Form 43.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Vacuum Bag Dust Instrument, Phase 2g

OMB Specification

Vacuum Bag Dust Instrument

Event Category:	Trigger-Based, PV1; Time-Based, 12M, 36M, 48M, 60M
Event:	PV1, 12M, 36M, 48M, 60M
Administration:	N/A
Instrument Target:	Child's Primary Residence
Instrument Respondent:	Primary Caregiver
Domain:	Environmental
Document Category:	Sample Collection
Method:	Data Collector Administered
Mode (for this instrument*):	In-Person, CAI
OMB Approved Modes:	In-Person, CAI
Estimated Administration Time:	3 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	N/A
Version:	3.0
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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Vacuum Bag Dust Instrument

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

VACUUM BAG DUST INSTRUMENT 3

VACUUM BAG PRIMARY SAMPLE 8

VACUUM BAG SPIKE SAMPLE 11

VACUUM SPLIT SAMPLE 13

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Vacuum Bag Dust Instrument

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.

VACUUM BAG DUST INSTRUMENT

(TIME_STAMP_VBD_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• PRELOAD DWELLING_UNIT_ID FOR THE DWELLING UNIT

• PRELOAD PARTICIPANT ID (P_ID) FOR CHILD AND RESPONDENT ID (R_P_ID) FOR CAREGIVER

• PRELOAD MULT_CHILD AND CHILD_NUM (IF MULT_CHILD = 1), FROM PVST INSTRUMENT.

• IF MULT_CHILD = 1, PRELOAD CHILD_QNUM

VBD01000/(STAFF_ID). ENTER STAFF ID

__________________________________________

STAFF ID

VBD02000/(VB_SAMPLES). WHICH VACUUM BAG DUST SAMPLES ARE SCHEDULED FOR THIS VISIT?

Label	Code	Go To
VACUUM BAG DUST PRIMARY	1	VBD04000
VACUUM BAG DUST PRIMARY AND QC SAMPLE(S)	2

VBD03000/(VB_SUBSAMPLES). WHICH VACUUM BAG DUST QC SAMPLES ARE SCHEDULED FOR THIS VISIT?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
VACUUM BAG DUST SPIKE	1
VACUUM BAG DUST SPLIT	2

VBD04000. DATE VACUUM BAG DUST SAMPLE COLLECTED

(VB_COLL_MM) MONTH:|___|___|

               M    M

(VB_COLL_DD) DAY:|___|___|

          D    D

(VB_COLL_YYYY) YEAR:|___|___|___|___|

            Y     Y     Y     Y 

PROGRAMMER INSTRUCTIONS

• DISPLAY HARD EDIT IF MM, DD OR YYYY ARE OUTSIDE CRITERIA DEFINED IN GENERAL PROGRAMMER INSTRUCTIONS.

VBD05000. Now we are going to ask you some questions that will help us collect the vacuum bag dust sample.

SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)

VBD06000/(VACUUM_IN_HOME). Do you have a vacuum cleaner in your home?

Label	Code	Go To
YES	1
NO	2	VB_COMMENTS
REFUSED	-1	VACUUM_REFUSE
DON'T KNOW	-2	VB_COMMENTS

SOURCE

American Healthy Homes Survey (AHHS)

VBD07000/(VACUUM_OKAY). We would like to collect the dust from your vacuum cleaner.  Is that okay?

Label	Code	Go To
YES	1	VACUUM_TYPE
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)

VBD08000/(VACUUM_REFUSE). RECORD REASON FOR REFUSAL IF GIVEN.

Label	Code	Go To
NONE GIVEN	1	VB_COMMENTS
NO REPLACEMENT VACUUM BAG	2	VACUUM_CONTENTS
VACUUM NOT IN HOME	3	VB_COMMENTS
OTHER	-5

SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)

VBD09000/(VACUUM_REFUSE_OTH). SPECIFY: ___________________________________

SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)

PROGRAMMER INSTRUCTIONS

• GO TO VB_COMMENTS.

VBD100000/(VACUUM_CONTENTS). We would like to collect the dust from your vacuum bag.  Is that okay?

Label	Code	Go To
YES	1
NO	2	VB_COMMENTS
REFUSED	-1	VB_COMMENTS
DON'T KNOW	-2	VB_COMMENTS

SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)

VBD110000/(VACUUM_TYPE). Can you show us the vacuum that is used most often in your home?  This is the vacuum that we would like to collect dust from.

DATA COLLECTOR INSTRUCTIONS

• RECORD THE TYPE OF VACUUM THAT YOU WILL COLLECT THE DUST FROM.

Label	Code	Go To
UPRIGHT OR FULL SIZED VACUUM	1	VACUUM_BAG_TYPE
HANDHELD VACUUM	2	VACUUM_BAG_TYPE
CENTRAL HOUSE COLLECTION SYSTEM	3	VACUUM_BAG_TYPE
ROBOTIC VACUUM	4	VACUUM_MAKE_MODEL
HARD SURFACE VACUUM	5	VACUUM_BAG_TYPE
SHOP VAC	6	VACUUM_BAG_TYPE
OTHER	-5

SOURCE

American Health Homes Survey (AHHS)

VBD120000/(VAC_TYPE_OTH). SPECIFY: _________________________________

SOURCE

American Healthy Homes Survey (AHHS)

VBD130000/(VACUUM_BAG_TYPE). RECORD THE TYPE OF VACUUM BAG FROM WHICH THE DUST SAMPLE IS COLLECTED.

Label	Code	Go To
BAGLESS	1
REUSABLE BAG	2
DISPOSABLE BAG	3

VBD140000/(VACUUM_MAKE_MODEL). RECORD THE MAKE AND MODEL OF THE VACUUM YOU ARE GOING TO COLLECT THE SAMPLE FROM.

MAKE: ___________________________

MODEL:__________________________

VBD150000. {Approximately how long has it been since the vacuum bag was changed?/Approximately how long has it been since you emptied the dust from the vacuum cleaner?}

SOURCE

American Healthy Homes Survey (AHHS)

(VACUUM_BAG_CHANGED) |___|___|

 NUMBER

(VACUUM_BAG_CHANGED_FREQ)

Label	Code	Go To
DAYS	1
WEEKS	2
MONTHS	3
YEARS	4
REFUSED	-1
DON'T KNOW	-2

PROGRAMMER INSTRUCTIONS

• IF VACUUM_BAG_TYPE= 1 OR 2 DISPLAY “Approximately how long has it been since you changed the vacuum bag or emptied the dust from the vacuum cleaner?”

• OTHERWISE, DISPLAY: “Approximately how long has it been since the vacuum bag was changed?”

VBD150000/(VAC_USED_OUTSIDE). {Since you changed the vacuum bag or the dust was emptied from your vacuum/Since the vacuum bag was changed} has your vacuum been used to clean a place other than your home such as…

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY

Label	Code	Go To
Never used vacuum outside home	1
Your car	2
Your garage	3
Your porch	4
Someone else's home	5
Somewhere outside your apartment, but within your apartment building	6
REFUSED	-1
DON'T KNOW	-2
OTHER	-5

SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)

PROGRAMMER INSTRUCTIONS

• IF VACUUM_BAG_TYPE = 1 OR 2, DISPLAY “Since the dust was emptied from your vacuum.”

• OTHERWISE, DISPLAY, “Since the vacuum bag was changed.

• IF VAC_USED_OUTSIDE = ANY COMBINATION OF 2 THROUGH 6, GO TO VB_COMMENTS

• IF VAC_USED_OUTSIDE = -5 OR ANY COMBINATION OF 2 THROUGH 6 AND -5, GO TO VAC_USED_OUTSIDE_OTH.

• IF VAC_USED_OUTSIDE = 1, -1, OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO VB_COMMENTS.

VBD160000/(VAC_USED_OUTSIDE_OTH). SPECIFY: _______________________________

SOURCE

National Children's Study, Vanguard Phase (PV1, PV2)

VBD170000/(VB_COMMENTS). RECORD ANY COMMENTS ABOUT THE VACUUM BAG DUST SAMPLE COLLECTION:

COMMENTS: __________________________________

(TIME_STAMP_VBD_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• IF VACUUM _IN_HOME = 2, -1 OR -2, VACUUM_OKAY = 2, -1, OR -2, OR VACUUM_CONTENT= 2, -1, OR -2, GO TO TIME_STAMP_VSS_ET.

• OTHERWISE, GO TO TIME_STAMP_VBP_ST.

VACUUM BAG PRIMARY SAMPLE

(TIME_STAMP_VBP_ST).

VBP01000/(VBP001). VACUUM BAG DUST SAMPLE COLLECTION INSTRUCTIONS

DATA COLLECTOR INSTRUCTIONS

• COLLECT THE VACUUM BAG DUST SAMPLE IN ACCORDANCE WITH THE VACUUM BAG DUST SAMPLE COLLECTION SOP.

VBP02000/(VACUUM_COLLECT). WAS A VACUUM BAG SAMPLE COLLECTED?

Label	Code	Go To
YES	1
NO	2

PROGRAMMER INSTRUCTIONS

• IF VACUUM_COLLECT = 1, SET SAMPLE_NUMBER = 1 AND GO TO VACUUM_MOST_USED.

• OTHERWISE, GO TO VACUUM_NOTCOLLECT.

VBP03000/(VACUUM_NOTCOLLECT). WHY WAS A VACUUM BAG SAMPLE NOT COLLECTED?

Label	Code	Go To
KIT NOT AVAILABLE	1	VB_PRIM_COMMENTS
SUPPLIES PROBLEM	2	VB_PRIM_COMMENTS
RAN OUT OF TIME	3	VB_PRIM_COMMENTS
TROUBLE REMOVING BAG/CUP	4	VB_PRIM_COMMENTS
REFUSAL	5	VB_PRIM_COMMENTS
OTHER	-5

VBP04000/(VACUUM_NOTCOLLECT_OTH). SPECIFY: ________________________________

PROGRAMMER INSTRUCTIONS

• GO TO VB_PRIM_COMMENTS.

VBP05000/(VACUUM_MOST_USED). WAS THE SAMPLE COLLECTED FROM THE MOST USED VACUUM?

Label	Code	Go To
YES	1
NO	2

VBP06000/(EQUIP_ID). T/RH METER ID

__________________________________________

DATA COLLECTOR INSTRUCTIONS

• ENTER THE ID OF THE T/RH METER.

VBP07000/(VACUUM_TEMP). TEMPERATURE WHEN THE VACUUM BAG DUST SAMPLE WAS COLLECTED:

|___|___|___|.|___|°F

DATA COLLECTOR INSTRUCTIONS

• IF UNABLE TO COLLECT VACUUM_TEMP, RECORD 999.9 °F AND COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.

PROGRAMMER INSTRUCTIONS

• DISPLAY SOFT EDIT ERROR MESSAGE IF VACUUM_TEMP IS LESS THAN 14 OR GREATER THAN 114.

VBP08000/(VACUUM_RH). RELATIVE HUMIDITY WHEN THE VACUUM BAG DUST SAMPLE WAS COLLECTED:

|___|___|___|.|___|%

DATA COLLECTOR INSTRUCTIONS

• IF UNABLE TO COLLECT VACUUM_RH, RECORD 999.9% AND COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.

PROGRAMMER INSTRUCTIONS

• DISPLAY SOFT EDIT ERROR MESSAGE IF VACUUM_RH IS LESS THAN 10 OR GREATER THAN 113.

• IF VACUUM_BAG_TYPE = 3, GO TO VACUUM_BAG.

• OTHERWISE, GO TO SAMPLE_PR_ID.

VBP09000/(VACUUM_BAG). DID YOU INCLUDE THE VACUUM BAG WITH THE SAMPLE?

Label	Code	Go To
YES, BAG WAS INCLUDED INTACT	1	SAMPLE_PR_ID
NO, DUST WAS REMOVED FROM BAG	2	SAMPLE_PR_ID
YES, BUT BAG WAS CUT OPEN	3	SAMPLE_PR_ID
OTHER	-5
NOT APPLICABLE	-7	SAMPLE_PR_ID

VBP10000/(VACUUM_BAG_OTH). SPECIFY: ______________________________

VBP11000/(SAMPLE_PR_ID). PRIMARY SAMPLE ID:

|E|__|__|__|__|__|__|__|__|-DB01

VACUUM BAG DUST ID

DATA COLLECTOR INSTRUCTIONS

• ENTER THE PRIMARY SAMPLE ID ON THE SAMPLE ID LABEL.

PROGRAMMER INSTRUCTIONS

• ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DB01

VBP12000/(VACUUM_PROBLEMS). DID YOU HAVE ANY PROBLEMS COLLECTING THE VACUUM SAMPLE?

Label	Code	Go To
NO PROBLEMS	1	VB_PRIM_COMMENTS
TROUBLE REMOVING BAG/CUP	2	VB_PRIM_COMMENTS
LOTS OF DUST FELL ON FOIL	3	VB_PRIM_COMMENTS
TROUBLE PUTTING VACUUM BACK TOGETHER	4	VB_PRIM_COMMENTS
OTHER	-5

VBP13000/(VACUUM_PROBLEMS_OTH). SPECIFY: ___________________________

VBP14000/(VB_PRIM_COMMENTS). RECORD ANY COMMENTS ABOUT THE VACUUM BAG DUST PRIMARY SAMPLE COLLECTION:

COMMENTS: ___________________________________

(TIME_STAMP_VBP_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIMESTAMP

• IF VB_SAMPLES = 1 OR VACUUM_COLLECT = 2, GO TO  TIME_STAMP_VSS_ET

• IF VACUUM_COLLECT= 1 AND
  
  

• IF VB_SUBSAMPLES = 1 ONLY, OR 1 AND 2, GO TO TIME_STAMP_VBS_ST.

• IF VB_SUBSAMPLES = 2 ONLY, GO TO TIME_STAMP_VSS_ST.

VACUUM BAG SPIKE SAMPLE

(TIME_STAMP_VBS_ST).

VBS01000/(VB_SPIKE_COLLECT). DID YOU INCLUDE A VACUUM BAG DUST SPIKE SAMPLE?

Label	Code	Go To
YES	1
NO	2

PROGRAMMER INSTRUCTIONS

• IF VB_SPIKE_COLLECT = 1, SET SAMPLE_NUMBER = 4 AND GO TO SAMPLE_SK_ID.

• OTHERWISE, GO TO VB_SPIKE_NOTCOLLECT.

VBS02000/(VB_SPIKE_NOTCOLLECT). WHY WAS THE VACUUM BAG DUST SPIKE SAMPLE NOT INCLUDED?

Label	Code	Go To
KIT NOT AVAILABLE	1	VB_SPIKE_COMMENTS
SUPPLIES PROBLEM	2	VB_SPIKE_COMMENTS
RAN OUT OF TIME	3	VB_SPIKE_COMMENTS
OTHER	-5

VBS03000/(VB_SPIKE_NOTCOLLECT_OTH). SPECIFY: _______________________________

PROGRAMMER INSTRUCTIONS

• GO TO VB_SPIKE_COMMENTS

VBS04000/(SAMPLE_SK_ID). SPIKE SAMPLE ID:

|E|__|__|__|__|__|__|__|__|-DB01

VACUUM BAG DUST SPIKE ID

DATA COLLECTOR INSTRUCTIONS

• ENTER THE VACUUM BAG DUST SPIKE SAMPLE ID ON THE SAMPLE ID LABEL.

PROGRAMMER INSTRUCTIONS

• ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DB01.

• DISPLAY SOFT EDIT IF SAMPLE_SK_ID = SAMPLE_PR_ID.

VBS05000/(VB_SPIKE_COMMENTS). RECORD ANY COMMENTS ABOUT THE VACUUM BAG DUST SPIKE SAMPLE:

COMMENTS: __________________________________

(TIME_STAMP_VBS_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• IF VACUUM_COLLECT = 1 AND
  
  

• IF VB_SUBSAMPLES = 1 ONLY, GO TO TIME_STAMP_VSS_ET.

• IF VB_SUBSAMPLES = 1 AND 2, GO TO TIME_STAMP_VSS_ST

VACUUM SPLIT SAMPLE

(TIME_STAMP_VSS_ST).

VSS01000/(VB_SPLIT_COLLECT). DID YOU INCLUDE A SET OF VACUUM BAG DUST SPLIT SAMPLE ID LABELS?

Label	Code	Go To
YES	1
NO	2

PROGRAMMER INSTRUCTIONS

• IF VB_SPLIT_COLLECT = 1, SET SAMPLE_NUMBER = 5 AND GO TO SAMPLE_SL_ID.

• OTHERWISE, GO TO VB_SPLIT_NOTCOLLECT.

VSS02000/(VB_SPLIT_NOTCOLLECT). WHY WERE THE VACUUM BAG DUST SPLIT SAMPLE ID LABELS NOT INCLUDED?

Label	Code	Go To
SUPPLIES PROBLEM	1	VB_SPLIT_COMMENTS
SPLIT SAMPLE ID MISSING FROM KIT	2	VB_SPLIT_COMMENTS
RAN OUT OF TIME	3	VB_SPLIT_COMMENTS
OTHER	-5

VSS03000/(VB_SPLIT_NOTCOLLECT_OTH). SPECIFY: _______________________________

PROGRAMMER INSTRUCTIONS

• GO TO VB_SPLIT_COMMENTS.

VSS04000/(SAMPLE_SL_ID). SPLIT SAMPLE ID:

|E|__|__|__|__|__|__|__|__|-DB01

VACUUM BAG DUST SPLIT ID

DATA COLLECTOR INSTRUCTIONS

• ENTER THE VACUUM BAG DUST SPLIT SAMPLE ID ON THE SAMPLE ID LABEL.

PROGRAMMER INSTRUCTIONS

• ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH DB01.

• DISPLAY SOFT EDIT IF SAMPLE_SL_ID = SAMPLE_SK_ID AND/OR SAMPLE_PR_ID.

VSS05000/(VB_SPLIT_COMMENTS). RECORD ANY COMMENTS ABOUT THE VACUUM BAG DUST SPLIT SAMPLE:

COMMENTS:__________________________________

(TIME_STAMP_VSS_ET).

Public reporting burden for this collection of information is estimated to average 3 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.