NY Questionnaire

Attachment 6g. NY Interview questionnaire, licensed anglers

In response to the comments sent via email and comments embedded in this document, we have prepared the following responses.

Question #	Variable	Response
2	Email address	We asked for e-mail on the screening questionnaire for anglers, but we need to ask again for confirmation, given the need for exact spellings on e-mails
10	Inclusion of "other" for race	The questionnaire is accomplished only via personal interview
14	Place of birth	This question was eliminated for the licensed angler questionnaire
15-18	Education and occupation	We agree and have moved the section to the end of the question. The section has been incorporated with the last section of the survey and retitled "Education, occupation, and income". The corresponding script has been revised to reflect the changes.
55	Red meat	The card provided to the participant with specifics for the question includes pork and game

Form Approved

OMB No. 0923-XXXX

Exp. Date xx/xx/20xx xxxxxx/xx/xx/20xx

Attachment 6g. NY Interview questionnaire, licensed anglers

New York State Biomonitoring of the Great Lakes Populations

Interview Questionnaire for Licensed Anglers

CONTACT INFORMATION

1. What is your full name?

First: __________________ Last: __________________ Middle initial: ___

___ Refused

2. Do you have an email address?

___ Yes  What is it? ________________________________________

___ No

___ Don’t know

___ Refused

3. Do you have a phone number where we can reach you? This can be the phone number of a friend, relative, or someone who will know how to find you.

___ Yes  _____________________ Home Work Cell Other: _________

_____________________ Home Work Cell Other: _________

_____________________ Home Work Cell Other: _________

___ No

___ Don’t know

___ Refused

4. What is your street address?

Street Number: ______ Street Name:_____________________ Unit: ____

City: ___________________________ State: _______ ZIP Code: ________

5. Is your mailing address different from your street address?

___ Yes  What is your mailing address?

Street Number: ______ Street Name:_____________________ Unit: ____

City: ___________________________ State: _______ ZIP Code: _______

___ No

___ Don’t know

___ Refused

Public reporting burden of this collection of information is estimated to average 30 minutes per response for total participation, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0923-XXXX).

6. If you want your blood and urine test results sent to your doctor, what is his/her name, phone number, and address?

Name of doctor: ______________________________

Telephone number: _________________

Address: _____________________________________________________________

Script (if participant does not provide physician’s name): If you do not want the results sent to your physician or you don’t have one, the results will be sent to a physician at the New York State Department of Health.

SEX AND AGE

Script. Now we will begin the interview. The first part is about your background. It will help us compare your answers to other participants’ answers.

7. Indicate whether the person is male or female. If unsure, ask his/her sex.

___ Male

___ Female

8. What is your birthdate?

____ / _____ / _______  So you are _____ years old?

mm dd yyyy

ETHNICITY AND RACE

9. Do you consider yourself to be Hispanic or Latino?

___ Yes

___ No

___ Don’t know

___ Refused

10. What race do you consider yourself to be? (Check all that apply.)

___ White

___ Black or African American

___ Asian

___ Native Hawaiian or Other Pacific Islander

___ American Indian or Alaska Native

___ Other  Specify: _______________

___ Don’t know

___ Refused

RESIDENTIAL HISTORY

Script: Next, I will ask you where you have lived.

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

___ Entire life

(If less than 1 year, enter 0 years and number of months. If full years reported, enter number of years and 0 months.)

_____ years _____ months

12. When was this home built?

___ 1978 or after

___ 1950 to 1977

___ Before 1950

___ Don’t know

___ Refused

13. How long have you lived in these counties? SHOW MAP.

___ Entire life

(If less than 1 year, enter 0 years and number of months. If full years reported, enter number of years and 0 months.)

_____ years _____ months

LIFESTYLE

Script: The next group of questions will be about any behaviors or customs you have that could expose you to some contaminants found in Great Lakes fish.

14. On most days, do you take or use any of the following? (Check all that apply.)

___ Herbal medicine or supplements  Specify: _________________________________

___ Fish oil

___ None

___ Don’t know

___ Refused

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

___ Yes (Ever smoker)  go to #21

___ No (Never smoker)  go to #25

___ Don’t know  go to #25

___ Refused  go to #25

16. (Ever smoker) Do you smoke cigarettes now?

___ Yes (Current smoker)  go to #23

___ No (Former smoker)  go to #22

___ Don’t know  go to #25

___ Refused  go to #25

17. (Former smoker) How long has it been since you last smoked cigarettes regularly?

_____ months or _____ years  go to #25

18. (Current smoker) How often do you smoke cigarettes?

___ Daily (Daily smoker)  go to #24

___ Weekly  go to #25

___ Monthly  go to #25

___ Don’t know  go to #25

___ Refused  go to #25

19. (Daily smoker) How many cigarettes do you smoke per day?

(1 pack=20 cigarettes)

___ 1-5 per day

___ 6-10 per day

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

___ >20 per day (>1 pack per day)

___ Don’t know

___ Refused

20. Do you use chewing tobacco or snuff?

___ Yes  go to #26

___ No  go to #27

___ Don’t know  go to #27

___ Refused  go to #27

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

___ Daily

___ Weekly

___ Monthly

___ Don’t know

___ Refused

PERSONAL ACTIVITIES

Script: The next questions are about activities or interests done as hobbies. You may do these activities for fun, to earn money, or to keep up your house.

22. In the past 12 months, have you or someone else in your household done any of the following activities? SHOW CARD

___ Yes  go to #28

___ No  go to # 30

___ Don’t know  go to #30

___ Refused  go to #30

23. Tell me which activities you did in the last 12 months.

SHOW CARD. (Check all that apply.)

___ Dyeing material ___ Metal work ___ None

___ Electronics assembly ___ Painting and glazing ___ Don’t know

___ Gardening or farming ___ Printmaking ___ Refused

___ Glass crafting ___ Woodworking

___ Leather crafting

24. Tell me which activities another household member has done in your home the last 12 months.

SHOW CARD. (Check all that apply.)

___ Electronics assembly ___ Painting and glazing ___ None

___ Gardening or farming ___ Printmaking ___ Don’t know

___ Glass crafting ___ Woodworking ___ Refused

___ Leather crafting

REPRODUCTIVE HISTORY

If MALE  go to #34

If FEMALE  go to #30

25. Are you pregnant?

___ Yes  go to #31

___ No  go to #32

___ Don’t know  go to #32

___ Refused  go to #32

26. How many weeks pregnant are you?

______ weeks

___ Don’t know  go to #32

___ Refused  go to #32

27. How many children have you given birth to?

(If NONE, enter 0  go to #34)

______ child/children

___ Don’t know  go to #34

___ Refused  go to #34

28. From oldest to youngest, what year was each child born and how many months was each child breastfed? (If a child was not breastfed, enter 0 months.)

Birth order	Birth year (yyyy)	Months breastfed	Birth order	Birth year (yyyy)	Months breastfed
1st			5th
2nd			6th
3rd			7th
4th			8th

FISH AND SHELLFISH

29. Have you eaten fish or shellfish in the past week?

___ Yes  go to #35

___ No  go to #36

___ Don’t know  go to #36

___ Refused  go to #36

30. When was the last time you ate fish or shellfish?

___ Today (same day)

___ Yesterday (1 day ago)

___ Day before yesterday (2 days ago)

___ 3 days ago

___ 4-7 days ago

___ Don’t know

___ Refused

CAUGHT FISH

Script: These questions are about the fish you eat that you caught yourself or by someone you know.

31. Compared to this model of a half-pound serving of fish, would you say that a typical meal of fish you eat is usually:

___ Less (smaller than the model)

___ Same or about the same

___ More (larger than the model)

___ Don’t know

___ Refused

32. Have you eaten fish from any of these bodies of water in New York State?

SHOW CARD AND MAPS. (Check all that apply.)

___ Lake Erie ___ Erie Canal (from Lake Erie to eastern border of Erie County only) ___ Buffalo River (including Cazenovia Creek) ___ Upper Niagara River (including shore of Lake Erie) ___ Lower Niagara River ___ Lake Ontario ___ Eighteenmile Creek ___ Creeks surrounding Eighteenmile, including Fourmile, Twelvemile, Hopkins, Bull, Keg, Golden Hill, Johnson, and Erie Canal

___ Lower Genesee River (from Driving Park Bridge to Lake Ontario) ___ Irondequoit Bay/Creek ___ Ponds of Greece, including Little, Round, Buck, Long, Cranberry ___ Braddock Bay ___ Lake Ontario Creeks, including Yanty, Sandy, Cowsucker, Brush, East, West, Salmon, Buttonwood, Northrup (including Black), Larkin (including Smith), Slater, Shipbuilder's, Mill, and Fourmile ___ Don’t know ___ Refused

33. Of the fish from these bodies of water, which have you eaten at least five times in your life? SHOW CARD.

(Check the species eaten at least 5 times.)

___ American eel ___ Black crappie ___ Brook trout ___ Brown bullhead ___ Brown trout ___ Chain pickerel ___ Channel catfish ___ Chinook (king) salmon ___ Coho salmon ___ Common carp ___ Freshwater drum, sheepshead	___ Goldfish ___ Lake sturgeon ___ Lake trout ___ Largemouth bass ___ Minnow ___ Northern hog sucker ___ Northern pike ___ Pink salmon ___ Quillback ___ Rainbow smelt ___ Rainbow/steelhead trout	___ Rock bass ___ Round goby ___ Smallmouth bass ___ Sunfish (blue gill, pumpkin seed) ___ Walleye ___ White (silver) bass ___ White perch ___ White sucker ___ Yellow bullhead ___ Yellow perch ___Other  Specify: ___________
If one or more species checked  go to #39 ___ None  go to #45 ___ Don’t know  go to #45 ___ Refused  go to #45

Script: I’m going to ask you about each fish species you just told me you’ve eaten at least five times.

34. Over your lifetime, how many years have you eaten [fish species] out of these bodies of water?

_____ years

___ Don’t know

___ Refused

35. In the past 12 months, how many times did you eat [fish species]? Tell me the number of times per week, month, or year, whichever is easiest to remember.

(If never, enter 0 times per year.)

___ times per (circle one) week month year

___ Don’t know

___ Refused

36. What parts of [fish species] did you usually eat? SHOW CARD.

(Check all that apply.)

___ Fillet ___ Liver ___ Don’t know

___ Skin ___ Eggs/Roe ___ Refused

___ Cheek ___ Other  Specify: ____________

37. How was the [fish species] usually cleaned? SHOW CARD.

(Check all that apply.)

___ Filleted ___ Trimmed belly meat ___ Don’t know

___ Gutted ___ Removed cheeks ___ Refused

___ Trimmed fat ___ Punctured or removed skin

38. How was the [fish species] usually cooked? SHOW CARD. Check all that apply.

___ Pan fried ___ Baked/broiled ___ Don’t know

___ Deep fried ___ Eaten raw ___ Refused

___ Boiled/poached ___ Smoked

___ Stew/chowder ___ Dried

___ Grilled ___ Pickled

39. For fish caught in any of these areas, how has the total amount of fish you eat changed during the past five years?

___ Eat less

___ Same or about the same

___ Eat more

___ Don’t know

___ Refused

WILD BIRDS AND ANIMALS

40. In the past 12 months, have you eaten waterfowl (such as ducks or geese) or bear that were hunted near any of the following bodies of water in New York State?

SHOW CARD AND MAPS.

(Check all that apply.)

___ Lake Erie ___ Erie Canal (from Lake Erie to eastern border of Erie County only) ___ Buffalo River (including Cazenovia Creek) ___ Upper Niagara River (including shore of Lake Erie) ___ Lower Niagara River ___ Lake Ontario ___ Eighteenmile Creek ___ Creeks surrounding Eighteenmile, including Fourmile, Twelvemile, Hopkins, Bull, Keg, Golden Hill, Johnson, and Erie Canal

___ Lower Genesee River (from Driving Park Bridge to Lake Ontario) ___ Irondequoit Bay/Creek ___ Ponds of Greece, including Little, Round, Buck, Long, Cranberry ___ Braddock Bay ___ Lake Ontario Creeks, including Yanty, Sandy, Cowsucker, Brush, East, West, Salmon, Buttonwood, Northrup (including Black), Larkin (including Smith), Slater, Shipbuilder's, Mill, and Fourmile ___ Don’t know ___ Refused

41. In the past 12 months, about how many times did you swim, dive, or wade (including wading for fishing or hunting) in any of these bodies of water? SHOW CARD AND MAPS.

(If never, enter 0 times.)

_____ times

___ Don’t know

___ Refused

42. In the past 12 months, have you eaten fish from any of these other bodies of water in New York State? SHOW CARD.

___ Adirondack Park Region lakes, ponds, or rivers  Specify: ________________________

___ Hudson River  Specify locations along the river: ________________________

___ Catskill Park Region lakes, ponds, or rivers  Specify: ___________________________

___ Canadice Lake (Ontario County)

___ Other bodies of water in the sportfish advisories  Specify: ______________________

_______________________________________________________________________

___ Don’t know

___ Refused

STORE BOUGHT FISH

Script: The following questions are about fish bought at a store or supermarket. Please do not include fish from restaurants.

43. Over your lifetime, how many years have you eaten any of these fish bought at a store or supermarket? SHOW CARD.

(If never or less than 1 year, enter 0 years.)

_____ years

___ Don’t know

___ Refused

44. Which of these fish that was bought at a store or supermarket have you eaten at least five times in your life? SHOW CARD.

(Check the species eaten at least 5 times.)

___ Grouper ___ Salmon (including canned)

___ Shark ___ Tuna (canned)

___ Swordfish ___ Tuna (not canned)

If ate at least one type of fish  go to #50

___ None

___ Don’t know  go to #52

___ Refused

45. How many years did you eat [fish species] bought at a store or supermarket?

_____ years

___ Don’t know

___ Refused

46. In the past 12 months, how many times did you eat [fish species]? Tell me the number of times per week, month, or year, whichever is easiest to remember.

(If never, enter 0 times.)

___ times per (circle one) week month year

___ Don’t know

___ Refused

OTHER STORE BOUGHT FOODS

Script: The following questions are about typical grocery store or market foods that you may have eaten in the past 12 months. The purpose of the following four questions is to estimate if you have a high animal fat diet or low animal fat diet.

In the past 12 months, how often did you eat meals with… SHOW CARD.

47. Whole eggs?

(If never, enter 0 times per year.)

___ times per (circle one) week month year

___ Don’t know

___ Refused

48. Whole milk products (including 2% milk)?

(If never, enter 0 times per year.)

___ times per (circle one) week month year

___ Don’t know

___ Refused

49. Poultry meat?

(If never, enter 0 times per year.)

___ times per (circle one) week month year

___ Don’t know

___ Refused

50. Red meat?

(If never, enter 0 times per year.)

___ times per (circle one) week month year

___ Don’t know

___ Refused

EDUCATION, OCCUPATION. AND INCOME

Script: "We also want to know about your education and occupation, and about your family's income."

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

___ 8th grade or less ___ Bachelor’s degree

___ 9^th to 11^th grade, no diploma ___ Postgraduate, professional, or doctoral degree

___ High school graduate or GED ___ Don’t know

___ Some college, no diploma ___ Refused

___ Associate degree

52. Have you had a job in the past 12 months?

___ Yes go to #17

___ No  go to #19

___ Don’t know go to #19

___ Refused go to #19

Script: I would like to know what type of work you’ve done and the kind of business where you worked in the past 12 months.

53. Currently, what is your job or job title and the kind of business or organization where you work?

Job 1. __________________________ Industry 1. ___________________________

(Optional) What are your usual activities or duties? ___________________________

______________________________________________________________________

54. If you had more than one job in the past 12 months, tell me about each one.

If no additional jobs, go to #19.

Job 2. __________________________ Industry 2. ___________________________

(Optional) What are your usual activities or duties? ___________________________

______________________________________________________________________

Job 3. __________________________ Industry 3. ___________________________

(Optional) What are your usual activities or duties? ___________________________

______________________________________________________________________

Job 4. __________________________ Industry 4. ___________________________

(Optional) What are your usual activities or duties? ___________________________

______________________________________________________________________

Script:

55. Including yourself, how many family members currently live with you? Your family includes everyone currently living with you who is related to you by birth, marriage, or adoption.

_______ members

___ Don’t know

___ Refused

56. Can you tell me your total family income in {LAST CALENDAR YEAR} before taxes?

SHOW CARD.

(Check one only.)

___ Less than $25,000

___ $25,000 to less than $35,000

___ $35,000 to less than $50,000

___ $50,000 to less than $75,000

___ $75,000 to less than $100,000

___ $100,000 or more

___ Don’t know

___ Refused

FISHING INFORMATION

57. Have you heard about the health advice on eating fish caught from New York State waters?

___ Yes

___ No

___ Don’t know

___ Refused

END OF INTERVIEW.