Form 8.1 Survey

Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months and Sibling Birth Enrollment

BirthQuestionnaireAdult

Birth Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/15/2014

Birth Questionnaire – Adult, Phase 2g

OMB Specification


Birth Questionnaire – Adult


Event Category:

Time-Based

Event:

Birth

Administration:

N/A

Instrument Target:

Biological Mother

Instrument Respondent:

Biological Mother

Domain:

Questionnaire

Document Category:

Questionnaire

Method:

Data Collector Administered

Mode (for this instrument*):

In-Person, CAI;
Phone, CAI

OMB Approved Modes:

In-Person, CAI;
Phone, CAI;
Web-Based, CAI

Estimated Administration Time:

7 minutes

Multiple Child/Sibling Consideration:

Per Event

Special Considerations:

N/A

Version:

1.0

MDES Release:

4.0


*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.


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Birth Questionnaire – Adult



TABLE OF CONTENTS





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Birth Questionnaire – Adult



GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:


DATA ELEMENT FIELDS

MAXIMUM CHARACTERS PERMITTED

DATA TYPE

PROGRAMMER INSTRUCTIONS

ADDRESS AND EMAIL FIELDS

100

CHARACTER


UNIT AND PHONE FIELDS

10

CHARACTER


_OTH AND COMMENT FIELDS

255

CHARACTER

  • Limit text to 255 characters

FIRST NAME AND LAST NAME

30

CHARACTER

  • Limit text to 30 characters

ALL ID FIELDS

36

CHARACTER


ZIP CODE

5

NUMERIC


ZIP CODE LAST FOUR

4

NUMERIC


CITY

50

CHARACTER


DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)

10

NUMERIC


CHARACTER

  • DISPLAY AS MM/DD/YYYY

  • STORE AS YYYY-MM-DD

  • HARD EDITS:

MM MUST EQUAL 01 TO 12

DD MUST EQUAL 01 TO 31

YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.

TIME VARIABLES

TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION

NUMERIC

  • HARD EDITS:

HOURS MUST BE BETWEEN 00 AND 12;

MINUTES MUST BE BETWEEN 00 AND 59


Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).


POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.



A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.





WORK


(TIME_STAMP_WOR_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD PARTICIPANT ID (P_ID)  FOR BIOLOGICAL MOTHER.

  • PRELOAD WORK_NAME, WORK_ADDRESS_1, WORK_ADDRESS_2, WORK_UNIT, WORK_CITY, WORK_STATE, WORK_ZIP, AND WORK_ZIP4 IF VALUES ≠ -1 OR -2: 

    • ​FROM INSTRUMENT_ID = XX (PREGNANCY VISIT 2 QUESTIONNAIRE - ADULT) IF EVENT_TYPE = 15 (PV2) SET TO COMPLETE 

    • FROM INSTRUMENT_ID = XX (PREGNANCY VISIT 1 QUESTIONNAIRE - ADULT) IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE.

  • PRELOAD CHILD_DOB FROM INSTRUMENT_ID = XX (PARTICIPANT VERIFICATION, SCHEDULING, AND TRACING QUESTIONNAIRE)

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, PRELOAD AND DISPLAY DATE OF PV2 VISIT.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 SET TO COMPLETE, PRELOAD AND DISPLAY DATE OF PV1 VISIT.


WOR01000/(EMPLOY2). Are you currently employed? 


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_WOR_ET

REFUSED

-1

TIME_STAMP_WOR_ET

DON'T KNOW

-2

TIME_STAMP_WOR_ET


SOURCE

Pregnancy, Infection, and Nutrition Study


WOR02000/(RETURN_JOB_YET). {Have you returned/Do you plan to return} to your current job?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study Vanguard Phase (Birth)


PROGRAMMER INSTRUCTIONS

  • IF BIRTH_DELIVER = 3 OR RELEASE = 1, DISPLAY “Have you returned”.

  • OTHERWISE, DISPLAY “Do you plan to return”.

  • IF BIRTH_DELIVER = 3 OR RELEASE = 1 AND RETURN_JOB_YET = 1, GO TO WOR03000.

  • IF RELEASE = 2 AND RETURN_JOB_YET = 1 OR IF EMPLOY2 =1 AND RETURN_JOB_YET = 2, GO TO WOR03100.

  • OTHERWISE, GO TO TIME_STAMP_WOR_ET.


WOR03000. When did you return to your job?


INTERVIEWER INSTRUCTIONS

  • ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND A FOUR-DIGIT YEAR


SOURCE

National Children’s Study Vanguard Phase (Birth)


(RETURN_JOB_DT_MM) MONTH:  |___|___|

                 M   M


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(RETURN_JOB_DT_DD) DAY:         |___|___|

                    D   D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(RETURN_JOB_DT_YYYY) DAY:         |___|___|

                    D   D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF WORK_NAME COLLECTED PREVIOUSLY IN INSTRUMENT_ID = XX (PV2) OR INSTRUMENT_ID = XX (PV1) AND WORK_NAME ≠ -1 OR -2, GO TO WORK_NAME_CONFIRM.

  • OTHERWISE, IF WORK_NAME NOT COLLECTED PREVIOUSLY OR WORK_NAME = -1 OR -2, GO TO WORK_NAME.


WOR03100. When do you plan to return to your current job?


SOURCE

National Children’s Study Vanguard Phase (Birth)


(RETURN_JOB) |___|___|


INTERVIEWER INSTRUCTIONS

  • ENTER IN NUMERIC VALUE AND THEN SELECT APPROPRIATE UNIT.


Label

Code

Go To

DOESN'T PLAN TO RETURN TO CURRENT JOB

-7


REFUSED

-1


DON'T KNOW

-2



(RETURN_JOB_UNIT)


Label

Code

Go To

DAYS

1


WEEKS

2


MONTHS

3


YEARS

4



PROGRAMMER INSTRUCTIONS

  • IF WORK_NAME COLLECTED PREVIOUSLY IN INSTRUMENT_ID = XX (PV2) OR INSTRUMENT_ID = XX (PV1) AND WORK_NAME ≠ -1 OR -2, GO TO WORK_NAME_CONFIRM.

  • OTHERWISE, IF WORK_NAME NOT COLLECTED PREVIOUSLY OR WORK_NAME = -1 OR -2, GO TO WORK_NAME.


WOR06000/(WORK_NAME_CONFIRM). Let me confirm the name of the place where you work.  I have it as {MOTHER’S WORK PLACE NAME}.  Is that correct?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Evaluation of the Community Health Marriage Incentive (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY WORK_NAME IN "MOTHER'S WORK PLACE NAME".

  • IF WORK_NAME_CONFIRM = 2, -1, OR -2, GO TO WORK_NAME.

  • IF WORK_NAME_CONFIRM = 1 AND:

    • IF ANY VALUE OF WORK_ADDRESS_1, WORK_CITY, WORK_STATE, AND WORK_ZIP ≠ -1 OR -2, GO TO WORK_ADDRESS_CONFIRM.

    • IF WORK_ADDRESS_1, WORK_CITY, WORK_STATE, AND WORK_ZIP NOT COLLECTED PREVIOUSLY OR ALL VALUES = -1 OR -2, GO TO WOR09000.


WOR07000/(WORK_NAME ). What is the name of the place where you work?

 

_____________________________________ 


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Evaluation of the Community Health Marriage Incentive (modified)


WOR08000/(WORK_ADDRESS_CONFIRM). Let me confirm your work address. I have it as {MOTHER’S WORK ADDRESS}. Is this correct?


Label

Code

Go To

YES

1

TIME_STAMP_WOR_ET

NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Evaluation of the Community Health Marriage Incentive (modified)


PROGRAMMER INSTRUCTIONS

  • DISPLAY WORK_ADDRESS_1, WORK_ADDRESS_2, WORK_UNIT, WORK_CITY, WORK_STATE, WORK_ZIP, AND WORK_ZIP4  IN "MOTHER'S WORK ADDRESS".


WOR09000. What is the address where you work?


INTERVIEWER INSTRUCTIONS

  • PROBE AND ENTER AS MUCH INFORMATION AS PARTICIPANT KNOWS.


SOURCE

Evaluation of the Community Health Marriage Incentive (modified)


(WORK_ADDRESS1) ____________________________________                                                                  

ADDRESS 1 - STREET/PO BOX


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(WORK_ADDRESS2) ___________________________________________

ADDRESS 2


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(WORK_UNIT) ____________________________________

UNIT


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(WORK_CITY) ___________________________________

CITY


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(WORK_STATE) |___|___|

STATE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(WORK_ZIP) |___|___|___|___|___|

ZIP CODE


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(WORK_ZIP4) |___|___|___|___|

ZIP + 4


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(TIME_STAMP_WOR_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



MEDICAL HISTORY


(TIME_STAMP_MH_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


MH01000. Now, I will ask about your recent medical history.


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, GO TO MH10000.

  • IF EVENT_TYPE = 13 OR EVENT_TYPE = 15 SET TO COMPLETE, GO TO USE_PR_LOG.


MH02000/(USE_PR_LOG). Have you used the Pregnancy Health Care Log since {DATE OF PV2 VISIT}/{DATE OF PV1 VISIT}? This is the booklet that you or your health care provider such as a doctor, midwife, or nurse uses to record information about your medical visits.


Label

Code

Go To

YES

1

NUM_PROV_PR_LOG

NO

2


REFUSED

-1

MH10000

DON'T KNOW

-2

MH10000


SOURCE

National Children’s Study Vanguard Phase (18M, 24M)


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET

TO COMPLETE, DISPLAY DATE OF PV2 VISIT. <span style="font-size:12.0pt;

mso-bidi-font-size:11.0pt;mso-bidi-font-family:Arial">

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 SET TO COMPLETE, DISPLAY DATE

OF PV1 VISIT.


MH03000/(REASON_NO_PR_LOG ). Is that because…


Label

Code

Go To

You haven’t had a medical visit since our last interview

1

MH10000

You’ve misplaced the log

2

MH07000

You’ve forgotten to bring it to your medical visits

3

MH07000

The log was too much trouble to complete

4

MH07000

The log was too difficult to understand

5

MH07000

OTHER

-5


REFUSED

-1

MH07000

DON’T KNOW

-2

MH07000


SOURCE

National Children’s Study Vanguard Phase (18M, 24M)


MH04000/(REASON_NO_PR_LOG_OTH). SPECIFY _____________________________________


Label

Code

Go To

REFUSED

-1

MH07000

DON'T KNOW

-2

MH07000


SOURCE

National Children’s Study Vanguard Phase (18M, 24M)


PROGRAMMER INSTRUCTIONS

  • GO TO MH07000.


MH05000/(NUM_PROV_PR_LOG). How many health care providers did you see {between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{between {DATE OF PV1 VISIT} and {CHILD_DOB}} using this Pregnancy Health Care Log.

 

|___|___|

NUMBER OF PROVIDERS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study Vanguard Phase (18M, 24M)


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE USING, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE, DATE OF PV1 EVENT, AND CHILD_DOB.


MH06000/(NUM_PROV_REC). Of those providers that you have seen, for how many providers have you recorded contact information such as their address or phone number?

 

|___|___|

NUMBER OF CONTACTS


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study Vanguard Phase (18M, 24M)


MH07000. I am now going to ask some questions about visits to a doctor or other health care provider such as a midwife or nurse. You may want to refer to {the Pregnancy Health Care Log that you received as part of this study or to} personal records or a calendar that you keep that would help you to remember the dates of these visits. If you have this information available, please go and get it now.


SOURCE

National Children’s Study Vanguard Phase (18M, 24M)


PROGRAMMER INSTRUCTIONS

  • IF USE_PR_LOG=1, DISPLAY "the Pregnancy Health Care Log that you received as part of this study or to".


MH08000/(MD08000). What was the date of your last doctor’s visit or checkup {between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{before {CHILD_DOB}}?


INTERVIEWER INSTRUCTIONS

  • ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND A FOUR-DIGIT YEAR


SOURCE

National Children’s Study Vanguard Phase (18M, 24M)


(DATE_VISIT_MM) MONTH:   |___|___|

                  M    M


Label

Code

Go To

HAVE NOT HAD A VISIT

-7

MH10000

REFUSED

-1

MH10000

DON'T KNOW

-2

MH01000


(DATE_VISIT_DD) DAY:         |___|___|

                  D     D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(DATE_VISIT_YY) YEAR:       |___|___|___|___|

                  Y     Y      Y      Y


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE USING, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT.

  • IF USE_PR_LOG=1, GO TO MH09000 

  • OTHERWISE, IF USE_PR_LOG = 2, -1, OR -2, GO TO MH10000.


MH09000. If you haven’t yet done so, please put a check mark in the box next to the visit you just told me about in your Pregnancy Health Care Log.


MH10000. {At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


SOURCE

National Health and Nutrition Examination Survey


MH11000/(DIABETES_1). Diabetes?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH12000/(HIGHBP_PREG). High blood pressure? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


DATA COLLECTOR INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH13000/(URINE). Protein in your urine? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH14000/(PREECLAMP). Preeclampsia or toxemia? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH15000/(EARLY_LABOR). Early or premature labor? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH16000/(ANEMIA). Anemia or low blood count? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH17000/(NAUSEA). Severe nausea or vomiting, also called hyperemesis? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH18000/(KIDNEY). Bladder or kidney infection? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH19000/(RH_DISEASE). Rh disease or isoimmunization? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH20000/(GROUP_B). Infection with a bacteria called Group B strep? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH21000/(HERPES). Infection with a herpes virus? 


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH22000/(VAGINOSIS). Infection of the vagina with bacteria, also called bacterial vaginosis?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH23000/(OTH_CONDITION). Any other serious condition?


INTERVIEWER INSTRUCTIONS

  • RE-READ INTRODUCTORY STATEMENT ({At this visit or at any time between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{At this visit or at any time between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{At any time during your pregnancy} did the doctor or other health care provider tell you that you have any of the following conditions?) AS NEEDED.


Label

Code

Go To

YES

1


NO

2

M_HOSPITAL

REFUSED

-1

M_HOSPITAL

DON'T KNOW

-2

M_HOSPITAL


SOURCE

National Health and Nutrition Examination Survey


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE IN INTERVIEWER INSTRUCTION, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT IN INTERVIEWER INSTRUCTION.


MH24000/(OTH_CONDITION_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Health and Nutrition Examination Survey


MH25000/(M_HOSPITAL). Between {{DATE OF PV2 VISIT} and {CHILD_DOB}}/{Between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{During your pregnancy}, did you spend at least one night in the hospital?


INTERVIEWER INSTRUCTIONS

  • DO NOT INCLUDE ADMISSION FOR CHILDBIRTH.


Label

Code

Go To

YES

1


NO

2

MH32000

REFUSED

-1

MH32000

DON'T KNOW

-2

MH32000


SOURCE

National Children’s Study Vanguard Phase (3M Phone, 6M Mother, 12M Mother)


PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT.


MH26000. What was the admission date of your last hospital stay {between {DATE OF PV2 VISIT} and {CHILD_DOB}}/{between {DATE OF PV1 VISIT} and {CHILD_DOB}}/{during your pregnancy}?


INTERVIEWER INSTRUCTIONS

  • ENTER TWO-DIGIT MONTH, TWO-DIGIT DAY, AND A FOUR-DIGIT YEAR.


SOURCE

National Children’s Study Vanguard Phase (3M Phone, 6M Mother, 12M Mother)


(ADMIN_DATE_MM) MONTH:   |___|___|

                 M    M


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(ADMIN_DATE_DD) DAY:         |___|___|

                  D     D


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



(ADMIN_DATE_YY) YEAR:       |___|___|___|___|

                  Y     Y      Y      Y


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



PROGRAMMER INSTRUCTIONS

  • IF EVENT_TYPE = 15 (PV2) FOR CURRENT PREGNANCY SET TO COMPLETE, DISPLAY FIRST BRACKETED PHRASE, DATE OF PV2 EVENT, AND CHILD_DOB.

  • IF EVENT_TYPE = 15 (PV2) NOT SET TO COMPLETE FOR CURRENT PREGNANCY, BUT EVENT_TYPE = 13 (PV1) SET TO COMPLETE, DISPLAY SECOND BRACKETED PHRASE, DATE OF PV1 EVENT, AND CHILD_DOB.

  • IF BOTH EVENT_TYPE = 13 AND EVENT_TYPE = 15 NOT SET TO COMPLETE, DISPLAY THIRD BRACKETED TEXT.


MH27000/(HOSP_NIGHTS). How many nights did you stay in the hospital during this hospital stay?

 

|___|___|___|

NUMBER OF NIGHTS


INTERVIEWER INSTRUCTIONS

  • CONFIRM RESPONSE.


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Risk Assessment and Monitoring System (modified)


MH28000/(DIAGNOSE). Did a doctor or other health care provider give you a diagnosis during this hospital stay?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study Vanguard Phase (3M Phone, 6M Mother, 12M Mother)


PROGRAMMER INSTRUCTIONS

  • IF DIAGNOSE = 1, GO TO DIAGNOSE_2.

  • IF DIAGNOSE = 2, -1, OR -2, AND:

    • IF USE_PR_LOG = 1, GO TO MH31000.

    • OTHERWISE, IF USE_PR_LOG = 2, -1, OR -2, GO TO MH32000.


MH29000/(DIAGNOSE_2). What was the diagnosis?


INTERVIEWER INSTRUCTIONS

  • PROBE FOR MULTIPLE RESPONSES.

  • SELECT ALL THAT APPLY.


Label

Code

Go To

DEHYDRATION

1


PRETERM LABOR

2


HYPEREMESIS

3


PREECLAMPSIA

4


RUPTURE OF MEMBRANES

5


KIDNEY DISORDER

6


OTHER

-5


REFUSED

-1


DON’T KNOW

-2


NOT APPLICABLE

-7



SOURCE

National Children’s Study Vanguard Phase (3M Phone, 6M Mother, 12M Mother)


PROGRAMMER INSTRUCTIONS

  • IF DIAGNOSE_2 = ANY COMBINATION OF VALUES 1 – 6, GO TO PROGRAMMER INSTRUCTIONS AFTER DIAGNOSE_2_OTH.

  • IF DIAGNOSE_2 = -5, OR ANY COMBINATION OF VALUES 1 – 6 AND -5, GO TO DIAGNOSE_2_OTH. 

  • IF DIAGNOSE_2 = -1,  -2 OR -7, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO PROGRAMMER INSTRUCTIONS AFTER DIAGNOSE_2_OTH.


MH30000/(DIAGNOSE_2_OTH). SPECIFY: _____________________________


Label

Code

Go To

REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study Vanguard Phase (18M Mother, 24M Mother)


PROGRAMMER INSTRUCTIONS

  • IF USE_PR_LOG = 1, GO TO MH31000.

  • OTHERWISE, IF USE_PR_LOG = 2, -1, OR -2, GO TO MH32000.


MH31000. If you haven’t yet, please put a check mark in the box next to the visit you just told me about in your Pregnancy Health Care Log.


SOURCE

National Children’s Study Vanguard Phase (18M Mother, 24M Mother)


MH32000. Thank you for participating in the National Children’s Study and for taking the time to complete this survey. This concludes the interview.


(TIME_STAMP_MH_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 7 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.

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