Summary of PRAMS Core Question Changes from Phase 8 to Phase 9

Summary of Changes between Phase 9 and Phase 8 Core Questionnaire

Topic	Phase 9 Core Question Number	Phase 8 Corresponding Core Question Number	Description of Changes
Demographic	Not available	1 (height) 2(pre-pregnancy weight)	Questions on height and pre-pregnancy weight are dropped from Phase 9 Core because information is available from the birth certificate file. These questions are available on the Phase 9 Standard questionnaire (as II1 and II2) and are optional for jurisdictions to select on their surveys.
Demographic	1 (date of birth)	3 (date of birth)	No modification between Phase 8 and 9
Demographic	2 (disability)	Not available	This question combines the six questions from the Disability Supplement into one question with six types of disability as responses and was adapted from the disability question from the American Community Survey (ACS).
Health conditions	3 (preconception) 15 (prenatal)	4 (preconception) 18 (prenatal)	Added “anxiety” as a response option in Phase 9 pre-conception and prenatal health condition questions. In Phase 9 (question #15) changed from asking if respondent had the condition to did their healthcare provider tell them that they had the condition.
Multivitamin use	Not available	5	This question on pre-conception multivitamin use is available on the Phase 9 Standard questionnaire (as G9) and is optional for jurisdictions to select on their surveys.
Pre-conception healthcare visit screener question	Not available	6	This question has been dropped from PRAMS since pre-conception health care visit status could be ascertained from Phase 9 question #4.
Pre-conception health care visit	4	7	In Phase 9, the response option for “visit for an injury” is combined with visit for “an illness or chronic condition” The question changed from a check-all-that-apply format to a yes/no grid format so we can assess pre-conception healthcare visit status without needing to add a screener question.
Preconception, prenatal, and postpartum health care checklist	5 (preconception) 11 (prenatal) 45 (postpartum)	8 (preconception) Core 14 (prenatal) Core 47 (postpartum)	Some of the response options for the preconception, prenatal, and postpartum health care checklist questions have been updated or new options added to reflect current health practice recommendations.
Health insurance coverage	6 (preconception) 7 (prenatal) 8 (postpartum)	Core 9 (preconception) Core 10 (preconception) Core 11 (postpartum)	For the three insurance questions, the private insurance category has been collapsed from 3 categories (in Phase 8) into one response category for Phase 9 because analysis of insurance indicators typically combines the three private options into one. For the prenatal insurance question (Phase 9, question #7), remove the “I did not go for prenatal care” response option because individuals who did not go for prenatal care get to skip this question in Phase 8. Removing this option in Phase 9 would allow us to assess health insurance status among those who did not have prenatal care.
Pregnancy intention	9	12	No modification between Phase 8 and Phase 9
Prenatal care and timing of prenatal care	10	13	In Phase 9, this question drops the response option on when respondent started prenatal care because the information is available on the birth certificate. The question on timing of prenatal care is available as Phase 9 Standard questionnaire (as R24) and is optional for jurisdictions to select on their surveys. The response option that asks if respondent had prenatal care is kept in Phase 9.
Vaccination	12 (provider offering) 13 (receipt)	15 (provider offering) 16 (receipt)	In Phase 9, added “Tdap” and “COVID-19” vaccinations to both of flu vaccination questions The receipt of vaccines question is changed from “Check ONE answer” format to a grid format (before pregnancy, during pregnancy, and no vaccine before or during pregnancy)
Oral health	14	17	No modification between Phase 8 and Phase 9
Blood pressure monitoring and maternal warning signs	16 (blood pressure) 17 (warning signs) 18 (warning signs)	Not available	These questions are new to Phase 9.
Cigarette use	19 (screener) 20 (preconception) 21 (prenatal) 22 (postpartum)	19 (screener) 20 (preconception) 21 (prenatal) 22 (postpartum)	Screener question: no modification For all three cigarette use questions, collapsed 7 response categories (in Phase 8) into 4 categories for Phase 9. Changed response categories from number of cigarettes smoked (in Phase 8) to pack size. Smokers tend to refer to frequency of use by pack size instead of number of cigarettes. Majority of analyses are focused on smoking status or changes in smoking status during pregnancy rather frequency of use.
E-cigarette use	23 (screener)	23 (screener)	In Phase 9, this question was modified to focus only on e-cigarette use and exclude other products such as hookah, based on FDA recommendations.
	24 (preconception) 25 (prenatal)	24 (preconception) 25 (prenatal)	Preconception and prenatal: Collapsing 5 response categories (in Phase 8) into 3 categories for Phase 9. Modifications were proposed by our FDA partner.
	26 (quit)	Not available	Question #26 (using e-cigarette as a way to cut down or stop cigarette smoke) is new to Phase 9.
Alcohol use	Not available	26 (screener)	The alcohol use screener question is dropped in Phase 9
	27 (any alcohol by trimester)	Not available	Question #27 (any alcohol use by trimester) is new to Phase 9
	28 (binge drinking by trimester)	Not available	Question #28 (binge drinking by trimester) is new to Phase 9.
	Not available	27 (pre-conception frequency of use)	This question is available in the Phase 9 Standard questionnaire (as JJ5) and is optional for jurisdictions to select on their surveys.
Stressors	29	Not available	This question was available as a Standard question (P19) in Phase 8 but is now available as a Core question in Phase 9. Response options have been updated from 15 to 11 options.
Intimate partner violence	30 (preconception) 31 (prenatal)	28 (preconception) 29 (prenatal)	No modification between Phase 8 and Phase 9.
Infant	Not available	30 (date of delivery)	This question is available in the Phase 9 Standard questionnaire (as II4) and is optional for jurisdictions to select on their surveys.
	32 (hospital stay)	31 (hospital stay)	Collapsed response categories of less than 24 hours and 24-48 hours into one category.
	33 (infant alive) 34 (infant living with mom)	32 (infant alive) 33 (infant living with mom)	No modification between Phase 8 and Phase 9
Breastfeeding	Not available	34 (sources of information)	This question is available in the Phase 9 Standard questionnaire (as B17) and is optional for jurisdictions to select on their surveys.
	35	Core 35 (ever breastfed) Core 36 (currently breastfeeding) Core 37 (breastfeeding duration)	Combined three breastfeeding questions in Phase 8 (did you ever breastfeed, are you currently breast feeding, and how many weeks/months did you breastfeed) into one question for Phase 9 with 4 response options (didn’t breastfeed; breastfed for less than 1 week; breastfed for ___weeks or _____months; I’m still breastfeeding).
Infant safe sleep	36 (sleep position)	38 (sleep position)	Modified to only ask about practices in the past 2 weeks.
	37 (bed-sharing)	39 (bed-sharing)	Modified to reference the time when the respondent was also asleep.
	38 (room-sharing)	40 (room-sharing)	Modified to only ask about practices in the past 2 weeks.
	39 (sleep surfaces) 40 (sleep items)	41 (sleep environment)	In phase 9, sleep environment is assessed by two separate questions, sleep surfaces and items infant slept with for clarity. Additional sleep surfaces and items were added to Phase 9 questions 39 and 40.
	Not available	42 (provider advice)	This question is available in the Phase 9 Standard questionnaire (as F5) and is optional for jurisdictions to select on their surveys.
Contraception	41 (screener)	43 (screener)	No modification
	42 (reasons for not using contraception)	44 (reasons)	Modified to add new options for “I’m pregnant now”, “we are same-sex spouse/partners”, “my spouse or partner doesn’t want me to use birth control”, and “I don’t think I can get pregnant because I’m breastfeeding.”
	43 (contraceptive types)	Core 45 (contraceptive types)	Removed brand names as examples of different types of contraception to simplify and reduce excessive text. Testing showed that respondents are often confused if they don’t recognize a specific brand.
Postpartum visit	44	46	No modification
Mental health	46 (depressive symptoms) 47 (depressive symptoms)	48 (depressive symptoms) 49 (depressive symptoms)	No modification on the first symptoms question Removed “…you usually enjoyed” from the second symptoms question
	48 (anxiety) 49 (anxiety)	Not available Not available	The anxiety questions are new to Phase 9.
Food security	51	Not available	This question is new to Phase 9.
Transportation security	52	Not available	This question is new to Phase 9.
Racism/discrimination experiences	53 (in healthcare setting) 54 (lifetime experience) 55 (situations)	Not available Not available Not available	The questions on experiences of racism and discrimination are new to Phase 9.
Income	56 57 (number of people)	50 (income) 51 (number of people)	Income categories have been modified to align with changes in the 2022 poverty indices, resulting in decrease from 12 to 10 response options. Number of people depended on income: no modification
Survey completion date	58	52	No modification