cash assistance STEP (Strategies to Empower People) |
Vermont |
ANFC (Aid to Families with Needy Children), cash assistance Reach Up, TANF work program |
Massachusetts |
TAFDC (Transitional Aid to Families with Dependent Children), cash assistance ESP (Employment Services Program), TANF work program |
Virginia |
VIEW (Virginia Initiative for Employment, Not Welfare) |
Michigan |
FIP (Family Independence Program) |
Washington |
WorkFirst |
Minnesota |
MFIP (Minnesota Family Investment Program) |
West Virginia |
West Virginia Works |
Mississippi |
TANF |
Wisconsin |
W-2 (Wisconsin Works) |
Missouri |
Beyond Welfare |
Wyoming |
POWER (Personal Opportunities With Employment Responsibility) |
Montana |
FAIM (Families Achieving Independence in Montana) |
|
|
Programmer Box M3.
IF Wave=1 OR (Wave=2 and PrevInt=0), GO TO M3 Else, GO TO N1. |
IF Wave=1 OR (Wave=2 and PrevInt=0) (fall 2019 OR NO PREVIOUS INTERVIEW) |
M3 and M3_response.
In the last 12 months, what was the total income of all members of your household from all sources before taxes and other deductions? Please include your own income and the income of everyone living with you. Please include money from jobs and public assistance programs, as well as any other sources, such as rental income, interest, dividends, and tribal subsidies or per capita distributions.
$XXX,XXX
(RANGE 0-999,999)
CATI ONLY: PROBE: Is that income per hour, per week, every two weeks, for a month, or for a year?
Select one only
Per hour 11 GO TO M9
Per day 12 GO TO M9
Per week 13 GO TO M9
Every two weeks 14 GO TO M9
Month 15 GO TO M9
Year 16 GO TO M9
Other (SPECIFY) 17 GO TO M9
Specify
CATI ANSWER PROVIDED 1
DON’T KNOW d GO TO M4
REFUSED r GO TO M4
NO RESPONSE M GO TO M4
WEB SOFT CHECK: IF M3_amt IS OUT OF RANGE; (IF ANSWER IS GREATER THAN:
You entered [M3_amt]. Please update or confirm your response and continue. |
WEB SOFT CHECK: IF M3_amt OR M3_per=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
(M3_response= M, d, R, OR 1) or (m3_1=blank or missing) |
M4. CATI: I just need a range. Was it…
WEB: Was it…
$25,000 or less, or 1 GO TO M5
more than $25,000? 2 GO TO M6
DON’T KNOW d GO TO M9
REFUSED r GO TO M9
NO RESPONSE M GO TO M9
WEB SOFT CHECK: IF M4=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
M4=1 |
M5. Was it…
Select one only
$5,000 or less, 1 GO TO M9
$5,001 to $10,000, 2 GO TO M9
$10,001 to $15,000, 3 GO TO M9
$15,001 to $20,000, or 4 GO TO M9
$20,001 to $25,000? 5 GO TO M9
DON’T KNOW d GO TO M9
REFUSED r GO TO M9
NO RESPONSE M GO TO M9
WEB SOFT CHECK: IF M5=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
M4=2 |
M6. Was it…
Select one only
$25,001 to $30,000, 6 GO TO M9
$30,001 to $35,000, 7 GO TO M9
$35,001 to $40,000, 8 GO TO M9
$40,001 to $50,000, 9 GO TO M9
$50,001 to $75,000, or 10 GO TO M9
more than $75,000? 11 GO TO M9
DON’T KNOW d GO TO M9
REFUSED r GO TO M9
NO RESPONSE M
WEB SOFT CHECK: IF M6=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
M9. Do you currently own your home or apartment, pay rent, live in public or subsidized housing, or live with someone else?
CATI PROBE IF RESPONDENT SAYS “RENTS”: Do you rent with or without public assistance?
Select one only
Own or buying home or apartment 1
Rent (without public assistance) 2
Public or subsidized housing 3
Live with someone else (whether you pay rent or not) 5
Some other arrangement (SPECIFY) 99
Specify (STRING (100))
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M9=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
-
IF Wave=1 OR (Wave=2 and PrevInt=0)
WEB DO NOT DISPLAY DK OR R
PROGRAMMER: GRAY QUESTION TEXT AFTER M9A_A
M9a. CATI: How often are these statements true about your housing? Let me know if it is never true, sometimes true, often true, or always true.
Our housing is…
WEB: How often are these statements true about your housing?
Our housing is…
-
SELECT ONE PER ROW
Never true
Sometimes true
Often true
Always true
DK
R
a. Just the right size
1
2
3
4
D
R
b. Crowded
1
2
3
4
D
R
c. Needs major repairs
1
2
3
4
D
R
d. Old and aged
1
2
3
4
D
R
e. Kept in good condition
1
2
3
4
d
R
WEB SOFT CHECK: IF ANY M9a_a-e=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
M9c. How many separate rooms are in your housing? Separate rooms are defined by built-in archways or walls that extend out at least 6 inches and go from floor to ceiling.
Number of rooms
(RANGE 1-50)
I live in a traditional Native dwelling (for example, Hogan, Long House, or adobe house) 99
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M9c=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
WEB DO NOT DISPLAY DK OR R |
IF OnlyAdult=0 (MORE THAN ONE ADULT IN HOUSEHOLD (B4_3=15 GT 17)), FILL your household; we; We IF OnlyAdult=1, FILL you; I |
PROGRAMMER: GRAY QUESTION TEXT AFTER M10_A |
M10. CATI [PROGRAMMER: Gray text after M10.a.]: People do different things when they are running out of money for food to make their food or food money go further.
For each statement I read, tell me if it was often true, sometimes true, or never true for [you/your household]. In the last 12 months…
WEB: People do different things when they are running out of money for food to make their food or food money go further.
For each statement below, indicate if it was often true, sometimes true, or never true for [you/your household]. In the last 12 months…
|
SELECT ONE PER ROW |
|
|
||
|
Often true |
Sometimes true |
Never true |
DK |
R |
a. The food that [I/we] bought just didn’t last, and [I/we] didn’t have money to get more |
1 |
2 |
3 |
D |
R |
b. [I/We] couldn’t afford to eat balanced meals |
1 |
2 |
3 |
D |
R |
WEB SOFT CHECK: IF ANY M10a-b=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
IF OnlyAdult=0 (MORE THAN ONE ADULT IN HOUSEHOLD (B4_3-15 GT 17)), FILL you or other adults in your household If OnlyAdult=1, FILL you |
M11. In the last 12 months, did [you/you or other adults in your household] ever cut the size of your meals or skip meals because there wasn’t enough money for food?
Yes 1 GO TO M12
No 0 GO TO M13
DON’T KNOW d GO TO M13
REFUSED r GO TO M13
NO RESPONSE M GO TO M13
WEB SOFT CHECK: IF M11=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
M11=1 |
M12. How often did this happen? Would you say…
Select one only
almost every month, 1
some months, but not every month, or 2
in only 1 or 2 months? 3
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M12=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
M13. In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money to buy food?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M13=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
M14. In the last 12 months, were you ever hungry but didn’t eat because you couldn’t afford enough food?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M14=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
WEB DO NOT DISPLAY DK OR R |
M15. CATI [PROGRAMMER: Gray text after M15a.]: Please think about how you feel about your family's economic situation. For each statement, indicate how much you agree or disagree.
[INSERT M15a-d.]
[PROGRAMMER: Gray text after M15a.]: Would you say strongly agree, agree, neutral, disagree, or strongly disagree?
WEB: Please think about how you feel about your family's economic situation. For each statement, indicate how much you agree or disagree.
-
SELECT ONE PER ROW
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
DK
R
a. My family has enough money to afford the kind of home we need.
1
2
3
4
5
D
R
b. We have enough money to afford the kind of clothing we need.
1
2
3
4
5
D
R
c. We have enough money to afford the kind of food we need.
1
2
3
4
5
D
R
d. We have enough money to afford the kind of medical care we need.
1
2
3
4
5
D
R
WEB SOFT CHECK: IF ANY M15a-d=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
M16. Think back over the past 12 months. How much difficulty did you have with paying your bills each month? Would you say you had...
Select one only
a great deal of difficulty, 1
quite a bit of difficulty, 2
some difficulty, 3
a little difficulty or, 4
no difficulty at all? 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M16=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
M17. Think again over the past 12 months. Generally, at the end of each month did you end up with...
Select one only
not enough to make ends meet, 1
almost enough to make ends meet, 2
just enough to make ends meet, 3
some money left over, or 4
more than enough money left over? 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M17=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
M18_Intro.
Some families have a hard time paying for all of the things they need. The next questions are about some of the basic things families need. Please choose the answer that best matches your experience of being able to afford things in the past 12 months.
IF Wave=1 OR (Wave=2 and PrevInt=0) |
M18. In the past 12 months, has there been a time when you and your family had the water to your home turned off because payments were not made?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M18=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
WEB DO NOT DISPLAY DK OR R |
M19. CATI: Next I’m going to read some statements. Please tell me whether these have happened almost every month, some months, but not every month, only 1 or 2 months, or never in the past 12 months.
In the past 12 months, my family had trouble getting where we needed to go because… {INSERT a-c}
PROBE: Would you say this happened almost every month, some months, but not every month, only 1 or 2 months, or never in the past 12 months?
WEB: For the following statements, please answer whether these have happened almost every month, some months, but not every month, only 1 or 2 months, or never in the past 12 months.
In the past 12 months, my family had trouble getting where we needed to go because… {INSERT a-c}
-
Almost every month
Some months, but not every month
Only 1 or 2 months
Never
Not applicable
DON’T KNOW
REFUSED
a. We didn't have access to a reliable vehicle.
1
2
3
0
4
d
r
b. We couldn’t afford gas.
1
2
3
0
4
d
r
c. We couldn't afford to take the bus or other public transportation.
1
2
3
0
4
d
r
WEB SOFT CHECK: IF ANY M19_a-c=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
WEB DO NOT DISPLAY DK OR R |
M20. CATI [PROGRAMMER: Gray after M20a.]: In the past 12 months… [INSERT a-d]
PROBE: Would you say this happened almost every month, some months, but not every month, only 1 or 2 months, or never in the past 12 months?
WEB: In the past 12 months… [insert a-d].
-
Almost every month
Some months, but not every month
Only 1 or 2 months
Never
DON’T KNOW
REFUSED
a. I or someone else in my family couldn’t afford to go to the doctor, dentist or other healthcare provider when we needed to. ……
1
2
3
0
d
r
b. My family couldn't afford to pay for medications, glasses, or other medical supplies that we needed.…
1
2
3
0
d
r
c. My family did not have telephone or cell phone service because we couldn’t afford to pay for it.
1
2
3
0
d
r
d. My family has had electricity or other utilities (for example, gas or oil) shut off because we couldn't afford to pay the bill.
1
2
3
0
d
r
WEB SOFT CHECK: IF ANY M20a-d=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
M21. In the past 12 months, how many times has your family had to move because you couldn’t afford where you were living?
None 0
One time 1
Two times 2
Three or more times 3
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF M21=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
N. CHILD CARE |
If Wave=2 (SPRING 2020) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
FILL PROGRAM NAME FROM PRELOAD |
N1. CATI: Now I’d like to talk to you about all child care [CHILD] now receives on a regular basis in the morning before Head Start and in the afternoon after Head Start. This child care may or may not be provided in the same building as [ProgramName].
Is [CHILD] now attending a day care center, nursery school, preschool, or pre-kindergarten program on a regular basis before or after Head Start?
WEB: The next questions are about all child care [CHILD] now receives on a regular basis in the morning before Head Start and in the afternoon after Head Start. This child care may or may not be provided in the same building as [ProgramName].
Is [CHILD] now attending a day care center, nursery school, preschool, or pre-kindergarten program on a regular basis before or after Head Start?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
SOFT CHECK: IF N1=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
If Wave=2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF SC9 = 11-16, FILL you ELSE, FILL a parent |
IF (J1 NE 11) OR (K1 NE 11), THEN [Do not include care by the child’s [father/mother/parents], even if [he does/she does/they do] not live with the child.] |
IF SC9 = 11, 13, 15 (R IS MOTHER) AND (K1 NE 11 (FATHER NOT DECEASED)), FILL FATHER; HE DOES IF SC9 = 12, 14, 16 (R IS FATHER) AND (J1 NE 11 (MOTHER NOT DECEASED)), FILL MOTHER; SHE DOES IF SC9 NE 11-16 (R IS NOT MOTHER OR FATHER), FILL PARENTS; THEY DO |
N6. Is [CHILD] now receiving care from a relative other than [you/a parent] on a regular basis, in the morning before or in the afternoon after Head Start? For example, please include care from grandparents, brothers or sisters, or any other relative.
[Do not include care by the child’s [father/mother/parents], even if [he does/she does/they do] not live with the child.]
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF N6=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
If Wave=2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
N13. Is [CHILD] now receiving care on a regular basis from anyone else in a private home in the morning before Head Start or in the afternoon after Head Start?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF N13=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
PROGRAMMER SKIP BOX N20a IF N1, N6, OR N13 = 1, CONTINUE TO N20, ELSE GO TO SECTION P |
N1 = 1 OR n6=1 or n13 = 1 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL she IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL he ELSE, FILL he or she |
N20. Thinking of all the child care you use for [CHILD] before or after Head Start, how many days a week is [he/she/he or she] in child care before or after Head Start, on average?
DAYS
(RANGE 0-7)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF N13=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button.
N1 = 1 OR N6 = 1 OR N13 = 1 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
N21. And, all together, how many hours a week is [CHILD] typically in care before or after Head Start?
HOURS
(RANGE 1-90)
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF N13=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button.
P. CHILD HEALTH |
IF Wave=1 OR 2 (ALL) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
P1. The next questions are about [CHILD]’s health and health related issues.
Overall, would you say [CHILD]’s health is…
excellent, 1
very good, 2
good,. 3
fair, or 4
poor? 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF P1=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
FILL CHILD’S NAME FROM SC5a; IF SC5a IS EMPTY, FILL FROM PRELOAD |
IF CHILD’S PRELOADED SEX = FEMALE OR A1 = 1, FILL she; her IF CHILD’S PRELOADED SEX = MALE OR A1 = 2, FILL he; his ELSE, FILL he or she; his or her |
P4a. Where does [CHILD] usually go if [he/she/he or she] is sick or you have concerns about [his/her/his or her] health?
Select one only
A private doctor, private clinic, or HMO 1
An outpatient clinic run by a hospital 2
The emergency room at a hospital 3
Public health department or community health center 4
A migrant health clinic 5
The Indian Health Service/Tribal Health Clinic or Hospital 6
Urgent care 8
Someplace else (SPECIFY) 99
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: P4a=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
FILL CHILD’S NAME FROM SC5a; IF SC5a IS EMPTY, FILL FROM PRELOAD |
P5. Where does [CHILD] go for routine medical care, like well-child care or regular check-ups?
Select one only
Doesn’t get preventive care/There is no regular place 0 GO TO P5a
A private doctor, private clinic, or HMO 1 GO TO P7
An outpatient clinic run by a hospital 2 GO TO P7
The emergency room at a hospital 3 GO TO P7
Public health department or community health center 4 GO TO P7
A migrant health clinic 5 GO TO P7
The Indian Health Service/Tribal Health Clinic or Hospital 6 GO TO P7
Urgent care 8 GO TO P7
Someplace else (SPECIFY) 99 GO TO P7
Specify
DON’T KNOW d GO TO P5a
REFUSED r GO TO P5a
NO RESPONSE M GO TO P5a
WEB SOFT CHECK: IF P5=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF (Wave=1 OR (Wave=2 and PrevInt=0)) ANDP5=0, D, R, OR M |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
P5a. Does [CHILD] have a regular health care provider?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF P5a=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
P7. When was the last time [CHILD] saw a doctor for a regular checkup? Was it...
Select one only
6 months ago or less, 1
more than 6 months ago, but not more than 1 year ago, 2
more than 1 year ago, but not more than 2 years ago, 3
more than 2 years ago, or 4
never? 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF P7=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
Wave = 2 AND PrevInt =1 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
Fill FallIntDate Fill with date of Fall 2019 interview |
P7a. Since the last time you answered questions for this study, on [FallIntDate], has [CHILD] seen a doctor for a regular checkup?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
P7 = 3, 4, 5 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
P7_1. What were the reasons that [CHILD] has not seen the doctor for a regular checkup recently?
Select all that apply
Could not afford the cost 1
Did not want to spend the money 2
Insurance did not cover 3
Doctor’s office is too far away 4
Doctor’s office is not open at convenient times 5
Another doctor recommended not doing it 6
Afraid of or do not like doctors 7
Unable to take time off from work 8
Too busy 9
I did not think anything serious was wrong 10
Other reason (SPECIFY) 11
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=1 OR (Wave=2 and PrevInt=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
P8a. Is there a particular dentist or dental clinic that you take [CHILD] for dental care or advice?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=1 OR (Wave=2 and PrevInt=0) |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
P8. When was the last time [CHILD] saw a dentist for a regular checkup? Was it...
Select one only
6 months ago or less, 1
more than 6 months ago, but not more than 1 year ago, 2
more than 1 year ago, but not more than 2 years ago, 3
more than 2 years ago, or 4
never? 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
Wave=2 AND PrevInt= 1 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
Fill FallIntDate |
P8_0. Since the last time you answered questions for this study, on [FallIntDate], has [CHILD] seen a dentist for a regular checkup?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
P8 = 2, 3, 4, 5 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
P8_1. What were the reasons that [CHILD] has not seen the dentist recently?
Select all that apply.
Could not afford the cost 1
Did not want to spend the money 2
Insurance did not cover 3
Dental office is too far away 4
Dental office is not open at convenient times 5
Another dentist recommended not doing it 6
Afraid of or do not like dentists 7
Unable to take time off from work 8
Too busy 9
I did not think anything serious was wrong 10
[CHILD] is not due for [his/her] next appointment yet 12
Next appointment is scheduled but has not yet occurred 13
Dentist is overbooked/hard to schedule 14
Transportation issues 15
[CHILD] is too young 16
Other reason (SPECIFY) 11
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
P42. Has anyone ever suggested that you get [CHILD] evaluated for a possible special condition or need?
Yes 1 GO TO P42a
No 0 GO TO P42b1
DON’T KNOW d GO TO P42b1
REFUSED r GO TO P42b1
NO RESPONSE M GO TO P42b1
P42=1 |
P42a. What was the special condition or need?
Select all that apply
Behavior problem 1
Emotional problem 2
Attention problem 3
Developmental delay 4
Problem with use of arms or legs 5
Speech problem 7
Hearing problem 8
Vision problem 9
Something else (SPECIFY) 10
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=2 |
P42b1. Did you get [CHILD] evaluated for a possible special condition or need?
Yes 1 GO TO P42b2
No 0 GO TO Q5
DON’T KNOW d GO TO Q5
REFUSED r GO TO Q5
NO RESPONSE M GO TO Q5
IF Wave=2 |
P42b2. Did your child ever receive a diagnosis for a special condition or need?
Yes 1 GO TO P42b3
No 0 GO TO Q5
DON’T KNOW d GO TO Q5
REFUSED r GO TO Q5
NO RESPONSE M GO TO Q5
P42b2=1 |
P42b3. What was the diagnosis for [CHILD]’s special condition or need?
Select all that apply
Behavior problem 1
Emotional problem 2
Attention problem 3
Developmental delay 4
Problem with use of arms or legs 5
Speech problem 7
Hearing problem 8
Vision problem 9
Something else (SPECIFY) 10
Specify
DON’T KNOW d
REFUSED r
NO RESPONSE M
Q. FAMILY HEALTH |
IF Wave=2 (SPRING 2020) |
The next set of questions are about the health of people in your household.
Q5. First are questions about smoking.
In the last 30 days, did you smoke tobacco such as cigarettes or cigars?
Please do NOT include ceremonial smoking.
Yes 1 GO TO Q6
No 0 GO TO Q9
DON’T KNOW d GO TO Q9
REFUSED r GO TO Q9
NO RESPONSE M GO TO Q9
Q5=1 |
Q6. CATI: How many cigarettes or packs of cigarettes do you smoke on an average day?
INTERVIEW NOTE: ENTER 1 IF RESPONDENT SMOKES LESS THAN 1 CIGARETTE A DAY.
WEB: How many cigarettes or packs of cigarettes do you smoke on an average day?
Enter “1” if you smoke less than one cigarette a day.
| | | NUMBER
(RANGE 1-99)
CIGARETTES 1
PACKS 2
DON’T KNOW d
REFUSED r
NO RESPONSE M
Q5=1 |
Q7a. Do you or other household members smoke anywhere inside the home?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=2 |
Q9. The next questions are about how frequently you drink alcoholic beverages. By a “drink” we mean either a bottle of beer, a wine cooler, a glass of wine, a shot of liquor, or a mixed drink. Remember, your answers will be kept private to the extent permitted by law. No one from Head Start will see or hear your answers.
During the last 30 days, how often, if ever, did you drink alcoholic beverages, including beer, wine or liquor? Would you say…
Less than once a week, 1 GO TO Q10
1 or 2 days per week, 2 GO TO Q10
3 or 4 days per week, 3 GO TO Q10
5 or 6 days per week, 4 GO TO Q10
every day, or 5 GO TO Q10
never? 0 GO TO Q11
DON’T KNOW d GO TO Q11
REFUSED r GO TO Q11
NO RESPONSE M GO TO Q11
Q9=1,2,3,4,5 |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
Q10. On the days that you drank alcoholic beverages (including beer, wine, and liquor) in the last 30 days, how many drinks did you usually have?
(Click here for an explanation on how to count the number of drinks.)
PROGRAMMER: INCLUDE FOLLOWING TEXT IN POP UP WINDOW:
HELP SCREEN: ALCOHOL EQUIVALENTS: |
|
Beer: |
Hard Liquor: |
1 12 oz. or 16 oz. bottle = 1 drink |
1 highball = 1 drink |
1 40 oz. bottle = 3 drinks |
1 shot glass = 1 drink |
1 case of beer = 24 drinks |
1/2 pint of liquor = 6 drinks |
Wine: |
1 pint of liquor = 12 drinks |
1 4 oz. glass of wine = 1 drink |
1 fifth of liquor = 20 drinks |
1 bottle of wine = 5 drinks 1 liter of wine = 6 drinks |
1 quart of liquor = 24 drinks |
1 wine cooler = 1 drink |
|
NUMBER
(RANGE 0-99)
DON’T KNOW d
REFUSED r
NO RESPONSE M
Q9 = 1, 2, 3, 4, or 5 |
IF SC9 SPRING WAS ASKED: If SC9 = 11, 13, 15, 17, 19, 21, 23, 25, 27, 29 (R = Female) OR D, R, OR M (UNKNOWN), display four If SC9 = 12, 14, 16, 18, 20, 22, 24, 26, 28, 30 (R = Male), display five IF SC9 SPRING WAS NOT ASKED, CHECK: If Fall_SC9 = 11, 13, 15, 17, 19, 21, 23, 25, 27, 29 (R = Female) OR D, R, OR M (UNKNOWN), display four If Fall_SC9 = 12, 14, 16, 18, 20, 22, 24, 26, 28, 30 (R = Male), display five |
Q10a. CATI: In the last 30 days, how many times did you drink [four/five] or more alcoholic drinks at one sitting?
INTERVIEWER NOTE: Enter “0” if R did not have [four/five] or more drinks at one sitting in the last month.
WEB: In the last 30 days, how many times did you drink [four/five] or more alcoholic drinks at one sitting?
Enter “0” if you did not have [four/five] or more drinks at one sitting in the last month.
| | | NUMBER
(RANGE 0-99)
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=2 |
If Q9 = 0, display anyone ELSE display anyone else |
Q11. Is there [anyone/anyone else] in your household who drinks alcohol?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=2 |
Q22. During the past 12 months, have you or anyone in your household received help or treatment for alcohol use?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=2 |
Q23. During the past 12 months, have you or anyone in your household received help or treatment for other substance abuse problems?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
IF Wave=2 |
Q24. During the past 12 months, have you or anyone in your household received mental health help or treatment other than for alcohol or substance use problems?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
R. HOME AND NEIGHBORHOOD CHARACTERISTICS |
IF Wave=2 (SPRING 2020) |
R_Intro.
The next questions are about situations that can be difficult for families. The questions ask about things that may have happened to you or others in your household over the past year. Please remember, all of your answers will be kept private to the extent permitted by law. No one from Head Start will see or hear your answers.
If Wave=2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
R4. In the past year, has [CHILD] ever been a witness to a violent crime? Please do not include domestic violence.
(Click here for a definition of violent crimes.)
WEB/CATI HELP SCREEN: According to the Uniform Crime Reporting (UCR) Program’s definition, violent crimes involve force or threat of force, to include: murder and non-negligent manslaughter, forcible rape, robbery, and aggravated assault. Domestic violence is any type of physical, mental or emotional abuse that happens between people who are married, in a romantic relationship, who are former partners or who are related by family. Examples of domestic violence include being beaten up, murder, kidnapping, rape, sexual assault and robbery. |
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF R4=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
R5. In the past year, has [CHILD] ever been a witness to domestic violence?
(Click here for a definition of domestic violence.)
WEB/CATI HELP SCREEN: Domestic violence is any type of physical, mental or emotional abuse that happens between people who are married, in a romantic relationship, who are former partners or who are related by family. Examples of domestic violence include being beaten up, murder, kidnapping, rape, sexual assault and robbery. |
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF R5=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
R6. In the past year, has [CHILD] ever been the victim of a violent crime? Please do not include domestic violence.
(Click here for a definition of violent crimes.)
WEB/CATI HELP SCREEN: According to the Uniform Crime Reporting (UCR) Program’s definition, violent crimes involve force or threat of force, to include: murder and non-negligent manslaughter, forcible rape, robbery, and aggravated assault. |
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF R6=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
PROGRAMMER: ADD BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB |
R7. In the past year, has [CHILD] ever been the victim of domestic violence?
(Click here for a definition of domestic violence.)
WEB/CATI HELP SCREEN: Domestic violence is any type of physical, mental or emotional abuse that happens between people who are married, in a romantic relationship, who are former partners or who are related by family. Examples of domestic violence include being beaten up, murder, kidnapping, rape, sexual assault and robbery. |
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF R7=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
FILL CHILD’S NAME FROM SC8a; IF SC8a IS EMPTY, FILL FROM PRELOAD |
IF SPRING SC9 WAS ASKED: IF SC9 = 12, OR 14, FILL or has [CHILD]’s mother IF SC9 = 11 OR 13, FILL or has [CHILD]’s father IF SC9 = 15-30, D, R, M, FILL [CHILD]’s mother or father IF SPRING SC9 NOT ASKED: IF Fall_SC9 = 12, OR 14, FILL or has [CHILD]’s mother IF Fall_SC9 = 11 OR 13, FILL or has [CHILD]’s father IF Fall_SC9 = 15-30, D, R, M, FILL [CHILD]’s mother or father |
R8. Since [CHILD] was born, have you, another household member, [or has [CHILD]’s mother/or has [CHILD]’s father/[CHILD]’s mother or father] been arrested or charged with any crime by the police?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF R8=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
R8=1 |
R10. Did the person or people who were arrested spend time in jail because of this?
Yes 1
No 0
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF R10=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
WEB DO NOT DISPLAY DK OR R |
PROGRAMMER: Gray question text after R14_a. |
R14. CATI: Now I’m going to read some statements about your community, neighborhood, or area where you live. For each statement, indicate how much you agree or disagree.
[INSERT R14a-d.]
PROBE: Would you say strongly agree, agree, neutral, disagree, or strongly disagree?
WEB: The next questions are about your community, neighborhood, or area where you live. How much do you agree or disagree with each statement?
|
Strongly agree |
Agree |
Neutral |
Disagree |
Strongly disagree |
DK |
R |
a. People around here are willing to help their neighbors. |
1 |
2 |
3 |
4 |
5 |
D |
R |
b. The place where I live is too noisy or too polluted. |
1 |
2 |
3 |
4 |
5 |
D |
R |
c. Roads in my community are often difficult or impossible to drive on. |
1 |
2 |
3 |
4 |
5 |
D |
R |
d. I have to go too far to get things done, like shopping, banking, buying gas, or going to school or work. |
1 |
2 |
3 |
4 |
5 |
|
|
WEB SOFT CHECK: IF R14_a-d=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
WEB DO NOT DISPLAY DK OR R |
PROGRAMMER: Gray question text after R15_a. |
R15. CATI: Now I’m going to read some statements about problems you might see in the community, neighborhood, or area where you live. For each statement, indicate if you think it is not a problem, somewhat of a problem, or a big problem.
[INSERT R15a-i.]
PROBE: Would you say this is not a problem, somewhat of a problem, or a big problem?
WEB: The next questions are about problems you might see in the community, neighborhood, or area where you live. How much of a problem is each of the following issues where you live?
|
Not a problem |
Somewhat of a problem |
Big problem |
DK |
R |
a. Run-down houses or abandoned cars. |
1 |
2 |
3 |
D |
R |
b. Crime. |
1 |
2 |
3 |
D |
R |
c. Police not being available. |
1 |
2 |
3 |
D |
R |
d. Public drunkenness or people being high or stoned in public. |
1 |
2 |
3 |
D |
R |
e. Broken homes and family breakups. |
1 |
2 |
3 |
D |
R |
f. Physical violence, abuse and neglect. |
1 |
2 |
3 |
D |
R |
g. Alcohol or drug abuse. |
1 |
2 |
3 |
D |
R |
h. Not enough good housing. |
1 |
2 |
3 |
D |
R |
i. Not enough jobs in the community. |
1 |
2 |
3 |
D |
R |
WEB SOFT CHECK: IF R15_a-i=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
T. SOCIAL SUPPORT |
IF Wave=1 OR (Wave=2 and PrevInt=0) |
WEB DO NOT DISPLAY DK OR R |
PROGRAMMER: Gray question text after T1_a. |
T1. CATI: Now I’m going to read some statements about other kinds of help you may get. Please tell me whether each statement is never true for you, sometimes true for you, or always true for you.
[INSERT T1a-i.]
PROBE: Would you say it is never true for you, sometimes true for you, or always true for you?
WEB: Below are statements about other kinds of help you may get. How often is each statement true for you?
|
Never true |
Sometimes true |
Always true |
DON’T KNOW |
REFUSED |
a. If I need to do an errand, I can easily find someone to watch [CHILD] ……….. |
1 |
2 |
3 |
d |
r |
g. If I need a place to stay, I can find someone to provide me and [CHILD] with a place to live …… |
1 |
2 |
3 |
d |
r |
e. If I have an emergency and need cash, family or friends will loan it to me …….. |
1 |
2 |
3 |
d |
r |
f. If I have troubles or need advice, I have someone I can talk to ….. |
1 |
2 |
3 |
d |
r |
h. If I have problems buying food, I have someone who can help me get a meal or I can go to a relative’s house to eat …………. |
1 |
2 |
3 |
d |
r |
i. If I need food for my family, I can rely on fishing, hunting, or gathering ………………… |
1 |
2 |
3 |
d |
r |
WEB SOFT CHECK: IF ANY T1a-i=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
U. YOUR FEELINGS |
IF WAVE=1 OR 2 (ALL) |
WEB DO NOT DISPLAY DK OR R |
For sub-item c, display additional BUTTON FOR WEB/CATI HYPERLINK TO NEW TAB HELP TEXT |
PROGRAMMER: Gray question text after u1_a |
U1. CATI [PROGRAMMER: For U1_a.]: The next questions are about how you have felt about yourself and your life in the past week. There are no right or wrong answers.
I am going to read a list of ways you may have felt or behaved. Please tell me how often you have felt or behaved this way during the past week. First…
[INSERT U1_a].
Did you feel this way rarely or never, some or a little, occasionally or a moderate amount of time, or most or all of the time in the past week?
[PROGRAMMER: FOR U1_B-L:]
[INSERT U1_B-L]
PROBE: Did you feel this way rarely or never, some or a little, occasionally or a moderate amount of time, or most or all of the time in the past week?
WEB [PROGRAMMER: For U1_a.]: The next questions are about how you have felt about yourself and your life in the past week. There are no right or wrong answers.
Please select if you felt this way rarely or never, some or a little, occasionally or a moderate amount of time, or most or all of the time in the past week.
[PROGRAMMER: FOR U1_B-L]
Please select if you felt this way rarely or never, some or a little, occasionally or a moderate amount of time, or most or all of the time in the past week.
CATI/WEB [For U1_c ONLY]: (Click here for a definition of “shake off the blues.”)
WEB/CATI HELP SCREEN: Not being able to “shake off the blues” refers to feeling sad, unhappy, miserable, or down in the dumps for short periods. |
Select one per row
|
Rarely |
Some
or |
Occasionally |
Most |
DK |
R |
a. Bothered by things that usually don’t bother you |
1 |
2 |
3 |
4 |
D |
R |
b. You did not feel like eating, your appetite was poor |
1 |
2 |
3 |
4 |
D |
R |
c. You could not shake off the blues, even with help from your family and friends |
1 |
2 |
3 |
4 |
D |
R |
d. You had trouble keeping your mind on what you were doing |
1 |
2 |
3 |
4 |
D |
R |
e. Depressed |
1 |
2 |
3 |
4 |
D |
R |
f. That everything you did was an effort |
1 |
2 |
3 |
4 |
D |
R |
g. Fearful |
1 |
2 |
3 |
4 |
D |
R |
h. Your sleep was restless |
1 |
2 |
3 |
4 |
D |
R |
i. You talked less than usual |
1 |
2 |
3 |
4 |
D |
R |
j. Lonely |
1 |
2 |
3 |
4 |
D |
R |
k. Sad |
1 |
2 |
3 |
4 |
D |
R |
l. You could not get “going” |
1 |
2 |
3 |
4 |
D |
R |
WEB SOFT CHECK: IF ANY U1a-l=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
V. Cultural Connections |
IF Wave=2 (ALL SPRING 2020) |
WEB DO NOT DISPLAY DK OR R |
PROGRAMMER: Gray question text after V1_A |
V1. For the next set of statements, think about your American Indian or Alaska Native group and indicate how much you agree or disagree.
[INSERT V1a-i.]
CATI PROBE: Would you say strongly agree, agree, neutral, disagree, or strongly disagree?
Select one per row.
-
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
DK
R
a. Being a part of my tribe or cultural group is important to me.
1
2
3
4
5
D
R
b. I think a lot about how my life has been affected by me being an American Indian or Alaska Native.
1
2
3
4
5
D
R
c. I have a lot of pride in my tribe or cultural group.
1
2
3
4
5
D
R
d. I speak or am learning to speak my Native language.
1
2
3
4
5
D
R
e. I follow religious or spiritual beliefs that are based on traditional cultural beliefs.
1
2
3
4
5
D
R
f. I listen to, sing, or dance to traditional Native music.
1
2
3
4
5
D
R
g. I have a strong sense of belonging to my own tribe or cultural group.
1
2
3
4
5
D
R
h. I have often talked to other people to learn about my tribe or culture.
1
2
3
4
5
D
R
i. I feel good about my cultural and Native background.
1
2
3
4
5
D
R
WEB SOFT CHECK: IF V1_a-i=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
WEB DO NOT DISPLAY DK OR R |
IF OnlyChild=0, (MORE THAN 1 CHILD IN HOUSEHOLD), FILL children IF OnlyChild=1 (JUST FOCAL CHILD IN HOUSEHOLD), FILL child |
PROGRAMMER: Gray question text after V2_a |
V2. CATI: Please tell me how often you did each of the following things in the past month.
[INSERT V2a-f.]
PROBE: Would you say very often, often, sometimes, rarely, or never?
WEB: How often you did each of the things below in the past month?
Select one per row.
-
Very often
Often
Some-times
Rarely
Never
DK
R
a. I told my [child/children] Native stories.
1
2
3
4
5
D
R
b. I took my [child/children] to Native cultural events, like powwows or ceremonies.
1
2
3
4
5
D
R
c. I made traditional Native cultural food for my [child/children].
1
2
3
4
5
D
R
d. I listened to Native cultural music with my [child/children].
1
2
3
4
5
D
R
e. I taught my [child/children] about Native cultural values and traditions.
1
2
3
4
5
D
R
f. I don’t make a big deal about Native cultural ways with my [child/children].
1
2
3
4
5
D
R
WEB SOFT CHECK: IF V2_a-f=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
WEB DO NOT DISPLAY DK OR R |
IF OnlyChild=0 (MORE THAN 1 CHILD IN HOUSEHOLD), FILL children; children show IF OnlyChild=1 (JUST FOCAL CHILD IN HOUSEHOLD), FILL child; child shows |
PROGRAMMER: Gray question text after V3_a |
V3. CATI: Please tell me how often you did each of the following things in the past month.
[INSERT V3a-e.]
PROBE: Would you say very often, often, sometimes, rarely, or never?
WEB: How often you did each of the things below in the past month?
Select one per row.
-
Very often
Often
Some-times
Rarely
Never
DK
R
a. I told my [child/children] about the importance of family in my Native culture.
1
2
3
4
5
D
R
b. I made sure my [child/children] spent time with family members, like grandmas, grandpas, aunts, uncles, and cousins.
1
2
3
4
5
D
R
c. I relied on family members such as grandmas, grandpas, aunts, or uncles to help me parent my [child/children].
1
2
3
4
5
D
R
d. I like to take care of my [child/children] myself, without a lot of other family getting involved.
1
2
3
4
5
D
R
e. I made sure my [child shows/children show] respect for Native elders.
1
2
3
4
5
D
R
WEB SOFT CHECK: IF V3_a-e=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
V4. How many of your relatives or in-laws live in your community?
None 1
1 or 2 2
3-5 3
6-9 4
10 or more 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF V4=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
IF Wave=2 |
V5. How many friends do you have in your community?
None 1
1 or 2 2
3-5 3
6-9 4
10 or more 5
DON’T KNOW d
REFUSED r
NO RESPONSE M
WEB SOFT CHECK: IF V5=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
W. PROGRAM SATISFACTION AND PRACTICES |
VERSION BOX 2 IF Wave=2 (SPRING 2020), GO TO W5 ELSE, GO TO SHELL TRACKING SECTION |
W_Intro.
CATI: Now I would like to ask you some questions about [CHILD]’s Head Start program.
WEB: The next questions are about [CHILD]’s Head Start program.
If wave=2 |
WEB DO NOT DISPLAY DK OR R |
programmer: gray question text after w5_g |
W5. CATI: The following statements are about your experiences with your child’s Head Start program and its staff. For each statement that I read you, please tell me whether you strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, or strongly agree.
[INSERT W5g-m.]
PROBE: Would you say you strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, or strongly agree?
WEB: The following statements are about your experiences with your child’s Head Start program and its staff.
|
Strongly disagree |
Somewhat disagree |
Neither agree nor disagree |
Somewhat agree |
Strongly agree |
DON’T KNOW |
REFUSED |
g. The program staff respect my family’s cultural and/or religious beliefs……… |
1 |
2 |
3 |
4 |
5 |
d |
r |
k. The program staff encourage me to learn about my culture and history…………………. |
1 |
2 |
3 |
4 |
5 |
d |
r |
m. The program staff have materials for my child that positively reflect our cultural background…………… |
1 |
2 |
3 |
4 |
5 |
d |
r |
WEB SOFT CHECK: IF ANY W5g-m=NO RESPONSE; Please provide an answer to this question and continue. To continue to the next question without providing a response, click the Next button. |
X. TRACKING INFORMATION |
END. This completes the interview. Thank you for your participation in AI/AN FACES.
BeginTracking. Thank you for completing the interview today. You’re almost done. We will send your thank you gift card within the next two weeks. The next questions will be about how to contact you in case we have any questions.
Continue 1 SKIP BOX BEGIN
TRACKING
PROGRAMMER SKIP BOX BEGINTRACKING IF SMUPDATENAME = 1 AND NAME LOADED, GO TO CONFNAME. IF SMUPDATENAME = 1 AND NO NAME LOADED, GO TO EDITNAME. IF SMUPDATENAME = 0, GO TO SKIP BOX EDITNAME. |
PROGRAMMER SKIP BOX EDITNAME. IF SMUPDATPHONE = 1 AND PHONE LOADED, GO TO CONFHOMEPHONE. IF SMUPDATPHONE = 1 AND NO PHONE LOADED, GO TO NEWHOMEPHONE. IF SMUPDATEPHONE = 0, GO TO SKIP BOX NEWPHONE. |
SMUpdatePhone = 1 and there is a HOME phone LOADED |
FILL PHONE with SAMPLE MEMBERS HOME PHONE from preload |
ConfHomePhone. We have your home telephone number as:
[NUMBER]
Is this the correct number to use to reach you?
YEs 1 SKIPBOX NEWPHONE
NO 0 NEWHOMEPHONE
REFUSED r SKIPBOX NEWPHONE
SMUPDATEPHONE = 1 AND (CONFPHONE = 0 OR NO PHONE LOADED) |
PROGRAMMER- extension may be missing |
NewHomePhone. Please give me your home telephone number, area code first.
INSTRUCTION: CONFIRM PHONE WITH RESPONDENT BEFORE CONTINUING
| | | | - | | | | - | | | | |
(0-999) (0-999) (0-9999)
Do not have a home telephone number 0 SKIPBOX NEWPHONE
DON’T KNOW d SKIPBOX NEWPHONE
REFUSED r SKIPBOX NEWPHONE
SOFT CHECK: IF Phone NE 10 digits: Phone number should be 10 numeric digits, no spaces, dashes, parentheses or other punctuation (or empty) |
SOFT CHECK: IF Area code LE 200: Area Code should be greater than 200 |
SOFT CHECK: IF Exchange LE 199: Exchange should be greater than 199 |
SMUpdatePhone = 1 and there is a CELL phone LOADED |
FILL PHONE with SAMPLE MEMBERS CELL PHONE from preload |
ConfCellPhone. We have your cell phone number as:
[NUMBER]
Is this the correct number to use to reach you?
YEs 1 SKIPBOX NEWPHONE
NO 0 NEWPHONE
REFUSED r SKIPBOX NEWPHONE
SMUPDATEPHONE = 1 AND (CONFPHONE = 0 OR NO PHONE LOADED) |
PROGRAMMER- extension may be missing |
NewCellPhone. Please give me your cell number, area code first.
INSTRUCTION: CONFIRM PHONE WITH RESPONDENT BEFORE CONTINUING
| | | | - | | | | - | | | | |
(0-999) (0-999) (0-9999)
Do not have a cell pone 0 SKIPBOX NEWPHONE
DON’T KNOW d SKIPBOX NEWPHONE
REFUSED r SKIPBOX NEWPHONE
SOFT CHECK: IF Phone NE 10 digits: Phone number should be 10 numeric digits, no spaces, dashes, parentheses or other punctuation (or empty) |
SOFT CHECK: IF Area code LE 200: Area Code should be greater than 200 |
SOFT CHECK: IF Exchange LE 199: Exchange should be greater than 199 |
If NEWCELLPHONE NE 0 OR D OR R OR MISSING |
Text. Is it okay for us to text you at this number? Message and data rates may apply.
YES 1
NO 0
DON’T KNOW d
REFUSED r
NewPhone COLLECTED |
NewPhoneTZ. What time zone are you in?
CATI: If NEEDED: What time is it there?
CATI: INSTRUCTION: A TIME ZONE IS REQUIRED. USE ORIGINAL TIME ZONE OR STATE IF NEEDED.
Eastern Time (US & Canada) [(FILL CURRENT TIME)] 62
Indiana (East) [(FILL CURRENT TIME)] 63
Central Time (US & Canada) [(FILL CURRENT TIME)] 65
ARIZONA [(FILL CURRENT TIME)] 68
MOUNTAIN TIME (US & CANADA) [(FILL CURRENT TIME)] 70
PACIFIC TIME (US & CANADA) [(FILL CURRENT TIME)] 71
ALASKA [(FILL CURRENT TIME)] 72
HAWAII [(FILL CURRENT TIME)] 73
BAJA CALIFORNIA [(FILL CURRENT TIME)] 93
PROGRAMMER SKIP BOX NEWPHONE IF SMUPDATEADDRESS = 1 AND ADDRESS LOADED, GO TO CONFADDRESS. IF SMUPDATEADDRESS = 1 AND NO ADDRESS LOADED, GO TO NEWADDRESS. IF SMUPDATEADDRESS = 0, GO TO SKIP BOX NEWADDRESS. |
SMUPDATEADDRESS = 1 AND ADDRESS LOADED |
ConfAddress. Please confirm your address.
The address we have is:
ADDRESS: [ADDRESS]
Is that correct?
YES, Correct 1 SKIP BOX NEWADDRESS
NO, edit address 2 NEWADDRESS
NO, HAS NEW ADDRESS 3 NEWADDRESS
DON’T KNOW d SKIP BOX NEWADDRESS
REFUSED r SKIP BOX NEWADDRESS
SMUPDATEADDRESS = 1 AND ((CONFADDRESS = 2 oR 3) OR NO ADDRESS LOADED) |
if confaddress = 2, FILL Address SAMPLE MEMBER address from preload |
NewAddress. CATI: Please give me your address.
WEB: Please enter your address.
INSTRUCTION: CONFIRM ADDRESS WITH RESPONDENT BEFORE CONTINUING
SPECIFY ADDRESS
What is the first line of the address?
(STRING (60))
Street Address Line 1
Is there an apartment or unit number for this address?
(STRING (60))
Street Address Line 2
(STRING (60))
Street Address Line 3
(STRING (60))
Street Address Line 4
And what is the zip code?
(STRING (10))
ZIP Code
Town or city?
(STRING (20))
City
State?
(STRING (2))
State
DON’T KNOW d
REFUSED r
PROGRAMMER SKIP BOX NEWADDRESS IF SMUPDATEEMAIL = 1 AND eMAIL ADDRESS LOADED, GO TO CONFEMAIL. IF SMUPDATEEMAIL = 1 AND NO ADDRESS LOADED, GO TO NEWEMAIL. IF SMUPDATEEMAIL = 0, GO TO SKIP BOX NEWEMAIL. |
SMUPDATEEMAIL=1 AND EMAILADDRESS IS LOADED |
fill email address with preload |
ConfEmail. Please confirm your email address. The address we have is:
Is this email address correct?
YES, Correct 1 SKIP BOX NEWEMAIL
NO, edit EMAIL address 2 NEWADDRESS
NO, HAS NEW EMAIL ADDRESS 3 NEWADDRESS
DON’T KNOW d SKIP BOX NEWEMAIL
REFUSED r SKIP BOX NEWEMAIL
SMUPDATEEMAIL = 1 AND ((CONFEMAIL = 2 oR 3) OR NO EMAIL LOADED) |
if confemail = 2, Fill email address with preload |
NewEmail. CATI: Please provide me your email address.
WEB: Please enter your email address.
INSTRUCTION: CONFIRM EMAIL ADDRESS WITH RESPONDENT BEFORE CONTINUING
SPECIFY EMAIL
(STRING (50)
DON’T KNOW d
REFUSED r
PROGRAMMER SKIP BOX NEWEMAIL IF PAYMENTTyPE = 1 – 3, GO TO MAILTO. IF PAYMENTTYPE = 0, GO TO SKIP BOX ALTCONTACTS. |
PAYMENTTYPE = 1 – 3 |
MailTo. Would you like us to send the payment to you or someone else?
SEND TO ME 1 SKIP BOX MAILTO
SOMEONE ELSE 2 SKIP BOX MAILTO
REFUSED / DO NOT WANT PAYMENT r SKIP BOX ALTCONTACTS
PROGRAMMER SKIP BOX MAILTO IF PAYMENTTYPE = 1 (MAIL), GO TO PAYADDR. IF PAYMENTTYPE = 3, GO TO MAILOREMAIL. |
(PAYMENTTYPE = 1 OR MAILOREMAIL = 1) and mailto ne refused |
confirm IF MAILTO = 1 AND RESPONDENT ADDRESS LOADED; get IF MAILTO = 2 |
confirmer IF MAILTO = 1 AND RESPONDENT ADDRESS LOADED; obtener IF MAILTO = 2 |
if MAILTO = 1 AND RESPONDENT ADDRESS LOADED, FILL NAME AND ADDRESS WITH RESPONDENT INFORMATION; IF MAILTO = 2, DO NOT FILL NAME AND ADDRESS FIELDS |
PayAddr.
INSTRUCTION: CONFIRM spelling of name and ADDRESS WITH RESPONDENT BEFORE CONTINUING
CATI: I would like to [confirm / get] the name and address where we should send the payment.
WEB: Please [confirm / enter] the name and address where we should send the payment.
What is the first name?
(STRING 20)
FIRST NAME
Middle initial
(STRING 1)
MIDDLE INITIAL
Last name?
(STRING 30)
LAST NAME
SPECIFY ADDRESS
What is the first line of the payment address?
(STRING (60))
Street Address Line 1, 2, 3, 4
Is there an apartment or unit number for this address?
(STRING (60))
Street Address Line 2
(STRING (60))
Street Address Line 3
(STRING (60))
Street Address Line 4
And what is the zip code?
(STRING (10))
ZIP Code
Town or city?
(STRING (20))
City
State?
(STRING (2))
State
DON’T KNOW d
REFUSED r
PROGRAMMER SKIP BOX PAYADDR. ALL RESPONSES GO TO SKIP BOX ALTCONTACTS. |
PROGRAMMER: SKIP BOX ALTCONTACTS IF SMALTCONTACTS = 1, GO TO ALTCONTACT LOOP. IF SMALTCONTACTS = 0, GO TO THANKS AND SET DISP = 13. |
fall 2019 only |
SMALTCONTACTS = 1 (LOOP NUMBER OF CONTACTS from NUMALTCONTACTS) |
AltContactName. In case you move, we would like to have the name, address, and phone number of one person who does not live with you who will know how to reach you. We would only contact this person if we have trouble getting in touch with you directly.
What
is the name of a person who will know how to reach you?
INSTRUCTION: CONFIRM NAME WITH RESPONDENT BEFORE CONTINUING
(STRING 20)
FIRST NAME
(STRING 01)
MIDDLE INITIAL
(STRING 30)
LAST NAME
NO CONTACT AVAILABLE 0 THANKS (DISP = 13)
DON’T KNOW d THANKS (DISP = 13)
REFUSED r THANKS (DISP = 13)
NAME COLLECTED AT ALTCONTACTNAME (OR NE 0, D OR R) |
PROGRAMMER: ALLOW ANY PART OF THE ADDRESS. |
AltContactAdd. CATI: Please tell me [CONTACT FIRST NAME]’s address.
WEB: Please enter [CONTACT FIRST NAME]’s address.
INSTRUCTION: CONFIRM ADDRESS WITH RESPONDENT BEFORE CONTINUING
What is the first line of the address?
(STRING (60))
Street Address Line 1
Is there an apartment or unit number for this address?
(STRING (60))
Street Address Line 2
And what is the zip code?
(STRING (10))
ZIP Code
Town or city?
(STRING (20))
City
State?
(STRING (2))
State
DON’T KNOW d ALTCONTACTPHONE
REFUSED r ALTCONTACTPHONE
NAME COLLECTED AT ALTCONTACTNAME (OR NE 0, D OR R) |
AltContactPhone. CATI: Please give me [CONTACT FIRST NAME]’s telephone number, area code first.
WEB: Please enter [CONTACT FIRST NAME]’s telephone number, area code first.
INSTRUCTION: CONFIRM PHONE WITH RESPONDENT BEFORE CONTINUING
| | | | - | | | | - | | | | |
(0-999) (0-999) (0-9999)
Is there an extension number?
| | | | | | |
(0-999999)
DON’T KNOW d
ALTCONTACTREL
REFUSED r ALTCONTACTREL
INSTRUCTION: CONFIRM PHONE WITH RESPONDENT BEFORE CONTINUING
NAME COLLECTED AT ALTCONTACTNAME (OR NE 0, D OR R) |
AltContactRel. What is [CONTACT FIRST NAME]’s relation to you?
SPOUSE 1
CHILD 2
SIBLING 3
PARENT 4
NIECE/NEPHEW 5
FRIEND/NEIGHBOR/OTHER RELATIVE 6
GROUP/FOSTER HOME/ASSISTED LIVING FACILITY
ADMINISTRATOR/CARER 7
OTHER (SPECIFY) 8 ALTOTHERREL
DON’T KNOW d
REFUSED r
ALTCONTACTREL = 8 |
OthAltContactRel
SPECIFY OTHER RELATIONSHIP.
(STRING 20)
OTHER RELATIONSHIP
DON’T KNOW d
REFUSED r
PROGRAMMER LOOP BOX ALTCONTACTS RETURN TO ALTCONTACTNAME FOR ANOTHER CONTACT. END LOOP AFTER NO MORE NAMES ARE PROVIDED OR MAX CONTACTS COLLECTED IS REACHED. |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | AIAN FACES 2019 PARENT SURVEY |
| Subject | WEB |
| Author | MATHEMATICA STAFF |
| File Modified | 0000-00-00 |
| File Created | 2021-06-11 |
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