Salt Sources Study--Follow-up Urine Collection Questionn

Salt Sources Study

Follow-up Urine Collection Questionnaire

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to  CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, NE, M/S D74, Atlanta, GA 30333, ATTN: PRA 0920-xxxx.

FQP1-FQP3 are completed based on Technician’s observation. No need to read the questions to the participants.

FQP1. WAS THE TIME OF URINE COLLECTION RECORDED?

YES 1

NO 2 (Go to REDO, FQR1)

FQP2. WAS THE LENGTH OF THE COLLECTION TIME WITHIN 22 TO 26 HOURS?

YES 1

NO 2 (Go to REDO, FQR1)

FQP3. WAS THE TOTAL AMOUNT OF URINE COLLECTION MORE THAN 500 ML?

YES 1

NO 2 (Go to REDO, FQR1)

We would like to ask you several questions about your experience in collecting the urine for a 24 hour period. Your answers to these questions will not affect your reimbursement.

FQ1. (FOR FEMALES ONLY) Were you having your period at any time in the last 24 hours?

YES 1

NO 2

REFUSED 7

DON'T KNOW 9

FQ2. During the 24-hour period, did you collect your urine every time you used the bathroom to urinate?

YES 1 (FQ4)

NO 2

REFUSED 7 (FQ4)

DON'T KNOW 9 (FQ4)

FQ3. How many times did you miss?

Interviewer instruction: Probe the amount of the void. Do not count as “miss” if the missed void was only a few drops.

|__|__| times

REFUSED 77

DON'T KNOW 99

FQ4. Is there any urine missing from the storage containers for any other reason such as spilling?

YES 1

NO 2 (FQ7)

REFUSED 7 (FQ7)

DON'T KNOW 9 (FQ7)

FQ5. Were more than a few drops of urine lost?

YES 1

NO 2 (FQ7)

REFUSED 7

DON'T KNOW 9

FQ6. How many times did this happen?

|__|__| times

REFUSED 77

DON'T KNOW 99

FQ7. Many people when having a bowel movement also urinate. Was there any time when you were not able to collect the complete urine sample because of a bowel movement?

Interviewer instruction: Probe the amount of the void. Do not count as “miss” if the missed void was only a few drops.

YES 1

NO 2 (FQ9)

REFUSED 7 (FQ9)

DON'T KNOW 9 (FQ9)

FQ8. How many times did this happen?

|__|__| times

REFUSED 77

DON'T KNOW 99

FQ9. Were you able to keep the storage containers in a cool place until this appointment?

YES 1 (FQ11)

NO 2

REFUSED 7 (FQ11)

DON'T KNOW 9 (FQ11)

FQ10. How long was the sample not kept cold?

|__|__| minutes/hour

REFUSED 7

DON'T KNOW 9

FQ11. Did you perform this collection on a day that you also went to work?

YES 1

NO 2

DO NOT WORK 3

REFUSED 7

DON'T KNOW 9

FQ12. When collecting the sample, did you have any difficulty in remembering or carrying out the instructions?

YES (specify_______) 1

NO 2

REFUSED 7

DON'T KNOW 9

FQ13. Did you have any other problem when collecting the 24 hr urine sample?

YES (specify_______) 1

NO 2

REFUSED 7

DON'T KNOW 9

FQ13. Did you have any other problem when collecting the 24 hr urine sample?

YES (specify_______) 1

NO 2

REFUSED 7

DON'T KNOW 9

FQ14. In the last 2 days, did you engage in physical activity, akin to brisk walking, jogging, bicycling, long enough to work up a sweat?

YES 1

NO 2

REFUSED 7

DON'T KNOW 9

FQ15. In the last 2 days, did you engage in work or home activity, akin to heavy lifting, digging, shoveling snow, or climbing stairs, etc, long enough to work up a sweat? ("Work" includes all jobs, school,,and volunteer work.)

YES 1

NO 2

REFUSED 7

DON'T KNOW 9

BOX 1

If (FQ2=1 AND (FQ4=2 OR FQ5=2) AND FQ7=2), mark as ‘CONTINUE’ and proceed with the next urine collection and diet interview;

Otherwise, mark as ‘REDO’ and proceed with item FQR1.

FQR1 is completed by the Technician for all cases that need re-do. No need to read the questions to the participants.

FQR1. DOES THE PARTICIPANT AGREE TO REDO THE COLLECTION?

YES 1 (END OF SECTION, MARK STATUS AS “NOT DONE” WITH COMMENT “NEEDS REDO”)

NO 2 (BOX2)

BOX 2

If FQP1=2, go to the end of section, mark status as “NOT DONE” with comment “FAILED TO FOLLOW PROTOCOL”.

Else if FQP2=1, go to BOX3;

Else if FQP3=2, go to the end of section, mark status as “NOT DONE” with comment “FAILED TO FOLLOW PROTOCOL”.

Return to FQR1 above.