1 54M Questionnaire Adult

OMB #: 0925-0593

OMB Expiration Date: 6/30/2017

54M Questionnaire– Adult, Phase 2g

OMB Specification

54M Questionnaire - Adult

Event Category:	Time-Based
Event:	54M
Administration:	N/A
Instrument Target:	Primary Caregiver
Instrument Respondent:	Primary Caregiver
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:	5 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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54M Questionnaire - Adult

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

PARENTING (PARENTAL MODERNITY SCALE) 3

RELIGIOUS AFFILIATION 18

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54M 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.

PARENTING (PARENTAL MODERNITY SCALE)

(TIME_STAMP_PPM_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

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

PPM01000. These next questions include some statements other parents have made about rearing and educating children. For each statement, please tell me how you feel in general, not just about your own child.  

PPM02000/(PARENT_PRETEND). Parents should go along with the game when their child is pretending something.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM03000/(OBEY_TEACHER). Children should always obey the teacher.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM04000/(FORCE_CORRECT). Children will not do the right thing unless they must.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.
Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM05000/(TEACH_OBEDIENCE). The most important thing to teach children is absolute obedience to whoever is in authority.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.
Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM06000/(OBEY_PARENTS). Children should always obey their parents.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM07000/(TEACH_RIGHT). Children will be bad unless they are taught what is right.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM08000/(PERMIT_DISAGREE). Children should be allowed to disagree with their parents if they feel their own ideas are better.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM09000/(PERSPEC_RIGHT). Children have a right to their own point of view and should be allowed to express it.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM10000/(OK_DISAGREE_PARENT). It’s all right for a child to disagree with his or her parents.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.) (modified)

PPM11000/(CONSIDER_IDEAS). A child’s ideas should be seriously considered in making family decisions.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

(TIME_STAMP_PPM_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

RELIGIOUS AFFILIATION

(TIME_STAMP_RA_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

RA01000. These next questions are about your religious faith.

RA02000/(CURRENT_REL_PREF). What is your religious preference?

Label	Code	Go To
PROTESTANT	1	PROTEST_DENOM
CATHOLIC	2	TIME_STAMP_RA_ET
MORMON	3	TIME_STAMP_RA_ET
JEHOVAH’S WITNESS	4	TIME_STAMP_RA_ET
GREEK/RUSSIAN/EASTERN ORTHODOX	5	TIME_STAMP_RA_ET
JEWISH	6	TIME_STAMP_RA_ET
BUDDHIST	7	TIME_STAMP_RA_ET
MUSLIM	8	TIME_STAMP_RA_ET
HINDU	9	TIME_STAMP_RA_ET
AGNOSTIC	10	TIME_STAMP_RA_ET
ATHEIST	11	TIME_STAMP_RA_ET
OTHER	-5
NONE	-7	TIME_STAMP_RA_ET
REFUSED	-1	TIME_STAMP_RA_ET
DON’T KNOW	-2	TIME_STAMP_RA_ET

SOURCE

Panel Study of Income Dynamics 2013

RA02100/(CURRENT_REL_PREF_OTH). SPECIFY: ________________________________________

Label	Code	Go To
REFUSED	-1
DON'T KNOW	-2

SOURCE

​Panel Study of Income Dynamics 2013

RA03000/(PROTEST_DENOM). What denomination is that?

Label	Code	Go To
BAPTIST	1	TIME_STAMP_RA_ET
LUTHERN	2	TIME_STAMP_RA_ET
METHODIST/AFRICAN METHODIST	3	TIME_STAMP_RA_ET
PRESBYTERIAN	4	TIME_STAMP_RA_ET
EPISCOPALIAN	5	TIME_STAMP_RA_ET
PROTESTANT, UNSPECIFIED	6	TIME_STAMP_RA_ET
PENTECOSTAL/ASSEMBLY OF GOD	7	TIME_STAMP_RA_ET
OTHER	-5
REFUSED	-1	TIME_STAMP_RA_ET
DON’T KNOW	-2	TIME_STAMP_RA_ET

SOURCE

Panel Study of Income Dynamics 2013

RA04000/(PROTEST_DENOM_OTH). SPECIFY    __________________________

Label	Code	Go To
REFUSED	-1
DON'T KNOW	-2

SOURCE

Panel Study of Income Dynamics 2013

(TIME_STAMP_RA_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 5 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.