2017-NSCH-Methodology Report

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National Survey of Children's Health

2017-NSCH-Methodology Report

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2017 National Survey of Children’s Health
Methodology Report
U.S. Census Bureau
08/02/2018

Contents
Abstract ......................................................................................................................................................... 5
Objectives.................................................................................................................................................. 5
Methods .................................................................................................................................................... 5
Results ....................................................................................................................................................... 5
Introduction .................................................................................................................................................. 6
Survey History ............................................................................................................................................... 7
Challenges faced by NSCH/NS-CSHCN and Subsequent Redesign............................................................ 7
Frame, Sample, and Subsampling Specifications .......................................................................................... 9
Overview of the Key Sampling Processes ................................................................................................. 9
Frame Development ............................................................................................................................... 10
Sample Size and Allocation ..................................................................................................................... 11
Subsampling Specifications: Selection of Sampled Child ........................................................................ 12
Instrument Specifications ........................................................................................................................... 15
Content Development............................................................................................................................. 15
Survey Content........................................................................................................................................ 16
Web Instrument Specifications ............................................................................................................... 17
Programming the Web Instrument ......................................................................................................... 18
Paper Instrument Specifications ............................................................................................................. 19
Data Collection ............................................................................................................................................ 20
Mailout Specifications ............................................................................................................................. 20
Telephone Questionnaire Assistance (TQA) ........................................................................................... 22
Email Questionnaire Assistance (EQA).................................................................................................... 23
Respondent Demographics ..................................................................................................................... 24
Confidentiality ......................................................................................................................................... 24
Spanish Language Availability ................................................................................................................. 25
Efforts to Maximize Response Rates....................................................................................................... 25
Response Analysis ....................................................................................................................................... 27
Response Rates ....................................................................................................................................... 27
Response Rates by State ......................................................................................................................... 29
Web Survey Breakoffs ............................................................................................................................. 29
Item Level Response and Skip Patterns .................................................................................................. 32
Incentive Effort........................................................................................................................................ 35
Infographic Effectiveness ........................................................................................................................ 38
Web Group Effectiveness........................................................................................................................ 38
Data Editing ................................................................................................................................................. 40
Unduplication .......................................................................................................................................... 40
Paper to Web Standardization ................................................................................................................ 41
Data Processing ....................................................................................................................................... 41
Standardized and Recoded Variables ..................................................................................................... 43
Weighting Plan ............................................................................................................................................ 51
Overview ................................................................................................................................................. 51
Population Controls ................................................................................................................................ 54
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Limitations............................................................................................................................................... 55
Imputation .................................................................................................................................................. 56
Overview of Missing Data ....................................................................................................................... 56
Imputed Variables and Flags ................................................................................................................... 56
Multiple Imputation ................................................................................................................................ 57
Estimation and Hypothesis Testing ............................................................................................................. 58
Variance Estimation ................................................................................................................................ 58
Combining Data across Survey Years ...................................................................................................... 58
Guidelines for Data Use .......................................................................................................................... 59
Supporting Material .................................................................................................................................... 60
References .............................................................................................................................................. 60
Attachment A – 2017 NSCH Sample Sizes, by Stratum and by State ...................................................... 61
Attachment B – Child with Special Health Care Needs Question Battery .............................................. 63
Attachment C - Completed Screeners and Topicals and Weighted Response Rates by State ............... 64
Attachment D – Invitation Letters .......................................................................................................... 66
Attachment E – Survey Questionnaires ................................................................................................ 115
Attachment F – Infographic .................................................................................................................. 264

2017 National Survey of Children’s Health

U.S. Census Bureau

Tables and Figures
Table 1. Anticipated Returns from the 2017 NSCH..................................................................................... 12
Table 2. Strategies for Selecting the 2017 NSCH Sample Child .................................................................. 13
Table 3. Web Submission Times (in minutes) ............................................................................................. 18
Table 4. Screener Mailout Schedule ........................................................................................................... 21
Table 5. Topical Mailout Schedule .............................................................................................................. 21
Table 6. TQA Purpose Codes used in ATAC System .................................................................................... 23
Table 7. Respondent Relation to Selected Child ......................................................................................... 24
Table 8. Final Disposition of Screener and Topical Returns ........................................................................ 28
Table 9. Breakoffs by Survey Section .......................................................................................................... 30
Table 10. Breakoffs by Survey Web Page (breakoffs>100) ......................................................................... 31
Table 11. Item Response by Mode, where abs(Web-Paper)>.05 ............................................................... 33
Table 12. Treatment Group by Incentive Amount and Web Response Likelihood .................................... 36
Table 13. Mailing Costs by Incentive Group ............................................................................................... 36
Table 14. Cost Effectiveness of Mail Data Collection Strategies................................................................. 37
Table 15. Cost Effectiveness of Incentivized Data Collection Strategies .................................................... 37
Table 16. Topical Response by Mail Count and Incentive .......................................................................... 38
Table 17. Data Collection for High Web vs. High Paper Addresses ............................................................ 39
Table 18. Unduplication Criteria for both Web and Paper Returns............................................................ 40
Table 19. Unduplication Criteria for Two Paper Returns ............................................................................ 41
Table 20. List of Standardized Variables ..................................................................................................... 43
Table 21. List of Recoded Variables ............................................................................................................ 43
Table 22. List of Suppressed Variables........................................................................................................ 47
Table 23. List of Geography Variables......................................................................................................... 49
Table 24. Geographies Identified at the Intersections ............................................................................... 49
Table 25. Collapsed Dimensions and Affected States ................................................................................. 55
Table 26. List of Imputed Variables............................................................................................................. 56
Table 27. List of Imputation Flags and Frequencies.................................................................................... 56
Figure 1. Probability of Nonresponse to SLEEPPOS by Age of Child in Months (2016) .............................. 35

2017 National Survey of Children’s Health

U.S. Census Bureau

Abstract
Objectives
This report details the development, plan, and operation of the 2017 National Survey of Children’s
Health (NSCH). This survey is designed to provide national and state-level estimates on key indicators of
the health and well-being of children, their families and their communities, as well as information about
the prevalence and impact of special health care needs. Funding and direction for this survey was
provided by the Health Resources and Services Administration’s Maternal and Child Health Bureau
(HRSA MCHB) within the U.S. Department of Health and Human Services. The U.S. Census Bureau
conducted the survey on behalf of HRSA MCHB.

Methods
The NSCH is self-administered using a web-based questionnaire or a mail-out/mail-back paper
questionnaire. The respondent was a parent or guarding who knew about the child’s health and health
care needs.
A sample of 170,726 households was selected from the Census Master Address File and allocated across
the 50 states and the District of Columbia. The sample was stratified by state and a child-presence
indicator that allowed the Census Bureau to oversample households that were more likely to have
children. The child-presence indicator was developed by the Census Bureau’s Center for Administrative
Records Research and Applications and builds on multiple sources of administrative data.
During data collection, a screener was first used to identify households with children. If children were
present, the respondent created a roster of children in the household. The roster included the age and
other demographics of each child as well as a battery of questions designed to identify children with
special health care needs. After completing this screener component of the survey, one child was
randomly selected from all children in each household to be the subject of an age-specific topical survey.

Results
The weighted Overall Response Rate for the 2017 NSCH was 37.4%. A total of 58,510 screener
questionnaires were completed from August 2017 to February 2018, and 29,343 of those were eligible
for topical questionnaire follow-up. Of those topical-eligible households, 21,599 completed a topical
interview. Weighted estimates from the Topical data file generalize to state and national resident child
populations. Weighted estimates from the Screener data file generalize to state and national resident
child populations (using the child weight) and households with children by state and nationally (using
the household weight).

2017 National Survey of Children’s Health

U.S. Census Bureau

Introduction
The 2017 National Survey of Children’s Health (NSCH) was conducted by the U.S. Census Bureau for the
Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), U.S.
Department of Health and Human Services. As stated in the Office of Management and Budget
Clearance Package, the purpose of the NSCH is to “collect information on factors related to the wellbeing of children, including access to and quality of health care, family interactions, parental health,
school and after-school experiences, and neighborhood characteristics.” This document details the
objectives, methodologies, and results of the 2017 NSCH. It is organized in 9 sections.












Survey History. The 2017 NSCH is the second production implementation following the redesign
and merging of the previous NSCH and National Survey of Children with Special Health Care
Needs.
Frame, Sample, and Subsampling Specifications. A screener instrument identified households
with children and enumerated the children in those households. A topical instrument collected
detailed information about one child selected at random from the household.
Content Development and Instrument Specifications. Data were collected using a two-stage
paper survey instrument and a single-stage web-based survey instrument.
Data Collection. This section discusses the mail schedule and data capture methods for web,
paper, and telephone questionnaire assistance operations.
Response Analysis. This section discusses the calculation of response rates along with analysis of
survey breakoffs, item nonresponse, and treatment group comparisons.
Data Processing and Editing. Web and paper survey responses were unduplicated, standardized
across modes, and prepared for analysis.
Weighting Specifications. Weights allow for generalizations of state and national child resident
populations (Screener and Topical file) and households with children (Screener file).
Imputation Specifications. Missing values were imputed for a subset of variables used as
controls in weighting and as inputs in estimating the family poverty ratio.
Estimation and Data Usage. This section discusses best practices for data users and limitations of
the 2017 NSCH.

2017 National Survey of Children’s Health

U.S. Census Bureau

Survey History
The Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB),
within the U.S. Department of Health and Human Services (HHS), has sponsored the National Survey of
Children’s Health (NSCH)1 and its companion survey, the National Survey of Children with Special Health
Care Needs (NS-CSHCN),2 since 2001. HRSA MCHB has provided funding and direction for the two
periodic surveys in order to provide both national and state estimates of key indicators of child health
and well-being for children ages 0-17 years.
Together, these surveys provided critical data on key measures of child health; the presence and impact
of special health care needs; health care access, utilization, and quality; and the family and community
factors that impact child and adolescent health and well-being. Both surveys were fielded three times
(NS-CSHCN 2001, 2005-06, and 2009-10; NSCH 2003, 2007, and 2011-12) as modules of the State and
Local Area Integrated Telephone Survey (SLAITS) system by the Centers for Disease Control and
Prevention’s National Center for Health Statistics. As part of the SLAITS system, the surveys utilized a
random-digit-dial sample of landline telephone numbers, with cell-phone supplementation in the last
year of administration for both surveys.
While the geographic representation, sample size, and content breadth remained significant strengths
of the surveys, over time HRSA MCHB and its stakeholders came to realize that a redesign of the two
surveys was warranted. Declining response rates, along with the declining proportion of households in
the U.S. with landline telephones, led to the decision to change the underlying sampling frame from
telephone numbers to household addresses. Efforts were made to moderate this trend through the
addition of a cell-phone frame to the last administrations of both the NSCH and the NS-CSHCN.
However, consistent with industry-wide challenges, the inclusion of cell-phone samples proved to be
both costly and inefficient.
In 2015, HRSA MCHB redesigned the NSCH and the NS-CSHCN into a single combined survey that utilized
an Address-Based Sampling frame. This newly consolidated survey incorporated questions from both of
the former surveys and retained the NSCH name. The U.S. Census Bureau now conducts the NSCH on
behalf of HRSA MCHB and HHS under Title 13, United States Code, Section 8(b), which allows the Census
Bureau to conduct surveys on behalf of other agencies.

Challenges faced by NSCH/NS-CSHCN and Subsequent Redesign
The telephone interview methodology utilized for the former NSCH and NS-CSHCN allowed for a
complex questionnaire as it ensured that skip patterns were properly followed. Furthermore, it
1

Blumberg SJ, Foster EB, Frasier AM, et al. 2012. Design and Operation of the National Survey of Children’s Health,
2007. National Center for Health Statistics. Vital Health Stat, 1(55).
http://www.cdc.gov/nchs/data/series/sr_01/sr01_055.pdf
2
Bramlett MD, Blumberg SJ, Ormson AE, et al. 2014. Design and Operation of the National Survey of Children with
Special Health Care Needs, 2009–2010. National Center for Health Statistics. Vital Health Stat, 1(57).
http://www.cdc.gov/nchs/data/series/sr_01/sr01_057.pdf

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protected against data entry error through preprogrammed range and logic checks on responses.
Interviewers were able to address respondent questions and concerns as they arose, helping reduce
response error. However, in recent years declining willingness of the public to participate in surveys and
changes in household telephone use resulted in declining response rates for Computer-Assisted
Telephone Interviewing surveys.3 Of particular concern was the increasing prevalence of households
substituting wireless service for their landline telephone. Efforts to include these non-landline
households within the telephone sampling frames for the former NSCH and NS-CSHCN through the
addition of cell-phones to the frame were ultimately not cost efficient or effective. Furthermore,
because the former NSCH and NS-CSHCN were administered using the Centers for Disease Control and
Prevention’s National Immunization Surveys (NIS) sampling frame and followed behind the NIS
interview, they experienced additional impacts in response rates when cases failed to move through the
NIS itself.
The surveys were no longer sustainable in the face of declining response rates and rising costs.
Therefore, considerable work was done to determine how to address these issues, and HRSA MCHB
reached the decision to utilize a two-phase multimode data collection design for a combined NSCH/NSCSHCN survey, henceforth known as the NSCH. The proposed approach to data collection and
nonresponse follow-up was based on previous project experience and recommendations made by
Dillman and colleagues (2009).4
The redesigned NSCH consists of two questionnaires: (1) an initial household screener to assess the
presence of children in the home and facilitate the selection of a target child within the household (with
oversampling of children with special health care needs and young children ages 0-5 years), and (2) a
substantive topical questionnaire that combines selected content from the former NSCH and NS-CSHCN
questionnaires along with some newly relevant content.
In 2015, the U.S. Census Bureau conducted a pretest of the NSCH redesign on behalf of HRSA MCHB. The
pretest was a one-time national data collection activity, based on a national sample of 16,000 addresses,
to evaluate and refine survey methodology, the survey instruments, and the operational procedures and
processes used in the 2016 production survey. The 2016 NSCH used an address-based sample covering
the 50 states and the District of Columbia. Addresses were randomly sampled within states, with a
roughly equal number of addresses selected within each state. The survey designs in 2016 and 2017
were very similar; key differences are noted in the discussion of the 2017 survey design below.

Blumberg SJ, Luke JV. 2010. Wireless Substitution: Early Release of Estimates from the National Health Interview
Survey, January–June 2010. National Center for Health Statistics. Available from:
https://www.cdc.gov/nchs/data/nhis/earlyrelease/wireless201012.htm
4
Dillman DA, Smyth JD, Christian LM. 2009. Internet, Mail and Mixed-Mode Surveys: The Tailored Design Method,
3rd edition. Hoboken, NJ: John Wiley & Sons.
2017 National Survey of Children’s Health

U.S. Census Bureau

Frame, Sample, and Subsampling Specifications
The 2017 NSCH used an address-based sample covering the 50 states and the District of Columbia.
Addresses were randomly sampled within states. Unlike the 2016 sample, which Census selected a
roughly equal number of addresses within each state, the 2017 sample was distributed across states
with the goal of producing a roughly equal number of responses by state.
Administrative records from multiple sources were utilized to match a list of child identifiers to
residential addresses. When a child identifier was matched to an address, the address was flagged as
being more likely to include children and designated as ‘Stratum 1’; the remaining addresses were
designated as ‘Stratum 2’. Starting in 2017, Stratum 2 addresses were divided between those addresses
with a higher probability of child presence, designated as ‘Stratum 2a’, and those addresses with a very
low probability of child presence, designated ‘Stratum 2b’. Addresses in Stratum 1 were sampled at a
higher rate than those in Stratum 2a. Stratum 2b addresses were excluded from sampling due to the
very low probability of those households having children in residence, with the constraint that Stratum
2b represented no more than 5% of households with children.
If a household reported more than one child, the age and special health care needs status of those
children were used to select a single child from the household and assign the household to receive one
of the three age-based topical questionnaires: T1 for 0 to 5 year old children, T2 for 6 to 11 year old
children, or T3 for 12 to 17 year old children. The subsampling of a single child from a household was
random, but children with special health care needs and young children (0 to 5 years old) had a higher
probability of selection. To limit respondent burden, no more than one child was sampled and no more
than one topical survey was administered in any given household.
The target population for the NSCH consisted of children ages 17 and younger. Addresses identified as
having the highest probability of responding by paper and not by web (‘High Paper’, approximately 30%
of addresses) were first mailed the paper screener as well as an invitation to respond to the survey using
the web instrument. The remaining addresses (‘High Web’, approximately 70% of addresses) were first
sent only the invitation to respond using the web instrument. High Web addresses were subsequently
sent paper screeners beginning in the second nonresponse follow-up mailing. The methodology for
assigning addresses to High Web and High Paper mailing groups is discussed in the Response Analysis
section, Web Group Effectiveness sub-section of this report. Ninety percent of the sample received a $2
bill with the initial invitation as an incentive to complete the survey. The other ten percent of the sample
did not receive an incentive and represented the control group for testing the effectiveness of the
incentive treatment. Finally, 50% of addresses received a one-page infographic in the initial mailing; the
other 50% of addresses did not receive an infographic.

Overview of the Key Sampling Processes


Initial Sample Size and Treatment Groups
o Sample Size: 170,726 addresses nationwide
o 2,014 (Minnesota) to 5,757 (Alaska) addresses per state
o Treatment Groups:

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U.S. Census Bureau

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o



Incentive Groups
 $0 (control): 17,047 (10%)
 $2 bill: 153,679 (90%)
o Web Groups
 High Paper: 46,999 (30% of mailable5 addresses)
 High Web: 109,676 (70% of mailable addresses)
o Infographic Groups
 Infographic: 85,339 (50%)
 No infographic: 85,387 (50%)
Initial Sample Stratification and Selection:
o 97,308 (57%) addresses from Stratum 1 (Flagged as households with children)
o 73,418 (43%) addresses from Stratum 2a (Not flagged, but a higher child-presence
probability than Stratum 2b)
Selection of the Sample Child
o Oversample children with special health care needs (CSHCN): 80%
(Note that the 80% oversample was only applied for those households having both CSHCN
and Non-CSHCN present.)
o Oversample young children (0 to 5 years old): 60%
(Note that the 60% oversample was only applied for those households having all or no
CSHCN.)

Frame Development
The 2017 NSCH utilized a sample of 170,726 household addresses randomly drawn from the Census
Master Address File (MAF), a complete listing of all known living quarters in the 50 states and the
District of Columbia that is used to support the decennial census. The Census Bureau’s Center for
Administrative Records Research and Applications (CARRA) appended indicators to the MAF to sort and
stratify the sample.
The sample file was selected from the Census MAF and supplemented with administrative recordsbased flags identifying households likely to include children. CARRA developed these child indicators
based on multiple sources of administrative data which were first used to identify households more
likely to have children in the 2016 NSCH, to improve sampling efficiency.
The child-presence flags were used to create three mutually exclusive sampling strata: Stratum 1
(addresses positively linked to a child using administrative records), Stratum 2a (addresses that could
not be linked to a specific child using administrative records but had a high probability of child presence

Sampled addresses were sent to the United States Postal Service (USPS) for address standardization. About 8% of
addresses were returned as invalid by the USPS, and these addresses were excluded from mailings. The remaining
156,675 addresses were labeled as ‘mailable’. Web group (High Web or High Paper) was assigned after address
standardization.

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U.S. Census Bureau

11
based on administrative records and small-area geographic characteristics), and Stratum 2b (addresses
with a very low probability of child presence).
To identify Stratum 1 addresses, Census linked child Numident6 records to addresses using a host of
administrative records. These records included IRS 1040s and 1099s, the Medicare Enrollment Database,
the Indian Health Service database, and the Selective Service System. Child records could be linked
directly to an address or through a parent (i.e., administrative records link the child to a parent and the
parent to an address). In 2017, this process matched about 69 million child records to 36 million
addresses. Approximately 75% of these addresses reported children in the American Community Survey
(ACS).
Among the remaining addresses, a linear probability model was developed against ACS returns to
predict child presence using block group7 characteristics and administrative records associated with the
address (e.g., presence of adults 20-50 years old, child-related tax deduction). Addresses were sorted on
the probability of child presence by state. The delineating threshold between Stratum 2a and Stratum
2b was determined by state so that no more than 5% of households with children were represented in
Stratum 2b in any state.
Within strata, addresses were sorted by the block group7 poverty rate (greater than 30% or less than or
equal to 30%) with the net result that addresses within states were listed in the following order for
sampling:




Stratum 1: Households with the ‘child present’ flag
o Addresses in high poverty block groups
o Remaining Stratum 1 households
Stratum 2a: Households without the ‘child present’ flag
o Addresses in high poverty block groups
o Remaining Stratum 2a households

Sample Size and Allocation
State sample sizes were determined objectively to produce an equal number of completed topicals per
state while summing to a total sample of 156,000 mailable addresses nationwide (see Table 1). Because
some selected addresses would be deemed unmailable, having address components that were not
recognized by the United States Postal Service, the sample was overprovisioned with an additional
14,000 addresses, such that the total selected sample of addresses was 170,726. In practice, 14,051
addresses were deemed unmailable.
For each state, sample sizes were allocated based on the relative sizes of Stratum 1 and Stratum 2a, and
the efficiency of the Stratum 1 flag (i.e., the probability that a flagged household did have children).
6

The Numident is the Social Security Administration’s database of United States Social Security number applicants.
A Census block group is a geographical unit with 600 to 3,000 population. Census blocks are grouped into block
groups; block groups, in turn, are grouped into Census tracts. The block group is the smallest scale geographical
unit for which the Census Bureau publishes sample statistics, i.e., estimates based on a sample of residents in the
block group. Consequently, it is the smallest scale geographical unit that could be used for this exercise.
7

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U.S. Census Bureau

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State-level samples were allocated to produce an equal number of completed topical interviews in each
state and the District of Columbia. Nationally, 57% of the sample was drawn from Stratum 1.
For a sampled address to complete a topical, it must progress through each of the following stages: 1) it
must be a valid residential address, 2) the residents must complete the screener, 3) the screener must
report that children are present and the age for at least one child, and 4) the topical-eligible household
must complete a topical. Before mailing, Census estimated valid address rates (representing an occupied
residence) and screener and topical response rates using response rates from the 2016 NSCH. Census
also audited the CARRA child-presence flag against American Community Survey (ACS) returns to
estimate the percent of households that have children by state and stratum. Anticipated returns based
on these estimates are presented in Table 1.
Table 1. Anticipated Returns from the 2017 NSCH

Stratum
Initial Stra tum 1: 57.0%
Sample Stra tum 2a : 43.0%

Incentive

Mailable
a

$0: 10%

S1: 97.2%

$2: 90%

S2a : 84.5%

Valid
S1: 92.3%

Screeners
a

S2a : 79.3%

$0: 38.2%

$2: 43.2%

Households
W/ Children
S1: 77.8%

S1: 69.3%

S2a : 17.3% b

1: 97,308
170,726
2: 73,418

$0
$2
$0
$2

9,709
87,599
7,338
66,080

Totals
Average per State
a
b

9,437
85,146
6,201
55,838
156,622

8,710
78,590
4,917
44,279
136,497

3,327
33,951
1,878
19,129
58,285

Completed
Topicals
a

S2a : 69.1% a

2,589
26,414
325
3,309
32,637
640

1,794
18,305
225
2,287
22,610
443

Response rates estimated based on response rates from the 2016 NSCH.
Percent of households with children estimated based on ACS audit.

Subsampling Specifications: Selection of Sampled Child
Eligible children within households that completed a screener were sampled for one of the three agebased topical surveys: T1 for 0 to 5 year old children, T2 for 6 to 11 year old children, or T3 for 12 to 17
year old children. Only one child per household was selected for a topical questionnaire in an effort to
minimize respondent burden.
To select the sample child from a household, Census determined whether each eligible child was
determined to be a Child with Special Health Care Needs (SHCN) or a Child without Special Health Care
Needs (Non-CSHCN). This determination was based on answers to a standard set of questions included
in the screener questionnaire.8
Next, based on the count of children and the SHCN status of those children, each household was
assigned to a specific Household Type (HHTYP) (See Table 2). For households having both CSHCN and
Non-CSHCN present (i.e., HHTYP=4, 6, and 7), an 80% oversample of CSHCN was applied. An additional

Bethell CD, Read D, Neff J, Blumberg SJ, Stein RE, Sharp V, Newacheck PW. 2002. “Comparison of the Children
with Special Health Care Needs Screener to the Questionnaire for Identifying Children with Chronic Conditions—
Revised.” Ambulatory Pediatrics, Jan-Feb 2(1): 49-57.
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60% oversampling of children aged 0-5 years was applied in HHTYP=3 and 5. The second oversample was
added in response to internal evaluations in 2016 that showed that approximately 4,433,000 households
with children aged 0-5 years were potentially not included in Stratum 1 (versus 7,256,000 households in
that age range that were correctly flagged). In other words, the child presence flag used to define
Stratum 1 performed less well for the very youngest children (aged 0-2 years) since some of the
administrative records used to identify those households are older than the children they need to
identify.
For subsampling purposes, all eligible children on the household roster were sorted and assigned a line
number. In most cases, children were sorted first by SHCN status (CSHCN then Non-CSHCN) and then by
age (youngest to oldest). If there was only one child (HHTYP=2), the sort was not applicable. Finally, in
households with four or more eligible children, children were sorted first on SHCN status, then by name,
and then by age. The line number to be selected in a given scenario was pre-assigned to each household
for each of the eight household types consistent with the probabilities listed in the “% Probability of
Selection” column in Table 2.
Table 2. Strategies for Selecting the 2017 NSCH Sample Child

Household
Type
(HHTYP)

Number of
Eligible
Children in
Household

Number of Eligible
Non-CSHCN, CSHCN

0 or ‘blank’

0,0

1,0 or 0,1

100%

2,0 or 0,2

1,1

3,0 or 0,3

2017 National Survey of Children’s Health

% Probability
of Selection for
Non-CSHCN

% Probability of
Selection for
CSHCN

No eligible children in
household.
Single child is always selected.

If only 1 child is aged 0-5 years, that
child’s probability of selection is 62%
and the other child’s probability of
selection is 38%.
Otherwise, each child has an equal
chance of selection of 50%.
36%

Notes

64%

Includes 60% oversampling of
children aged 0-5 years.

Includes 80% oversampling of
CSHCN.

If only 1 child is aged 0-5 years, that
child’s probability of selection is 44%
and each of the other two children
have an equal chance of selection of
28%.
Includes 60% oversampling of
If 2 children are aged 0-5 years, each
children aged 0-5 years.
has a probability of selection of 38%
and the other child has a probability of
selection of 24%.
If all 3 children are aged 0-5 years or
all 3 children are aged 6-17 years, then

U.S. Census Bureau

14
Household
Type
(HHTYP)

Number of
Eligible
Children in
Household

Number of Eligible
Non-CSHCN, CSHCN

% Probability
of Selection for
Non-CSHCN

% Probability of
Selection for
CSHCN

Notes

each child has an equal chance of
selection of 33%.
6

2,1

52%

48%

1,2

22%

78%

4 or more

Any combination

2017 National Survey of Children’s Health

Before the sort, each of the first 4
children has an equal 25% probability
of selection.

Includes 80% oversampling of
CSHCN.
Includes 80% oversampling of
CSHCN.
Simple random selection of 1
of the first 4 (sorted) children,
regardless of SHCN status.

U.S. Census Bureau

Instrument Specifications
Content Development
A key objective in developing the redesigned National Survey of Children’s Health (NSCH) instrument
was to consolidate the former NSCH and the National Survey of Children with Special Health Care Needs
(NS-CSHCN) content into one survey, reducing redundancy in the collection of data and the burden on
households that accompanied the administration of two separate surveys. The selection and refinement
of content for the redesigned survey reflected the need to retain critical content that was uniquely
available through the NSCH while creating room for emergent priorities.
Every effort was made to retain survey items from the former NSCH and NS-CSHCN within the
redesigned questionnaire. Revisions to existing items were generally made for the following reasons: 1)
a desire for consistency with federal policies or programs and harmonization of content across U.S.
Department of Health and Human Services surveys (e.g., the item on physical activity was edited to
reflect the new Dietary Guidelines for Americans); 2) changes in the field or our understanding of a topic
or issue (e.g., with direction and support from co-sponsors, content on attention deficit/hyperactivity
disorder treatment was expanded to include separate items on behavioral and medication treatment);
and 3) self-administered surveys require wording and framing that differs from interviewer-assisted
surveys (i.e., instructional text throughout the instrument was refined and simplified).
Concomitantly, the addition (or deletion) of content was driven by four factors: 1) the need to include
the most critical content from both former surveys; 2) the prioritization of topics highly relevant to HRSA
MCHB investments (e.g., items required to track 18 National Performance and Outcome Measures for
the Title V Maternal and Child Health Services Block Grant program); 3) the commitment to improve
methods for assessing key topics; and 4) the desire to address emergent priorities as identified by states
and the broader maternal and child health field (e.g., the addition of items to assess readiness to learn
among children aged 3-5 years).
Seven questions were added to the 2017 NSCH questionnaire, which were new since the 2016 NSCH:
•
•
•
•
•

COLOR (“Can this child identify the colors red, yellow, blue, and green by name?”),
MOLD (“DURING THE PAST 12 MONTHS, other than in a shower or bathtub, have you seen any
mold, mildew or other signs of water damage on walls or other surfaces inside your home?”),
PESTICIDE (“DURING THE PAST 12 MONTHS, how often were pesticides used inside your
residence to control for insects?”),
A1_ACTIVE/A2_ACTIVE (“Have you ever served on active duty in the U.S. Armed Forces, military
Reserves, or the National Guard?”), and
A1_DEPLSTAT/A2_DEPLSTAT (“Were you deployed at any time during (fill with SC_NAME)'s
life?”).

In addition, EXPULSION (“IN THE PAST 12 MONTHS, were you ever asked to keep your child home from
any child care or preschool because of their behavior (things like hitting, kicking, biting, tantrums or
disobeying)?”) was removed from the questionnaire in 2017.
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Following an expert review of survey materials, response options were modified on the 2017 NSCH for
the following items: CALMDOWN, CLEAREXP, CONFIDENT, COUNTTO, DISTRACTED, HURTSAD, INSTYPE,
K7Q02_R, NEWACTIVITY, PLAYWELL, RECOGABC, RECOGBEGIN, RECSHAPES, SIMPLEINST, SITSTILL,
STARTSCHOOL, TEMPER, WORKTOFIN, and WRITENAME. In addition, question wording was substantially
modified for K6Q08_R and USEPENCIL.

Survey Content
Consistent with all previous administrations, the 2017 NSCH retained a two-phase data collection
approach: (1) an initial household screener to assess the presence, basic demographic characteristics,
and SHCN status of any children in the home; and (2) a substantive topical questionnaire to be
completed by a parent or caregiver of the selected child.
The screener questionnaire consisted of two sections. The first section contained three questions about
the presence of children in the home and the primary language spoken. The next section contained
detailed questions about the demographics and health of up to four children, from youngest to oldest. If
there were more than four children in a household, the first name (or initials or nickname), age, and sex
were asked for up to ten children.
There were three different topical questionnaires tailored to three different age groups of the selected
children: T1 for 0 to 5 year old children, T2 for 6 to 11 year old children, and T3 for 12 to 17 year old
children. All three questionnaires contained 11 sections about the child, their family, and neighborhood,
but the specific questions were tailored to be relevant to children in that age specific range. Copies of
the screener and topical questionnaires can be found in Attachment E. The questionnaire sections are
summarized below:
Section A. This Child’s Health – Questions about whether the child has acute or chronic physical,
mental, behavioral, learning, or developmental conditions; if the child’s health conditions affect his or
her ability to do things.
Section B: This Child as an Infant – Birth-related questions including birth weight, breastfeeding, and
use of formula. Infant feeding questions are only included on T1.
Section C: Health Care Services – Questions about source of a usual place for health care, need for and
use of medical, dental, mental, and specialized health services in the last 12 months.
Section D: Experience with This Child’s Health Care Providers – Questions about frequency of care and
satisfaction with the child’s health care providers. Also, questions about how the child’s doctor or health
care provider worked with the child. T3 includes questions about the child’s preparation for transition
into adult health care.
Section E: This Child’s Health Insurance Coverage – Questions about whether the child has adequate
health care coverage, and whether there were any gaps in health care coverage in the past 12 months,
including at the time of the survey.

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17
Section F: Providing for this Child’s Health – Questions on cost of health care in the past 12 months and
time spent providing and arranging for the child’s health care.
Section G: This Child’s Learning/Schooling and Activities – Questions on early learning (e.g., speaking,
rhyming, counting, attentiveness, making friends, social/emotional development) for children ages 3 to
5 years. For children ages 6 to 17 years, questions about experience at school, participation in organized
activities, and physical activity.
Section H: About You and This Child – Questions about daily life and household activities, including the
child’s sleep habits, computer and television use, and the demands of parenting on the respondent.
Section I: About Your Family and Household – Questions about the frequency of family meals, the use
of tobacco in the household, how the family copes with problems, and if any assistance is needed to
provide food for the family. Also questions about the respondent’s perception of their neighborhood
(e.g., amenities, safety), and questions about whether the child has ever experienced any adverse
childhood experiences.
Section J: About You – Questions on demographic information about up to two adults in the household
who are the child’s primary caregivers.
Section K: Household Information – Questions on household count, family count, and family income.

Web Instrument Specifications
All households selected to participate in the 2017 NSCH received an invitation to respond to the survey
by web. The invitation included the website URL and a unique 8-digit login ID. After logging in and
reviewing the Privacy Act statement, respondents were asked to verify their address. If the listed
address matched the respondent’s residence, the case was assigned a pin that the respondent could use
to log back in to the survey. The respondent was also asked to provide answers to three security
questions that could be used to verify the respondent’s identity if the pin was lost. After pin creation,
the respondent was asked about the number of children (0-17 years of age) that usually reside at that
address.
If the respondent answered that the address selected for the sample (and displayed on screen) did not
match their own or that there were no children that usually reside at the address, then the survey was
concluded and the household was removed from further mailings.
If the respondent answered that there were children that usually reside at the address, the respondent
was presented with a battery of questions about each child (the screener portion of the survey). The
respondent was required to provide at least a first name, initials, or nickname and age for each child on
the household roster, as these elements were necessary for subsampling (discussed previously) and
name fills in question wording. The respondent was also asked about the race and ethnicity of each child
and English language ability for children age 4 and older. Finally, there was a series of 14 questions to
determine the SHCN status of each child.

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18
After the respondent entered and confirmed this information about all children in the household, the
web instrument applied the subsampling methodology to select one child from the household roster to
be the subject of the topical portion of the instrument. Once a child was selected, the web instrument
did not allow respondents to revise their answers to the screener portion of the instrument.
Respondents for households without children needed about 52 seconds on average to complete the
web instrument. Respondents for households with children completed the screener portion of the
instrument in 5 minutes, 42 seconds, the web topical portion in 31 minutes, 32 seconds, and the entire
web instrument in 37 minutes, 15 seconds on average. Table 3 details the mean and median time
needed to complete the web instrument.
Table 3. Web Submission Times (in minutes)

Screener
Topical
Total

Households with
Children
Mean
Median
5.7
4.6
31.5
27.2
37.3
32.5

Households without
Children
Mean
Median
2.2
1.3
-

2.2

1.3

After respondents answered all questions in the topical portion of the instrument, they were presented
with the opportunity to review and edit any answers before submitting. Once the survey was submitted,
a submission confirmation screen appeared with the date and time of completion. The instrument was
then locked and the respondent was only able to view the submission confirmation screen if they logged
back in.

Programming the Web Instrument
The web survey was conducted using the U.S. Census Bureau’s Centurion system for internet data
collection. This software presented the questionnaire on a computer screen. The interview was selfadministered by the respondent; the respondent logged in to the instrument with the login ID provided
in the web invitation letter and a PIN was generated along with verification questions for additional
security.
There were two hard edits programmed into the web instrument which required respondents to provide
a valid answer before continuing. These answers were necessary for subsampling: child’s first name,
initials, or nickname; and age. Otherwise, respondents were able to skip all other questions and
continue the survey. There were soft edits for some questions that prompted respondents to provide an
answer or revise an existing answer, but respondents were able to skip past these edits. Online help
screens and text were also available in the instrument to aid respondents. Submitted responses were
saved in a survey data file. The use of the web instrument reduced the time required to transfer,
process, and release data.
The web instrument guided respondents through skip patterns, established legitimate ranges for
numerical write-in items, and offered “pick lists” for some response categories. Also in an effort to
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19
reduce respondent burden, the instrument integrated the screener and topical instruments into a single
self-administered interview. After the respondent completed the screener questions and the web
instrument confirmed that the household was eligible to complete the topical questionnaire, the
instrument applied the subsampling methodology to select one child from the household to receive the
topical portion of the survey. Fills were then used to prefill the name of the selected child into the
topical survey questions.
Once programming of the instrument was completed, the various requirements of the instrument –
respondent login, PIN generation, screener subsampling, topical selection, skip pattern implementation,
fills, data output – were tested to ensure that the Centurion system was functioning correctly.

Paper Instrument Specifications
High Paper addresses and High Web non-respondent addresses received a two-phase, self-administered
mail survey. In the first phase, households received (a) an invitation letter to participate in the NSCH,
and (b) a paper screener instrument. Using the paper questionnaire, households were screened to
determine if there were any children 17 years or younger who usually lived or stayed at the address.
Those households that met the eligibility criteria went on to roster the children living at the address and
answered questions to determine the SHCN status of each child (up to 4 children). Detailed information
was collected for Child 1 through Child 4, while basic information (name, age, sex) was collected for
Child 5 through Child 10.
If the respondent mailed back the screener, it was then processed to determine if eligible children
usually reside at the address. If the respondent answered that the address selected for the sample did
not match their own or that there were no children that usually reside at the address, the survey was
concluded and the household was removed from further mailings. If the respondent answered that
there were children usually residing at the address, the subsampling methodology was applied to select
one child from the household roster to be the subject of the topical questionnaire.
In the second phase, households that were deemed to have eligible children were mailed one of the
three age-based topical questionnaires requesting more information about one selected child living at
the address. Docuprint systems were used to print the selected child’s first name, initials, or nickname,
age, and sex if provided on the topical questionnaires in order to ensure that respondents answered the
topical questions for the selected child.
The paper and web instruments were designed to be as similar as possible to minimize the influence of
mode on responses. While automatic skips and soft edits could not be implemented in the paper
instrument, the questionnaire did include skip instructions within the question wording to mimic the
web instrument.
Paper questionnaires were created using Amgraf One Form Plus. Returned forms were processed by
iCADE to capture responses through OMR (optical mark recognition), OCR (optical character
recognition), and KFI (keying from image). Questionnaires were printed, trimmed, and stitched through
an in-house print on-demand process using a Docuprint system that allowed personalization to each
respondent.
2017 National Survey of Children’s Health

U.S. Census Bureau

Data Collection
Data collection efforts for the 2017 National Survey of Children’s Health (NSCH) began on August 7,
2017, and included up to five screener mailings (and up to 2 reminder postcards) and up to four topical
mailings. The dates for the label creation, late mail return (LMR) pulls (packages for addresses that
responded after the initial mailing list was created were pulled and destroyed shortly before the
mailing), and mailout for each mailing are detailed in Table 4. Copies of the invitation letters and
postcards can be found in Attachment D. Respondents also had the opportunity to initiate and complete
the interview by phone via Telephone Questionnaire Assistance (TQA).

Mailout Specifications
Each address had a total of four (High Paper) or five (High Web) possible screener mailings that included
web invitations and, in some cases, a paper screener questionnaire. Respondents also received up to
two pressure-sealed reminder postcards, sent 5 to 7 days after a primary mailing.
All sampled addresses received an initial invitation letter with instructions to participate by web. The
letter included the web survey URL along with a unique login ID. Most invitations also included a $2 bill
(90% of addresses); the remaining addresses (10%) represented the control group and did not receive an
incentive. Addresses were randomly assigned to the incentive groups. High Paper addresses (30%) also
received a paper screener questionnaire and paid-postage return envelope with the initial mailing.
Additionally, half of each incentive group and High Paper/High Web group received a single-page color
infographic that contained information about the data being collected and how respondents’ answers
can help (see Attachment F). One week later, all addresses received a pressure-sealed reminder
postcard that again included the necessary details for the respondent to complete the survey by web.
If a High Web household did not complete the survey via the web by three weeks after the initial letter
was mailed, they were mailed a follow-up letter that included instructions for responding via web. If a
High Paper household did not complete the survey via the web or return the paper questionnaire by
four weeks after the initial letter was mailed, they were mailed a follow-up letter and another paper
questionnaire. This letter again included instructions for responding via web. High Paper addresses again
received a pressure-sealed reminder postcard 5 to 7 days after this first follow-up mailing.
Nonresponding addresses after the first follow-up mailing received a second follow-up mailing. High
Web addresses received their first paper screener questionnaires in this mailing. All nonresponding
addresses received paper screeners in this and all subsequent follow-up mailings. High Web addresses
also received a pressure-sealed reminder postcard 5 to 7 days after this second follow-up mailing.
A fourth follow-up mailing was sent to a subset of High Web addresses. Remaining materials,
approximately 50,000 mail packages, were not sufficient to cover the full list of High Web
nonresponding addresses. Instead, the mailing targeted, first, addresses in Arkansas (due to lower than
expected returns from that state) followed by addresses in high poverty block groups (greater than 30%
in poverty), sorted inversely by the number of topical returns from that state.

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21
Sampled addresses received up to five screener mailings; addresses received fewer mailings if the
residents submitted a web survey, returned a complete paper screener, explicitly refused to participate,
or if the address was out-of-scope (i.e., not an occupied residence).
Respondents that returned a paper screener, and did not submit a web survey, were assigned to one of
ten topical mailing groups. Group assignments were dependent on the date that the paper screener
form was received at the National Processing Center. All forms that were received before the first
topical label file was created were assigned to Topical Group A. Non-duplicate forms received from that
time until the second topical label file was created were assigned to Group B, and so forth. Respondents
received up to four topical survey packages; respondents received fewer packages if they returned a
topical form or explicitly refused to participate, the selected child no longer resided at the address when
the topical form was received, or the household was assigned to a later topical group (due to time
constraints based on survey closeout; see Table 5).
Table 4. Screener Mailout Schedule

Mailing
Initial Web Invitation Letter ($0 or $2, Infographic or
no Infographic, Paper Screener to High Paper only)
Pressure-Sealed Reminder Postcard
First Follow-up, Web Invitation Letter (High Web)

First Follow-up, Paper Screener (High Paper)
Pressure-Sealed Reminder Postcard (High Paper)
Second Follow-up, Paper Screener (High Web)
Pressure-Sealed Reminder Postcard (High Web)
Second Follow-up, Paper Screener (High Paper)
Third Follow-up, Paper Screener (High Web)
Third Follow-up, Paper Screener (High Paper)
Fourth Follow-up, Paper Screener (High Web,
Targeted)

Label file date
6/13/2017

LMR file date
N/A

Mail date
8/7/2017

6/13/2017
8/23/2017

N/A
9/1/2017

8/30/2017
8/30/2017
9/19/2017
9/19/2017
10/2/2017
10/25/2017
11/8/2017
11/27/2017

9/11/2017
9/11/2017
10/2/2017
10/2/2017
10/18/2017
11/6/2017
11/20/2017
12/6/2017

8/14/2017
9/6/2017,
9/7/2017
(Texas)
9/13/2017
9/20/2017
10/5/2017
10/11/2017
10/20/2017
11/8/2017
11/22/2017
12/11/2017

Table 5. Topical Mailout Schedule

Mailing
Mailing 1
Mailing 2
Mailing 3
Mailing 4
Mailing 5
Mailing 6

2017 National Survey of Children’s Health

Mail Groups
A
B
A, C
B, D
A, C, E
B, D, F

Label file
date
8/31/17
9/14/17
9/28/17
10/12/17
10/26/17
11/9/17

LMR file
date
9/13/17
9/27/17
10/11/17
10/25/17
11/7/17
11/21/17

Mail
date
9/15/17
9/29/17
10/13/17
10/27/17
11/9/17
11/24/17

U.S. Census Bureau

Mailing

Mail Groups

Label file
date

LMR file
date

Mailing 7
(w/ Incentive)

A, C, E, G

11/21/17

Mailing 8
(w/ Incentive)
Mailing 9
Mailing 10

B, D, F, H
C, E, G, I
D, F, H, J

12/6/17 12/18/17 12/20/17
12/19/17 12/29/17
1/3/18
1/5/18 1/16/18 1/18/18

12/4/17

Mail
date
12/6/17

Telephone Questionnaire Assistance (TQA)
A toll-free telephone line was provided to respondents to allow them to call if they had questions about
the survey, wanted to complete the interview over the phone, or submit feedback. All invitation letters,
the web instrument, and the paper instrument identified this toll-free number.
The telephone line was answered by NSCH trained interviewers in two of the three Census Bureau call
center locations: Hagerstown, MD and Tucson, AZ. During the course of data collection there were
approximately 5,730 calls made to the toll-free line. If a respondent requested to respond to the survey
over the phone, the TQA interviewer would administer the survey using the Centurion web instrument.
There were a total of 1,989 cases completed over the phone. Of those completed interviews, 1,829
households reported no children in the household and 160 reported children. Table 6 lists all possible
TQA purpose codes that could be assigned during a call or interview.

2017 National Survey of Children’s Health

U.S. Census Bureau

Table 6. TQA Purpose Codes used in ATAC System

Definitions
Internet instrument completed over the phone

Refusal to participate

Wrong address – Web respondent

Address is not a residence (out-of-scope)

06
20
30
31
40
49
50
51
52
53
60
80

Paper questionnaire status

TQA Purpose Codes

Questions about monetary incentive
Request replacement survey (English)
Request Spanish language questionnaire
Trouble filling out the paper questionnaire
Respondent requested PIN
Respondent requested Login ID
Problem logging into Internet instrument
Other instrument issues
PIN/security question reset request
Question regarding the survey (General FAQ)
Comments

TQA interviewer training was conducted prior to the initial 2017 mailing. A total of 45 interviewers
assisted respondents with their questions about the NSCH and conducted interviews over the phone
using the web instrument. A background of the survey was provided to TQA interviewers, along with
details on the mailout schedule and incentives used. Interviewers were trained on how to determine
and assign the correct purpose code in the ATAC (Automated Tracking and Control) system. They were
given examples on how to search for the respondent’s case in the web instrument and how to
administer the survey over the phone. Finally, they were trained on how to properly close out the case
and assign a purpose code to identify that the web questionnaire was completed over the phone. TQA
interviewers were given a manual that included these details and answers to frequently asked questions
that they were able to reference during the 2017 NSCH production cycle.
Call monitoring sessions of recorded TQA calls were scheduled throughout data collection. If any
changes were needed to the ATAC TQA instrument based on comments received from interviewers,
Census coordinated programming updates. All updates to procedures were communicated to the TQA
interviewers. Incoming call volumes were also monitored throughout data collection and scheduling of
the interviewers was adjusted accordingly.

Email Questionnaire Assistance (EQA)
In addition to the toll-free telephone line, respondents were able to interact with Census Bureau staff
via email. An email address (childrenshealth@census.gov) was listed in both the High Web and High
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24
Paper invitation letters as well as on the Centurion login page. Emails were answered by call center staff
in Hagerstown, MD. Staff checked the email inbox daily and replied to messages within 2 business days
when possible. Emails were logged in a tracking spreadsheet and cases were assigned purpose codes
similar to the TQA purpose codes in Table 6.
EQA agents employed scripted responses for common concerns and questions. These scripts ensured
consistent and accurate information. When replying to the messages, agents removed any information
in the response email that could be considered personally identifiable (e.g., address, phone number,
name).

Respondent Demographics
Web and mail survey instructions requested that the respondent be a parent or guardian who lived in
the household and knew about the health and health care of the selected child. TQA interviewers were
not permitted to conduct an interview with a respondent below the age of 18 years. Table 7 shows the
proportion of respondents by their relationship with the selected child for the topical survey; 90% of
topical survey respondents were biological or adoptive parents of the selected child.
Table 7. Respondent Relation to Selected Child

Relationship
Biological or
Adoptive Parent
Step-parent
Grandparent
Foster Parent
Aunt or Uncle
Other Relative
Other Non-Relative
Response Missing

Relative
Frequency
90.3%
1.9%
4.5%
0.3%
0.6%
0.3%
0.3%
2.0%

Confidentiality
Participation in the 2017 NSCH was voluntary, and all data collected that could potentially identify an
individual person are confidential. Data are kept private in accordance with applicable law. Respondents
are assured of the confidentiality of their replies in accordance with 13 U.S.C. Section 9. All access to
Title 13 data from this survey is restricted to Census Bureau employees and those holding Census
Bureau Special Sworn Status pursuant to 13 U.S.C. Section 23(c). In compliance with this law, all data
released to the public are only in a statistical format. No information that could personally identify a
respondent or household may be released. The Census Bureau ensured that all HRSA MCHB staff
obtained Special Sworn Status prior to receiving access to any confidential data. The Screener and
Topical public use data files went through a thorough disclosure review process and were approved by
the Census Disclosure Review Board prior to release.

2017 National Survey of Children’s Health

U.S. Census Bureau

Spanish Language Availability
The NSCH paper and web instruments were available in both English and Spanish. The Spanish
translation was originally provided by a contractor for the NSCH Pretest. For the 2016 NSCH, the Census
Bureau reviewed and verified the previously translated paper and web Spanish instruments and
provided new translations where necessary. Census also provided translations for the Spanish language
invitation letters that were included in the mailings, printed on the back of each letter. The letters
provided details about the survey and instructions for requesting a Spanish language paper
questionnaire through the TQA line.
If a respondent returned a Spanish language paper screener questionnaire indicating the presence of
children in the household, the Spanish language topical questionnaire was subsequently mailed to the
household. Eight addresses requested and received a Spanish language paper screener, approximately
half returned a Spanish language paper screener, and roughly a quarter returned a Spanish language
topical questionnaire.
The web instrument offered a toggle on the login page that allowed respondents to select the English or
Spanish language version of the instrument. Of the web respondents, 137 completed the screener
portion and 103 completed the topical portion of the instrument using the Spanish language version of
the instrument.
Spanish-speaking respondents that called the TQA line were placed in a Spanish language calling queue;
a trained Spanish language agent then answered any questions or administered the Spanish language
web instrument over the phone. The agent flagged the case if a Spanish paper questionnaire was
requested and informed the respondent that a questionnaire would arrive in the mail within three
weeks. The paper and web instruments were available in English and Spanish; additional language
support was available when calling into the TQA line.

Efforts to Maximize Response Rates
Cash incentives, follow-up mailings, reminder postcards, toll-free telephone numbers, and translated
questionnaires were used to maximize response. The NSCH screener and topical questionnaires were
specifically designed to encourage cooperation by prospective respondents. Questions were developed
and grouped by subject area to create logical, clear questionnaires with concrete question wording and
simple grammar. Both the paper and web versions of the questionnaires used design elements to
enhance respondent comprehension and make instructions clear and simple. In addition, the
respondent contact strategies and letters were carefully designed to capture the attention of the
respondent and pique interest in the subject matter.

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Data collection for the 2017 NSCH involved a series of mailings and nonresponse follow-up activities,
emphasizing questionnaire completion. The approach to data collection and nonresponse follow-up was
based on previous project experience and recommendations made by Dillman and colleagues (2009):9




Invitation letter. An initial invitation letter was mailed to all potential respondents providing
details about the study, a web URL with the login ID for accessing the web version of the
questionnaire (which combined the screener and topical into a consolidated instrument), and a
toll-free number for individuals to call if there were questions or comments. In addition to the
invitation letter, 90% of the sample also received a one-time cash incentive to complete the
survey in the amount of $2. Half of the sample received the one-page infographic. Each
household received up to five invitations and two reminders to participate in the survey.
Additional mailings. Subsequent to the first invitation mailing, the Census Bureau sent all
remaining non-respondents a second invitation letter. After the second mailing, all remaining
non-respondents received a paper screener questionnaires in follow-up mailings. Only High
Paper addresses received the paper questionnaire in the first two mailings. All addresses also
received a reminder postcard after the initial mailing, and nonresponding addresses received a
second reminder postcard after a follow-up mailing.
Paper topical questionnaire mailing. For respondents who returned a paper screener, the topical
questionnaire and accompanying cover letter were personalized to fill in the sample child’s
name and other identifying information to ensure that the survey was completed for the correct
child. This level of personalization in the questionnaire improved data quality by reducing the
opportunity for skip logic errors. It also resulted in a questionnaire that was as short as possible
for the selected child, increasing the likelihood that the respondent would complete it.

These operational strategies both facilitated response and reduced differential response and
nonresponse by mode.

Dillman DA, Smyth JD, Christian LM. 2009. Internet, Mail and Mixed-Mode Surveys: The Tailored Design Method,
3rd edition. Hoboken, NJ: John Wiley & Sons.

2017 National Survey of Children’s Health

U.S. Census Bureau

Response Analysis
Response Rates
For the purposes of calculating response rates, all sampled addresses were assigned screener and
topical outcomes codes. These outcomes can generally be categorized as not eligible, eligible but not
complete, or complete.
For some addresses, Census received insufficient correspondence to determine if the address was
eligible to complete the screener or topical questionnaires. These addresses were classified as
unresolved. Among these addresses, Census estimated the share that were occupied residences using
the Household Rate, which is the proportion of resolved addresses that are occupied residences.10
Census also estimated the Child Rate, which is the share of those households that include children,
based on the proportion of households that have children by state and stratum in the 2015 American
Community Survey (ACS). The product of the Household Rate and Child Rate is the Eligibility Rate (e), the
estimated proportion of unresolved addresses that are households with children. Using this approach,
Census estimated that 83.9% (weighted) of unresolved addresses were households and 46% (weighted)
of those households were households with children.
𝑒 = 𝐻𝑜𝑢𝑠𝑒ℎ𝑜𝑙𝑑 𝑅𝑎𝑡𝑒 ∗ 𝐶ℎ𝑖𝑙𝑑 𝑅𝑎𝑡𝑒
Three different response rates were calculated based on the estimated proportion of eligible addresses
that completed the screener and topical questionnaires. Definitions of completion and calculation of
these three response rates are detailed below.
A completed screener had to 1) be returned from a sampled address, and 2) indicate that there were no
children present or provide a valid age for at least one child. 58,510 households completed a screener
survey. Of those, 29,343 households with children completed the screener instrument and are included
on the Screener data file. There were 29,167 households without children that completed the screener
instrument and are not included in any published data files.
Complete and sufficient partial topical surveys are included on the Topical data file. Of the 29,343
eligible screened-in households, 21,599 households with children returned a complete or sufficient
partial topical survey. A returned topical survey was considered complete if at least 40 of 50 “check
items” had valid answers, and 1) the respondent completed at least one item in Section K (Household
Information) or 2) the respondent submitted the topical web instrument. Check items are on-path for all
respondents, are distributed across all sections of the survey, and offer an indication that the responses

Specifically, Census used the midpoint between the Household Rate including undeliverable addresses (the
proportion of all resolved addresses that are occupied residences) and the Household Rate excluding undeliverable
addresses (UAAs) by state and stratum. Because UAAs are identified by the United States Postal Service, it is
assumed that UAAs are identified at a higher rate than other noneligible addresses (businesses, vacant residences,
etc.) that must be self-identified. The midpoint assumes that there are some UAAs still unresolved but at a lower
rate than they appear among the resolved addresses.
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represent progress through those survey items. Of the 21,599 returned topicals, 21,108 returned topical
surveys were complete.
A returned topical survey was considered a sufficient partial if at least 25 of 50 check items had valid
answers, and 1) the respondent completed at least one item in Section H or beyond, or 2) the
respondent submitted the topical web instrument. Of the 21,599 valid topical questionnaires, 491 were
sufficient partials. Overall, there were 7,744 households with children that completed screeners but did
not return a topical survey or returned an insufficient partial topical survey.
Table 8. Final Disposition of Screener and Topical Returns

Final Disposition
Completed Screener
Topical-Eligible Screeners
Completed Topicals
Complete
Sufficient Partial

Count
58,510
29,343
21,599
21,108
491

Screener Completion Rate
The Screener Completion Rate is the estimated proportion of households (occupied residences) that
completed a screener. The denominator includes both screened households and the number of
unresolved addresses that are estimated to be households. This approach yielded a national weighted
screener completion rate of 46.2%.
𝐶𝑜𝑚𝑝𝑙𝑒𝑡𝑒𝑑 𝑆𝑐𝑟𝑒𝑒𝑛𝑒𝑟𝑠
𝑆𝑐𝑟𝑒𝑒𝑛𝑒𝑑 𝐻𝐻𝑠 + (𝑈𝑛𝑟𝑒𝑠𝑜𝑙𝑣𝑒𝑑 𝐴𝑑𝑑𝑟𝑒𝑠𝑠𝑒𝑠 ∗ 𝐻𝑜𝑢𝑠𝑒ℎ𝑜𝑙𝑑 𝑅𝑎𝑡𝑒)
Topical Completion Rate
The Topical Completion Rate is the estimated proportion of households with children that completed a
topical questionnaire. The denominator includes both screened households with children and the
number of unresolved addresses that are estimated to be households with children. This approach
yields a national weighted topical completion rate of 30.6%.
𝐶𝑜𝑚𝑝𝑙𝑒𝑡𝑒𝑑 𝑇𝑜𝑝𝑖𝑐𝑎𝑙𝑠
𝑆𝑐𝑟𝑒𝑒𝑛𝑒𝑑 𝐻𝐻𝑠 𝑤𝑖𝑡ℎ 𝐶ℎ𝑖𝑙𝑑𝑟𝑒𝑛 + (𝑈𝑛𝑟𝑒𝑠𝑜𝑙𝑣𝑒𝑑 𝐴𝑑𝑑𝑟𝑒𝑠𝑠𝑒𝑠 ∗ 𝑒)
Interview Completion Rate and Overall Response Rate
The Interview Completion Rate (ICR) and Overall Response Rate (ORR) are designed to account for the
multi-stage design of the NSCH. They are the product of two (in the ICR) or three (in the ORR) response
rate metrics that are each consistent with standards set by the American Association for Public Opinion
Research. Specifically, the ICR is the product of the proportion of resolved households that completed
the screener questionnaire (Screener Conversion Rate – 99.1%) and the proportion of screened
households with children that completed the topical questionnaire (Topical Conversion Rate – 71.5%).
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The ORR is the product of the ICR and the proportion of addresses that were resolved (Resolution Rate –
52.8%). Equivalently, the ORR is the product of the Resolution Rate, the Screener Conversion Rate, and
the Topical Conversion Rate. This approach yields a national weighted ICR of 70.9% and a weighted ORR
of 37.4%.
𝑅𝑒𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑅𝑎𝑡𝑒 =

𝑅𝑒𝑠𝑜𝑙𝑣𝑒𝑑 𝐴𝑑𝑑𝑟𝑒𝑠𝑠𝑒𝑠
𝑇𝑜𝑡𝑎𝑙 𝐴𝑑𝑑𝑟𝑒𝑠𝑠𝑒𝑠

𝑆𝑐𝑟𝑒𝑒𝑛𝑒𝑟 𝐶𝑜𝑛𝑣𝑒𝑟𝑠𝑖𝑜𝑛 𝑅𝑎𝑡𝑒 =

𝑇𝑜𝑝𝑖𝑐𝑎𝑙 𝐶𝑜𝑛𝑣𝑒𝑟𝑠𝑖𝑜𝑛 𝑅𝑎𝑡𝑒 =

𝐶𝑜𝑚𝑝𝑙𝑒𝑡𝑒𝑑 𝑆𝑐𝑟𝑒𝑒𝑛𝑒𝑟𝑠
𝑅𝑒𝑠𝑜𝑙𝑣𝑒𝑑 𝐻𝑜𝑢𝑠𝑒ℎ𝑜𝑙𝑑𝑠

𝐶𝑜𝑚𝑝𝑙𝑒𝑡𝑒𝑑 𝑇𝑜𝑝𝑖𝑐𝑎𝑙𝑠
𝑆𝑐𝑟𝑒𝑒𝑛𝑒𝑑 𝐻𝑜𝑢𝑠𝑒ℎ𝑜𝑙𝑑𝑠 𝑤𝑖𝑡ℎ 𝐶ℎ𝑖𝑙𝑑𝑟𝑒𝑛

Response Rates by State
The probability of response varied by state (see Attachment C). Weighted Screener Completion Rates
ranged from 37.3% in Texas to 63.2% in Vermont. Weighted Topical Completion Rates also ranged
across states, from 23.7% of households with children completing the topical in Louisiana to 40.3% in
Vermont.

Web Survey Breakoffs
In addition to respondent answers, the web instrument produces data that can be used to analyze how
respondents interact with the instrument. A set of events – link and button clicks, field entries, and page
entries and exits – are recorded and time stamped. Collectively, web instrument paradata offers a
valuable tool for evaluating instrument performance and identifying areas for instrument optimization.
The vast majority of respondents that accessed the web instrument completed the survey in the web
instrument. Of the respondents that reached the first question in the web instrument, 91% completed
the web survey. Effectively all households that reported no children by web completed the survey by
web. Of the households that reported children by web, 82% met the requirements of a complete or
sufficient partial topical.
Census uses the web instrument paradata to track the experience of respondents that did not complete
the web survey. For example, the paradata indicates the last page viewed by each respondent.
Respondents break off from an interview for many reasons, most of which are not tied to a particular
element of the survey instrument. But breakoffs that accumulate on a particular page may be an
indication of an off-putting set of questions or a difficult transition.
Particular sections of the instrument proved more difficult for some respondents to complete and were
associated with higher breakoff rates. Table 9 lists the number of respondent breakoffs by section and
the percent of all breakoffs that occurred in that section. Because some sections were longer than
others, and were therefore more likely to see breakoffs by chance alone, the final two columns list the
percent of all respondent time spent and items completed in each section.

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Table 9. Breakoffs by Survey Section

Section
Login/Pin
Verify Household
Screen Household
Roster Children
A. This Child's Health
B. This Child as an Infant
C. Health Care Services
D. Health Care Providers
E. Health Insurance Coverage
F. Providing for Child's Health
G. School and Activities
H. About You and This Child
I. Family and Household
J. About You
K. Household Information
Review and Submission
Instructions and FAQs
Total

# of
Breakoffs
755
662
149
686
608
301
838
366
236
200
100
131
195
70
302
17
39
5,655

% of
Breakoffs
13.4%
11.7%
2.6%
12.1%
10.8%
5.3%
14.8%
6.5%
4.2%
3.5%
1.8%
2.3%
3.4%
1.2%
5.3%
0.3%
0.7%
100.0%

% of Resp.
Time
1.5%
6.2%
2.2%
11.3%
14.3%
3.5%
14.3%
7.3%
3.4%
3.6%
4.0%
6.7%
9.6%
4.7%
5.4%
1.8%
0.2%
100.0%

% of Items
0.0%
1.9%
1.9%
6.1%
23.5%
2.3%
11.6%
7.1%
4.1%
3.2%
4.6%
8.0%
14.1%
7.9%
3.8%
0.0%
0.0%
100.0%

The 2017 NSCH saw a significant uptick in the number of respondents breaking off prior to screening
(‘Screen Household’) from 4.2% of breakoffs in 2016 to 25.1% in 2017. In 2016, respondents logged into
the web instrument with an 8-digit username and an 8-character password that were provided on the
invite letter. For 2017, a PIN system was implemented and the password requirement was removed.
Respondents logged in the first time using only the username, and then were asked to create a four digit
PIN and answer three security questions that could be used to recover a lost PIN. Users were required to
provide that four digit PIN to log back in to an incomplete survey; submitted web surveys were closed
out and not accessible. The PIN system, therefore, allowed Census to bypass the password requirement
and better protect respondents’ answers because the login credentials included on follow-up mailings
did not grant access to incomplete surveys. It also shifted respondent burden from the initial log in failed log in attempts are not captured in paradata - to the PIN creation process.
In the context of web breakoffs, the implementation of the PIN presumably had two effects. First, more
respondents passed the initial login threshold so their experience could be recorded in paradata.
Second, more respondents broke off in the first pages of the instrument in response to the additional
burden of answering three security questions. So the paradata in 2017 captured respondents that broke
off instead of answering the three security questions; an uncertain number of these respondents would
not have logged in if they were required to enter an 8-character password.

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Like 2016, the two other significant breakoff points, in terms of breakoffs per item, were ‘Roster
Children’ and ‘C. Health Care Services’. In the ‘Roster Children’ section, respondents were asked to
provide names, ages, and other demographic and health-related details for each child in the household.
It was the first section in the instrument to ask for detailed personal information.
Within ‘C. Health Care Services’, the webpage ‘hcsheightweight’ was particularly troublesome, which
included a series of questions about the child’s current height and weight. Respondents were asked to
type (or tap) in the child’s height (feet and inches or meters and centimeters) and weight (pounds or
kilograms, and ounces or grams if the child was 5 years old or younger). Respondents needed an average
of 20 seconds per completed item on this page, the most time per item of any page in the topical
instrument. In general, because write-in response items were more burdensome for respondents, both
in terms of time to respond and the inherent request for precision, these items were associated with
higher breakoff rates.
Table 10 highlights the 13 (of 105) pages responsible for more than 100 breakoffs. The first column lists
a page number indicating the sequence in which respondents typically reached a particular page. Pages
are listed in the table in descending order by the number of breakoffs. In addition to the number of
breakoffs, the final column reports the percentage of respondents that broke off upon reaching that
page.
Two major hurdles for respondents, both in terms of total breakoffs and the rate at which they broke
off, were again ‘childdashboard’ (in ‘Screen Household’) and ‘hcsheightweight’. A number of other pages
on this list required respondents to type in responses – ‘ihddbwma’ (birth weight), ‘ayincome’ (income),
‘childname’ (child’s name), and ‘ayhowmany’ (household and family count) – or immediately preceded
one of those pages.
The single page that experienced the most breakoffs was the street address verification page.
Respondents were four times as likely to break off on this page as they were in 2016. This increase is
undoubtedly associated with the addition PIN requirement and the additional burden for respondents in
the opening pages of the instrument.
Table 10. Breakoffs by Survey Web Page (breakoffs>100)

Pg #
2
49
5
46
48
99
6
71

Survey Web Page
streetaddress
hcsheightweight
childdashboard
ihddbwma
hcscheckup
ayincome
childname
pchhowmuchprob

Description
Street Address Verification
Height and Weight
Children at this Address
Due Date and Birth Weight
Doctor Check-up
Income
Child N Name
How Much and Problems Paying

2017 National Survey of Children’s Health

# of Breakoffs
452
326
304
253
246
171
138
136

% of
Respondents
Breaking Off
1.2%
1.8%
1.8%
1.4%
1.4%
1.1%
0.7%
0.8%
U.S. Census Bureau

Pg #
98
45
4
62
16

Survey Web Page
ayhowmany
ebdhcability
hhlanguage
hcphowoften
howwell

Description
How Many People
Health Condition Ability
Household Language
How Often Did Providers
How Well Items

# of Breakoffs
131
118
105
104
102

% of
Respondents
Breaking Off
0.8%
0.6%
0.5%
0.6%
0.5%

Item Level Response and Skip Patterns
The item response rate is the proportion of item-eligible respondents that provided a valid response to a
particular item. Many items were applicable to a subset of survey respondents only; for example, some
questions were applicable to children in a specific age range. In that case, the denominator for the item
response rate is the count of children in the eligible age range, and the numerator is the count of those
children with valid responses.
In some cases, it is uncertain if the child was eligible for an item. For example, before asking about the
severity of a condition, respondents reported if the child currently had the condition. The severity item
was applicable if the child currently had the condition, and it was not applicable if the child did not
currently have the condition. If the respondent chose to skip the current condition filter item, it was not
possible to definitively know whether the severity item was applicable.
Census accounts for this situation in the item response rate by assigning eligibility to cases with
unknown eligibility equal to the proportion of cases that were eligible when eligibility was known. For
example, if 10% of respondents reported that the child did have the condition currently, and so were
eligible for the severity follow-up question, the denominator for the severity item response rate
becomes
# 𝐸𝑙𝑖𝑔𝑖𝑏𝑙𝑒 + (# 𝐸𝑙𝑖𝑔𝑖𝑏𝑖𝑙𝑖𝑡𝑦 𝑈𝑛𝑘𝑛𝑜𝑤𝑛 ∗ .1)
Across all survey items, more than 98% of eligible items (estimated using this methodology) generated a
valid response.
Only one item on the public use file has an item response rate significantly below 95%: A2_LIVEUSA
(94.1% item response rate). Generally, items that require a write-in response, that require respondents
to follow a skip pattern, and are near the end of the instrument tend to have higher nonresponse.
A2_LIVEUSA is the rare intersection of all three conditions.
After A2_LIVEUSA, the items with the lowest item response rates are BMICLASS (which requires valid
answers to current height and current weight) at 95.8% and BIRTHWT at 95.7%. These items were
revised for the 2018 NSCH to encourage respondents to provide a best estimate.
Item nonresponse varied between web and paper responses. On the whole, item nonresponse was
higher on paper than web (2.0% versus 1.2%). There are several reasons nonresponse would differ
between web and paper; two are particularly important. First, the web instrument navigated
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respondents through the survey’s skip patterns; respondents using the paper instrument needed to
follow skip instructions. Second, the web and paper instruments recorded information differently.
Specifically, paper responses were converted from marks on paper to a digital record. Substantial
research and testing inform this process, yet it is still vulnerable to entry and translation errors that are
avoided in the web instrument’s digital record.
In total, 35 items had an item response rate that was more than 5 percentages points higher on web
than on paper; there were no items for which the inverse, paper over web, was true. Of these 35 items,
14 were linked to skip pattern navigation errors, another 16 were write-in response items, and 3 others
were small samples and not statistically significant (see Table 11).
Table 11. Item Response by Mode, where abs(Web-Paper)>.05

Web
Response
100%

Paper
Response
82%

Difference
17.4%

On-Path
(%)
4%

100%
98%
98%

87%
87%
87%

13.0%
11.7%
11.7%

3%
6%
6%

K12Q01_E - Reason Not Covered Inadequate Providers

98%

87%

11.7%

K12Q01_D - Reason Not Covered Inadequate Benefits

98%

87%

11.7%

K12Q01_C - Reason Not Covered –
Unaffordable

98%

87%

11.7%

K12Q01_B - Reason Not Covered Cancellation Overdue Premiums

98%

87%

11.7%

K12Q01_A - Reason Not Covered Change in Employer/Employment

98%

87%

11.7%

K6Q12 - Questionnaire - Development
Concerns

99%

90%

9.0%

26%

K4Q26 - Specialist Visit - Problem
SUBABUSE_CURR - Substance Abuse
Disorder Currently

99%
96%

91%
89%

8.0%
7.9%

19%
0%

FRSTFORMULA_MO_S - First Fed Formula
- Months (Standardized)

99%

92%

7.5%

13%

FRSTFORMULA_WK_S - First Fed Formula
- Weeks (Standardized)

99%

92%

7.5%

13%

FRSTFORMULA_DAY_S - First Fed
Formula - Days (Standardized)

99%

92%

7.5%

13%

LIVEUSA_MO - How Long Living in the
United States - Months

99%

92%

7.0%

Variable
SLEEPPOS - Position Most Often Lay Your
Baby Down to Sleep
K2Q35D - Autism ASD - Doctor Diagnose
K12Q01_G - Reason Not Covered - Other
K12Q01_F - Reason Not Covered Application/Renewal Problems

2017 National Survey of Children’s Health

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Web
Response
99%

Paper
Response
92%

Difference
7.0%

On-Path
(%)
3%

99%

92%

7.0%

K6Q14A - Words and Phrases Concerns
K2Q38C - Tourette Syndrome Description

99%
100%

92%
93%

7.0%
6.8%

8%
0%

ANYOTHER_CURR - Any Other Condition
Currently

99%

93%

6.8%

BMICLASS - Body Mass Index, Percentile
BIRTHWT - Birth Weight Status
BIRTHWT_L - Birth Weight is Low
(<2500g)
BIRTHWT_VL - Birth Weight is Very Low
(<1500g)
BIRTHWT_OZ_S - Standardized Birth
Weight, Ounces
TREATNEED - Mental Health Professional
Treatment - Problem
K2Q42C - Epilepsy Description
K2Q32B - Depression Currently
FRSTSOLIDS_MO_S - First Fed Solids Months (Standardized)

97%
97%
97%

91%
91%
91%

6.6%
6.1%
6.1%

52%
100%
100%

97%

91%

6.1%

100%

97%

91%

6.1%

100%

99%

93%

6.0%

12%

100%
99%
99%

94%
93%
94%

6.0%
5.9%
5.4%

1%
5%
26%

FRSTSOLIDS_WK_S - First Fed Solids Weeks (Standardized)

99%

94%

5.4%

26%

FRSTSOLIDS_DAY_S - First Fed Solids Days (Standardized)
BREASTFEDEND_MO_S - Stopped
Breastfeeding - Months (Standardized)
BREASTFEDEND_WK_S - Stopped
Breastfeeding - Weeks (Standardized)
BREASTFEDEND_DAY_S - Stopped
Breastfeeding - Days (Standardized)

99%

94%

5.4%

26%

98%

93%

5.1%

21%

98%

93%

5.1%

21%

98%

93%

5.1%

21%

Variable
LIVEUSA_YR - How Long Living in the
United States - Years
K6Q14B - Behaves and Gets Along
Concerns

Of particular note is SLEEPPOS. SLEEPPOS was asked only to respondents with children less than 12
months old. Census determined eligibility based on the age of the child provided on the screener. In the
web instrument, the instrument determined eligibility automatically based on the age of the child
entered only moments earlier. In the case of the paper instrument, the respondent returned the
screener by mail to be processed, and a topical survey form was then mailed out to the respondent.
Respondents were asked to complete the question for children less than 12 months old, but the delay
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between screener and topical mailings meant that some children that were eligible for the question
based on the screener instrument were no longer eligible by the time the respondent completed the
topical because their child had turned 1 year of age in the interim. The net result was higher than
anticipated nonresponse from paper respondents for children near 12 months of age on the screener
instrument.
Figure 1. Probability of Nonresponse to SLEEPPOS by Age of Child in Months (2016)
90%
80%

SLEEPPOS Nonresopnse

70%
60%
50%
40%
30%
20%
10%
0%
0 to 3 Months

4 to 5 Months

6 to 8 Months
Paper

9 Months

10 to 11 Months

Web

Incentive Effort
Survey research indicates that incentives are a necessary and cost-effective expense for achieving a
response rate that minimizes nonresponse bias.11 Due to a preponderance of such research, incentives
were used in all previous administrations of the NSCH and National Survey of Children with Special
Health Care Needs (NS-CSHCN), and the 2017 NSCH included an incentive in the screener and topical
mailings.
Screener Incentive
11

Brick JM, Williams D, Montaquila JM. 2011. “Address-Based Sampling for Subpopulation Surveys”. Public Opinion
Quarterly, 75(3): 409-28; Foster EB, Frasier AM, Morrison HM, O’Connor KS, Blumberg SJ. 2010. “All Things
Incentive: Exploring the Best Combination of Incentive Conditions”. Paper presented at the American Association
for Public Opinion Research annual conference, Chicago, IL.
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In the 2017 NSCH, sampled addresses received either a $2 bill or they were part of the control group
that did not receive a cash incentive in the initial screener mailing. The treatment group represented
90% of sample addresses, while the control group represented 10% of addresses. The sample
distribution is presented in Table 12.
Table 12. Treatment Group by Incentive Amount and Web Response Likelihood

Incentive
Treatment
Group

Cases

Control ($0)

17,047

153,679

Web Group
High Paper
High Web
Unmailablea
High Paper
High Web
Unmailablea

Cases
4,691
10,970
1,386
42,308
98,706
12,665

2.8%
6.4%
0.8%
24.8%
57.8%
7.4%

a Approximately 8% of sampled addresses were deemed unmailable. This determination was made when
the available address components were not recognized by the United States Postal Service.

On the whole, providing an unconditional screener incentive in the initial mailing was an effective but
more expensive strategy for encouraging response. Table 13 gives an overview of the cost effectiveness
of each incentive strategy. As noted earlier, the incentive was effective at encouraging response: the
share of eligible households that completed the screener (Screeners/Eligible Household) and completed
the topical (Topicals/Eligible Household) was higher for the $2 incentive group. But the difference in
response was not enough to overcome the additional cost of providing the incentive. An additional
$2.05 and $2.90 were spent for each screener and topical, respectively, for the $2 incentive group
relative to the control group.
Table 13. Mailing Costs by Incentive Group

Incentive
Group
Total
No Incentive
$2 Incentive

Screeners
58,510
5,333
53,177

Cost/
Screener
$28.82
$26.96
$29.01

Screeners/
Eligible
Household
46.1%
42.1%
46.6%

Topicals
21,599
1,906
19,693

Cost/
Topical
$78.07
$75.43
$78.33

Topicals/
Eligible
Household
31.3%
27.6%
31.7%

Screener incentives increased the cost per screener and topical collected, but the effort was cost
effective at generating response from a hard-to-reach segment of the sample – addresses that did not
respond when the monetary incentive was not offered. The cost of data collection scales with the
response rate, so the cost of collecting an additional percentage point of response is greater than the
last. The 4.5 percentage points of additional screener response (46.6% versus 42.1%) and 4.1 percentage
points of additional topical response (31.7% versus 27.6%) from the $2 incentive group represents
households that were not converted by the full battery of follow-up mailings.

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When evaluating the cost effectiveness of the screener incentive, then, it may be more appropriate to
compare it against the cost of other higher effort strategies. Tables 14 and 15 identify stages of data
collection in the 2017 NSCH and treat them as unique strategies. Table 14 compares the cost
effectiveness of follow-up (FU) mailings against a baseline strategy of one initial contact and one followup mailing. Adding a second follow-up mailing (2FU) increases response from eligible addresses from
18.1% to 23.1%, but at an additional cost of $2.68 per address. The additional 5 percentage points of
response cost $122.20 per topical, far larger than the $49.31 per topical for the baseline strategy. The
results for the third and fourth follow-up mailings are similar; the third and fourth follow-ups were
combined as 3.5FU because the fourth follow-up was targeted.
Table 14. Cost Effectiveness of Mail Data Collection Strategies

Impact of Adding Follow-Ups
Strategy
Baseline (1FU)
2FU
3.5FU

Cost
/Address
$3.93
$6.62
$9.18

Topicals
/Eligible
18.1%
23.1%
27.6%

Cost
/Topical
$49.31
$65.05
$75.43

Cost
/Address

Topicals
/Eligible

Cost
/Topical

+$2.68
+$2.56

+5.0%
+4.5%

$122.20
$128.30

Table 15 considers the cost effectiveness of adding a screener incentive to each of the above mail
strategies. For example, adding a $2 incentive to the baseline mail strategy increases response by 4.4
percentage points at a cost of $2.13 per address. Generally, the $2 incentive increases response by
about 4 percentage points at about $2 per address and follow-up mailings increase response by 4.5 to 5
percentage points at $2.50 per address. Both strategies are effective at increasing response and are
effective in tandem – the implementation of one strategy does not negatively impact the effectiveness
of the other.

Table 15. Cost Effectiveness of Incentivized Data Collection Strategies

Impact of Adding $2 Incentive
Strategy
1FU + $2
2FU + $2
3.5FU + $2

Cost
/Address
$6.06
$8.54
$10.94

Topicals
/Eligible
22.5%
27.2%
31.7%

Cost
/Topical
$61.18
$71.44
$78.33

Cost
/Address
+$2.13
+$1.92
+$1.76

Topicals
/Eligible
+4.4%
+4.1%
+4.1%

Cost
/Topical
$110.00
$107.90
$98.00

Topical Incentive
The 2017 NSCH also included a cash incentive in topical mailings 7 and 8. Approximately 20% of cases
were assigned to the control group (no incentive), with the remaining cases receiving a $2 incentive.
Households were assigned to topical mail groups and began receiving topical mailings soon after
returning a paper screener. They continued receiving mailings until they returned a topical
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questionnaire or until a fourth topical questionnaire invite was sent. Because the incentive was included
in the 7th and 8th topical mailings, addresses were receiving their first, second, third, or fourth topical
mailing. Topical mailings 7 and 8 are mutually exclusive; there were no addresses included in both.
As anticipated, response was higher for cases receiving the incentive (see Table 16). The $2 incentive
increased the odds of response by 51%, controlling for the number of mailings received prior. By this
measure, the incentive was responsible for 315 of the 1,176 topical returns from mailings 7 and 8. Given
an incentive cost just over $13,000, the cost per topical from the incentive treatment comes out to
$41.25, suggesting that the topical incentive was a very cost efficient data collection strategy.
Table 16. Topical Response by Mail Count and Incentive

Mailing
First
Second
Third
Fourth

Return Rate
$2
$0
27.8%
21.7%
17.3%
11.8%
12.4%
2.4%
11.1%
10.0%

Infographic Effectiveness
Half of addresses received a one-page infographic with the initial contact materials. It was anticipated
that a colorful infographic that provided additional information about the survey in an appealing form
would encourage some households to participate. In that respect, the infographic was less effective
than anticipated.
On the whole, the infographic reduced response. 37.3% of all addresses returned a screener; only 36.8%
of those addresses that received the infographic returned a screener. Though small, the difference is
significant. The negative impact of the infographic was larger for the High Web group (-1.4 percentage
points of response) than the High Paper group (-0.5 percentage points of response and not statistically
significant). This could indicate that the infographic added unwanted clutter to the smaller, web invite
only envelope received by the High Web group than the larger package mailed to High Paper addresses.
It should also be noted that these infographic treatment groups were objectively assigned and not
random, thus other differences between households in these two groups cannot be ruled out as the
driving force behind the differential effectiveness of the infographic. Regardless, the infographic was not
effective.

Web Group Effectiveness
Census modified data collection procedures based on the estimated block group-level paper response
likelihood. Since 2012, ACS respondents have been able to submit survey forms over the internet.
Alternatively, ACS respondents can eschew the online option and respond by mail (or personal
interview) instead. For the 2017 NSCH, Census developed a paper-response probability index built on
ACS response mode behavior and small-area geographic characteristics to identify block-groups with

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more residents that would opt against responding by web, but would ultimately respond by mail (versus
not responding entirely).
NSCH mailable addresses were assigned a paper-response probability score and sorted. The highest
scoring 30% of addresses were assigned to the High Paper group. To accelerate response and reduce
respondent frustration, these addresses were provided a paper screener questionnaire in the initial
contact. The remaining 70% of addresses were classified as High Web, and received a first paper
screener in the second nonresponse follow-up. See Table 17 for an overview of the data collection
procedures for both the High Web and High Paper groups.
Table 17. Data Collection for High Web vs. High Paper Addresses

Mailing 1
Mailing 2
Mailing 3
Mailing 4
Mailing 5

High Web
Web
Web
Web+Paper
Web+Paper
Web+Paper

High Paper
Web+Paper
Web+Paper
Web+Paper
Web+Paper
N/A

Screener response was significantly higher for the High Paper group, 43.3% of all addresses versus 34.8%
of all High Web addresses. The mode of response correlated with Census’ expectations; the High Paper
group was three times as likely to respond by paper but 60% as likely to respond by web as the High
Web group.
The additional response from the High Paper group came with a cost, approximately $2.10 per case. This
suggests that the additional High Paper screener response cost about $24.63 per returned screener, on
par with the average cost of about $25 per returned screener. At this stage we cannot evaluate the
independent effect of the High Paper treatment on screener response because High Web/Paper group
assignments were not random. But we are satisfied at this stage that the High Paper group assignment
methodology identified addresses likely to respond by paper, and that targeting these addresses with
paper screeners in the initial contact accelerates and probably increases response.

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Data Editing
Census processed the data for inconsistent, out-of-range, and out-of-path responses. Finally, Census
applied a completeness test to label cases as completed interviews, sufficient partials, or insufficient
partials, and Census removed insufficient partials from the data files.

Unduplication
All nonresponding households were offered two modes, web and paper, for completing the survey. In
some cases, respondents utilized both options. In these cases, Census selected one response, web or
paper, to include in the data file. The unduplicated process prioritized records based on the type of
return and the level of completeness. Completed web surveys were always selected over completed
paper returns. However, completed paper returns were chosen over partial web survey returns. The
web/paper unduplication hierarchy is detailed in Table 18.
Table 18. Unduplication Criteria for both Web and Paper Returns

Order Chosen
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Type of Return
Completed web survey - Household with children
Completed paper screener and topical
Completed web survey - Household w/o children
Completed paper screener - Household w/o children
Partially completed web survey
Out of scope paper return
Refusal paper return, Hard Refusal
Incomplete, Duplicate
Blank, Soft Refusal
Deceased
Undeliverable address (UAA) with address correction –
mail forwarded, UAA with address correction
UAAs, Forwarding Order Expired, Moved out of U.S.
Default
Blank form

Multiple follow-up mailings including the screener and topical questionnaires were sent out so it was
also possible that respondents received more than one paper questionnaire and sent back two paper
submissions. In these cases, only one return was chosen to be included in the data file. A completed
paper return for a household with children was always chosen first. Completed paper returns without
children were then chosen. A blank form was always the last type of return to be chosen. If both returns
were complete screeners without eligible children, the record with the most number of variables that
contained data was chosen. For all other Automated Tracking and Control (ATAC) status codes, if there
were two of the same code, the return with the earliest received date was chosen. The paper/paper
unduplication hierarchy is detailed in Table 19.

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Table 19. Unduplication Criteria for Two Paper Returns

Order Chosen
1
2
3
4
5
6
7
8
9
10
11

Type of Return
Completed paper screener/topical - Household with
children
Completed paper screener - Household w/o children
Out of scope paper return
Refusal paper return, Hard Refusal
Incomplete, Duplicate
Blank, Soft Refusal
Deceased
UAA with address correction – mail forwarded, UAA with
address correction
UAAs, Forwarding Order Expired, Moved out of U.S.
Default
Blank form

Paper to Web Standardization
Responses were standardized across web and paper so they could be appended in a single data file.
Although the majority of the survey questions had the same valid values for the paper and web
instruments, sometimes the values did not appear in the same order on the paper questionnaire as in
the web survey instrument. For instance, the first screener question on both the paper and the web
instruments asked the respondent if there were any children 0-17 years living or staying at their address.
For the paper screener, in order to provide the appropriate skip pattern, the “No” response option was
listed first with an instruction to the respondent that they were done with the survey; “Yes” was the
second response option with an instruction to continue with the rest of the screener questionnaire. In
the web instrument, there was no benefit to listing “No” as the first response option, because skips
were programmed into the web instrument and “No” is traditionally listed after the “Yes” response
option. Therefore, prior to appending web and paper responses into a single data file, paper responses
were reformatted to the proper valid values. After the topical responses were combined, screener and
sampling data were merged into the data file.

Data Processing
The 2017 National Survey of Children’s Health (NSCH) raw output was processed to manage inconsistent
and invalid responses in nine sequential steps: stop process, not in universe, range, backfill, yes/no,
consistency, legitimate skip, missing in error, and disclosure.


Stop Process Edit. A case is removed from the data file if the case fails address verification (the
respondent indicates that their address does not match the address on file), the respondent
indicates that there are no children in the household, or the respondent does not complete a
screener for a household with children. The cases are not eligible to be included on a NSCH data
file, so are removed from processing.

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






Not in Universe Edit. An item is not in universe if it is not included in the instrument the
respondent received. Some items are unique to web or paper, and others are specific to a
version of the topical instrument, T1, T2, or T3. The value for an item that is not in universe is
set to ‘.N’.
Range Edit. If a value falls outside the bounds of a defined minimum and maximum for that
item, the value is replaced with an indicator that the response is missing. The minimum and
maximum are selected to represent a reasonable range of possible responses to the item.
Backfill Edit. The backfill edit imputes values to some items based on responses to subsequent
items that necessarily indicate the correct response to the edited item. Backfill edits apply
almost exclusively to paper questionnaires, which cannot prevent a respondent from skipping a
root item but answering follow-up questions. For example, INCWAGES is a binary item that
filters respondents on whether the family did (INCWAGES=1) or did not (INCWAGES=2) receive
wage or salary income. If a respondent does not answer INCWAGES, but provides a valid and
non-zero value for INCWAGES_AMT, the dollar amount of wage and salary income, then it is
necessarily correct that INCWAGES=1.
Yes/No Edit. The NSCH includes several series that ask respondents to select all applicable items
from a list. These series may or may not allow the respondent to answer in the negative,
indicating that the item is not applicable. In most cases, if a respondent answers in the
affirmative (=1) to at least one item in the series, it is assumed that all other items in the series
do not apply (=2) unless otherwise noted. If a respondent is only able to respond in the
affirmative, and the items in the series are not comprehensive (e.g., they do not include an
“Other” option), then it is assumed that all unanswered items do not apply (=2) without
imposing the requirement that at least one item is answered in the affirmative.
Consistency Edit. If responses to two items in the survey are fundamentally inconsistent, one
response is maintained and the other is removed and changed to missing. Most consistency
edits require that a child does not experience a life event at an age greater than their current
age. Because the instrument generally trends from more general, fundamental information to
more specific, priority is given to the item that appears first in the instrument.
Legitimate Skip Edit. Unlike the ‘Not in Universe Edit’, the legitimate skip edit applies to items
that are on the respondent’s instrument, but not on path. The value for an item that is in
universe but not on path is set to ‘.L’.
Missing in Error Edit. If an item is in universe (does not equal .N), is on path (does not equal .L),
but does not hold a valid value, that item is missing in error, identified as ‘.M’.
Disclosure Edit. Some survey responses, if published, could compromise a respondent’s
confidentiality. Disclosure edits involve removing entire items (e.g., child’s name) or suppressing
rare or unique values (e.g., top codes on the family poverty ratio). Census disclosure avoidance
standards make reference to weighted and unweighted cell counts (i.e., the number of children
with a characteristic or set of characteristics), the size of the underlying population (e.g., the
number of children in Kentucky Metropolitan Statistical Areas), and the existence of outside
data sources that could be matched to the NSCH (e.g., a registry of children diagnosed with
Cerebral Palsy).

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Edits were applied in two stages. In the first stage, edits for screener items were applied to completed
screeners with children. When these edits were completed, cases that did not return a completed
topical were removed from edits, and the second stage edits to topical items were applied.

Standardized and Recoded Variables
Standardized Variables
Several questions in the 2016 NSCH allowed respondents to provide an answer using more than one unit
(e.g., years and months) and to choose from two systems of units (e.g., imperial or metric). In these
cases, standardized variables convert responses across units and systems to a single unit. See Table 20
for a list and description of these variables.
Table 20. List of Standardized Variables

Variable
BIRTHWT_OZ_S
BREASTFEDEND_DAY_S
BREASTFEDEND_WK_S
BREASTFEDEND_MO_S
FRSTFORMULA_DAY_S
FRSTFORMULA_WK_S
FRSTFORMULA_MO_S
FRSTSOLIDS_DAY_S
FRSTSOLIDS_WK_S
FRSTSOLIDS_MO_S

Description
Child birth weight
Stopped breastfeeding
Stopped breastfeeding
Stopped breastfeeding
First fed formula
First fed formula
First fed formula
First fed solids
First fed solids
First fed solids

Units
Ounces
Days
Weeks
Months
Days
Weeks
Months
Days
Weeks
Months

Recoded Variables
A number of variables were derived and recoded from existing variables on the survey. See Table 21 for
a list and description of these variables.
Table 21. List of Recoded Variables

Variable
AGEPOS4
TOTMALE
TOTFEMALE
C_CSHCN
SC_CSHCN
TOTCSHCN
TOTNONSHCN
TOTAGE_0_5
TOTAGE_6_11
TOTAGE_12_17
SC_AGE_LT4

Description
Birth position of the selected child relative to
other children in household
Count of male children in household
Count of female children in household
Special Health Care Needs (SHCN) status
SHCN status of selected child
Count of children with SHCN
Count of children without SHCN
Count of children 0 to 5 years old in household
Count of children 6 to 11 years old in household
Count of children 12 to 17 years old in household
Age of selected child (less than 4 months)

2017 National Survey of Children’s Health

Derived from
C_AGE_YEARS
C_AGE_MONTHS
C_SEX
C_SEX
C_K2Q10 - C_K2Q23
C_CSHCN
CSHCN
C_K2Q10 - C_K2Q23
C_AGE_YEARS
C_AGE_YEARS
C_AGE_YEARS
SC_AGE_YEARS
SC_AGE_MONTHS

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Variable
SC_AGE_LT6

Description
Age of selected child (less than 6 months)

SC_AGE_LT9

Age of selected child (less than 9 months)

SC_AGE_LT10

Age of selected child (less than 10 months)

C_RACER
C_RACEASIA

SC_HISPANIC_R
HOUSE_GEN

Race of child
Asian race category is included for the following
states: CA, HI, MA, MD, MN, NJ, NV, NY, VA, WA
American Indian/Alaska Native race category is
included for the following states: AK, AZ, NM,
MT, ND, OK, SD
Hispanic origin
Race of selected child
Asian race category is included for the following
states: CA, HI, MA, MD, MN, NJ, NV, NY, VA, WA
(Selected Child)
American Indian/Alaska Native race category is
included for the following states: AK, AZ, NM,
MT, ND, OK, SD (Selected Child)
Hispanic origin of selected child
Parental nativity

FAMILY

Family structure

CURRINS

Current health insurance coverage status

INSTYPE

Type of insurance

INSGAP

Health insurance coverage over the past 12
months
Family poverty ratio

C_RACEAIAN

C_HISPANIC_R
SC_RACER
SC_RACEASIA

SC_RACEAIAN

FPL

2017 National Survey of Children’s Health

Derived from
SC_AGE_YEARS
SC_AGE_MONTHS
SC_AGE_YEARS
SC_AGE_MONTHS
SC_AGE_YEARS
SC_AGE_MONTHS
C_RACE_R
C_RACE_R
C_RACE_R

C_HISPANIC
SC_RACE_R
SC_RACE_R

SC_RACE_R

SC_HISPANIC
BORNUSA
A1_RELATION
A1_BORN
A2_RELATION
A2_BORN
A1_RELATION
A2_RELATION
A1_MARITAL
A2_MARITAL
A1_SEX
A2_SEX
K3Q04_R
CURRCOV
K12Q03, K12Q04,
K12Q12, TRICARE,
HCCOVOTH, K11Q03R
CURRINS
K12Q03, K12Q04,
K12Q12, TRICARE,
HCCOVOTH, K11Q03R
K3Q04_R, CURRINS
FAMCOUNT
TOTINCOME

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Variable
HIGRADE
HIGRADE_TVIS
BIRTHWT
BIRTHWT_L
BIRTHWT_VL
BMICLASS

Description
Highest level of education for reported adults
(three categories)
Highest level of education for reported adults
(four categories)
Birth weight status
Low birth weight (<2500g)
Very low birth weight (<1500g)
Body Mass Index

Derived from
A1_GRADE
A2_GRADE
A1_GRADE
A2_GRADE
BIRTHWT_OZ_S
BIRTHWT_OZ_S
BIRTHWT_OZ_S
WEIGHT_*
HEIGHT_*

Specification of Select Derived Variables
Family Poverty Ratio (FPL) - The family poverty ratio is calculated as the ratio of total family income and
the family poverty threshold, and reported as a rounded percentage. Respondents reported total family
income in item K4 on the paper instrument: “The following question is about your 2016 income. Think
about your total combined family income IN THE LAST CALENDAR YEAR for all members of the family.
What is that amount before taxes?” Additional text instructed respondents to include all money
incomes, for example, social security, dividends, and child support. Responses to K4 were edited for
consistency against answers in K3, a series of questions about specific sources of income. Finally, missing
or invalid responses were replaced with multiply imputed values.
The family poverty threshold is derived from the Census Bureau’s poverty thresholds. Thresholds vary by
family size and the number of related children under 18 years. They do not vary across geographies.
Family size was reported in K2 of the paper instrument. Missing or invalid values were assigned using
reported or multiply imputed values of household count adjusted for the number of nonfamily members
in the household. The number of related children was determined by the number of children reported in
the screener.
To protect the confidentiality of respondents, only FPL is reported in the Public Use File; total family
income and the family poverty threshold are not included. Further, FPL is top and bottom coded.
Reported values range from 50 (total family income is 50% of the family poverty threshold) to 400 (total
family income is 400% of the family poverty threshold). Values beyond this range are reported as 50 or
400, respectively.
Household Nativity (HOUSE_GEN) - Household nativity is determined by the birth location of the child
(BORNUSA) and parents (A1_BORN and A2_BORN). If the child was born outside of the U.S. and all
reported parents were born outside of the U.S., the household is reported as a 1st generation household.
Second generation households have members born both inside and outside of the U.S. For example, the
child was born in the U.S. and at least one parent was born outside of the U.S., or the child was born
outside of the U.S. and one of two parents was born in the U.S.
Finally, in 3rd+ generation households, all parents were born in the U.S. A fourth category, “Other”,
captures households with insufficient information about the nativity of the parents.

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Family Structure (FAMILY) - A family structure variable uses the reported information on the child’s
primary caregivers to organize households into common types. Notably, the NSCH collects information
on only two adults in the household and requires only that the two adults be primary caregivers of the
child. As a result, in multigenerational households, this can mean that a biological, adoptive, or step
parent is not reported.
Further, respondents do not report their relationship to other adult members of the household, only to
the child; consequently, reported values may indicate that two adults are married, but not if they are
married to each other. Instead of making assumptions about the relationship between reported adults,
the family structure variable depends only on the number of adults in the household (one or two), their
relationship to the child, and their individual marital statuses. For example, a reported value of
FAMILY=1 means that the two reported adults are biological/adoptive parents of the child and they are
currently married; one may assume that they are married to each other, but in some cases that may not
be true.
Two family structure categories (FAMILY=5 and 6) are also defined by the sex of the respondent. In
these cases, it is specified that the responding adult is a female and that no other adults are in the
household.
Insurance - The 2017 NSCH reports several variables that include information on the child’s health
insurance status and insurance type. We strongly recommend that data users interested in current
health insurance status and insurance type use the derived variables CURRINS (Currently Insured),
INSGAP (Gaps in Coverage), and INSTYPE (Insurance Type) in their analyses.
Currently Covered (CURRINS) - CURRINS is derived primarily from the respondent-reported values in
K3Q04_R (Health Insurance Coverage – Past 12 Months) and CURRCOV (Health Insurance Coverage –
Currently Covered). The child is coded as currently insured (CURRINS=1) if the respondent reported that
the child had coverage for all of the last 12 months (K3Q04_R=1) or reported that the child is currently
covered (CURRCOV=1), but with an important caveat. If the respondent reported that the child is
currently insured but reported only Indian Health Service or health care sharing ministry as the type of
coverage, the child is coded as not having current insurance coverage (CURRINS=2). Consequently, a
respondent may report that a child is insured, but the child is coded as not insured in the data file.
Gaps in Coverage (INSGAP) - INSGAP is derived primarily from the respondent-reported values in
K3Q04_R (Health Insurance Coverage – Past 12 Months) and CURRCOV (Health Insurance Coverage –
Currently Covered). The child is coded as having consistent coverage (INSGAP=1) if the respondent
reported that the child had coverage for all of the last 12 months (K3Q04_R=1) but with an important
caveat. If the respondent reported that the child is currently insured but reported only Indian Health
Service or health care sharing ministry as the type of coverage, information about the consistency of the
child’s coverage is coded as missing (INSGAP=.M).
Insurance Type (INSTYPE) - INSTYPE is derived from CURRINS (Currently Insured) and respondent
answers to questions on the coverage type: K12Q03 (Current/Former Employer or Union), K12Q04
(Directly Purchased), K12Q12 (Government Assistance Plan), TRICARE (TRICARE or other military health
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care), K11Q03 (Indian Health Service), and HCCOVOTH_WRITEIN (Other Type, Write-in). Any insurance
reported as coming from an employer or union, directly purchased, TRICARE or other military health
care, or the Affordable Care Act is considered private. Coverage from any government assistance plan is
considered public. Both the private and public coverage categories reflect a single reported source of
coverage; a combined category for children with both public and private coverage is also included.
HCCOVOTH_WRITEIN - Write-in responses were back-coded to flag public and private insurance types,
religious health care sharing ministry, and Indian Health Service coverage. These flags were used in the
derivation of CURRINS and INSTYPE. To protect respondent confidentiality, answers to
HCCOVOTH_WRITEIN are not reported in the Public Use File.
Suppressed Variables
A number of variables had range caps or suppressed values to protect respondent confidentiality. See
Table 22 for a list and description of these variables.
Table 22. List of Suppressed Variables

Variable
TOTKIDS_R

Description
Number of children living in the household

MOMAGE

Age of mother when child was born

K2Q35A_1_YEARS

Age of child when first diagnosed with
autism
Birth weight

BIRTHWT_OZ_S
K11Q43R
A1_AGE

Number of time the child has moved to a
new address
Age of Adult 1

A2_AGE
A1_LIVEUSA

Age of Adult 2
When Adult 1 came to live in the U.S.

A2_LIVEUSA

When Adult 2 came to live in the U.S.

BREASTFEDEND_DAY_S
BREASTFEDEND_WK_S
BREASTFEDEND_MO_S
FRSTFORMULA_DAY_S
FRSTFORMULA_WK_S
FRSTFORMULA_MO_S
FRSTSOLIDS_DAY_S
FRSTSOLIDS_WK_S
FRSTSOLIDS_MO_S

Stopped breastfeeding, age in days
Stopped breastfeeding, age in weeks
Stopped breastfeeding, age in months
First fed formula, age in days
First fed formula, age in weeks
First fed formula, age in months
First fed solids, age in days
First fed solids, age in weeks
First fed solids, age in months

2017 National Survey of Children’s Health

Valid Values
1=1
2=2
3=3
4 = 4+
18 = 18 years or younger
45 = 45 years or older
1 = 1 year or younger
15 = 15 years or older
72 = 72 oz. or less
155 = 155 oz. or more
13 = 13 or more times
19 = 18 or 19 years old
75 = 75 years or older
75 = 75 years or older
1970 = Before or in 1970
2017 = In or after 2017
1970 = Before or in 1970
2017 = In or after 2017
Suppressed if > 5
Suppressed if > 10
30 = 30 or more
Suppressed if > 6
Suppressed if > 10
12 = 12 or more
Suppressed if > 1
Suppressed if > 4
15 = 15 or more
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Variable
FPL

Description
Family poverty ratio

FAMCOUNT
HHCOUNT
K4Q37
SESPLANYR

Family Count
Household Count
Received Special Services - Age in Years
Special Education Plan - Age in Years

Valid Values
50 = 50% or less
400 = 400% or more
8 = 8 or more
10 = 10 or more
15 = 15 or more
16 = 16 or more

Geography Variables
The 2017 NSCH includes four geographic variables on the Public Use File: FIPSST (State of Residence),
CBSAFP_YN (Core-Based Statistical Area Status), METRO_YN (Metropolitan Statistical Area Status), and
MPC_YN (Metropolitan Principal City Status) (see Table 23). The intersection of CBSAFP_YN and
METRO_YN also identifies children in Micropolitan Statistical Areas (see Table 24).
Core-Based Statistical Areas (CBSAs) are defined as a county or counties with at least one urbanized area
or urban cluster (a core) of at least 10,000 population, plus adjacent counties that have a high degree of
social and economic integration with the core (as measured through commuting ties). There are two
types of CBSAs: Metropolitan Statistical Areas (MSAs) and Micropolitan Statistical Areas (μSAs). The
differentiating factor between these types is that MSAs have a larger core, with a population of at least
50,000. Principal Cities include the largest incorporated place or census designated place (CDP) in a CBSA
and any other incorporated place or CDP that meets specific population and workforce requirements.12
The NSCH reports Principal City status only for addresses in MSAs.
The intersection of CBSAFP_YN, METRO_YN, and MPC_YN identifies four geographic areas (see Table
26):
-

Not in a CBSA (CBSAFP_YN=2)
Micropolitan Statistical Area (CBSAFP_YN=1 and METRO_YN=2)
Metropolitan Statistical Area, not Principal City (METRO_YN=1 and MPC_YN=2)
Metropolitan Principal City (MPC_YN=1)

To protect respondent confidentiality, CBSAFP_YN, METRO_YN, and MPC_YN are not reported in some
states. If a variable or intersection of variables could be used to identify a geographic area within a state
with a child population under 100,000, reported values for that variable were replaced with ".D",
indicating "Suppressed for Confidentiality". Note that values identifying both the suppressed area and
the counterpart area must be suppressed; for example, if the child population in non-MSAs for a
particular state is less than 100,000, then any indicator of MSA status (i.e., both non-MSA and MSA) in
that state is suppressed. CBSA status is suppressed in 27 states, MSA status is suppressed in 16 states,
and Metropolitan Principal City status is suppressed in 21 states.

See https://www.census.gov/geo/reference/gtc/gtc_cbsa.html

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Table 23. List of Geography Variables

Variable
CBSAFL_YN

METRO_YN

MPC_YN

Description
Core Based Statistical Area (CBSA): County or counties
associated with at least one core (urbanized area or urban
cluster) of at least 10,000 population, plus adjacent
counties having a high degree of social and economic
integration with the core as measured through commuting
ties.
Metropolitan Statistical Area (MSA): County or counties
associated with at least one urbanized area of at least
50,000 population, plus adjacent counties having a high
degree of social and economic integration with the core as
measured through commuting ties.
Metropolitan Principal City: An incorporated place or
census designated place in a Metropolitan Statistical Area
that meets specific population and workforce
requirements.

Valid Values
.D = Suppressed for confidentiality
1 = Located within a CBSA
2 = Located outside a CBSA

.D = Suppressed for confidentiality
1 = In MSA
2 = Not in MSA

.D = Suppressed for confidentiality
1 = In Metropolitan Principal City
2 = Not in Metropolitan Principal City

Table 24. Geographies Identified at the Intersections

Intersection

Geography Levels
In MSA

CBSAFP_YN x
METRO_YN

In Micropolitan Statistical Area

Not in CBSA (Metro or Micro)
In Metropolitan Principal City
METRO_YN x
MPC_YN

CBSAFP_YN x
METRO_YN x
MPC_YN

In MSA, not in Principal City
Not in MSA
In Metropolitan Principal City

In MSA, not in Principal City
2017 National Survey of Children’s Health

Definitions
County or counties associated with at
least one urbanized area of at least
50,000 population, plus adjacent counties
having a high degree of social and
economic integration with the core as
measured through commuting ties.
County or counties (or equivalent entities)
associated with at least one urban cluster
of at least 10,000 but less than 50,000
population, plus adjacent counties having
a high degree of social and economic
integration with the core as measured
through commuting ties.
An incorporated place or census
designated place in a Metropolitan
Statistical Area that meets specific
population and workforce requirements.
In an MSA but not in a Principal City.
An incorporated place or census
designated place in in a Metropolitan
Statistical Area that meets specific
population and workforce requirements.
In an MSA but not in a Principal City.
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Intersection

Geography Levels
In Micropolitan Statistical Area

Definitions
County or counties (or equivalent entities)
associated with at least one urban cluster
of at least 10,000 but less than 50,000
population, plus adjacent counties having
a high degree of social and economic
integration with the core as measured
through commuting ties.

Not in CBSA

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Weighting Plan
Overview
To obtain population-based estimates, each selected child for whom an interview was completed was
assigned a weight. The child’s weight was composed of a base sampling weight, adjustments for both
screener and topical nonresponse, an adjustment for the selection of a single child within the sample
household, and adjustments to control to population counts for various demographics obtained from
the 2016 American Community Survey (ACS) one-year data. In addition to a final weight for selected
children, household and child screener weights were assigned for all households and children with
completed screeners. These additional weights were comprised mostly of a subset of the adjustments
used to assign final weights to selected children. The various steps in the production of the weights are
described below.
Base Sampling Weights
The weighting process began with the base sampling weight for each sample household. The base
weight (i.e., sampling interval) for each sample housing unit was the inverse of its probability of
selection for the screener. Base weights were calculated separately for each of the two strata and each
state, including the District of Columbia. If there had been no nonresponse and the survey frame was
complete, using this weight would give unbiased estimates for the survey population.
Adjustment for Screener Nonresponse
Following the base weight, an adjustment for screener nonresponse was implemented to increase the
weights of the households that responded to the screener in order to account for all of the households
that did not respond to the screener. Households were put into one of sixteen cells defined by stratum,
a block group poverty measure variable (yes or no) indicating the proportion of households with income
less than 150% of the federal poverty level, web group (High Paper or High Web), and whether they
reside inside or outside of a Core Based Statistical Metropolitan Area. The screener nonresponse
adjustment factor was calculated within each cell using the following formula:
(

weighted sum of screener interviews + weighted number of screener non-interviews
)
weighted sum of screener interviews

where the number of screener non-interviews =
(

weighted sum of screener interviews
)
weighted sum of screener interviews + weighted sum of screener ineligible households
×
(weighted sum of households with unknown screener eligibility)

In other words, the count of screener non-interviews was an estimate of the expected number of
eligible households from those cases for which nothing was received back. The term “eligible” here
refers to the address belonging to an occupied, residential household. The expected number of eligible
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cases was estimated by taking the eligibility rate among the known cases and applying it to the unknown
cases. The screener nonresponse adjustment was the last step of the weight processing that included
the households for which there was no screener interview and the screener-interviewed households
that indicated no eligible children.
Adjustment to Population Controls at the Household Level
All households with children that completed a screener were given a household-level weight. In addition
to the base weight and screener nonresponse adjustment, a household post-stratification adjustment
was applied in order to achieve the final household screener weight. This factor consisted of ratio
adjustments to population controls at the household level obtained from the 2016 ACS data.
Households were put into one of 255 cells defined by state, race of the child selected for the topical, and
Hispanic origin (yes or no) of the selected child if the selected child’s race was White. Within each cell,
the household post-stratification adjustment was calculated as the ACS population count for the cell
divided by the cell’s weighted total. The product of the base weight, screener nonresponse adjustment,
and this household post-stratification adjustment constituted the final household screener weight.
First Raking to Population Controls: All Screener Children
All eligible children (four at most) from completed screener interviews were given a child-level screener
weight. The weights of children from completed screener interviews were adjusted to match the 2016
ACS estimates for the following characteristics:
•
•
•

Dimension #1 – State by Child’s Race (White, Black, Asian, Other)
Dimension #2 – State by Child’s Ethnicity (Hispanic, Non-Hispanic)
Dimension #3 – State by Child’s Sex by Child’s Age Group (0-5, 6-11, 12-17 years)

Each iteration of this process consisted of calculating three ratio adjustments, one for each dimension,
sequentially. The adjustment factor calculated for Dimension 1 was applied to the weights accordingly
and this newly adjusted weight went into the calculation of the adjustment factor for Dimension 2. This
iterative raking process continued until the difference between the sum of the weights and the control
total associated with each cell was less than 10% of the control. The resulting weight from this process
was the final child-level screener weight for each eligible child. Only the children selected for the topical
continued in the weighting process to eventually receive a final interviewed child weight.
Adjustment for Households with More than One Child
In households with multiple children, the selected child represented all eligible children in their
household. Thus, a within-household subsampling factor was applied to account for the selection of a
single child, as well as the oversampling for young children and children with special health care needs
(CSHCN). The value of this adjustment was the inverse of the probability of selection for the selected
child. Probabilities varied by the number of children in the household, the presence of children aged 0-5,
and the presence of CSHCN.

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Adjustment for Topical Nonresponse
Similar to the screener nonresponse adjustment, the weights of the households responding to the
topical needed to be increased to account for all of the households not responding to the topical. If the
respondent reached Section H of the topical questionnaire and answered at least 50% of the key items,
then it was considered a topical interview. A returned topical that did not meet these conditions was
considered a topical non-interview.
All topical-eligible households were put into one of seven cells depending on imputed poverty/non-poverty
status, web group (High Paper vs. High Web), and presence of CSHCN. The topical nonresponse adjustment was
calculated within each of the eight cells as:
weighted sum of topical interviews + weighted sum of topical non-interviews
(
)
weighted sum of topical interviews
After this adjustment, the selected children from topical non-interview households were no longer
involved in the weighting process and only interviewed children continued to the last steps.
Second Raking to Population Controls: Topical Interviewed Children
The final step of the weighting was accomplished through a second iterative raking process to ACS
population controls. The process was equivalent to that of the child-level screener weight, with the
exception of additional and different dimensions as well as a trimming step. The following eight
analytical domains of interest were used:









Dimension #1 – State by Family Poverty Ratio (≤100%, 101-200%, >200%)
Dimension #2 – State by Household Size (≤3, 4, >4)
Dimension #3 – State Groupings by Respondent’s Education (High School)
Dimension #4 – State by Selected Child’s Race (White, Black, Asian, Other)
Dimension #5 – State by Selected Child’s Ethnicity (Hispanic, Non-Hispanic)
Dimension #6 – State by Selected Child’s Special Health Care Needs Status
Dimension #7 – Selected Child’s Race by Ethnicity (at the national level)
Dimension #8 – Selected Child’s Sex by Single Age (at the national level)

For Dimension #3, states needed to be grouped due to the low number of respondents in each state
with less than a high school degree. States were grouped with others that had similar education
distributions based on ACS data. The states were first sorted by the ACS-derived percent of children in
households where the respondent has less than a high school degree, followed by an additional sort by
the percent of children in households where the respondent has a high school degree. State groupings
were made with the intent of keeping these distributions similar within each group. The following were
the resulting 15 groupings:
Group 1: Minnesota, New Hampshire, North Dakota, and Utah
Group 2: Maine, Montana, Vermont, and Wyoming
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Group 3: Colorado, Maryland, Massachusetts, and Virginia
Group 4: Connecticut, Kansas, Nebraska, and New Jersey
Group 5: Hawaii, Iowa, Michigan, and Wisconsin
Group 6: Illinois, Oregon, Rhode Island, and Washington
Group 7: Idaho, Ohio, South Dakota, and West Virginia
Group 8: Kentucky, Missouri, Pennsylvania, and Tennessee
Group 9: District of Columbia, Florida, North Carolina, and South Carolina
Group 10: Alaska, Delaware, and Indiana
Group 11: Georgia and New York
Group 12: Alabama and Mississippi
Group 13: Arkansas, Louisiana, and Oklahoma
Group 14: Arizona and Nevada
Group 15: California, New Mexico, and Texas
Trimming of Large Weights
The resulting weights from each iteration of the raking process were checked for extreme values in
order to prevent a small number of cases with large weights from having undue influence on estimates
and increasing the variance. An extreme value was determined to be a weight that exceeded the median
weight plus six times the interquartile range (IQR) of the weights in each state. These extreme weights
were truncated to this cutoff (median plus six times the IQR of weights in that state) and the weights
were checked for convergence to the controls. Convergence required the weighted total of each cell to
be within 1% of the control for the cell. If convergence was not met for every cell, another iteration of
the raking process was applied again. This process of raking and trimming was reiterated until
convergence was met and there were few extreme weights left. In general, the remaining extreme
weights were observed to be very close to the cutoff. The remaining extreme weights were truncated a
final time to the median plus six times the IQR in the state and the process was complete.

Population Controls
Population controls used throughout the weighting were derived from the 2016 ACS one-year estimates.
By using the 2016 ACS data, the weighted totals were ensured to match the most up-to-date population
control totals available for key demographic variables for children and households in the U.S. The
controls were used in the household post-stratification adjustment, the raking to attain the child-level
screener weights, and the raking to attain the final topical interviewed children weights. Almost all
controls used were at the state level, with the exception of the last two dimensions where national-level
controls were used in the second raking process.
For the household post-stratification adjustment, the National Survey of Children’s Health (NSCH)
household weights were adjusted so that the sum of the weights equaled the 2016 ACS estimates for
the number of households in each state by race (White, Black, Asian, Other) and by Hispanic origin (yes
or no) if the selected child’s race was White. In the first raking process, up to four children from each
screener received adjustments so that the sum of the weights of all children listed on screeners equaled
the ACS estimates for the number of children in each state by race, state by Hispanic origin, and state by
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sex by age group (0-5, 6-11, 12-17 years). Finally, in the second raking process, the weights of the NSCH
topical interviewed children were adjusted so that the sum of their weights equaled the ACS estimates
for each state by family poverty ratio (≤100%, 101-200%, >200%), household size ( ≤3, 4, >4),
respondent’s highest level of education (High School), race, Hispanic origin,
and special health care needs status, as well as race by ethnicity and sex by age in years at the national
level.

Limitations
In order to minimize the variability of the weights caused by large adjustment factors, cells having fewer
than 30 cases were collapsed with a neighboring cell. The adjustment factors were then calculated for
the merged cells by combining the population controls and the sample cases for the two cells. Since the
individual cells were combined, and only one adjustment factor was created per cell, only the weighted
total for the combined cell will match the control following the raking procedure. Consequently, the
weighted totals for the individual cells will most likely not match the population controls for the original
individual cells.
As shown in Table 25, cells were collapsed in two of the dimensions in the last raking step.
Table 25. Collapsed Dimensions and Affected States

Black collapsed with
Other in 24 states
Dimension #4 - State by Selected
Child’s Race (White, Black, Asian,
Other)

Dimension #5 - State by Selected
Child’s Ethnicity (Hispanic, NonHispanic)

2017 National Survey of Children’s Health

Asian collapsed with
Other in 34 states
Hispanic and NonHispanic collapsed in
7 states

Affected states:
AK, AZ, CO, HI, ID, IA, KS, ME, MA, MN,
MT, NE, NH, NM, ND, OK, OR, SD, UT, VT,
WA, WV, WI, WY
Affected states:
AL, AZ, AR, CO, DC, ID, IN, IA, KS, KY, LA,
ME, MN, MS, MO, MT, NE, NH, NM, NC,
ND, OH, OK, OR, PA, RI, SC, SD, TN, UT,
VT, WV, WI, WY
Affected states:
AL, ME, NH, ND, SD, VT, WV

U.S. Census Bureau

Imputation
Overview of Missing Data
Data from the 2017 National Survey of Children’s Health (NSCH) can be missing due to a few
reasons: a respondent did not answer a question, a question was not on path for a respondent,
or a respondent’s answer to a question was removed in order to protect their privacy. The SAS
and Stata data files for the NSCH include special missing value codes for analysts who may wish
to differentiate between different types of missing values.
 (.L) Legitimate Skip – The item is not applicable to the respondent, as determined by a
previous answer to a root question.
 (.M) Missing in Error – The value is missing due to respondent or system errors, or the
respondent did not provide a valid answer.
 (.N) Not in Universe – The item was not included on the respondent’s age-appropriate version of
the topical questionnaire.
 (.D) Suppressed for Confidentiality – The value is suppressed in order to protect respondent
confidentiality.

Imputed Variables and Flags
A small number of variables were imputed to be used in weighting (see Table 26). Race, ethnicity, and
sex were imputed using hot-deck imputation for all children with missing values on those items. Adult 1
education, household size, and total family income were imputed using regression imputation methods.
Total family income was used as an input for the derived family poverty ratio and is not reported on the
public use file.
Table 26. List of Imputed Variables

Variable
C_SEX
C_RACE_R
C_HISPANIC_R
SC_SEX
SC_RACE_R
SC_HISPANIC_R
A1_GRADE
HHCOUNT
FPL

Description
Child’s sex
Child’s race, detailed
Child’s Hispanic origin
Selected child’s sex
Selected child’s race, detailed
Selected child’s Hispanic origin
Adult 1 highest completed year of school
Household size
Family poverty ratio

Public Use File
Screener
Screener
Screener
Topical
Topical
Topical
Topical
Topical
Topical

The Public Use Files include imputation flags to indicate which records contain imputed values (see
Table 27).
Table 27. List of Imputation Flags and Frequencies

Flag Variable
C_SEX_IF

Associated Variable(s)
C_SEX

2017 National Survey of Children’s Health

Imputation Rate
0.3%
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57
C_RACE_R_IF
C_HISPANIC_R_IF
SC_SEX_IF
SC_RACE_R_IF
SC_HISPANIC_R_IF
A1_GRADE_IF
HHCOUNT_IF
FPL_IF

C_RACER, C_RACE_R, C_RACEASIA,
C_RACEAIAN
C_HISPANIC_R
SC_SEX
SC_RACER, SC_RACE_R, SC_RACEASIA,
SC_RACEAIAN
SC_HISPANIC_R
A1_GRADE_I
HHSIZE_I
FPL

0.8%
1.1%
0.2%
0.4%
0.7%
2.0%
2.1%
16.0%

Multiple Imputation
Household size (HHCOUNT) and total family income (TOTINCOME_I) were multiply imputed, creating six
implicates of each. In turn, these variables were used to create six implicates of the Family Poverty Ratio
(FPL). The imputation was executed by sequential regression modeling imputation13 using IVEWare.14
The primary motivation for the multiple imputation is to allow interested researchers to appropriately
account for uncertainty in estimates using FPL that is hidden when using a single implicate.15
The Screener and Topical Public Use Files include the imputed values for sex, race, and ethnicity, and the
associated imputation flags; the Topical Public Use File includes imputed values for Adult 1 education
(A1_GRADE) and household count (HHCOUNT), and the associated imputation flags. The Topical Public
Use File also includes the six implicates of FPL.

Raghunathan TE, Lepkowski JM, Hoewyk JV, Solenberger PW. 2001. “A Multivariate Technique for Multiply
Imputing Missing Values using a Sequence of Regression Models”. Survey Methodology, 27: 85–95.
14
Raghunathan TE, Solenberger PW, Hoewyk JV. 2016. IVEware: Imputation and Variance Estimation Software
User’s Guide (Version 0.3). Ann Arbor, MI: Institute for Social Research, University of Michigan.
www.isr.umich.edurs/c/smp/ive/
15
Schaefer JL, Graham JW. 2002. “Missing Data: Our View of State of the Art”. Psychological Methods, 7(2): 147-77.
2017 National Survey of Children’s Health

U.S. Census Bureau

Estimation and Hypothesis Testing
Variance Estimation
When survey weights are used, the resulting estimates from the 2017 National Survey of Children’s
Health (NSCH) are representative of all non-institutionalized children aged 0 to 17 years in the U.S. and
in each state and the District of Columbia who live in housing units. These weighted estimates do not
generalize to the population of parents, mothers, or pediatric health care providers. Analysts are
advised to avoid statements such as “the percent of parents”.
Two stratum identifiers should be used to estimate variance: FIPSST (state of residence) and STRATUM
(identifies households flagged with children). Each record in the data file is assigned a unique household
identifier, HHID. Some analysts may be using statistical programs that only permit the specification of a
single stratum variable. These users should define a new variable with 102 levels by crossing STRATUM (2
levels) with FIPSST (51 levels). This new variable can then be used as the stratum variable. For example,
Stata users can specify only one variable in the strata() option of svyset. This new variable (named here
as STRATACROSS) can be created using the following statement:


EGEN STRATACROSS = GROUP (FIPSST STRATUM)

SUDAAN users can identify both FIPSST and STRATUM in the NEST statement. However, SUDAAN users
should note that the first variable listed after the word NEST is assumed to be the stratum variable, and
the second variable listed is assumed to be the PSU. To properly identify the PSU variable, the PSULEV
option must be invoked in the NEST statement as shown here:


NEST FIPSST STRATUM HHID / PSULEV = 3;

Data should not be subsetted before analysis. The procedure of keeping only select records and listwise deleting other records is called subsetting the data. Most software packages that analyze complex
survey data will incorrectly compute standard errors for subsetted data, because subsetting the data
can delete important design information needed for variance estimation. Analysts should not subset
the data, with one exception: Subsetting the survey data to a particular state does not compromise the
design structure. Analysts interested in examining specific population subgroups (such as children living
in poverty) must use the appropriate options in their software package (e.g., SUBPOPN in SUDAAN).

Combining Data across Survey Years
Yes, the data sets can be combined (appended) to derive multi-year estimates, though the survey
weights should be adjusted. Since each year is already weighted to represent the population of children
residing in households for that year, the weight can simply be divided by the number of years being
combined to derive multi-year estimates with an average annual or midpoint population size. For
example, to calculate the combined 2016-2017 weight, analysts must divide each individual survey
weight by 2 (i.e., number of survey years being combined).

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59
Note: When analyzing combined years of data, it is also recommended that 2017 STRATUM=2a records
be recoded as STRATUM=2. Sampling strata need to be defined correctly in order to do variance
estimation or sampling error analyses. Whereas the two state-level sampling strata in 2016 were
STRATUM=1 and STRATUM=2, sampling in 2017 split Stratum 2 into Strata 2a and 2b, with no
households selected from STRATUM=2b. When analyzing individual years, the strata can be used as
defined on the data file. When analyzing combined years of data, it is recommended that 2017
STRATUM=2a records be recoded as STRATUM=2 to ensure that the combined file is correctly treated as
having two mutually exclusive sampling strata rather than three.

Guidelines for Data Use
The U.S. Census Bureau is conducting the NSCH on the behalf of the Health Resources and Services
Administration’s Maternal and Child Health Bureau (HRSA MCHB) within the U.S. Department of Health
and Human Services (HHS) under Title 13, United States Code, Section 8(b), which allows the Census
Bureau to conduct surveys on behalf of other agencies. Title 42 U.S.C. Section 701(a)(2) allows HHS to
collect information for the purpose of understanding the health and well-being of children in the U.S.
The data collected under this agreement are confidential under 13 U.S.C. Section 9. All access to Title 13
data from this survey is restricted to Census Bureau employees and those holding Census Bureau Special
Sworn Status pursuant to 13 U.S.C. Section 23(c).
Any effort to determine the identity of any reported case is prohibited. The Census Bureau and HRSA
MCHB take extraordinary measures to assure that the identity of survey subjects cannot be disclosed. All
direct identifiers, as well as characteristics that might lead to identification, have been omitted from the
data set. Any intentional identification or disclosure of a person or establishment violates the assurances
of confidentiality given to the providers of the information. Therefore, users must:




Use the data in this data set for statistical reporting and analysis only
Make no use of the identity of any person discovered, inadvertently or otherwise
Not link this data set with individually identifiable data from any other Census Bureau or nonCensus Bureau data sets

Use of the data set signifies users’ agreement to comply with the previously stated statutory-based
requirements. Before releasing any statistics to the public, the Census Bureau reviews them to make
sure none of the information or characteristics could identify someone. For more information about the
Census Bureau’s privacy and confidentiality protections, contact the Policy Coordination Office toll-free
at 1-800-923-8282.

2017 National Survey of Children’s Health

U.S. Census Bureau

Supporting Material
References
Bethell CD, Read D, Neff J, Blumberg SJ, Stein RE, Sharp V, Newacheck PW. 2002. “Comparison of the
Children with Special Health Care Needs Screener to the Questionnaire for Identifying Children with
Chronic Conditions—Revised.” Ambulatory Pediatrics, Jan-Feb 2(1): 49-57.
Blumberg SJ, Luke JV. 2010. Wireless Substitution: Early Release of Estimates from the National Health
Interview Survey, January–June 2010. National Center for Health Statistics. Available from:
http://www.cdc.gov/nchs/nhis.htm
Blumberg SJ, Foster EB, Frasier AM, et al. 2012. Design and Operation of the National Survey of
Children’s Health, 2007. National Center for Health Statistics. Vital Health Stat, 1(55). Available from:
http://www.cdc.gov/nchs/data/series/sr_01/sr01_055.pdf
Bramlett MD, Blumberg SJ, Ormson AE, et al. 2014. Design and Operation of the National Survey of
Children with Special Health Care Needs, 2009–2010. National Center for Health Statistics. Vital Health
Stat, 1(57). Available from: http://www.cdc.gov/nchs/data/series/sr_01/sr01_057.pdf
Brick JM, Williams D, Montaquila JM. 2011. “Address-Based Sampling for Subpopulation Surveys.” Public
Opinion Quarterly, 75(3): 409-28.
Dillman DA, Smyth JD, Christian LM. 2009. Internet, Mail and Mixed-Mode Surveys: The Tailored Design
Method, 3rd edition. Hoboken, NJ: John Wiley & Sons.
Foster EB, Frasier AM, Morrison HM, O’Connor KS, Blumberg SJ. 2010. All Things Incentive: Exploring
the Best Combination of Incentive Conditions. Paper presented at the American Association for Public
Opinion Research annual conference, Chicago, IL.
Raghunathan TE, Lepkowski JM, Hoewyk JV, Solenberger PW. 2001. “A Multivariate Technique for
Multiply Imputing Missing Values using a Sequence of Regression Models.” Survey Methodology, 27: 8595.
Raghunathan TE, Solenberger PW, Hoewyk JV. 2016. IVEware: Imputation and Variance Estimation
Software User’s Guide (Version 0.3). Ann Arbor, MI: Institute for Social Research, University of Michigan.
Available from: www.isr.umich.edurs/c/smp/ive/
Schaefer JL, Graham JW. 2002. “Missing Data: Our View of State of the Art”. Psychological Methods,
7(2): 147-77.

2017 National Survey of Children’s Health

U.S. Census Bureau

Attachment A – 2017 NSCH Sample Sizes, by Stratum and by State

State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of
Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
2017 National Survey of Children’s Health

Total
Sample
4,598
5,757
3,664
4,173
2,847
2,680
2,770
2,944

Stratum 1
(Address linked
to child admin
record)
2,540
1,785
2,046
2,200
1,976
1,633
1,759
2,030

Stratum 2A
(Not linked to child
admin record, higher
probability of child
presence)
2,058
3,972
1,618
1,973
871
1,047
1,011
914

3,226
3,621
3,619
3,714
2,840
2,733
3,188
2,780
2,877
3,336
4,787
3,726
2,515
2,474
2,444
2,014
5,287
3,036
3,765
2,601
4,187
3,119
2,663
5,379
3,355
3,044
3,238
2,712

2,091
2,454
2,330
1,211
1,578
1,723
1,975
1,602
1,907
2,044
2,836
1,805
1,726
1,573
1,695
1,391
3,050
1,967
1,698
1,657
2,438
1,770
1,782
2,096
1,926
2,004
1,771
1,883

1,135
1,167
1,289
2,503
1,262
1,010
1,213
1,178
970
1,292
1,951
1,921
789
901
749
623
2,237
1,069
2,067
944
1,749
1,349
881
3,283
1,429
1,040
1,467
829
U.S. Census Bureau

State
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total
Proportion by State

2017 National Survey of Children’s Health

Total
Sample
4,768
2,367
2,497
3,167
3,686
3,027
3,246
3,496
2,132
4,470
2,387
2,347
4,764
2,104
4,555
170,726

Stratum 1
(Address linked
to child admin
record)
2,393
1,573
1,691
1,921
2,178
1,585
2,015
2,285
1,512
1,547
1,625
1,597
2,056
1,489
1,889
97,308
57.0%

Stratum 2A
(Not linked to child
admin record, higher
probability of child
presence)
2,375
794
806
1,246
1,508
1,442
1,231
1,211
620
2,923
762
750
2,708
615
2,666
73,418
43.0%

U.S. Census Bureau

Attachment B – Child with Special Health Care Needs Question Battery
For an address that is eligible for topical sampling, the following is required to determine if an eligible
child has special health care needs (CSHCN). One or more of the following five groups must have ‘Yes”
responses to all of its variable/questionnaire items.
(1)

All of the following are marked "Yes":
K2Q10 - Does … currently need or use medicine prescribed by a doctor, other than vitamins?
K2Q11 - Is this child's need for prescription medicine because of ANY medical, behavioral, or
other health condition?
K2Q12 - If yes, is this a condition that has lasted or is expected to last 12 months or longer?

(2)

All of the following are marked "Yes":
K2Q13 - Does … need or use more medical care, mental health, or educational services than is
usual for most children of the same age?
K2Q14 - Is this child's need for medical care, mental health, or educational services because of
ANY medical, behavioral, or other health condition?
K2Q15 - If yes, is this a condition that has lasted or is expected to last 12 months or longer?

(3)

All of the following are marked "Yes":
K2Q16 - Is … limited or prevented in any way in his/her ability to do the things most
children of the same age can do?
K2Q17 - Is this child's limitation in abilities because of ANY medical, behavioral, or
other health condition?
K2Q18 - If yes, is this a condition that has lasted or is expected to last 12 months or
longer?

(4)

All of the following are marked "Yes":
K2Q19 - Does … need or get special therapy, such as physical, occupational, or speech
therapy?
K2Q20 - Is this child's need for special therapy because of ANY medical, behavioral, or
other health condition?
K2Q21 - If yes, is this a condition that has lasted or is expected to last 12 months or
longer?

(5)

Both of the following are marked "Yes":
K2Q22 - Does … have any kind of emotional, developmental, or behavioral problem for
which he or she needs treatment or counseling?
K2Q23 - If yes, has his or her emotional, developmental, or behavioral problem lasted or
is it expected to last 12 months or longer?

For an address that is eligible for topical sampling, an eligible child is classified as Non-CSHCN if no group
of questions listed above has “Yes” answers to all questions in the group.
2017 National Survey of Children’s Health

U.S. Census Bureau

Attachment C - Completed Screeners and Topicals and Weighted Response Rates by State
State
United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi

Sample
170726
4598
5757
3664
4173
2847
2680
2770
2944
3226
3621
3619
3714
2840
2733
3188
2780
2877
3336
4787
3726
2515
2474
2444
2014
5287

Screeners
58510
1255
1784
1204
1177
958
983
1063
1007
1141
1120
1065
1432
1051
1068
1075
1267
1024
1109
1255
1299
964
1036
965
923
1311

2017 National Survey of Children’s Health

Screener
Completion
Rate
46%
45%
55%
47%
45%
40%
50%
47%
44%
46%
42%
41%
53%
53%
50%
49%
59%
48%
48%
39%
54%
47%
51%
50%
57%
41%

Topicals
21599
426
431
434
343
450
431
470
419
441
413
420
427
406
441
429
421
429
392
416
445
454
417
428
433
432

Topical
Completion
Rate
30.6%
28.2%
36.2%
30.8%
24.8%
28.6%
35.0%
32.5%
28.1%
33.6%
26.9%
26.7%
37.1%
34.6%
34.9%
33.4%
36.7%
33.0%
27.7%
23.7%
34.1%
35.1%
32.3%
35.2%
40.3%
24.4%

Resolution
Rate
52.8%
56.7%
67.1%
54.4%
56.2%
44.6%
57.0%
51.8%
50.4%
50.8%
48.1%
48.8%
60.3%
61.8%
55.6%
57.3%
62.3%
55.3%
55.7%
47.8%
64.1%
51.3%
55.0%
55.4%
61.7%
53.0%

Screener
Conversion
Rate
99.1%
99.1%
99.3%
99.3%
99.2%
99.1%
98.7%
98.5%
99.1%
99.0%
98.5%
98.6%
99.3%
99.3%
98.9%
99.3%
99.8%
99.1%
99.5%
99.3%
99.7%
98.8%
99.5%
99.5%
99.2%
99.7%

Topical
Conversion
Rate
71.5%
69.4%
75.4%
71.8%
61.2%
75.4%
75.7%
69.7%
69.5%
75.2%
66.4%
71.0%
70.8%
73.7%
73.2%
73.2%
71.2%
71.7%
64.8%
68.4%
74.8%
75.5%
70.4%
74.1%
74.5%
65.8%

Interview
Completion
Rate
70.9%
68.8%
74.8%
71.4%
60.6%
74.7%
74.7%
68.7%
68.9%
74.4%
65.4%
70.0%
70.2%
73.2%
72.4%
72.7%
71.1%
71.1%
64.5%
67.9%
74.6%
74.7%
70.1%
73.7%
73.9%
65.6%

Overall
Response
Rate
37.4%
39.0%
50.2%
38.8%
34.1%
33.3%
42.6%
35.5%
34.7%
37.8%
31.5%
34.1%
42.4%
45.3%
40.2%
41.6%
44.3%
39.3%
35.9%
32.5%
47.8%
38.3%
38.5%
40.9%
45.6%
34.8%

U.S. Census Bureau

State
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

Sample
3036
3765
2601
4187
3119
2663
5379
3355
3044
3238
2712
4768
2367
2497
3167
3686
3027
3246
3496
2132
4470
2387
2347
4764
2104
4555

Screeners
1093
1403
1085
1264
1153
945
1628
1153
1000
1194
1004
1357
996
979
1080
1219
1246
1123
929
869
1655
937
956
1601
908
1197

2017 National Survey of Children’s Health

Screener
Completion
Rate
52%
58%
56%
41%
52%
45%
50%
44%
44%
56%
50%
46%
53%
50%
42%
44%
58%
45%
37%
50%
63%
48%
51%
55%
56%
50%

Topicals
425
445
429
452
427
436
398
441
391
429
415
422
408
425
417
411
447
404
381
442
440
421
433
383
416
413

Topical
Completion
Rate
33.4%
37.7%
35.3%
27.1%
32.6%
30.4%
29.1%
30.2%
27.5%
36.9%
31.6%
28.4%
34.5%
33.7%
27.5%
26.9%
38.8%
28.5%
24.6%
37.6%
40.3%
33.5%
36.6%
29.8%
38.2%
33.4%

Resolution
Rate
59.6%
67.7%
61.4%
47.0%
61.0%
49.9%
61.6%
50.5%
50.6%
63.5%
56.8%
56.0%
57.7%
55.9%
46.6%
50.3%
64.3%
51.3%
46.4%
55.3%
73.0%
53.2%
56.8%
64.4%
61.3%
66.4%

Screener
Conversion
Rate
99.2%
99.5%
99.5%
99.1%
99.5%
98.4%
99.5%
98.6%
99.3%
99.6%
99.2%
99.1%
99.0%
99.6%
99.4%
99.6%
99.5%
99.1%
98.7%
98.8%
99.8%
98.8%
99.0%
99.7%
99.9%
99.1%

U.S. Census Bureau

Topical
Conversion
Rate
68.7%
73.0%
72.1%
71.4%
70.1%
71.1%
69.0%
68.9%
70.2%
76.1%
70.5%
69.4%
72.7%
70.8%
71.7%
68.0%
73.9%
70.4%
69.7%
79.4%
76.0%
72.0%
76.5%
71.6%
72.4%
74.2%

Interview
Completion
Rate
68.2%
72.6%
71.8%
70.7%
69.7%
70.0%
68.7%
67.9%
69.8%
75.8%
69.9%
68.7%
72.0%
70.5%
71.3%
67.8%
73.5%
69.7%
68.8%
78.4%
75.8%
71.1%
75.7%
71.4%
72.3%
73.5%

Overall
Response
Rate
40.6%
49.2%
44.0%
33.2%
42.5%
34.9%
42.3%
34.3%
35.3%
48.1%
39.7%
38.5%
41.6%
39.4%
33.3%
34.1%
47.3%
35.8%
31.9%
43.4%
55.3%
37.8%
43.0%
46.0%
44.3%
48.8%

Attachment D – Invitation Letters

























[67-68] NSCH-11P(A)
[69-70] NSCH-11P(B)
[71-72] NSCH-11W(A)
[73-74] NSCH-11W(B)
[75-76] NSCH-12PB(A)
[77-78] NSCH-12WA(B)
[79-80] NSCH-13(B)
[81-82] NSCH-14(B)
[83-84] NSCH-21(A)
[85-86] NSCH-21(B)
[87-88] NSCH-21(C)
[89-90] NSCH-21(D)
[91-92] NSCH-22(A)
[93-94] NSCH-22(B)
[95-96] NSCH-22(C)
[97-98] NSCH-22(D)
[99-100] NSCH-23(A)
[101-102] NSCH-23(B)
[103-104] NSCH-23(C)
[105-106] NSCH-23(D)
[107-108] NSCH-24(A)
[109-110] NSCH-PC2
[111-112] NSCH-PCP
[113-114] NSCH-PCW

2017 National Survey of Children’s Health

NSCH-11P(A)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Your address has been selected to participate in the National Survey of Children’s Health. This survey collects
information that is used to improve the health of children and families throughout the United States. The U.S.
Census Bureau conducts this survey on behalf of the U.S. Department of Health and Human Services. Even if
there are no children age 0 to 17 in your household, it is important that you complete this survey.
Responding to this survey online is easy:
1. Go to https://respond.census.gov/nsch
2. Enter your Login ID:
If you need assistance with the survey or have questions, please call 1-800-845-8241 or email us at
childrenshealth@census.gov. If you are unable to complete the survey online, we have enclosed a paper
questionnaire. If you decide to complete the paper questionnaire instead of the online survey, please mail it back
in the postage-paid envelope provided.
Your household was randomly selected as part of this voluntary survey. We cannot replace your household with
another one. The survey takes less than 5 minutes if there are no children in your household, and an average of
33 minutes for households with children.
The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly release
your responses in a way that could identify your household. The U.S. Census Bureau is conducting this survey
under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and Section 501(a)(2) of the Social
Security Act (42 U.S.C. §701). Federal law protects your privacy and keeps your answers confidential under
Title 13, U.S.C., Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected
from cybersecurity risks through screening of the systems that transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval
number 0607-0990 appears in the bottom left corner of the survey web page and in the upper right corner of the
paper questionnaire. If this number were not displayed, we could not conduct this survey.
The success of this survey depends on your participation. The results will help our nation better understand
and respond to the health care needs of children and families.
Thank you for your help.
Enclosure

census.gov

NSCH-11P(A)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Su dirección fue seleccionada para participar en la Encuesta Nacional de Salud de los Niños. Esta encuesta
recopila información que se utiliza para mejorar la salud de los(as) niños(as) y sus familias en todos los Estados
Unidos. La Oficina del Censo realiza esta encuesta para el Departamento de Salud y Servicios Humanos de los
EE.UU. Aunque no haya niños(as) de 0 a 17 años en su hogar, es importante que usted complete esta encuesta.
Es muy fácil responder a esta encuesta por internet:
1. Vaya a https://respond.census.gov/nsch
2. Introduzca su ID de Usuario:
Si necesita ayuda con la encuesta o tiene preguntas, por favor, llame al 1-800-845-8241 o envíenos un correo
electrónico a: childrenshealth@census.gov. Hemos adjuntado un cuestionario impreso por si usted no puede completar
la encuesta por internet. Si usted decide completar el cuestionario impreso en lugar de la encuesta por internet, por
favor, envíelo de vuelta por correo utilizando el sobre con franqueo prepagado que le proporcionamos.
Su hogar fue seleccionado al azar como parte de este estudio voluntario. No podemos reemplazar su hogar con otro.
Completar esta encuesta toma menos de 5 minutos si no hay niños(as) en su hogar, y un promedio de 33 minutos
para aquellos hogares con niños(as).
La Oficina del Censo de los EE.UU. está obligada por ley a proteger su información. No se nos permite divulgar sus
respuestas de manera que su hogar pudiera ser identificado. La Oficina del Censo de los Estados Unidos está
llevando a cabo esta encuesta de acuerdo con la autoridad de la Sección 8(b) del Título 13 del Código de los Estados
Unidos y de la Sección 501(a)(2) de la Ley de Seguro Social (Sección 701 del Título 42 del Código de los EE.UU.).
Las leyes federales protegen su privacidad y mantienen confidenciales sus respuestas, en conformidad con la Sección
9 del Título 13, Código de los Estados Unidos. En conformidad con la Ley para el Fortalecimiento de la Seguridad
Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de seguridad cibernética mediante los
controles aplicados a los sistemas que los transmiten.
Esta encuesta ha sido aprobaba por la Oficina de Administración y Presupuesto (OMB, por sus siglas en inglés). El
número de aprobación de ocho dígitos de la OMB, 0607-0990, aparece en la esquina inferior izquierda de la encuesta
en la página web o en la esquina superior derecha del cuestionario impreso. De no mostrarse este número, no
podríamos realizar esta encuesta.
El éxito de esta encuesta depende de su participación. Los resultados ayudarán a nuestra nación a comprender y
responder mejor a las necesidades de atención médica de los(as) niños(as) y sus familias.
Muchas gracias por su ayuda.
Documento adjunto

census.gov

NSCH-11P(B)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

census.gov

NSCH-11P(B)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

census.gov

NSCH-11W(A)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Go to https://respond.census.gov/nsch
Enter your Login ID:

We are conducting this survey online to help us reduce costs and report results quickly. If you are
unable to complete the survey online, need assistance, or have questions, please call 1-800-845-8241
or email us at childrenshealth@census.gov.
Your household was randomly selected as part of this voluntary survey. We cannot replace your
household with another one. The survey takes less than 5 minutes if there are no children in your
household and an average of 33 minutes for households with children.
The U.S. Census Bureau is required by law to protect your information. We are not permitted to
publicly release your responses in a way that could identify your household. The Census Bureau is
conducting this survey under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and
Section 501(a)(2) of the Social Security Act (42 U.S.C. §701). Federal law protects your privacy and
keeps your answers confidential under Title 13, U.S.C., Section 9. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the
systems that transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit
OMB approval number 0607-0990 appears in the bottom left corner of the survey web page. If this
number were not displayed, we could not conduct this survey.
The success of this survey depends on your participation. The results will help our nation better
understand and respond to the health care needs of children and families.
Thank you for your help.

census.gov

NSCH-11W(A)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Su dirección fue seleccionada para participar en la Encuesta Nacional de Salud de los Niños. Esta
encuesta recopila información que se utiliza para mejorar la salud de los(as) niños(as) y sus familias en
todos los Estados Unidos. La Oficina del Censo realiza esta encuesta para el Departamento de Salud y
Servicios Humanos de los EE.UU. Aunque no haya niños(as) de 0 a 17 años en su hogar, es importante
que usted complete esta encuesta.
Es muy fácil responder a esta encuesta por internet:
1. Vaya a https://respond.census.gov/nsch
2. Introduzca su ID de Usuario:
Estamos llevando a cabo esta encuesta por internet para reducir los costos y poder reportar los resultados
rápidamente. Si no puede contestar la encuesta por internet, necesita ayuda o tiene preguntas, por favor,
llame al 1-800-845-8241 o envíenos un correo electrónico a: childrenshealth@census.gov.
Su hogar fue seleccionado al azar como parte de este estudio voluntario. No podemos reemplazar su hogar
con otro. Completar esta encuesta toma menos de 5 minutos si no hay niños(as) en su hogar, y un
promedio de 33 minutos para aquellos hogares con niños(as).
La Oficina del Censo de los EE.UU. está obligada por ley a proteger su información. No se nos permite
divulgar sus respuestas de manera que su hogar pudiera ser identificado. La Oficina del Censo de los
Estados Unidos está llevando a cabo esta encuesta de acuerdo con la autoridad de la Sección 8(b) del
Título 13 del Código de los Estados Unidos y de la Sección 501(a)(2) de la Ley de Seguro Social (Sección
701 del Título 42 del Código de los EE.UU.). Las leyes federales protegen su privacidad y mantienen
confidenciales sus respuestas, en conformidad con la Sección 9 del Título 13, Código de los Estados
Unidos. En conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética Federal del 2015,
sus datos están protegidos contra los riesgos de seguridad cibernética mediante los controles aplicados a
los sistemas que los transmiten.
Esta encuesta ha sido aprobaba por la Oficina de Administración y Presupuesto (OMB, por sus siglas en
inglés). El número de aprobación de ocho dígitos de la OMB, 0607-0990, aparece en la esquina inferior
izquierda de la encuesta en la página web. De no mostrarse este número, no podríamos realizar esta
encuesta.
El éxito de esta encuesta depende de su participación. Los resultados ayudarán a nuestra nación a
comprender y responder mejor a las necesidades de atención médica de los(as) niños(as) y sus familias.
Muchas gracias por su ayuda.

census.gov

NSCH-11W(B)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Your address has been selected to participate in the National Survey of Children’s Health. This survey
collects information that is used to improve the health of children and families throughout the United
States. The U.S. Census Bureau conducts this survey on behalf of the U.S. Department of Health and
Human Services. Even if there are no children age 0 to 17 in your household, it is important that you
complete this survey.
Responding to this survey online is easy:
1. Go to https://respond.census.gov/nsch
2. Enter your Login ID:
We are conducting this survey online to help us reduce costs and report results quickly. If you are unable
to complete the survey online, need assistance, or have questions, please call 1-800-845-8241 or email us
at childrenshealth@census.gov.
Your household was randomly selected as part of this voluntary survey. We cannot replace your
household with another one. The survey takes less than 5 minutes if there are no children in your
household and an average of 33 minutes for households with children.
The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly
release your responses in a way that could identify your household. The Census Bureau is conducting this
survey under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and Section 501(a)(2) of
the Social Security Act (42 U.S.C. §701). Federal law protects your privacy and keeps your answers
confidential under Title 13, U.S.C., Section 9. Per the Federal Cybersecurity Enhancement Act of 2015,
your data are protected from cybersecurity risks through screening of the systems that transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB
approval number 0607-0990 appears in the bottom left corner of the survey web page. If this number were
not displayed, we could not conduct this survey.
The success of this survey depends on your participation. The results will help our nation better
understand and respond to the health care needs of children and families. We have enclosed a small
token of appreciation for your participation.
Thank you for your help.
Enclosure

census.gov

NSCH-11W(B)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Su dirección fue seleccionada para participar en la Encuesta Nacional de Salud de los Niños. Esta encuesta
recopila información que se utiliza para mejorar la salud de los(as) niños(as) y sus familias en todos los Estados
Unidos. La Oficina del Censo realiza esta encuesta para el Departamento de Salud y Servicios Humanos de los
EE.UU. Aunque no haya niños(as) de 0 a 17 años en su hogar, es importante que usted complete esta
encuesta.
Es muy fácil responder a esta encuesta por internet:
1. Vaya a https://respond.census.gov/nsch
2. Introduzca su ID de Usuario:
Estamos llevando a cabo esta encuesta por internet para reducir los costos y poder reportar los resultados
rápidamente. Si no puede contestar la encuesta por internet, necesita ayuda o tiene preguntas, por favor, llame
al 1-800-845-8241 o envíenos un correo electrónico a: childrenshealth@census.gov.
Su hogar fue seleccionado al azar como parte de este estudio voluntario. No podemos reemplazar su hogar con
otro. Completar esta encuesta toma menos de 5 minutos si no hay niños(as) en su hogar, y un promedio de 33
minutos para aquellos hogares con niños(as).
La Oficina del Censo de los EE.UU. está obligada por ley a proteger su información. No se nos permite divulgar
sus respuestas de manera que su hogar pudiera ser identificado. La Oficina del Censo de los Estados Unidos
está llevando a cabo esta encuesta de acuerdo con la autoridad de la Sección 8(b) del Título 13 del Código de
los Estados Unidos y de la Sección 501(a)(2) de la Ley de Seguro Social (Sección 701 del Título 42 del Código
de los EE.UU.). Las leyes federales protegen su privacidad y mantienen confidenciales sus respuestas, en
conformidad con la Sección 9 del Título 13, Código de los Estados Unidos. En conformidad con la Ley para el
Fortalecimiento de la Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de
seguridad cibernética mediante los controles aplicados a los sistemas que los transmiten.
Esta encuesta ha sido aprobaba por la Oficina de Administración y Presupuesto (OMB, por sus siglas en
inglés). El número de aprobación de ocho dígitos de la OMB, 0607-0990, aparece en la esquina inferior
izquierda de la encuesta en la página web. De no mostrarse este número, no podríamos realizar esta encuesta.
El éxito de esta encuesta depende de su participación. Los resultados ayudarán a nuestra nación a
comprender y responder mejor a las necesidades de atención médica de los(as) niños(as) y sus
familias. Hemos incluido una pequeña muestra de agradecimiento por su participación.
Muchas gracias por su ayuda.
Documento adjunto

census.gov

NSCH-12P(B)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Recently, we requested your participation in the National Survey of Children’s Health
(NSCH). If you have completed the NSCH prior to receiving this mailing, please accept our
thanks. If you have not yet responded, we encourage you to complete the survey online or
return the enclosed paper questionnaire today. This survey collects important information
used to improve the health of children and families throughout the United States.
Responding to this survey online is easy:
1. Go to https://respond.census.gov/nsch
2. Enter your Login ID:
If you need assistance with the survey or have questions, please call 1-800-845-8241 or
email us at childrenshealth@census.gov.
Even if there are no children 0 to 17 years old in your household, it is important that you
respond. The survey takes less than 5 minutes to respond if there are no children in your
household and an average of 33 minutes for households with children.
The information gathered in this survey is critical to understanding children’s health care
needs in your state and across the country. Your household was scientifically selected from
all of the households in the country and your response represents thousands of other
households. The U.S. Census Bureau is not permitted to publicly release your responses in
a way that could identify your household. By law, the Census Bureau can only use your
responses for statistical research.
Your response is vital to the success of this survey. Thank you again for your
participation. We hope to hear from you soon.
Enclosure

census.gov

NSCH-12P(B)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Recientemente solicitamos su participación en la Encuesta Nacional de Salud de los Niños
(NSCH). Si usted ya completó la NSCH antes de recibir esta carta, por favor, acepte nuestro
agradecimiento. Si aún no la ha completado, le exhortamos a que complete hoy la encuesta por
internet o el cuestionario impreso adjunto. Esta encuesta recoge información importante que se
utiliza para mejorar la salud de los(as) niños(as) y sus familias en todos los Estados Unidos.
Es muy fácil responder a esta encuesta por internet:
1. Vaya a https://respond.census.gov/nsch
2. Introduzca su ID de Usuario:
Si necesita ayuda con la encuesta o tiene preguntas, por favor, llame al 1-800-845-8241 o
envíenos un correo electrónico a: childrenshealth@census.gov.
Aunque no haya niños(as) de 0 a 17 años en su hogar, es importante que usted responda. Por
lo general, completar esta encuesta toma menos de 5 minutos si no hay niños(as) en su hogar,
y un promedio de 33 minutos para aquellos hogares con niños(as).
La información obtenida en esta encuesta es crítica para entender la salud de los(as) niños(as) y
sus necesidades de cuidado de salud tanto en su estado como en todo el país. Su hogar fue
seleccionado de manera científica entre todos los hogares en el país y su respuesta representa
a miles de otros hogares. A la Oficina del Censo de los EE.UU. no se le permite divulgar sus
respuestas de manera que su hogar pudiera ser identificado. Por ley, la Oficina del Censo
solamente puede usar sus repuestas para investigaciones estadísticas.
Su respuesta es esencial para el éxito de esta encuesta. Muchas gracias de nuevo por su
participación. Esperamos pronto su respuesta.
Documento adjunto

census.gov

NSCH-12W(A)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Recently, we requested your participation in the National Survey of Children’s Health
(NSCH) If you have completed the NSCH prior to receiving this mailing, please accept our
thanks. If you have not yet responded, we encourage you to complete the survey online.
This survey collects important information used to improve the health of children and families
throughout the United States.
Responding to this survey online is easy:
1.
2.

Go to https://respond.census.gov/nsch
Enter your Login ID:

If you would prefer a paper version of the survey, need assistance or have questions, please
call 1-800-845-8241 or email us at childrenshealth@census.gov.
Even if there are no children 0 to 17 years old in your household, it is important that you
respond. The survey takes less than 5 minutes to respond if there are no children in your
household and an average of 33 minutes for households with children.
The information gathered in this survey is critical to understanding children’s health care
needs in your state and across the country. Your household was scientifically selected from
all of the households in the country and your response represents thousands of other
households. The U.S. Census Bureau is not permitted to publicly release your responses in
a way that could identify your household. By law, the Census Bureau can only use your
responses for statistical research.
Your response is vital to the success of this survey. Thank you again for your
participation. We hope to hear from you soon.

census.gov

NSCH-12W(A)
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Recientemente solicitamos su participación en la Encuesta Nacional de Salud de los
Niños (NSCH). Si usted ya completó la NSCH antes de recibir esta carta, por favor, acepte
nuestro agradecimiento. Si aún no la ha completado, le exhortamos a que complete hoy la
encuesta por internet. Esta encuesta recoge información importante que se utiliza para
mejorar la salud de los(as) niños(as) y sus familias en todos los Estados Unidos.
Es muy fácil responder a esta encuesta por internet:
1. Vaya a https://respond.census.gov/nsch
2. Introduzca su ID de Usuario:
Si usted prefiere el cuestionario impreso, necesita ayuda o tiene preguntas, por favor, llame
al 1-800-845-8241 o envíenos un correo electrónico a: childrenshealth@census.gov.
Aunque no haya niños(as) de 0 a 17 años en su hogar, es importante que usted responda.
Por lo general, completar esta encuesta toma menos de 5 minutos si no hay niños(as) en su
hogar, y un promedio de 33 minutos para aquellos hogares con niños(as).
La información obtenida en esta encuesta es crítica para entender la salud de los(as)
niños(as) y sus necesidades de cuidado de salud tanto en su estado como en todo el país.
Su hogar fue seleccionado de manera científica entre todos los hogares en el país y su
respuesta representa a miles de otros hogares. A la Oficina del Censo de los EE.UU. no se
le permite divulgar sus respuestas de manera que su hogar pudiera ser identificado. Por
ley, la Oficina del Censo solamente puede usar sus repuestas para investigaciones
estadísticas.
Su respuesta es esencial para el éxito de esta encuesta. Muchas gracias de nuevo por
su participación. Esperamos pronto su respuesta.

census.gov

NSCH-13
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Recently, we wrote asking for your help with the National Survey of Children’s Health. If
you have already responded, thank you. If you have not, we are asking you to complete this
survey because your participation is vital to its success. The survey period is ending soon.
There are two ways you can respond:
1. Go to https://respond.census.gov/nsch and enter your
Login ID:
OR
2. Complete the enclosed paper questionnaire and mail it back in the
postage-paid envelope provided.
If you need assistance with the survey or have questions, please call 1-800-845-8241 or
email us at childrenshealth@census.gov. It is important that we hear from you, even if there
are no children age 0 to 17 living in your household.
The results of the survey will help us better understand the health and health care needs of
children in the United States. Your household was scientifically selected from all of the
households in the country and will represent thousands of other households. The U.S.
Census Bureau is not permitted to publicly release your responses in a way that could
identify your household. By law, the Census Bureau can only use your responses for
statistical research.
Thank you again for your participation. We hope to hear from you soon.
Enclosure

census.gov

NSCH-13
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Recientemente le escribimos solicitando su ayuda con la Encuesta Nacional de Salud de
los Niños. Si usted ya respondió, muchas gracias. Si aún no ha respondido, le pedimos
que complete esta encuesta ya que su participación es vital para el éxito de esta. El periodo
de la encuesta está a punto de terminar.
Hay dos maneras de completar la encuesta:
1. Vaya a https://respond.census.gov/nsch e introduzca su
ID de Usuario:
O
2. Complete y devuelva por correo el cuestionario adjunto en el sobre con
franqueo prepagado que le proporcionamos.
Si necesita ayuda con la encuesta o tiene preguntas, por favor, llame al 1-800-845-8241 o
envíenos un correo electrónico a: childrenshealth@census.gov. Es importante que nos
conteste, aunque no haya niños(as) de 0 a 17 años viviendo en su hogar.
Los resultados de la encuesta nos ayudarán a entender mejor la salud y las necesidades de
cuidado de salud de los(as) niños(as) de los EE.UU. Su hogar fue seleccionado de manera
científica entre todos los hogares en el país y su respuesta representará a miles de otros
hogares. A la Oficina del Censo de los EE.UU. no se le permite divulgar sus respuestas de
manera que su hogar pudiera ser identificado. Por ley, la Oficina del Censo solamente
puede usar sus repuestas para investigaciones estadísticas.
Muchas gracias de nuevo por su participación. Esperamos pronto su respuesta.
Documento adjunto

census.gov

NSCH-14
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
In July, we requested your participation in the National Survey of Children’s Health. We
are contacting you today one final time to ask for your help with this very important survey.
If you have already responded to the survey, please accept our sincere thanks. If you have
not yet responded, please respond today. The information gathered in this survey is critical
to understanding children’s health care needs in your state and across the country. It
provides key insights about the health and welfare of the youngest members of our society
and what they need to thrive.
There are two ways you can respond:
1. Go to https://respond.census.gov/nsch and enter your
Login ID:
OR
2. Complete the enclosed paper questionnaire and mail it back in the
postage-paid envelope provided.
This is your last opportunity to ensure that the survey results reflect the characteristics of
households like yours. It is important that we hear from you, even if there are no
children age 0 to 17 living in your household.
If you have any questions about participating, please contact us at 1-800-845-8241 or by
email at childrenshealth@census.gov.
Thank you for your help.
Enclosure

census.gov

NSCH-14
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
En julio le invitamos a participar de la Encuesta Nacional de Salud de los Niños. Le
estamos contactando hoy por última vez para pedirle su ayuda con esta encuesta tan
importante.
Si usted ya contestó la encuesta, por favor, acepte nuestro más sincero agradecimiento. Si
usted no ha completado todavía la encuesta, por favor, hágalo hoy mismo. La información
obtenida en esta encuesta es crítica para entender la salud de los(as) niños(as) y sus
necesidades de cuidado de salud tanto en su estado como en todo el país. Esta encuesta
proporciona información clave acerca de la salud y bienestar de los miembros más jóvenes
de nuestra sociedad.
Hay dos maneras de completar la encuesta:
1. Vaya a https://respond.census.gov/nsch e introduzca su
ID de Usuario:
O
2. Complete y devuelva por correo el cuestionario adjunto en el sobre con
franqueo prepagado que le proporcionamos.
Esta es su última oportunidad para asegurarnos de que la encuesta refleje las
características de hogares como el suyo. Es importante que nos conteste, aunque no
haya niños(as) de 0 a 17 años viviendo en su hogar.
Si tiene alguna pregunta o preguntas acerca de su participación, por favor, llámenos al
1-800-845-8241 o envíenos un correo electrónico a: childrenshealth@census.gov.
Muchas gracias por su ayuda.
Documento adjunto

census.gov

NSCH-21(A)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
A few weeks ago you responded to the National Survey of Children’s Health. We greatly
appreciate your participation.
The second and final step of this survey is to answer some follow-up questions about:

This voluntary survey should be filled out by an adult who is familiar with this child’s health and health
care. For most households, it usually takes an average of 33 minutes to complete. Please return your
completed questionnaire in the postage-paid envelope provided.
The U.S. Census Bureau is required by law to protect your information. We are not permitted to
publicly release your responses in a way that could identify your household. The U.S. Census Bureau
is conducting this survey under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and
Section 501(a)(2) of the Social Security Act (42 U.S.C. §701). Federal law protects your privacy and
keeps your answers confidential under Title 13, U.S.C., Section 9. Per the Federal Cybersecurity
Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the
systems that transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit
OMB approval number 0607-0990 appears in the upper right corner of the paper questionnaire. If this
number were not displayed, we could not conduct this survey.
If you need assistance with the survey or have questions, please call 1-800-845-8241 or email
childrenshealth@census.gov.
The success of this survey depends on your participation. The results will help our nation better
understand and respond to the health care needs of children and families.
Thank you once again for your help.
Enclosure

census.gov

NSCH-21(A)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Hace unas semanas usted respondió a nuestra solicitud de ayuda con la Encuesta Nacional de Salud de los
Niños. Le agradecemos mucho su participación.
El segundo y último paso de esta encuesta es contestar algunas preguntas de seguimiento sobre:

Esta encuesta voluntaria debe ser completada por un adulto que esté familiarizado con la salud y atención
médica de este(a) niño(a). A la mayoría de los hogares les toma un promedio de 33 minutos completar esta
encuesta. Por favor, envíe el cuestionario completado utilizando el sobre con franqueo prepagado que le
proporcionamos.
La Oficina del Censo de los EE.UU. está obligada por ley a proteger su información. No se nos permite
divulgar sus respuestas de manera que usted, este(a) niño(a) o su hogar pudieran ser identificados. La Oficina
del Censo de los Estados Unidos está llevando a cabo esta encuesta de acuerdo con la autoridad de la
Sección 8(b) del Título 13 del Código de los Estados Unidos y de la Sección 501(a)(2) de la Ley de Seguro
Social (Sección 701 del Título 42 del Código de los EE.UU.). Las leyes federales protegen su privacidad y
mantienen confidenciales sus respuestas, en conformidad con la Sección 9 del Título 13, Código de los
Estados Unidos. En conformidad con la Ley para el Fortalecimiento de la Seguridad Cibernética Federal del
2015, sus datos están protegidos contra los riesgos de seguridad cibernética mediante los controles aplicados
a los sistemas que los transmiten.
Esta encuesta ha sido aprobaba por la Oficina de Administración y Presupuesto (OMB, por sus siglas en
inglés). El número de aprobación de ocho dígitos de la OMB, 0607-0990, confirma esta aprobación y aparece
en la esquina superior derecha del cuestionario impreso. De no mostrarse este número, no podríamos realizar
esta encuesta.
Si necesita ayuda con la encuesta o tiene preguntas, por favor, llame al 1-800-845-8241 o envíenos un correo
electrónico a: childrenshealth@census.gov.
El éxito de esta encuesta depende de su participación. Los resultados ayudarán a nuestro país a
comprender y responder mejor a las necesidades de atención médica de los(as) niños(as) y sus familias.
Gracias una vez más por su ayuda.
Documento adjunto

census.gov

NSCH-21(B)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
A few weeks ago you responded to the National Survey of Children’s Health. We greatly appreciate your
participation.
The second and final step of this survey is to answer some follow-up questions about:

This voluntary survey should be filled out by an adult who is familiar with this child’s health and health
care. We have selected only one child in your household to minimize the amount of time you will need to
complete the survey. This child was selected at random to ensure the survey results represent every type
of child and health situation across the country. For most households, it usually takes an average of 33
minutes to complete. Please return your completed questionnaire in the postage-paid envelope provided.
The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly
release your responses in a way that could identify your household. The U.S. Census Bureau is conducting
this survey under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and Section 501(a)(2)
of the Social Security Act (42 U.S.C. §701). Federal law protects your privacy and keeps your answers
confidential under Title 13, U.S.C., Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your
data are protected from cybersecurity risks through screening of the systems that transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB
approval number 0607-0990 appears in the upper right corner of the paper questionnaire. If this number
were not displayed, we could not conduct this survey.
If you need assistance with the survey or have questions, please call 1-800-845-8241 or email
childrenshealth@census.gov.
The success of this survey depends on your participation. The results will help our nation better
understand and respond to the health care needs of children and families.
Thank you once again for your help.
Enclosure

census.gov

NSCH-21(B)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Esta encuesta voluntaria debe ser completada por un adulto que esté familiarizado con la salud y atención médica de
este(a) niño(a). Hemos seleccionado a un(a) solo(a) niño(a) en su hogar con el fin de minimizar la cantidad de
tiempo que necesitará para completar la encuesta. Este(a) niño(a) fue seleccionado(a) al azar para así poder
asegurarnos que los resultados de la encuesta representan a todos(as) los(as) tipos de niños(as) y toda la gama de
situaciones de salud en todo el país. A la mayoría de los hogares les toma un promedio de 33 minutos completar
esta encuesta. Por favor, envíe el cuestionario completado utilizando el sobre con franqueo prepagado que le
proporcionamos.
La Oficina del Censo de los EE.UU. está obligada por ley a proteger su información. No se nos permite divulgar sus
respuestas de manera que usted, este(a) niño(a) o su hogar pudieran ser identificados. La Oficina del Censo de los
Estados Unidos está llevando a cabo esta encuesta de acuerdo con la autoridad de la Sección 8(b) del Título 13 del
Código de los Estados Unidos y de la Sección 501(a)(2) de la Ley de Seguro Social (Sección 701 del Título 42 del
Código de los EE.UU.). Las leyes federales protegen su privacidad y mantienen confidenciales sus respuestas, en
conformidad con la Sección 9 del Título 13, Código de los Estados Unidos. En conformidad con la Ley para el
Fortalecimiento de la Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de
seguridad cibernética mediante los controles aplicados a los sistemas que los transmiten.
Esta encuesta ha sido aprobaba por la Oficina de Administración y Presupuesto (OMB, por sus siglas en inglés). El
número de aprobación de ocho dígitos de la OMB, 0607-0990, confirma esta aprobación y aparece en la esquina
superior derecha del cuestionario impreso. De no mostrarse este número, no podríamos realizar esta encuesta.
Si necesita ayuda con la encuesta o tiene preguntas, por favor, llame al 1-800-845-8241 o envíenos un correo
electrónico a: childrenshealth@census.gov.
El éxito de esta encuesta depende de su participación. Los resultados ayudarán a nuestro país a comprender y
responder mejor a las necesidades de atención médica de los(as) niños(as) y sus familias.
Gracias una vez más por su ayuda.
Documento adjunto

census.gov

NSCH-21(C)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
A few weeks ago you responded to the National Survey of Children’s Health. We greatly appreciate your
participation.
The second and final step of this survey is to answer some follow-up questions about:

This voluntary survey should be filled out by an adult who is familiar with this child’s health and health care.
For most households, it usually takes an average of 33 minutes to complete. Please return your completed
questionnaire in the postage-paid envelope provided.
The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly
release your responses in a way that could identify your household. The U.S. Census Bureau is
conducting this survey under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and
Section 501(a)(2) of the Social Security Act (42 U.S.C. §701). Federal law protects your privacy and keeps
your answers confidential under Title 13, U.S.C., Section 9. Per the Federal Cybersecurity Enhancement
Act of 2015, your data are protected from cybersecurity risks through screening of the systems that
transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB
approval number 0607-0990 appears in the upper right corner of the paper questionnaire. If this number
were not displayed, we could not conduct this survey.
If you need assistance with the survey or have questions, please call 1-800-845-8241 or email
childrenshealth@census.gov.
Since the survey is ending soon, this is your last opportunity to help. We hope that you will complete the
questionnaire and mail it back. The success of this survey depends on your participation. The results
will help our nation better understand and respond to the health care needs of children and families.
Thank you once again for your help.
Enclosure

census.gov

NSCH-21(C)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Esta encuesta voluntaria debe ser completada por un adulto que esté familiarizado con la salud y atención médica de
este(a) niño(a). A la mayoría de los hogares les toma un promedio de 33 minutos completar esta encuesta. Por
favor, envíe el cuestionario completado utilizando el sobre con franqueo prepagado que le proporcionamos.
La Oficina del Censo de los EE.UU. está obligada por ley a proteger su información. No se nos permite divulgar sus
respuestas de manera que usted, este(a) niño(a) o su hogar pudieran ser identificados. La Oficina del Censo de los
Estados Unidos está llevando a cabo esta encuesta de acuerdo con la autoridad de la Sección 8(b) del Título 13 del
Código de los Estados Unidos y de la Sección 501(a)(2) de la Ley de Seguro Social (Sección 701 del Título 42 del
Código de los EE.UU.). Las leyes federales protegen su privacidad y mantienen confidenciales sus respuestas, en
conformidad con la Sección 9 del Título 13, Código de los Estados Unidos. En conformidad con la Ley para el
Fortalecimiento de la Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de
seguridad cibernética mediante los controles aplicados a los sistemas que los transmiten.
Esta encuesta ha sido aprobaba por la Oficina de Administración y Presupuesto (OMB, por sus siglas en inglés). El
número de aprobación de ocho dígitos de la OMB, 0607-0990, confirma esta aprobación y aparece en la esquina
superior derecha del cuestionario impreso. De no mostrarse este número, no podríamos realizar esta encuesta.
Si necesita ayuda con la encuesta o tiene preguntas, por favor, llame al 1-800-845-8241 o envíenos un correo
electrónico a: childrenshealth@census.gov.
Dado que la encuesta esta a punto de terminar, ésta es su última oportunidad para poder ayudarnos. El éxito de
esta encuesta depende de su participación. Los resultados ayudarán a nuestro país a comprender y responder
mejor a las necesidades de atención médica de los(as) niños(as) y sus familias.
Gracias una vez más por su ayuda.
Documento adjunto

census.gov

NSCH-21(D)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
A few weeks ago you responded to the National Survey of Children’s Health. We greatly appreciate your
participation.
The second and final step of this survey is to answer some follow-up questions about:

This voluntary survey should be filled out by an adult who is familiar with this child’s health and health care. We
have selected only one child in your household to minimize the amount of time you will need to complete the
survey. This child was selected at random to ensure the survey results represent every type of child and health
situation across the country. For most households, it usually takes an average of 33 minutes to complete.
Please return your completed questionnaire in the postage-paid envelope provided.
The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly
release your responses in a way that could identify your household. The U.S. Census Bureau is conducting this
survey under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and Section 501(a)(2) of the
Social Security Act (42 U.S.C. §701). Federal law protects your privacy and keeps your answers confidential
under Title 13, U.S.C., Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your data are
protected from cybersecurity risks through screening of the systems that transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB
approval number 0607-0990 appears in the upper right corner of the paper questionnaire. If this number were
not displayed, we could not conduct this survey.
If you need assistance with the survey or have questions, please call 1-800-845-8241 or email
childrenshealth@census.gov.
Since the survey is ending soon, this is your last opportunity to help. We hope that you will complete the
questionnaire and mail it back. The success of this survey depends on your participation. The results will
help our nation better understand and respond to the health care needs of children and families.
Thank you once again for your help.
Enclosure

census.gov

NSCH-21(D)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Esta encuesta voluntaria debe ser completada por un adulto que esté familiarizado con la salud y atención médica de
este(a) niño(a). Hemos seleccionado a un(a) solo(a) niño(a) en su hogar con el fin de minimizar la cantidad de tiempo
que necesitará para completar la encuesta. Este(a) niño(a) fue seleccionado(a) al azar para así poder asegurarnos
que los resultados de la encuesta representan a todos(as) los(as) tipos de niños(as) y toda la gama de situaciones de
salud en todo el país. A la mayoría de los hogares les toma un promedio de 33 minutos completar esta encuesta. Por
favor, envíe el cuestionario completado utilizando el sobre con franqueo prepagado que le proporcionamos.
La Oficina del Censo de los EE.UU. está obligada por ley a proteger su información. No se nos permite divulgar sus
respuestas de manera que usted, este(a) niño(a) o su hogar pudieran ser identificados. La Oficina del Censo de los
Estados Unidos está llevando a cabo esta encuesta de acuerdo con la autoridad de la Sección 8(b) del Título 13 del
Código de los Estados Unidos y de la Sección 501(a)(2) de la Ley de Seguro Social (Sección 701 del Título 42 del
Código de los EE.UU.). Las leyes federales protegen su privacidad y mantienen confidenciales sus respuestas, en
conformidad con la Sección 9 del Título 13, Código de los Estados Unidos. En conformidad con la Ley para el
Fortalecimiento de la Seguridad Cibernética Federal del 2015, sus datos están protegidos contra los riesgos de
seguridad cibernética mediante los controles aplicados a los sistemas que los transmiten.
Esta encuesta ha sido aprobaba por la Oficina de Administración y Presupuesto (OMB, por sus siglas en inglés). El
número de aprobación de ocho dígitos de la OMB, 0607-0990, confirma esta aprobación y aparece en la esquina
superior derecha del cuestionario impreso. De no mostrarse este número, no podríamos realizar esta encuesta.
Si necesita ayuda con la encuesta o tiene preguntas, por favor, llame al 1-800-845-8241 o envíenos un correo
electrónico a: childrenshealth@census.gov.
Dado que la encuesta esta a punto de terminar, ésta es su última oportunidad para poder ayudarnos. El éxito de esta
encuesta depende de su participación. Los resultados ayudarán a nuestro país a comprender y responder mejor a
las necesidades de atención médica de los(as) niños(as) y sus familias.
Gracias una vez más por su ayuda.
Documento adjunto

census.gov

NSCH-22(A)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
We recently contacted you to ask for your participation in the final step of the National
Survey of Children’s Health. The final step is to answer some follow-up questions about:

To the best of our knowledge, we have not yet received your response. If you have already
responded, please accept our thanks. If you have not, we encourage you to complete and
return the enclosed paper questionnaire today. For most households, it usually takes an
average of 33 minutes to complete the survey.
Please contact us at 1-800-845-8241 or childrenshealth@census.gov if you have any
questions or need any assistance completing this survey.
The information collected in this survey will help our nation better understand and respond to
the health care needs of children and families. We ask for your response because this
survey is the only way we have to gather this important information. Your household was
scientifically selected from all of the households in the country and will represent thousands
of other households.
We want to assure you that your responses to this questionnaire are confidential as
explained on the front page of the survey. The U.S. Census Bureau and the U.S.
Department of Health and Human Services are required by law to protect the confidentiality
of your responses.
Your response is vital to the success of this survey. Thank you in advance for your
participation. We hope to hear from you soon.
Enclosure

census.gov

NSCH-22(A)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Recientemente lo(a) contactamos para solicitar su participación en el último paso de la Encuesta
Nacional de Salud de los Niños. El último paso es completar algunas preguntas de
seguimiento sobre:

No tenemos conocimiento de haber recibido su respuesta. Si usted ya respondió, por favor,
acepte nuestro agradecimiento. Si aún no ha contestado, lo(a) exhortamos a que complete y
nos envíe hoy el cuestionario impreso adjunto. A la mayoría de los hogares les toma un
promedio de 33 minutos completar esta encuesta.
Por favor llámenos al 1-800-845-8241 o envíenos un correo electrónico a
childrenshealth@census.gov si tiene alguna pregunta o necesita ayuda para completar la
encuesta.
La información recopilada en esta encuesta ayudará a nuestro país a comprender y responder
mejor a las necesidades de atención médica de los(as) niños(as) y sus familias. Solicitamos su
respuesta porque esta encuesta es la única manera que tenemos de recopilar esta importante
información. Su hogar fue seleccionado de manera científica entre todos los hogares en el país
y su respuesta representará a miles de otros hogares.
Queremos asegurarle que sus respuestas a este cuestionario son confidenciales como se
explica en la primera página de la encuesta. La ley estipula que la Oficina del Censo de los
EE.UU. y el Departamento de Salud y Servicios Humanos de los EE.UU. tienen que proteger la
confidencialidad de sus respuestas.
Su respuesta es esencial para el éxito de esta encuesta. Gracias de antemano por su
participación. Esperamos pronto su respuesta.
Documento adjunto

census.gov

NSCH-22(B)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

To the best of our knowledge, we have not yet received your response. If you have already
responded, please accept our thanks. If you have not, we encourage you to complete and
return the enclosed paper questionnaire today. To reduce the time you will need to respond
to the questions, we have selected only one child from your household. For most
households, it usually takes an average of 33 minutes to complete the survey.
Please contact us at 1-800-845-8241 or childrenshealth@census.gov if you have any
questions or need any assistance completing this survey.
The information collected in this survey will help our nation better understand and respond to
the health care needs of children and families. We ask for your response because this
survey is the only way we have to gather this important information. Your household was
scientifically selected from all of the households in the country and will represent thousands
of other households.
We want to assure you that your responses to this questionnaire are confidential as
explained on the front page of the survey. The U.S. Census Bureau and the U.S.
Department of Health and Human Services are required by law to protect the confidentiality
of your responses.
Your response is vital to the success of this survey. Thank you in advance for your
participation. We hope to hear from you soon.
Enclosure

census.gov

NSCH-22(B)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

No tenemos conocimiento de haber recibido su respuesta. Si usted ya respondió, por favor,
acepte nuestro agradecimiento. Si aún no ha contestado, lo(a) exhortamos a que complete y
nos envíe hoy el cuestionario impreso adjunto. Con el fin de reducir el tiempo que le tomará
contestar estas preguntas, hemos seleccionado a un(a) solo(a) niño(a) de su hogar. A la
mayoría de los hogares les toma un promedio de 33 minutos completar esta encuesta.
Por favor, llámenos al 1-800-845-8241 o envíenos un correo electrónico a
childrenshealth@census.gov si tiene alguna pregunta o necesita ayuda para completar la
encuesta.
La información recopilada en esta encuesta ayudará a nuestro país a comprender y responder
mejor a las necesidades de atención médica de los(as) niños(as) y sus familias. Solicitamos su
respuesta porque esta encuesta es la única manera que tenemos de recopilar esta importante
información. Su hogar fue seleccionado de manera científica entre todos los hogares en el país
y su respuesta representará a miles de otros hogares.
Queremos asegurarle que sus respuestas a este cuestionario son confidenciales como se
explica en la primera página de la encuesta. La ley estipula que la Oficina del Censo de los
EE.UU. y el Departamento de Salud y Servicios Humanos de los EE.UU. tienen que proteger la
confidencialidad de sus respuestas.
Su respuesta es esencial para el éxito de esta encuesta. Gracias de antemano por su
participación. Esperamos pronto su respuesta.
Documento adjunto

census.gov

NSCH-22(C)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
We recently contacted you to ask for your participation in the final step of the National
Survey of Children’s Health. Since the survey is ending soon, this is your last opportunity
to help. The final step is to answer some follow-up questions about:

census.gov

NSCH-22(C)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Recientemente lo(a) contactamos para solicitar su participación en el paso final de la Encuesta
Nacional de Salud de los Niños. Dado que la encuesta está a punto de terminar, esta es su
última oportunidad para poder ayudarnos. El último paso es completar algunas preguntas de
seguimiento sobre:

census.gov

NSCH-22(D)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

To the best of our knowledge, we have not yet received your response. If you have already
responded, please accept our thanks. If you have not, we encourage you to complete and
return the enclosed paper questionnaire today. To reduce the time you will need to respond
to the questions, we have selected only one child from your household. For most
households, it usually takes an average of 33 minutes to complete the survey.
Please contact us at 1-800-845-8241 or childrenshealth@census.gov if you have any
questions or need any assistance completing this survey.
The information collected in this survey will help our nation better understand and respond to
the health care needs of children and families. We ask for your response because this
survey is the only way we have to gather this important information. Your household was
scientifically selected from all of the households in the country and will represent thousands
of other households.
We want to assure you that your responses to this questionnaire are confidential as
explained on the front page of the survey. The U.S. Census Bureau and the U.S.
Department of Health and Human Services are required by law to protect the confidentiality
of your responses.
Your response is vital to the success of this survey. Thank you in advance for your
participation. We hope to hear from you soon.
Enclosure

census.gov

NSCH-22(D)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Recientemente lo(a) contactamos para solicitar su participación en el último paso de la Encuesta
Nacional de Salud de los Niños. Dado que la encuesta está a punto de terminar, esta es su última
oportunidad para poder ayudarnos. El último paso es completar algunas preguntas de seguimiento
sobre:

No tenemos conocimiento de haber recibido su respuesta. Si usted ya respondió, por favor, acepte
nuestro agradecimiento. Si aún no ha contestado, lo(a) exhortamos a que complete y nos envíe hoy
el cuestionario impreso adjunto. Con el fin de reducir el tiempo que le tomará contestar estas
preguntas, hemos seleccionado a un(a) solo(a) niño(a) de su hogar. A la mayoría de los hogares les
toma un promedio de 33 minutos completar esta encuesta.
Por favor, llámenos al 1-800-845-8241 o envíenos un correo electrónico a
childrenshealth@census.gov si tiene alguna pregunta o necesita ayuda para completar la encuesta.
La información recopilada en esta encuesta ayudará a nuestro país a comprender y responder mejor
a las necesidades de atención médica de los(as) niños(as) y sus familias. Solicitamos su respuesta
porque esta encuesta es la única manera que tenemos de recopilar esta importante información. Su
hogar fue seleccionado de manera científica entre todos los hogares en el país y su respuesta
representará a miles de otros hogares.
Queremos asegurarle que sus respuestas a este cuestionario son confidenciales como se explica en
la primera página de la encuesta. La ley estipula que la Oficina del Censo de los EE.UU. y el
Departamento de Salud y Servicios Humanos de los EE.UU. tienen que proteger la confidencialidad
de sus respuestas.
Su respuesta es esencial para el éxito de esta encuesta. Gracias de antemano por su
participación. Esperamos pronto su respuesta.
Documento adjunto

census.gov

NSCH-23(A)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Over the past few months, we have contacted you to ask you to complete the final part of
the National Survey of Children’s Health. We conduct this important survey for the U.S.
Department of Health and Human Services.
The survey provides vital information about the health status and needs of our nation’s
children. This information gives the public insights into how the youngest members of our
society are doing and what they need to thrive.
We know there are competing demands for your time. We ask for your response because
this survey is the only way we have to gather this important information. Your household
was scientifically selected from all of the households in the country and cannot be replaced
with another household.
To the best of our knowledge, we have not yet received your response. If you have
completed the survey prior to receiving this mailing, please accept our thanks. If you have
not yet responded, please complete and return the enclosed paper questionnaire as soon as
possible.
Contact us at 1-800-845-8241 or childrenshealth@census.gov if you have any questions or
need any assistance completing this survey.
Thank you in advance for your continued participation in this important survey.
Enclosure

census.gov

NSCH-23(A)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
En los últimos meses nos hemos comunicado con usted para pedirle que complete el último
paso de la Encuesta Nacional de Salud de los Niños. Estamos llevando a cabo esta
importante encuesta para el Departamento de Salud y Servicios Humanos de los EE.UU.
Esta encuesta provee información vital sobre las necesidades y el estado de salud de
los(as) niños(as) de nuestro país. Esta información le dará al público una visión clave sobre
cómo se encuentran los miembros más jóvenes de nuestra sociedad y lo que necesitan para
su bienestar.
Sabemos que usted tiene que dedicarles tiempo a muchas otras cosas. Solicitamos su
respuesta porque esta encuesta es la única manera que tenemos de recopilar esta
importante información. Su hogar fue seleccionado de manera científica entre todos los
hogares en el país y no puede ser reemplazado por otro hogar.
No tenemos conocimiento de haber recibido su respuesta. Si usted ya completó la encuesta
antes de recibir esta correspondencia, por favor, acepte nuestro agradecimiento. Si aún no
ha contestado, por favor, complete el cuestionario impreso adjunto y envíelo por correo lo
antes posible.
Llámenos al 1-800-845-8241 o envíenos un correo electrónico a
childrenshealth@census.gov si tiene alguna pregunta o necesita ayuda para completar la
encuesta.
Gracias de antemano por su continua participación en esta importante encuesta.
Documento adjunto

census.gov

NSCH-23(B)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

If you have completed the survey prior to receiving this mailing, please accept our thanks. If
you have not yet responded, please complete and return the enclosed paper questionnaire
as soon as possible.
Contact us at 1-800-845-8241 or childrenshealth@census.gov if you have any questions or
need any assistance completing this survey.
Thank you in advance for your continued participation in this important survey.
Enclosure

census.gov

NSCH-23(B)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Si usted ya completó la encuesta antes de recibir esta correspondencia, por favor, acepte
nuestro agradecimiento. Si aún no ha contestado, por favor, complete el cuestionario
impreso adjunto y envíelo por correo lo antes posible.
Llámenos al 1-800-845-8241 o envíenos un correo electrónico a
childrenshealth@census.gov si tiene alguna pregunta o necesita ayuda para completar la
encuesta.
Gracias de antemano por su continua participación en esta importante encuesta.
Documento adjunto

census.gov

NSCH-23(C)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Over the past few months, we have contacted you to ask you to complete the final part of
the National Survey of Children’s Health. We conduct this important survey for the U.S.
Department of Health and Human Services. Since the survey will soon end, this is your last
opportunity to help.
The survey provides vital information about the health status and needs of our nation’s
children. This information gives the public insights into how the youngest members of our
society are doing and what they need to thrive.
We know there are competing demands for your time. We ask for your response because
this survey is the only way we have to gather this important information. Your household
was scientifically selected from all of the households in the country and cannot be replaced
with another household.
To the best of our knowledge, we have not yet received your response. If you have
completed the survey prior to receiving this mailing, please accept our thanks. If you have
not yet responded, please complete and return the enclosed paper questionnaire as soon as
possible.
Contact us at 1-800-845-8241 or childrenshealth@census.gov if you have any questions or
need any assistance completing this survey.
Thank you in advance for your continued participation in this important survey.
Enclosure

census.gov

NSCH-23(C)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
En los últimos meses nos hemos comunicado con usted para pedirle que complete el último
paso de la Encuesta Nacional de Salud de los Niños. Estamos llevando a cabo esta
importante encuesta para el Departamento de Salud y Servicios Humanos de los EE.UU.
Dado que la encuesta está a punto de terminar, esta es su última oportunidad para poder
ayudarnos.
Esta encuesta provee información vital sobre las necesidades y el estado de salud de
los(as) niños(as) de nuestro país. Esta información le dará al público una visión clave sobre
cómo se encuentran los miembros más jóvenes de nuestra sociedad y lo que necesitan para
su bienestar.
Sabemos que usted tiene que dedicarles tiempo a muchas otras cosas. Solicitamos su
respuesta porque esta encuesta es la única manera que tenemos de recopilar esta
importante información. Su hogar fue seleccionado de manera científica entre todos los
hogares en el país y no puede ser reemplazado por otro hogar.
No tenemos conocimiento de haber recibido su respuesta. Si usted ya completó la encuesta
antes de recibir esta correspondencia, por favor, acepte nuestro agradecimiento. Si aún no
ha contestado, por favor, complete el cuestionario impreso adjunto y envíelo por correo lo
antes posible.
Llámenos al 1-800-845-8241 o envíenos un correo electrónico a
childrenshealth@census.gov si tiene alguna pregunta o necesita ayuda para completar la
encuesta.
Gracias de antemano por su continua participación en esta importante encuesta.
Documento adjunto

census.gov

NSCH-23(D)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Over the past few months, we have contacted you to ask you to complete the final part of
the National Survey of Children’s Health. We conduct this important survey for the U.S.
Department of Health and Human Services. Since the survey will soon end, this is your last
opportunity to help.
The survey provides vital information about the health status and needs of our nation’s
children. This information gives the public insights into how the youngest members of our
society are doing and what they need to thrive.
We know there are competing demands for your time. We ask for your response because
this survey is the only way we have to gather this important information. Your household
was scientifically selected from all of the households in the country and cannot be replaced
with another household.
To the best of our knowledge, we have not yet received your response to follow up questions
about:

census.gov

NSCH-23(D)
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
En los últimos meses nos hemos comunicado con usted para pedirle que complete el último
paso de la Encuesta Nacional de Salud de los Niños. Estamos llevando a cabo esta
importante encuesta para el Departamento de Salud y Servicios Humanos de los EE.UU. Dado
que la encuesta está a punto determinar, esta es su última oportunidad para poder ayudarnos.
Esta encuesta provee información vital sobre las necesidades y el estado de salud de los(as)
niños(as) de nuestro país. Esta información le dará al público una visión clave sobre cómo se
encuentran los miembros más jóvenes de nuestra sociedad y lo que necesitan para su bienestar.
Sabemos que usted tiene que dedicarles tiempo a muchas otras cosas. Solicitamos su
respuesta porque esta encuesta es la única manera que tenemos de recopilar esta importante
información. Su hogar fue seleccionado de manera científica entre todos los hogares en el país
y no puede ser reemplazado por otro hogar.
No tenemos conocimiento de haber recibido su respuesta a las preguntas de seguimiento sobre:

Si usted ya completó la encuesta antes de recibir esta correspondencia, por favor, acepte
nuestro agradecimiento. Si aún no ha contestado, por favor, complete el cuestionario impreso
adjunto y envíelo por correo lo antes posible.
Llámenos al 1-800-845-8241 o envíenos un correo electrónico a childrenshealth@census.gov si
tiene alguna pregunta o necesita ayuda para completar la encuesta.
Gracias de antemano por su continua participación en esta importante encuesta.
Documento adjunto

census.gov

NSCH-24
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
In recent months we have contacted you regarding the final part of the National Survey of
Children’s Health.
If you have responded to our request to participate in the final part of the survey, we thank
you. By participating, you ensure that we gather accurate and complete information.
If you have not responded, please complete and return the enclosed survey as soon as
possible. The survey is ending soon. This is your last opportunity to help us collect
information that is critical to understanding children’s health care needs, in your state and
across the country.
Thousands of families have already returned their surveys. We understand that your time is
valuable. For most households, the survey takes an average of 33 minutes to complete.
Respond today to ensure that the survey results reflect the characteristics of households like
yours.
If you have questions or need assistance, please contact us at 1-800-845-8241 or
childrenshealth@census.gov.
We greatly appreciate your help.
Enclosure

census.gov

NSCH-24
(6-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Mensaje del Director de la Oficina del Censo de los EE.UU.:
En los últimos meses nos hemos comunicado con usted sobre el último paso de la
Encuesta Nacional de Salud de los Niños.
Si usted ya respondió a nuestra solicitud de que participe de la última parte de la encuesta,
queremos darle las gracias. Su participación garantiza que la información que recopilemos
sea precisa y completa.
Si aún no ha contestado, por favor, complete el cuestionario impreso adjunto y envíelo por
correo lo antes posible. La encuesta está a punto de terminar. Esta es su última
oportunidad para ayudarnos a recopilar información que es crítica para entender
necesidades de cuidado de salud de los(as) niños(as), tanto en su estado como en todo el
país.
Miles de familias ya han enviado de vuelta sus encuestas. Entendemos que su tiempo es
valioso. A la mayoría de los hogares les toma un promedio de 33 minutos completar esta
encuesta. Responda hoy para asegurarnos que los resultados de la encuesta reflejen las
características de hogares como el suyo.
Si tiene preguntas o necesita ayuda, por favor, llámenos al 1-800-845-8241 o envíenos un
correo electrónico a childrenshealth@census.gov.
Agradecemos mucho su ayuda.
Documento adjunto

census.gov

NSCH-PC2
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
We’ve attempted to reach you to ask for your help with the National Survey of
Children’s Health. Your response will help us better understand the health care
needs of children in the United States.
If you have already responded to the survey, please accept our sincere thanks. If you
have not yet completed the survey, please do so right away.
Responding to this survey online is easy:
1.
2.

Go to https://respond.census.gov/nsch
Enter your Login ID:

If you need a paper version of the survey or have questions, please call
1-800-845-8241 or email us at childrenshealth@census.gov.
Thank you for your help.

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Hemos intentado comunicarnos con usted para solicitar su ayuda con la Encuesta
Nacional de Salud de los Niños. Su respuesta nos ayudará a entender mejor la
salud y las necesidades de cuidado de salud de los(as) niños(as) de los EE.UU.
Si usted ya respondió a la encuesta, por favor, acepte nuestro más sincero
agradecimiento. Si usted no ha completado todavía la encuesta, por favor, hágalo
inmediatamente.
Es muy fácil responder a esta encuesta por internet:
1.
2.

Vaya a: https://respond.census.gov/nsch
Introduzca su ID de Usuario:

Si usted necesita un cuestionario impreso o tiene preguntas, por favor, llame al
1-800-845-8241 o envíenos un correo electrónico a: childrenshealth@census.gov.
Muchas gracias por su ayuda.

census.gov

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
1201 E 10th St
Jeffersonville IN 47134-0001
OFFICIAL BUSINESS
Penalty for Private Use $300
NSCH-PC2 (05-2018)

AN EQUAL OPPORTUNITY EMPLOYER

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

NSCH-PCP
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Recently we mailed you a letter requesting your participation in the National Survey
of Children’s Health. If you have already responded to the survey, please accept our
sincere thanks. If you have not yet completed your survey online or returned the
paper questionnaire we sent you, please do so right away.
Responding to this survey online is easy:
1.
2.

Go to https://respond.census.gov/nsch
Enter your Login ID:

If you need assistance with the survey or have questions, please call 1-800-845-8241
or email us at childrenshealth@census.gov.
Thank you for your help.

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Recientemente le enviamos una carta invitándolo(a) a participar en la Encuesta
Nacional de Salud de los Niños. Si usted ya respondió a la encuesta, por favor,
acepte nuestro más sincero agradecimiento. Si usted no ha completado la encuesta
por internet ni ha completado y enviado el cuestionario impreso que le enviamos, por
favor, hágalo inmediatamente.
Es muy fácil responder a esta encuesta por internet:
1.
2.

Vaya a: https://respond.census.gov/nsch
Introduzca su ID de Usuario:

Si necesita ayuda para o tiene preguntas, por favor, llame al 1-800-845-8241 o
envíenos un correo electrónico a: childrenshealth@census.gov.
Muchas gracias por su ayuda.

census.gov

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
1201 E 10th St
Jeffersonville IN 47134-0001
OFFICIAL BUSINESS
Penalty for Private Use $300
NSCH-PCP (05-2018)

AN EQUAL OPPORTUNITY EMPLOYER

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

NSCH-PCW
(5-2018)

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

A Message from the Director, U.S. Census Bureau:
Recently we mailed you a letter requesting your participation in the National Survey
of Children’s Health. If you have already responded to the survey, please accept our
sincere thanks. If you have not yet completed your survey, please do so right away.
Responding to this survey online is easy:
1.
2.

Go to https://respond.census.gov/nsch
Enter your Login ID:

If you are unable to complete the survey online, need assistance, or have questions,
please call 1-800-845-8241 or email us at childrenshealth@census.gov.
Thank you for your help.

Mensaje del Director de la Oficina del Censo de los EE.UU.:
Recientemente le enviamos una carta invitándolo(a) a participar en la Encuesta
Nacional de Salud de los Niños. Si usted ya respondió a la encuesta, por favor,
acepte nuestro más sincero agradecimiento. Si usted no ha completado todavía la
encuesta, por favor, hágalo inmediatamente.
Es muy fácil responder a esta encuesta por internet:
1.
2.

Vaya a: https://respond.census.gov/nsch
Introduzca su ID de Usuario:

Si usted no puede completar la encuesta por internet, necesita ayuda o tiene
preguntas, por favor, llame al 1-800-845-8241 o envíenos un correo electrónico a:
childrenshealth@census.gov.
Muchas gracias por su ayuda.

census.gov

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
1201 E 10th St
Jeffersonville IN 47134-0001
OFFICIAL BUSINESS
Penalty for Private Use $300
NSCH-PCW (05-2018)

AN EQUAL OPPORTUNITY EMPLOYER

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

Attachment E – Survey Questionnaires




[116-183] English Questionnaires
o [116-123] Screener
o [124-143] Topical T1
o [144-163] Topical T2
o [164-183] Topical T3
[184-263] Spanish Questionnaires
o [184-191] Screener
o [192-211] Topical T1
o [212-231] Topical T2
o [232-251] Topical T3

26008086
OMB No. 0607-0990: Approval Expires 05/31/2019

National Survey of Children’s Health
A study by the U.S. Department of Health and Human Services
to better understand the health issues faced by children in the
United States today.

The U.S. Census Bureau is required by law to protect your information and is not permitted to publicly release your responses in
a way that could identify you or your household. The U.S. Census Bureau is conducting the National Survey of Children’s Health
on the behalf of the Department of Health and Human Services (HHS) under Title 13, United States Code, Section 8(b), which allows
the Census Bureau to conduct surveys on behalf of other agencies. Title 42 U.S.C. Section 701(a)(2) allows HHS to collect information
for the purpose of understanding the health and well-being of children in the United States. Federal law protects your privacy and
keeps your answers confidential under 13 U.S.C. Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your data are
protected from cybersecurity risks through screening of the systems that transmit your data.
Any information you provide will be shared for the work-related purposes identified above and as permitted under the Privacy Act
of 1974 (5 U.S.C. Section 552a) and SORN COMMERCE/CENSUS-3, Demographic Survey Collection (Census Bureau Sampling Frame).
Participation in this survey is voluntary and there are no penalties for refusing to answer questions. However, your cooperation in
obtaining this much needed information is extremely important in order to ensure complete and accurate results.

NSCH-S1
(02/26/2018)

§;!qw¤

26008078

Start Here
Respond online today at:
https://respond.census.gov/nsch
OR
Complete this form and mail it back as soon as possible.
Thank you for helping us learn about the health and well-being of America’s children.
If your household has children 0 - 17 years old, the questions on this form should be answered by an adult who is familiar with
their health and health care.
If your household does not have any children, please answer question 1 below AND return the questionnaire.
If you need help or have questions about completing this form, please call 1-800-845-8241. The telephone call is free.
For Telephone Device for the Deaf (TDD) assistance, please call: 1-800-582-8330. The telephone call is free.
Si necesita ayuda o tiene preguntas sobre cómo completar este formulario, llame al 1-800-845-8241. La llamada es gratuita.
Para recibir ayuda relacionada con el Dispositivo Telefónico para Personas Sordas (TDD), llame al 1-800-582-8330. La llamada
es gratuita.

In Your Home
1

Are there any children 0-17 years old who usually live or stay at this address?
Yes
No – STOP HERE after marking “No” and return this survey to us in the enclosed envelope. It is important that we
receive a response from every household selected for this study.

How many children 0-17 years old usually live or stay at this address?

Number of children living or staying at this address
3

What is the primary language spoken in the household?
English
Spanish
Other Language, specify:

Is this house, apartment, or mobile home –
Mark (X) ONE box.
Owned by you or someone in this household with a mortgage or loan? Include home equity loans.
Owned by you or someone in this household free and clear (without a mortgage or loan)?
Rented?
Occupied without payment of rent?

➜

Answer the remaining questions for each of the children 0-17 years old who usually live or stay at this address.
Start with the YOUNGEST CHILD, who we will call “Child 1” and continue with the next youngest until you have
answered the questions for all children who usually live or stay at this address.

NSCH-S1

§;!qo¤

26008060

CHILD 1

(Youngest)
1

First name, initials, or nickname of the youngest child

How old is this child? If the child is less than one month
old, round age in months to 1.

Years OR

Yes

Months

Female

Does this child need or use more medical care, mental
health, or educational services than is usual for most
children of the same age?
Yes

➜ NOTE: Answer BOTH question

If yes, is this child’s need for medical care, mental
health, or educational services because of ANY
medical, behavioral, or other health condition?

4 about Hispanic
origin and question 5 about race.
For this survey, Hispanic origins are not races.

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

What is this child’s sex?
Male

If yes, is this child’s need for prescription medicine
because of ANY medical, behavioral, or other health
condition?

8
3

Does this child CURRENTLY need or use medicine
prescribed by a doctor, other than vitamins?

Yes

Is this child of Hispanic, Latino, or Spanish origin?

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

No, not of Hispanic, Latino, or Spanish origin

Yes

Yes, Mexican, Mexican American, Chicano
9
Yes, Puerto Rican

Is this child limited or prevented in any way in his or her
ability to do the things most children of the same age
can do?

Yes, Cuban
Yes
Yes, another Hispanic, Latino, or Spanish origin
5

If yes, is this child’s limitation in abilities because of
ANY medical, behavioral, or other health condition?

What is this child’s race? Mark (X) one or more boxes.
Yes
White

Vietnamese

Black or
African American

Other Asian

American Indian or
Alaska Native

Native Hawaiian

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?
Yes

Asian Indian

Guamanian or
Chamorro

Chinese

Samoan

Filipino

Other Pacific Islander

Japanese

Some other race

10 Does this child need or get special therapy, such as
physical, occupational, or speech therapy?
Yes

If yes, is this because of ANY medical, behavioral,
or other health condition?
Yes

Answer the following question only if this child is at
least 4 years old. Otherwise, SKIP to question 7 .
How well does this child speak English?

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

Korean
6

Yes

11 Does this child have any kind of emotional,
developmental, or behavioral problem for which he or
she needs treatment or counseling?

Very well

Yes

Well

If yes, has his or her emotional, developmental, or
behavioral problem lasted or is it expected to last
12 months or longer?

Not well
Yes

Not at all
NSCH-S1

§;!q]¤

26008052

CHILD 2

(Next youngest)
1

First name, initials, or nickname of the next youngest
child

How old is this child? If the child is less than one month
old, round age in months to 1.

Years OR

Yes

Months

Female

Does this child need or use more medical care, mental
health, or educational services than is usual for most
children of the same age?
Yes

➜ NOTE: Answer BOTH question

If yes, is this child’s need for medical care, mental
health, or educational services because of ANY
medical, behavioral, or other health condition?

4 about Hispanic
origin and question 5 about race.
For this survey, Hispanic origins are not races.

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

What is this child’s sex?
Male

If yes, is this child’s need for prescription medicine
because of ANY medical, behavioral, or other health
condition?

8
3

Does this child CURRENTLY need or use medicine
prescribed by a doctor, other than vitamins?

Yes

Is this child of Hispanic, Latino, or Spanish origin?

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

No, not of Hispanic, Latino, or Spanish origin

Yes

Yes, Mexican, Mexican American, Chicano
9
Yes, Puerto Rican

Is this child limited or prevented in any way in his or her
ability to do the things most children of the same age
can do?

Yes, Cuban
Yes
Yes, another Hispanic, Latino, or Spanish origin
5

If yes, is this child’s limitation in abilities because of
ANY medical, behavioral, or other health condition?

What is this child’s race? Mark (X) one or more boxes.
Yes
White

Vietnamese

Black or
African American

Other Asian

American Indian or
Alaska Native

Native Hawaiian

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?
Yes

Asian Indian

Guamanian or
Chamorro

Chinese

Samoan

Filipino

Other Pacific Islander

Japanese

Some other race

10 Does this child need or get special therapy, such as
physical, occupational, or speech therapy?
Yes

If yes, is this because of ANY medical, behavioral,
or other health condition?
Yes

Answer the following question only if this child is at
least 4 years old. Otherwise, SKIP to question 7 .
How well does this child speak English?

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

Korean
6

Yes

11 Does this child have any kind of emotional,
developmental, or behavioral problem for which he or
she needs treatment or counseling?

Very well

Yes

Well

If yes, has his or her emotional, developmental, or
behavioral problem lasted or is it expected to last
12 months or longer?

Not well
Yes

Not at all
NSCH-S1

§;!qU¤

26008045

CHILD 3

(Next youngest)
1

First name, initials, or nickname of the next youngest
child

How old is this child? If the child is less than one month
old, round age in months to 1.

Years OR

Yes

Months

Female

Does this child need or use more medical care, mental
health, or educational services than is usual for most
children of the same age?
Yes

➜ NOTE: Answer BOTH question

If yes, is this child’s need for medical care, mental
health, or educational services because of ANY
medical, behavioral, or other health condition?

4 about Hispanic
origin and question 5 about race.
For this survey, Hispanic origins are not races.

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

What is this child’s sex?
Male

If yes, is this child’s need for prescription medicine
because of ANY medical, behavioral, or other health
condition?

8
3

Does this child CURRENTLY need or use medicine
prescribed by a doctor, other than vitamins?

Yes

Is this child of Hispanic, Latino, or Spanish origin?

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

No, not of Hispanic, Latino, or Spanish origin

Yes

Yes, Mexican, Mexican American, Chicano
9
Yes, Puerto Rican

Is this child limited or prevented in any way in his or her
ability to do the things most children of the same age
can do?

Yes, Cuban
Yes
Yes, another Hispanic, Latino, or Spanish origin
5

If yes, is this child’s limitation in abilities because of
ANY medical, behavioral, or other health condition?

What is this child’s race? Mark (X) one or more boxes.
Yes
White

Vietnamese

Black or
African American

Other Asian

American Indian or
Alaska Native

Native Hawaiian

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?
Yes

Asian Indian

Guamanian or
Chamorro

Chinese

Samoan

Filipino

Other Pacific Islander

Japanese

Some other race

10 Does this child need or get special therapy, such as
physical, occupational, or speech therapy?
Yes

If yes, is this because of ANY medical, behavioral,
or other health condition?
Yes

Answer the following question only if this child is at
least 4 years old. Otherwise, SKIP to question 7 .
How well does this child speak English?

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

Korean
6

Yes

11 Does this child have any kind of emotional,
developmental, or behavioral problem for which he or
she needs treatment or counseling?

Very well

Yes

Well

If yes, has his or her emotional, developmental, or
behavioral problem lasted or is it expected to last
12 months or longer?

Not well
Yes

Not at all
NSCH-S1

§;!qN¤

26008037

CHILD 4

(Next youngest)
1

First name, initials, or nickname of the next youngest
child

How old is this child? If the child is less than one month
old, round age in months to 1.

Years OR

Yes

Months

Female

Does this child need or use more medical care, mental
health, or educational services than is usual for most
children of the same age?
Yes

➜ NOTE: Answer BOTH question

If yes, is this child’s need for medical care, mental
health, or educational services because of ANY
medical, behavioral, or other health condition?

4 about Hispanic
origin and question 5 about race.
For this survey, Hispanic origins are not races.

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

What is this child’s sex?
Male

If yes, is this child’s need for prescription medicine
because of ANY medical, behavioral, or other health
condition?

8
3

Does this child CURRENTLY need or use medicine
prescribed by a doctor, other than vitamins?

Yes

Is this child of Hispanic, Latino, or Spanish origin?

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

No, not of Hispanic, Latino, or Spanish origin

Yes

Yes, Mexican, Mexican American, Chicano
9
Yes, Puerto Rican

Is this child limited or prevented in any way in his or her
ability to do the things most children of the same age
can do?

Yes, Cuban
Yes
Yes, another Hispanic, Latino, or Spanish origin
5

If yes, is this child’s limitation in abilities because of
ANY medical, behavioral, or other health condition?

What is this child’s race? Mark (X) one or more boxes.
Yes
White

Vietnamese

Black or
African American

Other Asian

American Indian or
Alaska Native

Native Hawaiian

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?
Yes

Asian Indian

Guamanian or
Chamorro

Chinese

Samoan

Filipino

Other Pacific Islander

Japanese

Some other race

10 Does this child need or get special therapy, such as
physical, occupational, or speech therapy?
Yes

If yes, is this because of ANY medical, behavioral,
or other health condition?
Yes

Answer the following question only if this child is at
least 4 years old. Otherwise, SKIP to question 7 .
How well does this child speak English?

If yes, is this a condition that has lasted or
is expected to last 12 months or longer?

Korean
6

Yes

11 Does this child have any kind of emotional,
developmental, or behavioral problem for which he or
she needs treatment or counseling?

Very well

Yes

Well

If yes, has his or her emotional, developmental, or
behavioral problem lasted or is it expected to last
12 months or longer?

Not well
Yes

Not at all
NSCH-S1

§;!qF¤

26008029

➜

If there are more than four children 0-17 years old who usually live or stay at this address, list the first name, initials,
or nickname for each child as well as their age and sex.
Do not repeat information for children already included for Child 1 through Child 4.

First name, initials, or nickname

Child 5
▲

(Next youngest)

Age

Years OR

Months

Sex

Male

Female

Months

Sex

Male

Female

Months

Sex

Male

Female

Months

Sex

Male

Female

Months

Sex

Male

Female

Months

Sex

Male

Female

First name, initials, or nickname

Child 6
▲

(Next youngest)

Age

Years OR

First name, initials, or nickname

Child 7
▲

(Next youngest)

Age

Years OR

First name, initials, or nickname

Child 8
▲

(Next youngest)

Age

Years OR

First name, initials, or nickname

Child 9
▲

(Next youngest)

Age

Years OR

First name, initials, or nickname

Child 10
▲

(Next youngest)

Age

Years OR

NSCH-S1

§;!q>¤

26008011

➜ Make sure you have:
• Listed all first names, initials, or nicknames of children 0-17 years old in the household
• Answered all questions for each child reported

➜ Place the completed questionnaire in the postage-paid return envelope. If the envelope has been
misplaced, please mail the questionnaire to:
U.S. Census Bureau
ATTN: DCB 60-A
1201 E. 10th Street
Jeffersonville, IN 47132-0001
You may also call 1-800-845-8241 to request a replacement envelope.

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. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project
0607-0990, U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington, DC 20233. You may e-mail
comments to DEMO.Paperwork@census.gov; use "Paperwork Project 0607-0990" as the subject.

NSCH-S1

§;!q,¤

26018200
OMB No. 0607-0990: Approval Expires 05/31/2019

National Survey of Children’s Health
A study by the U.S. Department of Health and Human Services
to better understand the health issues faced by children in the
United States today.

NSCH-T1
(04/17/2018)

§;"s!¤

26018192

Start Here

How often...
Always

Usually Sometimes

Never

a. Is this child
affectionate and
tender with you?

Recently, you completed a survey that asked about the
children usually living or staying at this address.
Thank you for taking the time to complete that survey.

b. Does this child
bounce back
quickly when
things do not go
his or her way?

We now have some follow-up questions to ask about:

c. Does this child
show interest
and curiosity in
learning new
things?

If the name listed above is not correct or does not
correspond to a child living in this household, please
call 1-800-845-8241 for assistance.

d. Does this child
smile and laugh?

We have selected only one child per household in an
effort to minimize the amount of time you will need to
complete the follow-up questions.
A4

The survey should be completed by an adult who is
familiar with this child’s health and health care.
Your participation is important. Thank you.

DURING THE PAST 12 MONTHS, has this child had
FREQUENT or CHRONIC difficulty with any of the
following?
Yes

Yes

a. Breathing or other respiratory
problems (such as wheezing or
shortness of breath)
b. Eating or swallowing because of
a health condition
c. Digesting food, including
stomach/intestinal problems,
constipation, or diarrhea

A. This Child’s Health

d. Repeated or chronic physical pain,
including headaches or other back
or body pain

A1 In general, how would you describe this child’s health

(the one named above)?
Excellent

e. Using his or her hands

Very good

f. Coordination or moving around

Good

g. Toothaches

Fair

h. Bleeding gums

Poor

A2 How would you describe the condition of this child’s

Decayed teeth or cavities

Does this child have any of the following?

teeth?
This child does not have any teeth

a. Deafness or problems with hearing

Excellent

b. Blindness or problems with seeing,
even when wearing glasses

Very good
Good
Fair
Poor

NSCH-T1

§;"r}¤

26018184

Has a doctor or other health care provider EVER told
you that this child has...
A6

Allergies (including food, drug, insect, or other)?
Yes

Has a doctor or other health care provider EVER told
you that this child has...
A12 Epilepsy or Seizure Disorder?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, does this child CURRENTLY have the
condition?

Yes

If yes, is it:

If yes, is it:
Mild

Moderate

Severe

A7 Arthritis?

Mild

Moderate

Severe

A13 Heart Condition?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, does this child CURRENTLY have the
condition?

Yes

If yes, is it:

Mild

Moderate

Severe

A8 Asthma?

Mild

Moderate

Severe

A14 Frequent or severe headaches, including migraine?

Yes

Mild

Moderate

Severe

Mild

Yes

Severe

If yes, does this child CURRENTLY have the
condition?

Yes

If yes, is it:

If yes, is it:
Mild

Moderate

Mild

Severe

A10 Cerebral Palsy?

Yes

Moderate

A15 Tourette Syndrome?

A9 Brain injury, concussion or head injury?

Yes

If yes, is it:

Yes

If yes, does this child CURRENTLY have the
condition?

Moderate

Severe

A16 Anxiety Problems?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, is it:

If yes, is it:
Mild

Moderate

Mild

Severe

A11 Diabetes?

Moderate

Severe

A17 Depression?

Yes

If yes, does this child CURRENTLY have the
condition?

If yes, does this child CURRENTLY have the
condition?
Yes

Yes

If yes, is it:

If yes, is it:
Mild

Moderate

Mild

Severe

NSCH-T1

Moderate

Severe

§;"ru¤

26018176

Has a doctor or other health care provider EVER told
you that this child has...
A18 Down Syndrome?

Yes

Has a doctor or other health care provider EVER told
you that this child has...
A21 Other genetic or inherited condition?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, specify: C

No
Is it:

If yes, is it:
Mild

Moderate

Mild

Severe

Thalassemia, or Hemophilia)?

Yes

If yes, is it:
Mild

Moderate

Has a doctor, other health care provider, or educator
EVER told you that this child has...
Examples of educators are teachers and school nurses.

Severe

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.
Yes

Severe

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.

A19 Blood Disorders (such as Sickle Cell Disease,

Yes

Moderate

A22 Behavioral or Conduct Problems?

Yes

If yes, does this child CURRENTLY have the
condition?

If yes, was this child diagnosed with:
Sickle Cell Disease?

Yes

Thalassemia?

Yes

Hemophilia?

Yes

Other Blood Disorders?

Yes

If yes, is it:
Mild

Yes

If yes, is it:

If yes, is it:
Moderate

Severe

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.
Yes

If yes, does this child CURRENTLY have the
condition?
No

Mild

Severe

A23 Developmental Delay?

A20 Cystic Fibrosis?

Yes

Moderate

Mild

Moderate

Severe

A24 Intellectual Disability (formerly known as Mental

Retardation)?

Yes

If yes, does this child CURRENTLY have the
disability?
Yes

If yes, is it:
Mild

NSCH-T1

Moderate

Severe

§;"rm¤

26018168

Has a doctor, other health care provider, or educator
EVER told you that this child has...
Examples of educators are teachers and school nurses.

A29 How old was this child when a doctor or other health

care provider FIRST told you that he or she had Autism,
ASD, Asperger’s Disorder or PDD?

A25 Speech or other language disorder?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

A30 What type of doctor or other health care provider was

the FIRST to tell you that this child had Autism, ASD,
Asperger’s Disorder or PDD? Mark (X) ONE box.

Primary Care Provider

If yes, is it:
Mild

Moderate

Specialist

Severe

School Psychologist/Counselor

A26 Learning Disability?

Yes

Don’t know

Age in years

Other Psychologist (Non-School)

If yes, does this child CURRENTLY have the
disability?
Yes

Psychiatrist
Other, specify:

If yes, is it:
Mild

Moderate

Severe

Has a doctor or other health care provider EVER told
you that this child has...

Don’t know
A31 Is this child CURRENTLY taking medication for Autism,

ASD, Asperger’s Disorder or PDD?

A27 Any other mental health condition?

Yes

A32 At any time DURING THE PAST 12 MONTHS, did this

If yes, specify: C

child receive behavioral treatment for Autism, ASD,
Asperger’s Disorder or PDD, such as training or an
intervention that you or this child received to help
with his or her behavior?

If yes, does this child CURRENTLY have the
condition?

Yes
Yes

A33 Has a doctor or other health care provider EVER told

If yes, is it:
Mild

Moderate

you that this child has Attention Deficit Disorder or
Attention Deficit/Hyperactivity Disorder, that is, ADD or
ADHD?

Severe

A28 Has a doctor or other health care provider EVER told

If yes, does this child CURRENTLY have the
condition?

No ➔ SKIP to question A33

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, is it:
Mild

No ➔ SKIP to question A36 on
page 6

Yes

you that this child has Autism or Autism Spectrum
Disorder (ASD)? Include diagnoses of Asperger’s Disorder
or Pervasive Developmental Disorder (PDD).
Yes

Moderate

Severe

A34 Is this child CURRENTLY taking medication for ADD or

Moderate

ADHD?

Severe

Yes

NSCH-T1

§;"re¤

26018150

A35 At any time DURING THE PAST 12 MONTHS, did this

child receive behavioral treatment for ADD or ADHD,
such as training or an intervention that you or this
child received to help with his or her behavior?
Yes

If yes, how old was this child when he or she
COMPLETELY stopped breastfeeding or being fed
breast milk?

days
OR

A36 DURING THE PAST 12 MONTHS, how often have this

child’s health conditions or problems affected his or her
ability to do things other children his or her age do?

weeks

This child does not have any
health conditions ➔ SKIP to question B1

Never

months

Sometimes

Usually

Check this box if child is still breastfeeding

Always

How old was this child when he or she was FIRST fed
formula?

A37 To what extent do this child’s health conditions or

problems affect his or her ability to do things?

Check this box if child has never been fed formula
OR

Very little

At birth

Somewhat

A great deal

days
OR

B. This Child as an Infant
B1

weeks

Was this child born more than 3 weeks before his or
her due date?

Yes
months

No
B2

How much did he or she weigh when born? Answer in
pounds and ounces OR kilograms and grams. Your best
estimate is fine.
pounds AND

How old was this child when he or she was FIRST fed
anything other than breast milk or formula? Include
juice, cow’s milk, sugar water, baby food, or anything else
that your child might have been given, even water.
Check this box if child has never been fed anything
other than breast milk or formula
OR

ounces

At birth
kilograms AND
B3

grams

What was the age of the mother when this child was
born? Your best estimate is fine.

days
OR

Age in years
B4

weeks

Was this child EVER breastfed or fed breast milk?
OR

Yes
No ➔ SKIP to question B6

months

NSCH-T1

§;"rS¤

26018143

C. Health Care Services

C1 DURING THE PAST 12 MONTHS, did this child see a

Yes

doctor, nurse, or other health care professional for
medical care (for example, preventive care, sick care,
hospitalizations)?

No
C8

Yes
No ➔ SKIP to question C4
C2

Has a doctor or other health care provider ever told you
that this child is overweight?

DURING THE PAST 12 MONTHS, did this child’s doctors
or other health care providers ask if you have concerns
about this child’s learning, development, or behavior?

Yes
If yes, DURING THE PAST 12 MONTHS, how many times
did this child visit a doctor, nurse, or other health care
No
professional to receive a PREVENTIVE check-up?
A preventive check-up is when this child was not sick or
C9 Answer the following question only if this child is at
injured, such as an annual or sports physical, or well-child
least 9 months old. Otherwise skip to question C10 .
visit.
DURING THE PAST 12 MONTHS, did a doctor or other
health care provider have you or another caregiver fill
0 visits
out a questionnaire about observations or concerns you
may have about this child’s development, communication,
1 visit
or social behaviors? Sometimes a child’s doctor or other
health care provider will ask a parent to do this at home or
2 or more visits
during a child’s visit.
Thinking about the LAST TIME you took this child for
a PREVENTIVE check-up, about how long was the
doctor or health care provider who examined this child
in the room with you? Your best estimate is fine.

Yes

If yes, and this child is 9-23 Months:
Did the questionnaire ask about your concerns
or observations about: Mark (X) ALL that apply.

Less than 10 minutes

How this child talks or makes speech sounds?

10-20 minutes

How this child interacts with you and others?

More than 20 minutes
C4

If yes, and this child is 2-5 Years:
Did the questionnaire ask about your concerns
or observations about: Mark (X) ALL that apply.
Words and phrases this child uses and
understands?

What is this child’s CURRENT height?
Your best estimate is fine.
feet AND

inches

How this child behaves and gets along with
you and others?

C10 Is there a place you or another caregiver USUALLY

meters AND
C5

take this child when he or she is sick or you need
advice about his or her health?

centimeters

Yes

How much does this child CURRENTLY weigh?
Your best estimate is fine.
pounds AND

ounces

No ➔ SKIP to question C12 on page 8
C11 If yes, where does this child USUALLY go first?

Mark (X) ONE box.
OR
Doctor’s Office
kilograms AND
C6

grams

Hospital Emergency Room
Hospital Outpatient Department

Are you concerned about this child’s weight?
Yes, it’s too high

Clinic or Health Center

Yes, it’s too low

Retail Store Clinic or “Minute Clinic”

No, I am not concerned

School (Nurse’s Office, Athletic Trainer’s Office)
Some other place

NSCH-T1

§;"rL¤

26018135

C12 Is there a place that this child USUALLY goes when

C18 If yes, DURING THE PAST 12 MONTHS, what

preventive dental service(s) did this child receive?
Mark (X) ALL that apply.

he or she needs routine preventive care, such as a
physical examination or well-child check-up?
Yes

Check-up

No ➔ SKIP to question C14

Cleaning
Instruction on tooth brushing and oral health care

C13 If yes, is this the same place this child goes when he

or she is sick?
X-Rays
Yes
Fluoride treatment
No
Sealant (plastic coatings on back teeth)
C14 DURING THE PAST 12 MONTHS, has this child had his

or her vision tested, such as with pictures, shapes, or
letters?

Don’t know
C19 DURING THE PAST 12 MONTHS, has this child

Yes

received any treatment or counseling from a mental
health professional? Mental health professionals include
psychiatrists, psychologists, psychiatric nurses, and clinical
social workers.

No ➔ SKIP to question C16
C15 If yes, where was this child’s vision tested?

Yes

Mark (X) ALL that apply.
Eye doctor or eye specialist (ophthalmologist,
optometrist) office

No, but this child needed to see a mental health
professional

Pediatrician or other general doctor’s office

No, this child did not need to see a
mental health professional ➔ SKIP to question C21

Clinic or health center

C20 How difficult was it to get the mental health treatment

or counseling that this child needed?
School
Not difficult
Other, specify:

Somewhat difficult
Very difficult

C16 DURING THE PAST 12 MONTHS, did this child see a

It was not possible to obtain care

dentist or other oral health care provider for any kind
of dental or oral health care?

C21 DURING THE PAST 12 MONTHS, has this child taken

any medication because of difficulties with his or her
emotions, concentration, or behavior?

Yes, saw a dentist
Yes, saw other oral health care provider

Yes

No ➔ SKIP to question C19
C17 If yes, DURING THE PAST 12 MONTHS, did this child

see a dentist or other oral health care provider for
preventive dental care, such as check-ups, dental
cleanings, dental sealants, or fluoride treatments?

No
C22 DURING THE PAST 12 MONTHS, did this child see a

specialist other than a mental health professional?
Specialists are doctors like surgeons, heart doctors, allergy
doctors, skin doctors, and others who specialize in one
area of health care.

No preventive visits in
the past 12 months ➔ SKIP to question C19

Yes
Yes, 1 visit
No, but this child needed to see a specialist
Yes, 2 or more visits
No, this child did not need to see
a specialist ➔ SKIP to question C24 on page 9

NSCH-T1

§;"rD¤

26018127

C23 How difficult was it to get the specialist care that this

C28 DURING THE PAST 12 MONTHS, how often were you

child needed?

frustrated in your efforts to get services for this child?

Not difficult

Never

Somewhat difficult

Sometimes

Very difficult

Usually

It was not possible to obtain care

Always

C24 DURING THE PAST 12 MONTHS, did this child use any

C29 DURING THE PAST 12 MONTHS, how many times did

type of alternative health care or treatment? Alternative
health care can include acupuncture, chiropractic care,
relaxation therapies, herbal supplements, and others.
Some therapies involve seeing a health care provider,
while others can be done on your own.

this child visit a hospital emergency room?
None
1 time

Yes

2 or more times

C30 DURING THE PAST 12 MONTHS, was this child

admitted to the hospital to stay for at least one night?

C25 DURING THE PAST 12 MONTHS, was there any time

when this child needed health care but it was not
received? By health care, we mean medical care as well
as other kinds of care like dental care, vision care, and
mental health services.

Yes
No
C31 Has this child EVER had a special education or early

Yes

intervention plan? Children receiving these services often
have an Individualized Family Service Plan (IFSP) or
Individualized Education Plan (IEP).

No ➔ SKIP to question C28
C26 If yes, which types of care were not received?

Yes

Mark (X) ALL that apply.

No ➔ SKIP to question C34

Medical Care
Dental Care

C32 If yes, how old was this child at the time of the FIRST

plan?
Vision Care
Years AND

Hearing Care

C33 Is this child CURRENTLY receiving services under one

Mental Health Services
Other, specify:

Months

of these plans?
Yes

No
C27 Did any of the following reasons contribute to this child C34 Has this child EVER received special services to meet

his or her developmental needs such as speech,
occupational, or behavioral therapy?

not receiving needed health services? Mark (X) Yes or No
for each item.
Yes

Yes

a. This child was not eligible for the
services
b. The services this child needed were
not available in your area

No ➔ SKIP to question D1 on page 10
C35 If yes, how old was this child when he or she began

receiving these special services?

c. There were problems getting an
appointment when this child needed
one
d. There were problems with getting
transportation or child care

Years AND

Months

C36 Is this child CURRENTLY receiving these special

services?

e. The clinic or doctor’s office wasn’t
open when this child needed care

Yes

f. There were issues related to cost

NSCH-T1

§;"r<¤

26018119

D. Experience with This
Child’s Health Care
Providers

If yes, DURING THE PAST 12 MONTHS, how often did
this child’s doctors or other health care providers...
Always

Usually Sometimes Never

a. Discuss with you
the range of options
to consider for his
or her health care or
treatment?

D1 Do you have one or more persons you think of as this

child’s personal doctor or nurse? A personal doctor or
nurse is a health professional who knows this child well
and is familiar with this child’s health history. This can be
a general doctor, a pediatrician, a specialist doctor, a
nurse practitioner, or a physician’s assistant.

b. Make it easy for you
to raise concerns or
disagree with
recommendations
for this child’s health
care?

Yes, one person
Yes, more than one person

c. Work with you to
decide together
which health care
and treatment
choices would be
best for this child?

No
D2 DURING THE PAST 12 MONTHS, did this child need a

referral to see any doctors or receive any services?
Yes
D7

No ➔ SKIP to question D4

DURING THE PAST 12 MONTHS, did anyone help you
arrange or coordinate this child’s care among the
different doctors or services that this child uses?

D3 How difficult was it to get referrals?

Yes
Not difficult
No
Somewhat difficult
Did not see more than one health care provider
in the PAST 12 MONTHS

Very difficult
D8

It was not possible to get a referral
D4 Answer the following questions only if this child had a

health care visit IN THE PAST 12 MONTHS. Otherwise
skip to question E1 on page 11.

DURING THE PAST 12 MONTHS, have you felt that you
could have used extra help arranging or coordinating
this child’s care among the different health care
providers or services?
Yes

DURING THE PAST 12 MONTHS, how often did this
child’s doctors or other health care providers...
Always

Usually Sometimes

No ➔ SKIP to question D10

Never

a. Spend enough time
with this child?

b. Listen carefully to
you?

Usually

c. Show sensitivity to
your family’s values
and customs?
d. Provide the specific
information you
needed concerning
this child?

If yes, DURING THE PAST 12 MONTHS, how often
did you get as much help as you wanted with
arranging or coordinating this child’s health care?

Sometimes
Never
D10 DURING THE PAST 12 MONTHS, how satisfied were

you with the communication between this child’s
doctors and other health care providers?

e. Help you feel like a
partner in this
child’s care?

Very satisfied

D5 DURING THE PAST 12 MONTHS, did this child need

Somewhat satisfied

any decisions to be made regarding his or her health
care, such as whether to get prescriptions, referrals,
or procedures?

Somewhat dissatisfied

Yes

Very dissatisfied

No ➔ SKIP to question D7
NSCH-T1

§;"r4¤

26018101

D11 DURING THE PAST 12 MONTHS, did this child’s health

care provider communicate with the child’s school, child
care provider, or special education program?

Is this child CURRENTLY covered by ANY kind of
health insurance or health coverage plan?
Yes

Yes

No ➔ SKIP to question F1 on page 12

No ➔ SKIP to question E1
E4

Did not need health care
provider to communicate
with these providers ➔ SKIP to question E1

Is this child CURRENTLY covered by any of the
following types of health insurance or health coverage
plans? Mark (X) Yes or No for EACH item.
Yes

a. Insurance through a current or
former employer or union

D12 If yes, during this time, how satisfied were you with the

health care provider’s communication with the school,
child care provider, or special education program?

b. Insurance purchased directly
from an insurance company
c. Medicaid, Medical Assistance,
or any kind of government
assistance plan for those with
low incomes or a disability

Very satisfied
Somewhat satisfied
Somewhat dissatisfied

d. TRICARE or other military
health care

Very dissatisfied

e. Indian Health Service

E. This Child’s Health
Insurance Coverage
E1

f. Other, specify: C

DURING THE PAST 12 MONTHS, was this child EVER
covered by ANY kind of health insurance or health
coverage plan?

How often does this child’s health insurance offer
benefits or cover services that meet this child’s needs?

Yes, this child was covered
all 12 months ➔ SKIP to question E4

Always

Yes, but this child had a gap in coverage

Usually

Sometimes

Indicate whether any of the following is a reason this
child was not covered by health insurance at any time
DURING THE PAST 12 MONTHS:
Yes

Never
E6

How often does this child’s health insurance allow him
or her to see the health care providers he or she needs?

a. Change in employer or employment
status

Always

b. Cancellation due to overdue
premiums

Usually

c. Dropped coverage because it was
unaffordable

Sometimes

d. Dropped coverage because benefits
were inadequate

Never

e. Dropped coverage because choice
of health care providers was
inadequate

Thinking specifically about this child’s mental or
behavioral health needs, how often does this child’s
health insurance offer benefits or cover services that
meet these needs?

f. Problems with application or
renewal process

This child does not use mental or behavioral
health services

g. Other, specify: C

Always
Usually
Sometimes
Never

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26018093

F. Providing for This
Child’s Health
F1

IN AN AVERAGE WEEK, how many hours do you or
other family members spend providing health care at
home for this child? Care might include changing bandages,
or giving medication and therapies when needed.
This child does not need health care provided at home
on a weekly basis

Including co-pays and amounts reimbursed from
Health Savings Accounts (HSA) and Flexible Spending
Accounts (FSA), how much money did you pay for this
child’s medical, health, dental, and vision care
DURING THE PAST 12 MONTHS? Do not include health
insurance premiums or costs that were or will be
reimbursed by insurance or another source.

Less than 1 hour per week
1-4 hours per week
5-10 hours per week

$0 (No medical or health-related
expenses) ➔ SKIP to question F4

11 or more hours per week
$1-$249
F6

$250-$499
$500-$999

IN AN AVERAGE WEEK, how many hours do you or
other family members spend arranging or coordinating
health or medical care for this child, such as making
appointments or locating services?

$1,000-$5,000

This child does not need health care coordinated
on a weekly basis

More than $5,000

Less than 1 hour per week
1-4 hours per week

How often are these costs reasonable?
Always

5-10 hours per week

Usually

11 or more hours per week

Sometimes

G. This Child’s Learning

Never
F3

DURING THE PAST 12 MONTHS, did your family have
problems paying for any of this child’s medical or
health care bills?

Answer the following question only if this child is at
least 1 year old. Otherwise skip to H1 on page 15.
G1

Yes

a. Say at least one word, such as "hi"
or "dog"?

No
F4

Is this child able to do the following...
Mark (X) Yes or No for each item.

b. Use 2 words together, such as
"car go"?

DURING THE PAST 12 MONTHS, have you or other
family members...
Yes

c. Use 3 words together in a sentence,
such as, "Mommy come now."?

a. Left a job or taken a leave of
absence because of this child’s
health or health conditions?

d. Ask questions like "who," "what,"
"when," "where"?

b. Cut down on the hours you work
because of this child’s health or
health conditions?

e. Ask questions like "why" and "how"?
f. Tell a story with a beginning,
middle, and end?

c. Avoided changing jobs because of
concerns about maintaining health
insurance for this child?

g. Understand the meaning of the
word "no"?
h. Follow a verbal direction without
hand gestures, such as "Wash your
hands."?
i.

Point to things in a book when
asked?
j. Follow 2-step directions, such as
"Get your shoes and put them in the
basket."?
k. Understand words such as "in,"
"on," and "under"?

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26018085

G2 Is this child 3 years old or older?

G8 Can this child rhyme words?

Yes

No ➔ SKIP to question H1 on page 15

G3 Has this child started school? Include any formal

G9 How often can this child explain things he or she has seen

home schooling.

or done so that you get a very good idea what happened?

Yes, preschool

Always

Yes, kindergarten

Most of the time

Yes, first grade

About half the time

Sometimes
Never

G4 Are you concerned about how this child is learning to

do things for him or herself?
G10 How often can this child write his or her first name, even

Yes, somewhat concerned

if some of the letters aren’t quite right or are backwards?

Yes, very concerned

Always

Most of the time
About half the time

G5 How confident are you that this child is ready to be in

school?
Sometimes
Completely confident
Never
Mostly confident
G11 How high can this child count?

Somewhat confident
This child cannot count
Not at all confident
Up to five
G6 How often can this child recognize the beginning

sound of a word? For example, can this child tell you
that the word “ball” starts with the “buh” sound?

Up to ten
Up to 20

Always

Up to 50

Most of the time

Up to 100 or more

About half the time
Sometimes

G12 How often can this child identify basic shapes such as

a triangle, circle, or square?

Never

Always

G7 About how many letters of the alphabet can this child

Most of the time

recognize?

About half the time

All of them

Sometimes

Most of them

Never

About half of them
Some of them
None of them

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26018077

G13 Can this child identify the colors red, yellow, blue,

G19 How often does this child become angry or anxious

and green by name?

when going from one activity to another?

Yes, all of them

Always

Yes, some of them

Most of the time

No, none of them

About half the time

G14 How often is this child easily distracted?

Sometimes

Always
Most of the time

Never
G20 How often does this child show concern when others

are hurt or unhappy?

About half the time

Always
Sometimes
Most of the time
Never
About half the time
G15 How often does this child keep working at something

until he or she is finished?

Sometimes

Always
Most of the time

Never
G21 When excited or all wound up, how often can this child

calm down quickly?

About half the time

Always
Sometimes
Most of the time
Never
About half the time
G16 When this child is paying attention, how often can he

Sometimes

or she follow instructions to complete a simple task?
Always
Most of the time

Never
G22 How often does this child lose control of his or her

temper when things do not go his or her way?

About half the time

Always
Sometimes
Most of the time
Never
About half the time
G17 How does this child usually hold a pencil?

Sometimes

Uses fingers to hold the pencil

Never

Grips the pencil in his or her fist
This child cannot hold a pencil

G23 Compared to other children his or her age, how much

difficulty does this child have making or keeping
friends?

G18 How often does this child play well with others?

No difficulty

Always

A little difficulty

Most of the time

A lot of difficulty

About half the time
Sometimes
Never
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26018069

G24 Compared to other children his or her age, how often

is this child able to sit still?

Answer the next question only if this child is LESS THAN
12 MONTHS OLD. Otherwise, SKIP to question H7 .
In which position do you most often lay this baby down
to sleep now? Mark (X) ONE box.

Always
Most of the time

On his or her side

About half the time

On his or her back

Sometimes

On his or her stomach

Never

H. About You and This
Child

ON MOST WEEKDAYS, about how much time did this
child spend in front of a TV, computer, cellphone or
other electronic device watching programs, playing
games, accessing the internet or using social media?
Do not include time spent doing schoolwork.
Less than 1 hour

H1 Was this child born in the United States?

Yes ➔ SKIP to question

1 hour
H3

2 hours

3 hours
H2 If no, how long has this child been living in the

United States?
Years AND

4 or more hours
Months

H3 How many times has this child moved to a new address

DURING THE PAST WEEK, how many days did you or
other family members read to this child?
0 days

since he or she was born?

1-3 days
Number of times
4-6 days
H4 How often does this child go to bed at about the same

Every day

time on weeknights?
Always

Usually

DURING THE PAST WEEK, how many days did you or
other family members tell stories or sing songs to this
child?

Sometimes

0 days

Rarely

1-3 days

Never

4-6 days
Every day

H5 DURING THE PAST WEEK, how many hours of sleep

did this child get during an average day (count both
nighttime sleep and naps)?

H10 How well do you think you are handling the day-to-day

demands of raising children?

Less than 7 hours

Very well
7 hours
Somewhat well
8 hours
Not very well
9 hours
Not well at all
10 hours
11 hours
12 or more hours

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26018051

I. About Your Family and
Household

H11 DURING THE PAST MONTH, how often have you

felt...

Never

Rarely Sometimes Usually Always

a. That this
child is much
harder to care
for than most
children his
or her age?

DURING THE PAST WEEK, on how many days did all
the family members who live in the household eat a
meal together?
0 days

b. That this
child does
things that
really bother
you a lot?

1-3 days
4-6 days

c. Angry with
this child?

Every day

H12 DURING THE PAST 12 MONTHS, was there someone

that you could turn to for day-to-day emotional support
with parenting or raising children?

Does anyone living in your household use cigarettes,
cigars, or pipe tobacco?
Yes

Yes

No ➔ SKIP to question I4

No ➔ SKIP to question

H14

H13 If yes, did you receive emotional support from...
Yes

If yes, does anyone smoke inside your home?
Yes

a. Spouse or domestic partner?
b. Other family member or close friend?

c. Health care provider?

DURING THE PAST 12 MONTHS, how often were
pesticides used inside your residence to control for
insects? If the frequency changed throughout the year,
report the highest frequency.

d. Place of worship or religious leader?

More than once a week

e. Support or advocacy group related
to specific health condition?

Once a week

f. Peer support group?

Once a month

g. Counselor or other mental health
professional?

Once every 2-5 months

h. Other person, specify:

Once every 6 months
C

Once during the past 12 months
Never
H14 Does this child receive care for at least 10 hours per

week from someone other than his or her parent or
guardian? This could be a day care center, preschool,
Head Start program, family child care home, nanny,
au pair, babysitter or relative.

Don’t know
I5

Yes

DURING THE PAST 12 MONTHS, other than in a shower
or bathtub, have you seen any mold, mildew or other
signs of water damage on walls or other surfaces inside
your home?
Yes

H15 DURING THE PAST 12 MONTHS, did you or anyone in

the family have to quit a job, not take a job, or greatly
change your job because of problems with child care
for this child?
Yes
No

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26018044

When your family faces problems, how often are you
likely to do each of the following?
All of
the time

Most of
the time

Some of
the time

I10 In your neighborhood, is/are there...

Yes

None of
the time

a. Sidewalks or walking paths?

a. Talk together
about what to do

b. A park or playground?

b. Work together to
solve our problems

c. A recreation center, community
center, or boys’ and girls’ club?

c. Know we have
strengths to draw on

d. A library or bookmobile?

d. Stay hopeful
even in difficult
times

e. Litter or garbage on the street
or sidewalk?
f. Poorly kept or rundown housing?

SINCE THIS CHILD WAS BORN, how often has it been
very hard to cover the basics, like food and housing,
on your family’s income?
Never

g. Vandalism such as broken
windows or graffiti?
I11 To what extent do you agree with these statements

about your neighborhood or community?
Rarely

Definitely Somewhat Somewhat Definitely
agree
agree
disagree disagree

Somewhat often

a. People in this
neighborhood
help each other
out
b. We watch out for
each other’s
children in this
neighborhood

Very often
I8

Which of these statements best describes your
household’s ability to afford the food you need
DURING THE PAST 12 MONTHS?
We could always afford to eat good nutritious meals.

c. This child is
safe in our
neighborhood

We could always afford enough to eat but not always
the kinds of food we should eat.

d. When we
encounter
difficulties, we
know where to
go for help in
our community

Sometimes we could not afford enough to eat.
Often we could not afford enough to eat.
I9

At any time DURING THE PAST 12 MONTHS, even for
one month, did anyone in your family receive...
Yes

I12 The next questions are about events that may have

happened during this child’s life. These things can
happen in any family, but some people may feel
uncomfortable with these questions. You may skip
any questions you do not want to answer.

a. Cash assistance from a government
welfare program?

To the best of your knowledge, has this child EVER
experienced any of the following?
Yes
No
a. Parent or guardian divorced or
separated

b. Food Stamps or Supplemental Nutrition
Assistance Program (SNAP) benefits?
c. Free or reduced-cost breakfasts or
lunches at school?

b. Parent or guardian died

d. Benefits from the Woman, Infants,
and Children (WIC) Program?

c. Parent or guardian served time in jail
d. Saw or heard parents or adults slap,
hit, kick, punch one another in the
home
e. Was a victim of violence or
witnessed violence in his or her
neighborhood
f. Lived with anyone who was mentally
ill, suicidal, or severely depressed
g. Lived with anyone who had a problem
with alcohol or drugs
h. Treated or judged unfairly because
of his or her race or ethnic group
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26018036

J. Child’s Caregivers

Married

➜ Complete the questions for up to two adults in the
household who are this child’s primary caregivers.
If there is just one adult primary caregiver, provide
answers for that adult.
J1

Not married, but living with a partner
Never Married

How are you related to this child?

Divorced

Biological or Adoptive Parent

Separated

Step-parent
Grandparent

Widowed
J8

Foster Parent

In general, how is your physical health?
Excellent

Other: Relative

Very good

Other: Non-Relative
J2

What is your marital status?

Good

What is your sex?

Fair

Male

Poor

Female
J9
J3

What is your age?

Excellent

Age in years
J4

In general, how is your mental or emotional health?

Very good

Where were you born?

Good

In the United States ➔ SKIP to question J6

Fair

Outside of the United States

Poor

When did you come to live in the United States?

J10

Year

Were you employed at least 50 out of the past 52 weeks?
Yes
No

What is the highest grade or level of school you have
completed? Mark (X) ONE box.

J11

8th grade or less

Have you ever served on active duty in the
U.S. Armed Forces, Reserves, or the National Guard?
Mark (X) ONE box.

9th-12th grade; No diploma

Never served in the
military ➔ SKIP to question J13 on page 19

High School Graduate or GED Completed

Only on active duty for training in the Reserves or
National Guard ➔ SKIP to question J13 on page 19

Completed a vocational, trade, or business school
program

Now on active duty
On active duty in the past, but not now

Some College Credit, but no Degree
Associate Degree (AA, AS)

J12

Were you deployed at any time during this child’s life?
Yes

Bachelor’s Degree (BA, BS, AB)

Master’s Degree (MA, MS, MSW, MBA)
Doctorate (PhD, EdD) or Professional Degree
(MD, DDS, DVM, JD)
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26018028

➜

Questions J13 - J24 ask about another adult primary
caregiver who may be in the household in addition to
yourself.

J19 What is this primary caregiver’s marital status?

Married

J13 How is this adult primary caregiver in the household

Not married, but living with a partner

related to this child?
There is only one primary adult caregiver in the
household for this child ➔ SKIP to question K1 on
page 20

Never Married
Divorced

Biological or Adoptive Parent

Separated

Step-parent

Widowed

Grandparent
Foster Parent

J20 In general, how is this primary caregiver’s physical

health?

Other: Relative

Excellent

Other: Non-Relative

Very good

J14 What is this primary caregiver’s sex?

Good

Male

Fair

Female

Poor

J15 What is this primary caregiver’s age?

J21 In general, how is this primary caregiver’s mental or

emotional health?
Age in years

Excellent

J16 Where was this primary caregiver born?

Very good

In the United States ➔ SKIP to question J18

Good

Outside of the United States

Fair

J17 When did this primary caregiver come to live in the

United States?
Year

Poor
J22 Was this primary caregiver employed at least 50 out of

the past 52 weeks?
Yes
J18 What is the highest grade or level of school this primary

caregiver has completed? Mark (X) ONE box.
8th grade or less

No
J23 Has this primary caregiver ever served on active duty in

the U.S. Armed Forces, Reserves, or the National Guard?
Mark (X) ONE box.

9th-12th grade; No diploma
High School Graduate or GED Completed

Never served in the
military ➔ SKIP to question K1 on page 20

Completed a vocational, trade, or business school
program

Only on active duty for training in the Reserves or
National Guard ➔ SKIP to question K1 on page 20

Some College Credit, but no Degree

Now on active duty

Associate Degree (AA, AS)

On active duty in the past, but not now

Bachelor’s Degree (BA, BS, AB)

J24 Was this primary caregiver deployed at any time during

this child’s life?

Master’s Degree (MA, MS, MSW, MBA)

Yes

Doctorate (PhD, EdD) or Professional Degree
(MD, DDS, DVM, JD)

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26018010

K. Household Information
K1

d. Social security or railroad retirement; retirement,
survivor, or disability pensions.

How many people are living or staying at this address?
Include everyone who usually lives or stays at this address.
Do NOT include anyone who is living somewhere else for
more than two months, such as a college student living away
or someone in the Armed Forces on deployment.

Yes ➔

How many of these people in your household are family
members? Family is defined as anyone related to this child
by blood, marriage, adoption, or through foster care.

Yes ➔

Number of people

b. Self-employment income from own nonfarm
businesses or farm business, including
proprietorships and partnerships.
Yes ➔

.00

TOTAL AMOUNT
in the last calendar year

The following question is about your 2017 income.
Think about your total combined family income IN THE
LAST CALENDAR YEAR for all members of the family.
What is that amount before taxes? Include money from
jobs, child support, social security, retirement income,
unemployment payments, public assistance, and so forth.
Also, include income from interest, dividends, net income
from businesses, farm or rent, and any other money income
received.

.00

TOTAL AMOUNT
in the last calendar year

c. Interest, dividends, net rental income, royalty
income, or income from estates and trusts.
Yes ➔

Loss

TOTAL AMOUNT
in the last calendar year

No
K4

.00

TOTAL AMOUNT
in the last calendar year

Yes ➔

TOTAL AMOUNT
in the last calendar year

.00

f. Any other sources of income received regularly
such as Veterans’ (VA) payments, unemployment
compensation, child support, or alimony.

Income in 2017
Mark (X) the "Yes" box for each type of income this child’s
family received, and give your best estimate of the TOTAL
AMOUNT IN THE LAST CALENDAR YEAR. Mark (X) the
“No” box to show types of income NOT received.
a. Wages, salary, commissions, bonuses, or tips for
all jobs.
Yes ➔

e. Supplemental security income (SSI); any public
assistance or welfare payments from the state or
local welfare office.

TOTAL AMOUNT
in the last calendar year

Number of people
K2

Loss

TOTAL AMOUNT
in the last calendar year

Mailing Instructions
Thank you for your participation.
On behalf of the U.S. Department of Health and Human Services, we would like to thank you for the time and effort you have
spent sharing information about this child and your family.
Your answers are important to us and will help researchers, policymakers, and family advocates to better understand the health
and health care needs of children in our diverse population.
Place the completed questionnaire in the postage-paid return envelope. If the envelope has been misplaced, mail the
questionnaire to:
U.S. Census Bureau
ATTN: DCB 60-A
1201 E. 10th Street
Jeffersonville, IN 47132-0001
You may also call 1-800-845-8241 to request a replacement envelope.
Public reporting burden for this collection of information is estimated to average 33 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. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project
0607-0990, U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington, DC 20233. You may e-mail comments to DEMO.Paperwork@census.gov;
use "Paperwork Project 0607-0990" as the subject.

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26028209
OMB No. 0607-0990: Approval Expires 05/31/2019

National Survey of Children’s Health
A study by the U.S. Department of Health and Human Services
to better understand the health issues faced by children in the
United States today.

NSCH-T2
(05/02/2018)

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26028191

Start Here

How often does this child...
Always

Usually Sometimes

Never

a. Show interest and
curiosity in learning
new things?

Recently, you completed a survey that asked about the
children usually living or staying at this address.
Thank you for taking the time to complete that survey.

b. Work to finish tasks
he or she starts?

We now have some follow-up questions to ask about:

c. Stay calm and in
control when faced
with a challenge?
d. Care about doing
well in school?

If the name listed above is not correct or does not
correspond to a child living in this household, please
call 1-800-845-8241 for assistance.

e. Do all required
homework?

We have selected only one child per household in an
effort to minimize the amount of time you will need to
complete the follow-up questions.
The survey should be completed by an adult who is
familiar with this child’s health and health care.

f. Argue too much?

Your participation is important. Thank you.

DURING THE PAST 12 MONTHS, how often was this
child bullied, picked on, or excluded by other children?
If the frequency changed throughout the year, report the
highest frequency.
Never (in the past 12 months)
1-2 times (in the past 12 months)
1-2 times per month

A. This Child’s Health

1-2 times per week
Almost every day

A1 In general, how would you describe this child’s health

(the one named above)?
Excellent

Very good
Good

DURING THE PAST 12 MONTHS, how often did this
child bully others, pick on them, or exclude them?
If the frequency changed throughout the year, report the
highest frequency.
Never (in the past 12 months)

Fair

1-2 times (in the past 12 months)

Poor

1-2 times per month

A2 How would you describe the condition of this child’s

1-2 times per week

teeth?

Almost every day

Excellent
Very good
Good
Fair
Poor

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26028183

A6 DURING THE PAST 12 MONTHS, has this child had

Has a doctor or other health care provider EVER told
you that this child has...

FREQUENT or CHRONIC difficulty with any of the
following?
Yes

A10 Asthma?

a. Breathing or other respiratory
problems (such as wheezing or
shortness of breath)

Yes

If yes, does this child CURRENTLY have the
condition?

b. Eating or swallowing because of
a health condition

Yes

If yes, is it:

c. Digesting food, including
stomach/intestinal problems,
constipation, or diarrhea

Mild

Moderate

Severe

A11 Brain injury, concussion or head injury?

d. Repeated or chronic physical pain,
including headaches or other back
or body pain

Yes

If yes, does this child CURRENTLY have the
condition?

e. Toothaches
f. Bleeding gums

Yes

If yes, is it:

g. Decayed teeth or cavities

Mild
A7 Does this child have any of the following?
Yes

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

b. Serious difficulty walking or climbing
stairs

Mild

Moderate

Yes

e. Blindness or problems with seeing,
even when wearing glasses

If yes, does this child CURRENTLY have the
condition?

Has a doctor or other health care provider EVER told
you that this child has...

Yes

If yes, does this child CURRENTLY have the
condition?

If yes, is it:

A8 Allergies (including food, drug, insect, or other)?

Mild

Moderate

Yes

If yes, does this child CURRENTLY have the
condition?

If yes, is it:
Moderate

Yes

Severe

If yes, is it:

A9 Arthritis?

Mild
No

Moderate

Severe

A15 Heart Condition?

If yes, does this child CURRENTLY have the
condition?
Yes

Severe

A14 Epilepsy or Seizure Disorder?

Yes

Severe

A13 Diabetes?

d. Deafness or problems with hearing

Mild

If yes, is it:

c. Difficulty dressing or bathing

Yes

Severe

A12 Cerebral Palsy?

a. Serious difficulty concentrating,
remembering, or making decisions
because of a physical, mental, or
emotional condition

Yes

Moderate

Yes

If yes, does this child CURRENTLY have the
condition?

If yes, is it:
Yes
Mild

Moderate

Severe

If yes, is it:
Mild

NSCH-T2

Moderate

Severe

§;#rt¤

26028175

Has a doctor or other health care provider EVER told
you that this child has...
A16 Frequent or severe headaches, including migraine?

Has a doctor or other health care provider EVER told
you that this child has...
A21 Blood Disorders (such as Sickle Cell Disease,

Thalassemia, or Hemophilia)?
Yes

No
Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, is it:

Mild

If yes, is it:
Mild

Moderate

Severe

Yes

Severe

If yes, was this child diagnosed with:

If yes, does this child CURRENTLY have the
condition?

Sickle Cell Disease?

Yes

Thalassemia?

Yes

Hemophilia?

Yes

Other Blood
Disorders?

Yes

If yes, is it:
Mild

Moderate

Severe

A22 Cystic Fibrosis?

A18 Anxiety Problems?

Yes

Mild

Moderate

Severe

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.

If yes, is it:
Mild

If yes, is it:

If yes, does this child CURRENTLY have the
condition?

Moderate

Severe

A19 Depression?

Yes

A23 Other genetic or inherited condition?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, specify: C

If yes, is it:

Is it:

Mild
A20

Moderate

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.

A17 Tourette Syndrome?

Yes

Moderate

Severe

Mild

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

A24 Substance Use Disorder?

If yes, is it:
Mild

Severe

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.

Down Syndrome?
Yes

Moderate

Yes
Moderate

If yes, does this child CURRENTLY have the
disorder?

Severe

Yes

If yes, is it:
Mild

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Moderate

Severe

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Has a doctor, other health care provider, or educator
EVER told you that this child has...
Examples of educators are teachers and school nurses.
A25 Behavioral or Conduct Problems?

Yes

Has a doctor or other health care provider EVER told
you that this child has...
A30 Any other mental health condition?

Yes

If yes, specify: C

If yes, does this child CURRENTLY have the
condition?
Yes

No
If yes, does this child CURRENTLY have the
condition?

If yes, is it:
Mild

Moderate

Severe

Yes

A26 Developmental Delay?

Yes

If yes, is it:

Mild

If yes, does this child CURRENTLY have the
condition?
Yes

Moderate

Severe

A31 Has a doctor or other health care provider EVER told

you that this child has Autism or Autism Spectrum
Disorder (ASD)? Include diagnoses of Asperger’s Disorder
or Pervasive Developmental Disorder (PDD).

If yes, is it:
Mild

Moderate

No ➔ SKIP to question A36 on page 6

Yes

Severe

If yes, does this child CURRENTLY have the
condition?

A27 Intellectual Disability (formerly known as Mental

Retardation)?
Yes
Yes

If yes, is it:

If yes, does this child CURRENTLY have the
disability?
Yes

Mild

Moderate

Severe

A32 How old was this child when a doctor or other health

care provider FIRST told you that he or she had Autism,
ASD, Asperger’s Disorder or PDD?

If yes, is it:
Mild

Moderate

Severe
Don’t know

Age in years
A28 Speech or other language disorder?

Yes

A33 What type of doctor or other health care provider was

the FIRST to tell you that this child had Autism, ASD,
Asperger’s Disorder or PDD? Mark (X) ONE box.

If yes, does this child CURRENTLY have the
condition?
Yes

Primary Care Provider

No
Specialist

If yes, is it:
Mild

Moderate

School Psychologist/Counselor

Severe

Other Psychologist (Non-School)

A29 Learning Disability?

Yes

Psychiatrist

If yes, does this child CURRENTLY have the
disability?
Yes

Other, specify: C

If yes, is it:
Mild

Don’t know
Moderate

Severe

A34 Is this child CURRENTLY taking medication for Autism,

ASD, Asperger’s Disorder or PDD?
Yes

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26028159

B. This Child as an Infant

A35 At any time DURING THE PAST 12 MONTHS, did this

child receive behavioral treatment for Autism, ASD,
Asperger’s Disorder or PDD, such as training or an
intervention that you or this child received to help
with his or her behavior?
Yes

Yes
No

A36 Has a doctor or other health care provider EVER told

you that this child has Attention Deficit Disorder or
Attention Deficit/Hyperactivity Disorder, that is, ADD or
ADHD?

No ➔ SKIP to question A39

Yes

Was this child born more than 3 weeks before his or
her due date?

How much did he or she weigh when born? Answer in
pounds and ounces OR kilograms and grams. Your best
estimate is fine.

If yes, does this child CURRENTLY have the
condition?
Yes

pounds AND

ounces

If yes, is it:
kilograms AND
Mild

Moderate

A37 Is this child CURRENTLY taking medication for ADD or

ADHD?
Yes

grams

Severe
What was the age of the mother when this child was
born? Your best estimate is fine.

Age in years

A38 At any time DURING THE PAST 12 MONTHS, did this

child receive behavioral treatment for ADD or ADHD,
such as training or an intervention that you or this
child received to help with his or her behavior?

C. Health Care Services
C1

Yes

A39 DURING THE PAST 12 MONTHS, how often have this

child’s health conditions or problems affected his or her
ability to do things other children his or her age do?

Yes

This child does not have any
health conditions ➔ SKIP to question B1
Never

No ➔ SKIP to question C4 on page 7
C2

Sometimes
Usually
Always

If yes, DURING THE PAST 12 MONTHS, how many times
did this child visit a doctor, nurse, or other health care
professional to receive a PREVENTIVE check-up?
A preventive check-up is when this child was not sick or
injured, such as an annual or sports physical, or well-child
visit.
0 visits

A40 To what extent do this child’s health conditions or

1 visit

problems affect his or her ability to do things?

2 or more visits

Very little
Somewhat

DURING THE PAST 12 MONTHS, did this child see a
doctor, nurse, or other health care professional for
medical care (for example, preventive care, sick care,
hospitalizations)?

A great deal

Thinking about the LAST TIME you took this child for
a PREVENTIVE check-up, about how long was the
doctor or health care provider who examined this child
in the room with you? Your best estimate is fine.
Less than 10 minutes
10-20 minutes
More than 20 minutes

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26028142

C4 What is this child’s CURRENT height?

C10 Is there a place that this child USUALLY goes when

Your best estimate is fine.
feet AND

he or she needs routine preventive care, such as a
physical examination or well-child check-up?
inches

Yes

No ➔ SKIP to question C12
meters AND

centimeters

C11 If yes, is this the same place this child goes when he

or she is sick?
C5 How much does this child CURRENTLY weigh?

Yes

Your best estimate is fine.

No
pounds
C12 DURING THE PAST 12 MONTHS, has this child had his

or her vision tested, such as with pictures, shapes, or
letters?
kilograms

Yes

Are you concerned about this child’s weight?
Yes, it’s too high

No ➔ SKIP to question C14
C13 If yes, where was this child’s vision tested?

Mark (X) ALL that apply.

Yes, it’s too low

Eye doctor or eye specialist (ophthalmologist,
optometrist) office

No, I am not concerned

Pediatrician or other general doctor’s office
C7

Has a doctor or other health care provider ever told
you that this child is overweight?

Clinic or health center

Yes

School

Other, specify:

Is there a place you or another caregiver USUALLY
take this child when he or she is sick or you need
advice about his or her health?

C14 DURING THE PAST 12 MONTHS, did this child see a

dentist or other oral health care provider for any kind
of dental or oral health care?

Yes
No ➔ SKIP to question C10
C9

Yes, saw a dentist
Yes, saw other oral health care provider

If yes, where does this child USUALLY go first?
Mark (X) ONE box.

No ➔ SKIP to question C17 on page 8
Doctor’s Office
C15 If yes, DURING THE PAST 12 MONTHS, did this child

Hospital Emergency Room

see a dentist or other oral health care provider for
preventive dental care, such as check-ups, dental
cleanings, dental sealants, or fluoride treatments?

Hospital Outpatient Department
Clinic or Health Center

No preventive visits in the past
12 months ➔ SKIP to question C17 on page 8

Retail Store Clinic or “Minute Clinic”

Yes, 1 visit

School (Nurse’s Office, Athletic Trainer’s Office)

Yes, 2 or more visits

Some other place

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26028134

C16 If yes, DURING THE PAST 12 MONTHS, what

C21 How difficult was it to get the specialist care that this

child needed?

preventive dental service(s) did this child receive?
Mark (X) ALL that apply.

Not difficult
Check-up
Somewhat difficult
Cleaning
Very difficult
Instruction on tooth brushing and oral health care
It was not possible to obtain care
X-Rays
C22 DURING THE PAST 12 MONTHS, did this child use any

Fluoride treatment
Sealant (plastic coatings on back teeth)
Don’t know

Yes
C17 DURING THE PAST 12 MONTHS, has this child

received any treatment or counseling from a mental
health professional? Mental health professionals include
psychiatrists, psychologists, psychiatric nurses, and clinical
social workers.

No
C23 DURING THE PAST 12 MONTHS, was there any time

when this child needed health care but it was not
received? By health care, we mean medical care as well
as other kinds of care like dental care, vision care, and
mental health services.

Yes
No, but this child needed to see a mental health
professional

Yes

No, this child did not need to see a
mental health professional ➔ SKIP to question C19

No ➔ SKIP to question C26 on page 9
C24 If yes, which types of care were not received?

C18 How difficult was it to get the mental health treatment

Mark (X) ALL that apply.

or counseling that this child needed?
Medical Care
Not difficult
Dental Care
Somewhat difficult
Vision Care
Very difficult
Hearing Care
It was not possible to obtain care
Mental Health Services
C19 DURING THE PAST 12 MONTHS, has this child taken

Other, specify: C

any medication because of difficulties with his or her
emotions, concentration, or behavior?
Yes
No

C25 Did any of the following reasons contribute to this child

not receiving needed health services? Mark (X) Yes or No
for each item.
Yes

C20 DURING THE PAST 12 MONTHS, did this child see a

a. This child was not eligible for the
services

specialist other than a mental health professional?
Specialists are doctors like surgeons, heart doctors, allergy
doctors, skin doctors, and others who specialize in one
area of health care.

b. The services this child needed were
not available in your area
c. There were problems getting an
appointment when this child needed
one

Yes
No, but this child needed to see a specialist

d. There were problems with getting
transportation or child care

No, this child did not need to
see a specialist ➔ SKIP to question C22

e. The clinic or doctor’s office wasn’t
open when this child needed care
f. There were issues related to cost

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26028126

D. Experience with This
Child’s Health Care
Providers

C26 DURING THE PAST 12 MONTHS, how often were you

frustrated in your efforts to get services for this child?
Never
Sometimes
D1

Usually
Always
C27 DURING THE PAST 12 MONTHS, how many times did

Do you have one or more persons you think of as this
child’s personal doctor or nurse? A personal doctor or
nurse is a health professional who knows this child well
and is familiar with this child’s health history. This can be
a general doctor, a pediatrician, a specialist doctor, a
nurse practitioner, or a physician’s assistant.

this child visit a hospital emergency room?
Yes, one person

None

Yes, more than one person

1 time

2 or more times
C28 DURING THE PAST 12 MONTHS, was this child

admitted to the hospital to stay for at least one night?

DURING THE PAST 12 MONTHS, did this child need a
referral to see any doctors or receive any services?

Yes

No ➔ SKIP to question D4

C29 Has this child EVER had a special education or early

intervention plan? Children receiving these services often
have an Individualized Family Service Plan (IFSP) or
Individualized Education Plan (IEP).

How difficult was it to get referrals?
Not difficult

Yes

Somewhat difficult

No ➔ SKIP to question C32

Very difficult
It was not possible to get a referral

C30 If yes, how old was this child at the time of the FIRST

plan?
D4

Years AND

Months

C31 Is this child CURRENTLY receiving services under one

Answer the following questions only if this child had a
health care visit IN THE PAST 12 MONTHS. Otherwise
skip to question E1 on page 11.
DURING THE PAST 12 MONTHS, how often did this
child’s doctors or other health care providers...

of these plans?
Yes

Always

Usually Sometimes

a. Spend enough time
with this child?

b. Listen carefully to
you?

C32 Has this child EVER received special services to meet

his or her developmental needs such as speech,
occupational, or behavioral therapy?

c. Show sensitivity to
your family’s values
and customs?

Yes

d. Provide the specific
information you
needed concerning
this child?

No ➔ SKIP to question D1
C33 If yes, how old was this child when he or she began

receiving these special services?
Years AND

e. Help you feel like a
partner in this
child’s care?

Months

C34 Is this child CURRENTLY receiving these special

services?
Yes
No
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Never

26028118

D5 DURING THE PAST 12 MONTHS, did this child need

D10 DURING THE PAST 12 MONTHS, how satisfied were

any decisions to be made regarding his or her health
care, such as whether to get prescriptions, referrals,
or procedures?

you with the communication between this child’s
doctors and other health care providers?
Very satisfied

Yes
Somewhat satisfied
No ➔ SKIP to question D7
Somewhat dissatisfied
D6 If yes, DURING THE PAST 12 MONTHS, how often did

this child’s doctors or other health care providers...
Always

Very dissatisfied

Usually Sometimes Never

a. Discuss with you
the range of options
to consider for his
or her health care or
treatment?

D11 DURING THE PAST 12 MONTHS, did this child’s health

b. Make it easy for you
to raise concerns or
disagree with
recommendations
for this child’s health
care?

No ➔ SKIP to question E1 on page 11

c. Work with you to
decide together
which health care
and treatment
choices would be
best for this child?

care provider communicate with the child’s school, child
care provider, or special education program?
Yes

Did not need health care provider to communicate
with these providers ➔ SKIP to question E1 on
page 11
D12 If yes, during this time, how satisfied were you with the

health care provider’s communication with the school,
child care provider, or special education program?
Very satisfied
Somewhat satisfied

D7 DURING THE PAST 12 MONTHS, did anyone help you

arrange or coordinate this child’s care among the
different doctors or services that this child uses?

Somewhat dissatisfied
Very dissatisfied

Yes
No
Did not see more than one health care provider
in the PAST 12 MONTHS
D8 DURING THE PAST 12 MONTHS, have you felt that you

could have used extra help arranging or coordinating
this child’s care among the different health care
providers or services?
Yes
No ➔ SKIP to question D10
D9 If yes, DURING THE PAST 12 MONTHS, how often

did you get as much help as you wanted with
arranging or coordinating this child’s health care?
Usually
Sometimes
Never

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26028100

E. This Child’s Health
Insurance Coverage

Is this child CURRENTLY covered by any of the
following types of health insurance or health coverage
plans? Mark (X) Yes or No for EACH item.
Yes

DURING THE PAST 12 MONTHS, was this child EVER
covered by ANY kind of health insurance or health
coverage plan?

b. Insurance purchased directly
from an insurance company
c. Medicaid, Medical Assistance,
or any kind of government
assistance plan for those with
low incomes or a disability

Yes, this child was covered
all 12 months ➔ SKIP to question E4
Yes, but this child had a gap in coverage
No
E2

a. Insurance through a current or
former employer or union

d. TRICARE or other military
health care

Indicate whether any of the following is a reason this
child was not covered by health insurance at any time
DURING THE PAST 12 MONTHS:
Yes

e. Indian Health Service
f. Other, specify: C

a. Change in employer or employment
status
b. Cancellation due to overdue
premiums

c. Dropped coverage because it was
unaffordable

Always

d. Dropped coverage because benefits
were inadequate

Usually

e. Dropped coverage because choice
of health care providers was
inadequate

Sometimes
Never

f. Problems with application or
renewal process
g. Other, specify: C

How often does this child’s health insurance offer
benefits or cover services that meet this child’s needs?

How often does this child’s health insurance allow him
or her to see the health care providers he or she needs?
Always

Usually

Is this child CURRENTLY covered by ANY kind of
health insurance or health coverage plan?

Sometimes

Yes

Never

No ➔ SKIP to question F1 on page 12
E7

Thinking specifically about this child’s mental or
behavioral health needs, how often does this child’s
health insurance offer benefits or cover services that
meet these needs?
This child does not use mental or behavioral
health services
Always
Usually
Sometimes
Never

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26028092

F. Providing for This
Child’s Health
F1

Including co-pays and amounts reimbursed from Health
Savings Accounts (HSA) and Flexible Spending
Accounts (FSA), how much money did you pay for this
child’s medical, health, dental, and vision care DURING
THE PAST 12 MONTHS? Do not include health insurance
premiums or costs that were or will be reimbursed by
insurance or another source.

$0 (No medical or health-related
expenses) ➔ SKIP to question F4

11 or more hours per week
$1-$249
F6

$250-$499
$500-$999

IN AN AVERAGE WEEK, how many hours do you or
other family members spend arranging or coordinating
health or medical care for this child, such as making
appointments or locating services?

$1,000-$5,000

This child does not need health care coordinated
on a weekly basis

More than $5,000

Less than 1 hour per week
1-4 hours per week

How often are these costs reasonable?
Always

5-10 hours per week

Usually

11 or more hours per week

Sometimes
Never
F3

DURING THE PAST 12 MONTHS, did your family have
problems paying for any of this child’s medical or
health care bills?
Yes
No

DURING THE PAST 12 MONTHS, have you or other
family members...
Yes

a. Left a job or taken a leave of
absence because of this child’s
health or health conditions?
b. Cut down on the hours you work
because of this child’s health or
health conditions?
c. Avoided changing jobs because of
concerns about maintaining health
insurance for this child?

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26028084

G. This Child’s Schooling
and Activities

DURING THE PAST 12 MONTHS, did this child
participate in...
Yes

a. A sports team or did he or she
take sports lessons after school
or on weekends?

G1 DURING THE PAST 12 MONTHS, about how many days

did this child miss school because of illness or injury?
Include days missed from any formal home schooling.

b. Any clubs or organizations after
school or on weekends?

No missed school days

c. Any other organized activities or
lessons, such as music, dance,
language, or other arts?

1-3 days
4-6 days

d. Any type of community service or
volunteer work at school, place of
worship, or in the community?

7-10 days

e. Any paid work, including regular
jobs as well as babysitting, cutting
grass, or other occasional work?

11 or more days
This child was not enrolled in school
G2

DURING THE PAST 12 MONTHS, how many times has
this child’s school contacted you or another adult in
your household about any problems he or she is
having with school?

DURING THE PAST WEEK, on how many days did
this child exercise, play a sport, or participate in
physical activity for at least 60 minutes?
0 days

None

1-3 days

1 time

4-6 days

2 or more times

Every day

G3 SINCE STARTING KINDERGARTEN, has this child

repeated any grades?

Yes

Compared to other children his or her age, how much
difficulty does this child have making or keeping
friends?
No difficulty

A little difficulty
G4 DURING THE PAST 12 MONTHS, how often did you

attend events or activities that this child participated in?

A lot of difficulty

Always
Usually
Sometimes
Rarely
Never

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26028076

H. About You and This
Child
H1

How well can you and this child share ideas or talk
about things that really matter?
Very well

Was this child born in the United States?

Somewhat well

Yes ➔ SKIP to question H3
Not very well
No
Not well at all
H2

If no, how long has this child been living in the United
States?
Years AND

Months

How well do you think you are handling the day-to-day
demands of raising children?
Very well

How many times has this child moved to a new address
since he or she was born?

Somewhat well
Not very well

Number of times
Not well at all
H4

How often does this child go to bed at about the same
time on weeknights?

Never

Always

Sometimes

b. That this child
does things
that really
bother you
a lot?

Rarely
Never
DURING THE PAST WEEK, how many hours of sleep
did this child get on most weeknights?
Less than 6 hours

Rarely Sometimes Usually Always

a. That this child
is much harder
to care for than
most children
his or her age?

Usually

DURING THE PAST MONTH, how often have you felt...

c. Angry with
this child?
H10 DURING THE PAST 12 MONTHS, was there someone

that you could turn to for day-to-day emotional support
with parenting or raising children?

6 hours
7 hours

Yes

8 hours

No ➔ SKIP to question I1 on page 15

9 hours
10 hours

H11 If yes, did you receive emotional support from...
Yes

a. Spouse or domestic partner?
11 or more hours
b. Other family member or close friend?
H6

c. Health care provider?
d. Place of worship or religious leader?

Less than 1 hour

e. Support or advocacy group related
to specific health condition?

1 hour

f. Peer support group?

2 hours

g. Counselor or other mental health
professional?

3 hours

h. Other person, specify:

4 or more hours
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26028068

I. About Your Family and
Household
I1

All of
the time

DURING THE PAST WEEK, on how many days did all the
family members who live in the household eat a meal
together?

Some of
the time

None of
the time

b. Work together to
solve our problems

1-3 days

c. Know we have
strengths to draw on

4-6 days

d. Stay hopeful even
in difficult times

Every day

Most of
the time

a. Talk together
about what to do

0 days

When your family faces problems, how often are you
likely to do each of the following?

Does anyone living in your household use cigarettes,
cigars, or pipe tobacco?

SINCE THIS CHILD WAS BORN, how often has it been
very hard to cover the basics, like food and housing,
on your family’s income?
Never

Yes

Rarely

No ➔ SKIP to question I4
I3

Somewhat often

If yes, does anyone smoke inside your home?
Yes

Very often
I8

No
I4

Which of these statements best describes your
household’s ability to afford the food you need DURING
THE PAST 12 MONTHS?
We could always afford to eat good nutritious meals.

DURING THE PAST 12 MONTHS, how often were
pesticides used inside your residence to control for
insects? If the frequency changed throughout the year,
report the highest frequency.

We could always afford enough to eat but not always
the kinds of food we should eat.

More than once a week

Sometimes we could not afford enough to eat.

Once a week

Often we could not afford enough to eat.

Once a month

At any time DURING THE PAST 12 MONTHS, even for
one month, did anyone in your family receive...

Once every 2-5 months

Yes

Once every 6 months

a. Cash assistance from a government
welfare program?

Once during the past 12 months

b. Food Stamps or Supplemental Nutrition
Assistance Program (SNAP) benefits?

Never

c. Free or reduced-cost breakfasts or
lunches at school?

Don’t know
I5

d. Benefits from the Woman, Infants,
and Children (WIC) Program?

DURING THE PAST 12 MONTHS, other than in a shower
or bathtub, have you seen any mold, mildew or other
signs of water damage on walls or other surfaces inside
your home?
Yes
No

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26028050

I10 In your neighborhood, is/are there...

Yes

I13 The next questions are about events that may have

happened during this child’s life. These things can
happen in any family, but some people may feel
uncomfortable with these questions. You may skip
any questions you do not want to answer.

a. Sidewalks or walking paths?
b. A park or playground?

To the best of your knowledge, has this child EVER
experienced any of the following?
Yes
No
a. Parent or guardian divorced or
separated

c. A recreation center, community
center, or boys’ and girls’ club?
d. A library or bookmobile?

b. Parent or guardian died

e. Litter or garbage on the street
or sidewalk?

c. Parent or guardian served time in jail
f. Poorly kept or rundown housing?
d. Saw or heard parents or adults slap,
hit, kick, punch one another in the
home

g. Vandalism such as broken
windows or graffiti?

e. Was a victim of violence or
witnessed violence in his or her
neighborhood

I11 To what extent do you agree with these statements

about your neighborhood or community?
Definitely Somewhat Somewhat Definitely
agree
agree
disagree disagree

f. Lived with anyone who was mentally
ill, suicidal, or severely depressed

a. People in this
neighborhood
help each other
out

g. Lived with anyone who had a problem
with alcohol or drugs
h. Treated or judged unfairly because
of his or her race or ethnic group

b. We watch out for
each other’s
children in this
neighborhood
c. This child is
safe in our
neighborhood
d. When we
encounter
difficulties, we
know where to
go for help in
our community
e. This child is safe
at school
I12 Other than you or other adults in your home, is there at

least one other adult in this child’s school, neighborhood,
or community who knows this child well and who he or
she can rely on for advice or guidance?
Yes
No

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26028043

J. Child’s Caregivers

➜ Complete the questions for up to two adults in the

What is the highest grade or level of school you have
completed? Mark (X) ONE box.
8th grade or less

household who are this child’s primary caregivers.
If there is just one adult primary caregiver, provide
answers for that adult.

9th-12th grade; No diploma
High School Graduate or GED Completed

How are you related to this child?
Biological or Adoptive Parent

Completed a vocational, trade, or business school
program

Step-parent

Some College Credit, but no Degree

Grandparent

Associate Degree (AA, AS)

Foster Parent

Bachelor’s Degree (BA, BS, AB)

Other: Relative

Master’s Degree (MA, MS, MSW, MBA)

Other: Non-Relative

Doctorate (PhD, EdD) or Professional Degree
(MD, DDS, DVM, JD)

What is your sex?

What is your marital status?

Male

Married

Female

Not married, but living with a partner
Never Married

What is your age?

Divorced
Age in years
Separated
J4

Where were you born?

Widowed

In the United States ➔ SKIP to question J6
J8

In general, how is your physical health?

Outside of the United States
Excellent
J5

When did you come to live in the United States?

Very good

Year

Good
Fair
Poor
J9

In general, how is your mental or emotional health?
Excellent
Very good
Good
Fair
Poor

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26028035

J10 Were you employed at least 50 out of the past

J17 When did this primary caregiver come to live in the

52 weeks?

United States?
Year

Yes
No
J11 Have you ever served on active duty in the

J18 What is the highest grade or level of school this primary

caregiver has completed? Mark (X) ONE box.

U.S. Armed Forces, Reserves, or the National Guard?
Mark (X) ONE box.

8th grade or less
Never served in the military ➔ SKIP to question J13
9th-12th grade; No diploma
Only on active duty for training in the
Reserves or National Guard ➔ SKIP to question J13

High School Graduate or GED Completed

Now on active duty

Completed a vocational, trade, or business school
program

On active duty in the past, but not now

Some College Credit, but no Degree

J12 Were you deployed at any time during this child’s life?

Associate Degree (AA, AS)

Yes

Bachelor’s Degree (BA, BS, AB)

➜

Master’s Degree (MA, MS, MSW, MBA)

Questions J13 - J24 ask about another adult primary
caregiver who may be in the household in addition to
yourself.

Doctorate (PhD, EdD) or Professional Degree
(MD, DDS, DVM, JD)

J13 How is this adult primary caregiver in the household

related to this child?

J19 What is this primary caregiver’s marital status?

There is only one primary adult caregiver in the
household for this child ➔ SKIP to question K1 on
page 19

Married
Not married, but living with a partner

Biological or Adoptive Parent

Never Married

Step-parent

Divorced

Grandparent

Separated

Foster Parent

Widowed

Other: Relative
Other: Non-Relative

J20 In general, how is this primary caregiver’s physical

health?
Excellent

J14 What is this primary caregiver’s sex?

Male

Very good

Female

Good
Fair

J15 What is this primary caregiver’s age?

Poor
Age in years
J16 Where was this primary caregiver born?

In the United States ➔ SKIP to question J18
Outside of the United States

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26028027

J21 In general, how is this primary caregiver’s mental or

emotional health?
Excellent
Very good

Good

Yes ➔

Fair

.00

TOTAL AMOUNT
in the last calendar year

Poor

b. Self-employment income from own nonfarm
businesses or farm business, including
proprietorships and partnerships.

J22 Was this primary caregiver employed at least 50 out of

the past 52 weeks?
Yes

Yes ➔

.00

Loss

TOTAL AMOUNT
in the last calendar year

c. Interest, dividends, net rental income, royalty
income, or income from estates and trusts.

J23 Has this primary caregiver ever served on active duty in

the U.S. Armed Forces, Reserves, or the National Guard?
Mark (X) ONE box.

Yes ➔

Never served in the military ➔ SKIP to question K1

.00

Loss

TOTAL AMOUNT
in the last calendar year

Only on active duty for training in the
Reserves or National Guard ➔ SKIP to question K1

d. Social security or railroad retirement; retirement,
survivor, or disability pensions.

Now on active duty
Yes ➔

On active duty in the past, but not now

Yes ➔

.00

TOTAL AMOUNT
in the last calendar year

K. Household Information

f. Any other sources of income received regularly
such as Veterans’ (VA) payments, unemployment
compensation, child support, or alimony.

.00

e. Supplemental security income (SSI); any public
assistance or welfare payments from the state or
local welfare office.

Yes

TOTAL AMOUNT
in the last calendar year

No
J24 Was this primary caregiver deployed at any time during

this child’s life?

Yes ➔

How many of these people in your household are family
members? Family is defined as anyone related to this child
by blood, marriage, adoption, or through foster care.
Number of people

.00

TOTAL AMOUNT
in the last calendar year

No
K4

.00

TOTAL AMOUNT
in the last calendar year

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26028019

Public reporting burden for this collection of information is estimated to average 33 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. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0990,
U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington, DC 20233. You may e-mail comments to
DEMO.Paperwork@census.gov; use "Paperwork Project 0607-0990" as the subject.

NSCH-T2

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26038208
OMB No. 0607-0990: Approval Expires 05/31/2019

National Survey of Children’s Health
A study by the U.S. Department of Health and Human Services
to better understand the health issues faced by children in the
United States today.

NSCH-T3
(04/17/2018)

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26038190

Start Here

How often does this child...
Always

Usually Sometimes

Never

a. Show interest and
curiosity in learning
new things?

Recently, you completed a survey that asked about the
children usually living or staying at this address.
Thank you for taking the time to complete that survey.

b. Work to finish tasks
he or she starts?

We now have some follow-up questions to ask about:

c. Stay calm and in
control when faced
with a challenge?
d. Care about doing
well in school?

If the name listed above is not correct or does not
correspond to a child living in this household, please
call 1-800-845-8241 for assistance.

e. Do all required
homework?

f. Argue too much?

Your participation is important. Thank you.

A. This Child’s Health

1-2 times per week
Almost every day

A1 In general, how would you describe this child’s health

(the one named above)?
Excellent

Very good
Good

Fair

1-2 times (in the past 12 months)

Poor

1-2 times per month

A2 How would you describe the condition of this child’s

1-2 times per week

teeth?

Almost every day

Excellent
Very good
Good
Fair
Poor

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26038182

A6 DURING THE PAST 12 MONTHS, has this child had

FREQUENT or CHRONIC difficulty with any of the
following?
Yes

Has a doctor or other health care provider EVER told
you that this child has...
No

A10 Asthma?

a. Breathing or other respiratory
problems (such as wheezing or
shortness of breath)

Yes

If yes, does this child CURRENTLY have the
condition?

b. Eating or swallowing because of
a health condition

Yes

c. Digesting food, including
stomach/intestinal problems,
constipation, or diarrhea

If yes, is it:
Mild

d. Repeated or chronic physical pain,
including headaches or other back
or body pain

Moderate

Severe

A11 Brain injury, concussion or head injury?

Yes

If yes, does this child CURRENTLY have the
condition?

e. Toothaches
f. Bleeding gums

Yes

g. Decayed teeth or cavities

If yes, is it:

Mild

A7 Does this child have any of the following?
Yes

Moderate

Severe

A12 Cerebral Palsy?

a. Serious difficulty concentrating,
remembering, or making decisions
because of a physical, mental, or
emotional condition

Yes

If yes, does this child CURRENTLY have the
condition?

b. Serious difficulty walking or climbing
stairs

Yes

If yes, is it:

c. Difficulty dressing or bathing
Mild

d. Difficulty doing errands alone, such
as visiting a doctor’s office or shopping,
because of a physical, mental, or
emotional condition

Yes

If yes, does this child CURRENTLY have the
condition?

f. Blindness or problems with seeing,
even when wearing glasses

Yes

A8 Allergies (including food, drug, insect, or other)?

If yes, is it:

Has a doctor or other health care provider EVER told
you that this child has...

Mild

Moderate

Severe

A14 Epilepsy or Seizure Disorder?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

Severe

A13 Diabetes?

e. Deafness or problems with hearing

Yes

Moderate

If yes, does this child CURRENTLY have the
condition?

Yes

If yes, is it:

Mild

Moderate

Severe

A9 Arthritis?

Mild

Moderate

Severe

A15 Heart Condition?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, does this child CURRENTLY have the
condition?

Yes

If yes, is it:
Mild

If yes, is it:
Moderate

Severe

Mild

NSCH-T3

Moderate

Severe

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26038174

Has a doctor or other health care provider EVER told
you that this child has...
A16 Frequent or severe headaches, including migraine?

Has a doctor or other health care provider EVER told
you that this child has...
A21 Blood Disorders (such as Sickle Cell Disease,

Thalassemia, or Hemophilia)?
Yes

No
Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, is it:

Mild

If yes, is it:
Mild

Moderate

Severe

Yes

Severe

If yes, was this child diagnosed with:

If yes, does this child CURRENTLY have the
condition?

Sickle Cell Disease?

Yes

Thalassemia?

Yes

Hemophilia?

Yes

Other Blood
Disorders?

Yes

If yes, is it:
Mild

Moderate

Severe

A22 Cystic Fibrosis?

A18 Anxiety Problems?

Yes

Mild

Moderate

Severe

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.

If yes, is it:
Mild

If yes, is it:

If yes, does this child CURRENTLY have the
condition?

Moderate

Severe

A19 Depression?

Yes

A23 Other genetic or inherited condition?

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

If yes, specify: C

If yes, is it:

Is it:

Mild
A20

Moderate

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.

A17 Tourette Syndrome?

Yes

Moderate

Severe

Mild

Yes

If yes, does this child CURRENTLY have the
condition?
Yes

A24 Substance Use Disorder?

If yes, is it:
Mild

Severe

Was this condition identified through a blood
test done shortly after birth? These tests are
sometimes called newborn screening.

Down Syndrome?
Yes

Moderate

Yes
Moderate

If yes, does this child CURRENTLY have the
disorder?

Severe

Yes

If yes, is it:
Mild

NSCH-T3

Moderate

Severe

§;$rk¤

26038166

Has a doctor, other health care provider, or educator
EVER told you that this child has...
Examples of educators are teachers and school nurses.
A25 Behavioral or Conduct Problems?

Yes

Has a doctor or other health care provider EVER told
you that this child has...
A30 Any other mental health condition?

Yes

If yes, specify: C

If yes, does this child CURRENTLY have the
condition?
Yes

No
If yes, does this child CURRENTLY have the
condition?

If yes, is it:
Mild

Moderate

Severe

Yes

A26 Developmental Delay?

Yes

If yes, is it:

Mild

If yes, does this child CURRENTLY have the
condition?
Yes

Moderate

Severe

A31 Has a doctor or other health care provider EVER told

you that this child has Autism or Autism Spectrum
Disorder (ASD)? Include diagnoses of Asperger’s Disorder
or Pervasive Developmental Disorder (PDD).

If yes, is it:
Mild

Moderate

No ➔ SKIP to question A36 on page 6

Yes

Severe

If yes, does this child CURRENTLY have the
condition?

A27 Intellectual Disability (formerly known as Mental

Retardation)?
Yes
Yes

If yes, is it:

If yes, does this child CURRENTLY have the
disability?
Yes

Mild

Moderate

Severe

A32 How old was this child when a doctor or other health

care provider FIRST told you that he or she had Autism,
ASD, Asperger’s Disorder or PDD?

If yes, is it:
Mild

Moderate

Severe
Don’t know

Age in years
A28 Speech or other language disorder?

Yes

A33 What type of doctor or other health care provider was

the FIRST to tell you that this child had Autism, ASD,
Asperger’s Disorder or PDD? Mark (X) ONE box.

If yes, does this child CURRENTLY have the
condition?
Yes

Primary Care Provider

No
Specialist

If yes, is it:
Mild

Moderate

School Psychologist/Counselor

Severe

Other Psychologist (Non-School)

A29 Learning Disability?

Yes

Psychiatrist

If yes, does this child CURRENTLY have the
disability?
Yes

Other, specify: C

If yes, is it:
Mild

Don’t know
Moderate

Severe

A34 Is this child CURRENTLY taking medication for Autism,

ASD, Asperger’s Disorder or PDD?
Yes

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26038158

B. This Child as an Infant

A35 At any time DURING THE PAST 12 MONTHS, did this

child receive behavioral treatment for Autism, ASD,
Asperger’s Disorder or PDD, such as training or an
intervention that you or this child received to help
with his or her behavior?
Yes

Yes
No

A36 Has a doctor or other health care provider EVER told

you that this child has Attention Deficit Disorder or
Attention Deficit/Hyperactivity Disorder, that is, ADD or
ADHD?

No ➔ SKIP to question A39

Yes

Was this child born more than 3 weeks before his or
her due date?

How much did he or she weigh when born? Answer in
pounds and ounces OR kilograms and grams. Your best
estimate is fine.

If yes, does this child CURRENTLY have the
condition?
Yes

pounds AND

ounces

If yes, is it:
kilograms AND
Mild

Moderate

A37 Is this child CURRENTLY taking medication for ADD or

ADHD?
Yes

grams

Severe
What was the age of the mother when this child was
born? Your best estimate is fine.

Age in years

A38 At any time DURING THE PAST 12 MONTHS, did this

child receive behavioral treatment for ADD or ADHD,
such as training or an intervention that you or this
child received to help with his or her behavior?

C. Health Care Services
C1

Yes

A39 DURING THE PAST 12 MONTHS, how often have this

child’s health conditions or problems affected his or her
ability to do things other children his or her age do?

Yes

This child does not have any
health conditions ➔ SKIP to question B1
Never

DURING THE PAST 12 MONTHS, did this child see a
doctor, nurse, or other health care professional for
medical care (for example, preventive care, sick care,
hospitalizations)?

No ➔ SKIP to question C5 on page 7
C2

Sometimes

If yes, at his or her LAST medical care visit, did this
child have a chance to speak with a doctor or other
health care provider privately, without you or another
caregiver in the room?

Usually
Yes
Always
No
A40 To what extent do this child’s health conditions or

problems affect his or her ability to do things?

Very little
Somewhat

DURING THE PAST 12 MONTHS, how many times did
this child visit a doctor, nurse, or other health care
professional to receive a PREVENTIVE check-up?
A preventive check-up is when this child was not sick or
injured, such as an annual or sports physical, or well-child
visit.

A great deal
0 visits
1 visit
2 or more visits

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26038141

C10 If yes, where does this child USUALLY go first?

Mark (X) ONE box.
Doctor’s Office

Less than 10 minutes

Hospital Emergency Room

10-20 minutes

Hospital Outpatient Department

More than 20 minutes

Clinic or Health Center
Retail Store Clinic or “Minute Clinic”

C5 What is this child’s CURRENT height?

Your best estimate is fine.
School (Nurse’s Office, Athletic Trainer’s Office)
feet AND

inches

Some other place

OR
C11 Is there a place that this child USUALLY goes when

meters AND

he or she needs routine preventive care, such as a
physical examination or well-child check-up?

centimeters

Yes

C6 How much does this child CURRENTLY weigh?

Your best estimate is fine.
pounds

No ➔ SKIP to question C13
C12 If yes, is this the same place this child goes when he

or she is sick?

Yes
kilograms
C7 Are you concerned about this child’s weight?

No
C13 DURING THE PAST 12 MONTHS, has this child had his

or her vision tested, such as with pictures, shapes, or
letters?

Yes, it’s too high
Yes, it’s too low

Yes

No, I am not concerned

No ➔ SKIP to question C15 on page 8

C8 Has a doctor or other health care provider ever told

C14 If yes, where was this child’s vision tested? Mark (X)

you that this child is overweight?

ALL that apply.

Yes

Eye doctor or eye specialist (ophthalmologist,
optometrist) office

Pediatrician or other general doctor’s office
Clinic or health center

C9 Is there a place you or another caregiver USUALLY

take this child when he or she is sick or you need
advice about his or her health?

School

Yes

Other, specify:

No ➔ SKIP to question C11

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26038133

C15 DURING THE PAST 12 MONTHS, did this child see a

C20 DURING THE PAST 12 MONTHS, has this child taken

any medication because of difficulties with his or her
emotions, concentration, or behavior?

dentist or other oral health care provider for any kind
of dental or oral health care?
Yes, saw a dentist

Yes

Yes, saw other oral health care provider

No ➔ SKIP to question C18

C21 DURING THE PAST 12 MONTHS, did this child see a

specialist other than a mental health professional?
Specialists are doctors like surgeons, heart doctors, allergy
doctors, skin doctors, and others who specialize in one
area of health care.

C16 If yes, DURING THE PAST 12 MONTHS, did this child

see a dentist or other oral health care provider for
preventive dental care, such as check-ups, dental
cleanings, dental sealants, or fluoride treatments?

Yes

No preventive visits in
the past 12 months ➔ SKIP to question C18

No, but this child needed to see a specialist

Yes, 1 visit

No, this child did not need to
see a specialist ➔ SKIP to question C23

Yes, 2 or more visits

C22 How difficult was it to get the specialist care that this

child needed?
C17 If yes, DURING THE PAST 12 MONTHS, what

Not difficult

preventive dental service(s) did this child receive?
Mark (X) ALL that apply.

Somewhat difficult

Check-up

Very difficult

Cleaning

It was not possible to obtain care

Instruction on tooth brushing and oral health care
C23 DURING THE PAST 12 MONTHS, did this child use any

X-Rays
Fluoride treatment
Sealant (plastic coatings on back teeth)

Yes

Don’t know
C18 DURING THE PAST 12 MONTHS, has this child

received any treatment or counseling from a mental
health professional? Mental health professionals include
psychiatrists, psychologists, psychiatric nurses, and clinical
social workers.

No
C24 DURING THE PAST 12 MONTHS, was there any time

when this child needed health care but it was not
received? By health care, we mean medical care as well
as other kinds of care like dental care, vision care, and
mental health services.

Yes

No, but this child needed to see a mental health
professional

No ➔ SKIP to question C27 on page 9
C25 If yes, which types of care were not received?

No, this child did not need to see a
mental health professional ➔ SKIP to question C20

Mark (X) ALL that apply.
Medical Care

C19 How difficult was it to get the mental health treatment

or counseling that this child needed?

Dental Care

Not difficult

Vision Care

Somewhat difficult

Hearing Care

Very difficult

Mental Health Services

It was not possible to obtain care

Other, specify:

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26038125

C26 Did any of the following reasons contribute to this child C32 Is this child CURRENTLY receiving services under one

not receiving needed health services? Mark (X) Yes or No
for each item.
Yes

of these plans?

Yes

a. This child was not eligible for the
services

b. The services this child needed were
not available in your area

C33 Has this child EVER received special services to meet

c. There were problems getting an
appointment when this child needed
one

his or her developmental needs such as speech,
occupational, or behavioral therapy?
Yes

d. There were problems with getting
transportation or child care
e. The clinic or doctor’s office wasn’t
open when this child needed care

No ➔ SKIP to question D1
C34 If yes, how old was this child when he or she began

receiving these special services?

f. There were issues related to cost
C27 DURING THE PAST 12 MONTHS, how often were you

Years AND

frustrated in your efforts to get services for this child?

Months

C35 Is this child CURRENTLY receiving these special

Never

services?

Sometimes

Yes

Usually

Always

D. Experience with This
Child’s Health Care
Providers

C28 DURING THE PAST 12 MONTHS, how many times did

this child visit a hospital emergency room?
None
D1

1 time
2 or more times
C29 DURING THE PAST 12 MONTHS, was this child admitted

to the hospital to stay for at least one night?

Yes, one person

Yes

Yes, more than one person

C30 Has this child EVER had a special education or early

intervention plan? Children receiving these services often
have an Individualized Family Service Plan (IFSP) or
Individualized Education Plan (IEP).

DURING THE PAST 12 MONTHS, did this child need a
referral to see any doctors or receive any services?

Yes

No ➔ SKIP to question C33

No ➔ SKIP to question D4 on page 10

C31 If yes, how old was this child at the time of the FIRST

plan?

How difficult was it to get referrals?
Not difficult

Years AND

Somewhat difficult

Months

Very difficult
It was not possible to get a referral

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26038117

D4 Answer the following questions only if this child had a

health care visit IN THE PAST 12 MONTHS. Otherwise
skip to question D13 .
DURING THE PAST 12 MONTHS, how often did this
child’s doctors or other health care providers...
Always

Usually Sometimes

DURING THE PAST 12 MONTHS, have you felt that you
could have used extra help arranging or coordinating
this child’s care among the different health care
providers or services?
Yes

Never

No ➔ SKIP to question D10

a. Spend enough time
with this child?
D9

b. Listen carefully to
you?
c. Show sensitivity to
your family’s values
and customs?

If yes, DURING THE PAST 12 MONTHS, how often
did you get as much help as you wanted with
arranging or coordinating this child’s health care?
Usually
Sometimes

d. Provide the specific
information you
needed concerning
this child?

Never

e. Help you feel like a
partner in this
child’s care?

D10 DURING THE PAST 12 MONTHS, how satisfied were

you with the communication between this child’s
doctors and other health care providers?

D5 DURING THE PAST 12 MONTHS, did this child need

Very satisfied

any decisions to be made regarding his or her health
care, such as whether to get prescriptions, referrals,
or procedures?

Somewhat satisfied
Somewhat dissatisfied

Yes

Very dissatisfied

No ➔ SKIP to question D7

D11 DURING THE PAST 12 MONTHS, did this child’s health
D6 If yes, DURING THE PAST 12 MONTHS, how often did

care provider communicate with the child’s school, child
care provider, or special education program?

this child’s doctors or other health care providers...
Always

Usually Sometimes Never

Yes

a. Discuss with you
the range of options
to consider for his
or her health care or
treatment?
b. Make it easy for you
to raise concerns or
disagree with
recommendations
for this child’s health
care?

No ➔ SKIP to question D13
Did not need health care
provider to communicate
with these providers ➔ SKIP to question D13
D12 If yes, during this time, how satisfied were you with the

health care provider’s communication with the school,
child care provider, or special education program?
Very satisfied

c. Work with you to
decide together
which health care
and treatment
choices would be
best for this child?

Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied

D7 DURING THE PAST 12 MONTHS, did anyone help you

arrange or coordinate this child’s care among the
different doctors or services that this child uses?

D13 Do any of this child’s doctors or other health care

providers treat only children?

Yes

No ➔ SKIP to question D15 on page 11

Did not see more than one health care provider
in the PAST 12 MONTHS

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26038109

D14 If yes, have they talked with you about when this child

D20 Eligibility for health insurance often changes in young

will need to see doctors or other health care providers
who treat adults?

adulthood. Do you know how this child will be insured
as he or she becomes an adult?

Yes

Yes ➔ SKIP to question E1

D15 Has this child’s doctor or other health care provider

actively worked with this child to:
Yes

D21 If no, has anyone discussed with you how to obtain or

keep some type of health insurance coverage as this
child becomes an adult?

Don’t
know

a. Make positive choices about
his or her health. For example,
by eating healthy, getting
regular exercise, not using
tobacco, alcohol or other drugs,
or delaying sexual activity?
b. Gain skills to manage his or
her health and health care.
For example, by understanding
current health needs, knowing
what to do in a medical
emergency, or taking
medications he or she may need?

Yes
No

E. This Child’s Health
Insurance Coverage
E1

Yes, this child was covered
all 12 months ➔ SKIP to question E4 on page 12

c. Understand the changes in
health care that happen at
age 18. For example, by
understanding changes in privacy,
consent, access to information, or
decision-making?
D16 Did you and this child receive a summary of your

child’s medical history (for example, medical conditions,
allergies, medications, immunizations)?

DURING THE PAST 12 MONTHS, was this child EVER
covered by ANY kind of health insurance or health
coverage plan?

Yes, but this child had a gap in coverage
No
E2

Indicate whether any of the following is a reason this
child was not covered by health insurance at any time
DURING THE PAST 12 MONTHS:
Yes

Yes

a. Change in employer or employment
status

b. Cancellation due to overdue
premiums

D17 Have this child’s doctors or other health care providers

worked with you and this child to create a plan of care
to meet his or her health goals and needs?

c. Dropped coverage because it was
unaffordable
d. Dropped coverage because benefits
were inadequate

Yes

e. Dropped coverage because choice
of health care providers was
inadequate

No ➔ SKIP to question D20
D18 If yes, do you and this child have access to this plan of

care?

f. Problems with application or
renewal process

Yes

g. Other, specify: C

No
D19 Does this plan of care address transition to doctors and

other health care providers who treat adults?

Yes

Is this child CURRENTLY covered by ANY kind of
health insurance or health coverage plan?
Yes

No ➔ SKIP to question F1 on page 12

No, child already sees providers who treat adults

NSCH-T3

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26038091

F. Providing for This
Child’s Health

Is this child CURRENTLY covered by any of the
following types of health insurance or health coverage
plans? Mark (X) Yes or No for EACH item.
Yes

a. Insurance through a current or
former employer or union

b. Insurance purchased directly
from an insurance company
c. Medicaid, Medical Assistance,
or any kind of government
assistance plan for those with
low incomes or a disability

Including co-pays and amounts reimbursed from Health
Savings Accounts (HSA) and Flexible Spending
Accounts (FSA), how much money did you pay for this
child’s medical, health, dental, and vision care DURING
THE PAST 12 MONTHS? Do not include health insurance
premiums or costs that were or will be reimbursed by
insurance or another source.
$0 (No medical or health-related
expenses) ➔ SKIP to question F4

d. TRICARE or other military
health care

$1-$249

e. Indian Health Service
$250-$499
f. Other, specify: C
$500-$999
$1,000-$5,000
E5

How often does this child’s health insurance offer
benefits or cover services that meet this child’s needs?
Always

More than $5,000
F2

Always

Usually

Sometimes

Never
E6

How often does this child’s health insurance allow him
or her to see the health care providers he or she needs?

Never
F3

Always

DURING THE PAST 12 MONTHS, did your family have
problems paying for any of this child’s medical or
health care bills?

Usually

Yes

Sometimes

Never
E7

How often are these costs reasonable?

Thinking specifically about this child’s mental or
behavioral health needs, how often does this child’s
health insurance offer benefits or cover services that
meet these needs?

DURING THE PAST 12 MONTHS, have you or other
family members...
Yes

a. Left a job or taken a leave of
absence because of this child’s
health or health conditions?

This child does not use mental or behavioral
health services

b. Cut down on the hours you work
because of this child’s health or
health conditions?

Always

c. Avoided changing jobs because of
concerns about maintaining health
insurance for this child?

Usually
Sometimes
Never

NSCH-T3

§;$q|¤

26038083

IN AN AVERAGE WEEK, how many hours do you or
G3 SINCE STARTING KINDERGARTEN, has this child
other family members spend providing health care at
repeated any grades?
home for this child? Care might include changing
bandages, or giving medication and therapies when needed.
Yes
This child does not need health care provided at home
No
on a weekly basis
Less than 1 hour per week

G4 DURING THE PAST 12 MONTHS, how often did you

attend events or activities that this child participated in?
1-4 hours per week
Always
5-10 hours per week
Usually
11 or more hours per week
Sometimes
F6

IN AN AVERAGE WEEK, how many hours do you or
other family members spend arranging or coordinating
health or medical care for this child, such as making
appointments or locating services?
This child does not need health care coordinated
on a weekly basis

Rarely
Never
G5 DURING THE PAST 12 MONTHS, did this child

participate in...

Less than 1 hour per week

Yes

1-4 hours per week
5-10 hours per week

b. Any clubs or organizations after
school or on weekends?

11 or more hours per week

c. Any other organized activities or
lessons, such as music, dance,
language, or other arts?

G. This Child’s Schooling
and Activities

d. Any type of community service or
volunteer work at school, place of
worship, or in the community?

G1 DURING THE PAST 12 MONTHS, about how many days

e. Any paid work, including regular
jobs as well as babysitting, cutting
grass, or other occasional work?

did this child miss school because of illness or injury?
Include days missed from any formal home schooling.
No missed school days

1-3 days

DURING THE PAST WEEK, on how many days did
this child exercise, play a sport, or participate in
physical activity for at least 60 minutes?

4-6 days

0 days

7-10 days

1-3 days

11 or more days

4-6 days

This child was not enrolled in school

Every day

G2 DURING THE PAST 12 MONTHS, how many times has

a. A sports team or did he or she
take sports lessons after school
or on weekends?

this child’s school contacted you or another adult in
your household about any problems he or she is
having with school?

Compared to other children his or her age, how much
difficulty does this child have making or keeping
friends?
No difficulty

None
A little difficulty
1 time
A lot of difficulty
2 or more times

NSCH-T3

§;$qt¤

26038075

H. About You and This
Child
H1

How well can you and this child share ideas or talk
about things that really matter?
Very well

Was this child born in the United States?

Somewhat well

Yes ➔ SKIP to question H3
Not very well
No
Not well at all
H2

If no, how long has this child been living in the
United States?
Years AND

Months

How well do you think you are handling the day-to-day
demands of raising children?
Very well

How many times has this child moved to a new address
since he or she was born?

Somewhat well
Not very well

Number of times
Not well at all
H4

How often does this child go to bed at about the same
time on weeknights?

Never

Always

Sometimes

b. That this child
does things
that really
bother you
a lot?

Rarely
Never
DURING THE PAST WEEK, how many hours of sleep
did this child get on most weeknights?
Less than 6 hours

Rarely Sometimes Usually Always

a. That this child
is much harder
to care for than
most children
his or her age?

Usually

DURING THE PAST MONTH, how often have you felt...

c. Angry with
this child?
H10 DURING THE PAST 12 MONTHS, was there someone

that you could turn to for day-to-day emotional support
with parenting or raising children?

6 hours
7 hours

Yes

8 hours

No ➔ SKIP to question I1 on page 15

9 hours
10 hours

H11 If yes, did you receive emotional support from...
Yes

a. Spouse or domestic partner?
11 or more hours
b. Other family member or close friend?
H6

c. Health care provider?
d. Place of worship or religious leader?

Less than 1 hour

e. Support or advocacy group related
to specific health condition?

1 hour

f. Peer support group?

2 hours

g. Counselor or other mental health
professional?

3 hours

h. Other person, specify:

4 or more hours
NSCH-T3

§;$ql¤

26038067

I. About Your Family and
Household
I1

All of
the time

DURING THE PAST WEEK, on how many days did all the
family members who live in the household eat a meal
together?

Some of
the time

None of
the time

b. Work together to
solve our problems

1-3 days

c. Know we have
strengths to draw on

4-6 days

d. Stay hopeful even
in difficult times

Every day

Most of
the time

a. Talk together
about what to do

0 days

When your family faces problems, how often are you
likely to do each of the following?

Does anyone living in your household use cigarettes,
cigars, or pipe tobacco?

SINCE THIS CHILD WAS BORN, how often has it been
very hard to cover the basics, like food and housing,
on your family’s income?
Never

Yes

Rarely

No ➔ SKIP to question I4
I3

Somewhat often

If yes, does anyone smoke inside your home?
Yes

Very often
I8

No
I4

Which of these statements best describes your
household’s ability to afford the food you need DURING
THE PAST 12 MONTHS?
We could always afford to eat good nutritious meals.

DURING THE PAST 12 MONTHS, how often were
pesticides used inside your residence to control for
insects? If the frequency changed throughout the year,
report the highest frequency.

We could always afford enough to eat but not always
the kinds of food we should eat.

More than once a week

Sometimes we could not afford enough to eat.

Once a week

Often we could not afford enough to eat.

Once a month

At any time DURING THE PAST 12 MONTHS, even for
one month, did anyone in your family receive...

Once every 2-5 months

Yes

Once every 6 months

a. Cash assistance from a government
welfare program?

Once during the past 12 months

b. Food Stamps or Supplemental Nutrition
Assistance Program (SNAP) benefits?

Never

c. Free or reduced-cost breakfasts or
lunches at school?

Don’t know
I5

d. Benefits from the Woman, Infants,
and Children (WIC) Program?

DURING THE PAST 12 MONTHS, other than in a shower
or bathtub, have you seen any mold, mildew or other
signs of water damage on walls or other surfaces inside
your home?
Yes
No

NSCH-T3

§;$qd¤

26038059

I10 In your neighborhood, is/are there:

Yes

I13 The next questions are about events that may have

happened during this child’s life. These things can
happen in any family, but some people may feel
uncomfortable with these questions. You may skip
any questions you do not want to answer.

a. Sidewalks or walking paths?
b. A park or playground?

To the best of your knowledge, has this child EVER
experienced any of the following?
Yes
No
a. Parent or guardian divorced or
separated

c. A recreation center, community
center, or boys’ and girls’ club?
d. A library or bookmobile?

b. Parent or guardian died

e. Litter or garbage on the street
or sidewalk?

c. Parent or guardian served time in jail
f. Poorly kept or rundown housing?
d. Saw or heard parents or adults slap,
hit, kick, punch one another in the
home

g. Vandalism such as broken
windows or graffiti?

e. Was a victim of violence or
witnessed violence in his or her
neighborhood

I11 To what extent do you agree with these statements

about your neighborhood or community?
Definitely Somewhat Somewhat Definitely
agree
agree
disagree disagree

f. Lived with anyone who was mentally
ill, suicidal, or severely depressed

a. People in this
neighborhood
help each other
out

g. Lived with anyone who had a problem
with alcohol or drugs
h. Treated or judged unfairly because
of his or her race or ethnic group

least one other adult in this child’s school, neighborhood,
or community who knows this child well and who he or
she can rely on for advice or guidance?
Yes
No

NSCH-T3

§;$q\¤

26038042

J. Child’s Caregivers

➜ Complete the questions for up to two adults in the

What is the highest grade or level of school you have
completed? Mark (X) ONE box.
8th grade or less

household who are this child’s primary caregivers.
If there is just one adult primary caregiver, provide
answers for that adult.

9th-12th grade; No diploma
High School Graduate or GED Completed

How are you related to this child?
Biological or Adoptive Parent

Completed a vocational, trade, or business school
program

Step-parent

Some College Credit, but no Degree

Grandparent

Associate Degree (AA, AS)

Foster Parent

Bachelor’s Degree (BA, BS, AB)

Other: Relative

Master’s Degree (MA, MS, MSW, MBA)

Other: Non-Relative

Doctorate (PhD, EdD) or Professional Degree
(MD, DDS, DVM, JD)

What is your sex?

What is your marital status?

Male

Married

Female

Not married, but living with a partner
Never Married

What is your age?

Divorced
Age in years
Separated
J4

Where were you born?

Widowed

In the United States ➔ SKIP to question J6
J8

In general, how is your physical health?

Outside of the United States
Excellent
J5

When did you come to live in the United States?

Very good

Year

Good
Fair
Poor
J9

In general, how is your mental or emotional health?
Excellent
Very good
Good
Fair
Poor

NSCH-T3

§;$qK¤

26038034

J10 Were you employed at least 50 out of the past

J17 When did this primary caregiver come to live in the

52 weeks?

United States?
Year

Yes
No
J11 Have you ever served on active duty in the

J18 What is the highest grade or level of school this primary

caregiver has completed? Mark (X) ONE box.

U.S. Armed Forces, Reserves, or the National Guard?
Mark (X) ONE box.

8th grade or less
Never served in the military ➔ SKIP to question J13
9th-12th grade; No diploma
Only on active duty for training in the
Reserves or National Guard ➔ SKIP to question J13

High School Graduate or GED Completed

Now on active duty

Completed a vocational, trade, or business school
program

On active duty in the past, but not now

Some College Credit, but no Degree

J12 Were you deployed at any time during this child’s life?

Associate Degree (AA, AS)

Yes

Bachelor’s Degree (BA, BS, AB)

➜

Master’s Degree (MA, MS, MSW, MBA)

Questions J13 - J24 ask about another adult primary
caregiver who may be in the household in addition to
yourself.

Doctorate (PhD, EdD) or Professional Degree
(MD, DDS, DVM, JD)

J13 How is this adult primary caregiver in the household

related to this child?

J19 What is this primary caregiver’s marital status?

There is only one primary adult caregiver in the
household for this child ➔ SKIP to question K1 on
page 19

Married
Not married, but living with a partner

Biological or Adoptive Parent

Never Married

Step-parent

Divorced

Grandparent

Separated

Foster Parent

Widowed

Other: Relative
Other: Non-Relative

J20 In general, how is this primary caregiver’s physical

health?
Excellent

J14 What is this primary caregiver’s sex?

Male

Very good

Female

Good
Fair

J15 What is this primary caregiver’s age?

Poor
Age in years
J16 Where was this primary caregiver born?

In the United States ➔ SKIP to question J18
Outside of the United States

NSCH-T3

§;$qC¤

26038026

J21 In general, how is this primary caregiver’s mental or

emotional health?
Excellent
Very good

Good

Yes ➔

Fair

.00

TOTAL AMOUNT
in the last calendar year

Poor

b. Self-employment income from own nonfarm
businesses or farm business, including
proprietorships and partnerships.

J22 Was this primary caregiver employed at least 50 out of

the past 52 weeks?
Yes

Yes ➔

.00

Loss

TOTAL AMOUNT
in the last calendar year

c. Interest, dividends, net rental income, royalty
income, or income from estates and trusts.

J23 Has this primary caregiver ever served on active duty in

the U.S. Armed Forces, Reserves, or the National Guard?
Mark (X) ONE box.

Yes ➔

Never served in the military ➔ SKIP to question K1

.00

Loss

TOTAL AMOUNT
in the last calendar year

Only on active duty for training in the
Reserves or National Guard ➔ SKIP to question K1

d. Social security or railroad retirement; retirement,
survivor, or disability pensions.

Now on active duty
Yes ➔

On active duty in the past, but not now

Yes ➔

.00

TOTAL AMOUNT
in the last calendar year

K. Household Information

f. Any other sources of income received regularly
such as Veterans’ (VA) payments, unemployment
compensation, child support, or alimony.

.00

e. Supplemental security income (SSI); any public
assistance or welfare payments from the state or
local welfare office.

Yes

TOTAL AMOUNT
in the last calendar year

No
J24 Was this primary caregiver deployed at any time during

this child’s life?

Yes ➔

How many of these people in your household are family
members? Family is defined as anyone related to this child
by blood, marriage, adoption, or through foster care.
Number of people

.00

TOTAL AMOUNT
in the last calendar year

No
K4

.00

TOTAL AMOUNT
in the last calendar year

NSCH-T3

§;$q;¤

26038018

NSCH-T3

§;$q3¤

26108084
OMB No. 0607-0990: Aprobado hasta el 05/31/2019

Encuesta Nacional de Salud de los Niños
Un estudio realizado por el Departamento de Salud y Servicios
Humanos de los EE. UU. para entender mejor los problemas de salud
que enfrentan actualmente los(as) niños(as) en los Estados Unidos.

La Oficina del Censo de los EE. UU. está obligada por ley a proteger su información y no se le permite divulgar sus respuestas de
manera que usted o su hogar pudieran ser identificados. La Oficina del Censo de los Estados Unidos está llevando a cabo la Encuesta
Nacional de Salud de los Niños para el Departamento de Salud y Servicios Humanos de los Estados Unidos (HHS) en conformidad
con la Sección 8(b) del Título 13, Código de los Estados Unidos, que le permite a la Oficina del Censo realizar encuestas para otras
agencias. La Sección 701(a)(2) del Título 42, Código de los Estados Unidos, le permite al HHS recopilar información con el propósito
de entender la salud y el bienestar de los(as) niños(as) en los Estados Unidos. Las leyes federales protegen su privacidad y mantienen
confidenciales su respuestas, en conformidad con la Sección 9 del Título 13, Código de los Estados Unidos. De acuerdo con la Ley
para el Fortalecimiento de la Seguridad Cibernética del 2015, sus datos están protegidos contra los riesgos de seguridad cibernética
mediante los controles aplicados a los sistemas que los transmiten.
Cualquier información que proporcione será compartida para fines relacionados
con el trabajo identificado anteriormente y según
a
lo permitido por la Ley de Privacidad de 1974 (Sección 552 del Título 5, Código de los Estados Unidos) y SORN
COMMERCE/CENSUS-3, Recopilación de la Encuesta Demográfica (Marco Muestral de la Oficina del Censo).
La participación en esta encuesta es voluntaria y no hay sanciones por negarse a responder a las preguntas. Sin embargo, su
cooperación en la obtención de esta información necesaria es de suma importancia a fin de garantizar resultados completos y
precisos.

NSCH-S-S1
(03/15/2018)

§;+qu¤

26108076

Comienze Aquí
Responda hoy por la Internet en:
https://respond.census.gov/nsch
O
Llene y devuelva por correo este cuestionario tan pronto sea posible.
Gracias por ayudarnos a conocer sobre la salud y el bienestar de los(as) niños(as) de los Estados Unidos.
Si su hogar tiene niños(as) de 0 a 17 años de edad, las preguntas de esta encuesta deben ser contestadas por un adulto que esté
familiarizado(a) con la salud y cuidado médico de estos(as) niños(as).
Si su hogar no tiene niños(as), por favor conteste la pregunta 1 y devuelva el cuestionario.
Si necesita ayuda o tiene preguntas sobre cómo completar este formulario, llame al 1-800-845-8241. La llamada es gratuita.
Para recibir ayuda relacionada con el Dispositivo Telefónico para Personas Sordas (TDD), llame al 1-800-582-8330. La llamada es
gratuita.

En su casa
1

¿Hay niños(as) de 0 a 17 años que usualmente viven o se quedan en esta dirección?
Sí
No – NO CONTINUE. Marque "No" y envíenos esta encuesta en el sobre adjunto. Es importante que recibamos una respuesta
de cada hogar seleccionado para este estudio.

¿Cuántos(as) niños(as) de 0 a 17 años de edad usualmente viven o se quedan en esta dirección?

Número de niños(as) que viven o se quedan en esta dirección

¿Qué idioma se habla principalmente en el hogar?
Inglés
Español
Otro idioma, especifique: C

¿Es esta casa, apartamento o casa móvil: –
Marque (X) UNA sola casilla.
Propiedad suya o de alguien en este hogar con una hipoteca o préstamo? Incluya préstamos sobre el valor líquido de esta casa.
Propiedad suya o de alguien en este hogar libre y sin deuda (sin una hipoteca o préstamo)?
Alquilada?
Ocupada sin pago de alquiler?

➜

Responda a las preguntas restantes para cada uno de los(as) niños(as) de 0 a 17 años de edad que
usualmente viven o se quedan en esta dirección.
Comience con el (la) NIÑO(A) MÁS JOVEN, a quien llamaremos "Niño(a) 1" y continúe con el(la) siguiente
niño(a) más joven hasta haber respondido las preguntas para todos(as) los(as) niños(as) que usualmente
viven o se quedan en esta dirección.

NSCH-S-S1

§;+qm¤

26108068

NIÑO(A) 1

(el(la) más joven)

¿ACTUALMENTE este(a) niño(a) necesita o toma
medicamentos recetados por un médico, aparte de vitaminas?
Sí

Nombre, Iniciales, o Apodo del (de la) niño(a) más joven

¿Qué edad tiene este(a) niño(a)? Si el(la) niño(a) tiene menos
de un mes de edad, redondee la edad de meses a 1.

Años O

Sí

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Meses

Femenino

¿Necesita o utiliza este(a) niño(a) más servicios de atención
médica, salud mental o educativos de los que normalmente
requiren la mayoría de los(as) niños(as) de su misma edad?
Sí

➜

NOTA: Responda AMBAS PREGUNTAS, la pregunta 4
sobre el origen hispano Y la pregunta 5 sobre la raza.
Para esta encuesta, origen hispano no es una raza.

¿Es este(a) niño(a) de origen hispano, latino o español?

Si la respuesta es sí, la necesidad de servicios de
atención médica, salud mental o educativos de
este(a) niño(a), ¿se debe a ALGUNA condición
médica, de conducta u otro problema de salud?
Sí

No, no es de origen hispano, latino o español

Sí

Sí, puertorriqueño(a)

9
Sí, cubano(a)
Sí, de otro origen hispano, latino o español

¿Hay algo que le limite o le impida de alguna manera a
este(a) niño(a) hacer las cosas que hacen la mayoría de
los(as) niños(as) de su misma edad?
Sí

Si la respuesta es sí, la limitación en las capacidades
de este(a) niño(a), ¿se debe a ALGUNA condición
médica, de conducta, o alguna otra condición de salud?

¿Cuál es la raza de este(a) niño(a)? Marque (X) una o más
casillas.
Vietnamita

Sí

Negra o afroamericana

Otra asiática

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Indígena de las Américas
o nativa de Alaska

Nativa de Hawaii

Blanca

Guameña o Chamorro
India asiática
China

Sí

10 ¿Necesita o recibe este(a) niño(a) alguna terapia especial,
como terapia física, ocupacional o del habla?

Samoana

Filipina

Otra de las Islas
del Pacífico

Japonesa

Alguna otra raza

Sí

Si la respuesta es sí, ¿se debe a ALGUNA condición
médica, de conducta, o alguna otra condición de salud?
Sí

Conteste la siguiente pregunta sólo si este(a) niño(a) tiene al
menos 4 años de edad. De lo contrario pase a la pregunta 7 .
¿Qué tan bien habla inglés este(a) niño(a)?

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Coreana

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Sí, mexicano(a), mexicano(a) americano(a), chicano(a)

Sí

¿Cuál es el sexo de este(a) niño(a)?
Masculino

Si la respuesta es sí, la necesidad de medicamentos
recetados para este(a) niño(a), ¿se debe a ALGUNA
condición médica, de conducta o alguna otra condición
de salud?

Sí

11 ¿Tiene este(a) niño(a) algún tipo de problema emocional, de
desarrollo o de conducta para el cual necesita tratamiento o
consejería?

Muy bien
Bien

Sí

Regular

Si la respuesta es sí, este problema emocional, de
desarrollo o de conducta, ¿ha durado 12 meses o se
espera que dure más de 12 meses?

No habla inglés

Sí

NSCH-S-S1

§;+qe¤

26108050

NIÑO(A) 2

(siguiente niño(a) más joven)

¿ACTUALMENTE este(a) niño(a) necesita o toma
medicamentos recetados por un médico, aparte de vitaminas?
Sí

Nombre, Iniciales, o Apodo del (de la) siguiente niño(a)
más joven

¿Qué edad tiene este(a) niño(a)? Si el(la) niño(a) tiene menos
de un mes de edad, redondee la edad de meses a 1.

Años O

Sí

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Meses

Femenino

¿Necesita o utiliza este(a) niño(a) más servicios de atención
médica, salud mental o educativos de los que normalmente
requiren la mayoría de los(as) niños(as) de su misma edad?
Sí

➜

NOTA: Responda AMBAS PREGUNTAS, la pregunta 4
sobre el origen hispano Y la pregunta 5 sobre la raza.
Para esta encuesta, origen hispano no es una raza.

¿Es este(a) niño(a) de origen hispano, latino o español?

Si la respuesta es sí, la necesidad de servicios de
atención médica, salud mental o educativos de
este(a) niño(a), ¿se debe a ALGUNA condición
médica, de conducta u otro problema de salud?
Sí

No, no es de origen hispano, latino o español

Sí

Sí, puertorriqueño(a)

9
Sí, cubano(a)
Sí, de otro origen hispano, latino o español

¿Hay algo que le limite o le impida de alguna manera a
este(a) niño(a) hacer las cosas que hacen la mayoría de
los(as) niños(as) de su misma edad?
Sí

Si la respuesta es sí, la limitación en las capacidades
de este(a) niño(a), ¿se debe a ALGUNA condición
médica, de conducta, o alguna otra condición de salud?

¿Cuál es la raza de este(a) niño(a)? Marque (X) una o más
casillas.
Vietnamita

Sí

Negra o afroamericana

Otra asiática

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Indígena de las Américas
o nativa de Alaska

Nativa de Hawaii

Blanca

Guameña o Chamorro
India asiática
China

Sí

10 ¿Necesita o recibe este(a) niño(a) alguna terapia especial,
como terapia física, ocupacional o del habla?

Samoana

Filipina

Otra de las Islas
del Pacífico

Japonesa

Alguna otra raza

Sí

Si la respuesta es sí, ¿se debe a ALGUNA condición
médica, de conducta, o alguna otra condición de salud?
Sí

Conteste la siguiente pregunta sólo si este(a) niño(a) tiene al
menos 4 años de edad. De lo contrario pase a la pregunta 7 .
¿Qué tan bien habla inglés este(a) niño(a)?

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Coreana

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Sí, mexicano(a), mexicano(a) americano(a), chicano(a)

Sí

¿Cuál es el sexo de este(a) niño(a)?
Masculino

Si la respuesta es sí, la necesidad de medicamentos
recetados para este(a) niño(a), ¿se debe a ALGUNA
condición médica, de conducta o alguna otra condición
de salud?

Sí

11 ¿Tiene este(a) niño(a) algún tipo de problema emocional, de
desarrollo o de conducta para el cual necesita tratamiento o
consejería?

Muy bien
Bien

Sí

Regular

Si la respuesta es sí, este problema emocional, de
desarrollo o de conducta, ¿ha durado 12 meses o se
espera que dure más de 12 meses?

No habla inglés

Sí

NSCH-S-S1

§;+qS¤

26108043

NIÑO(A) 3

(siguiente niño(a) más joven)

¿ACTUALMENTE este(a) niño(a) necesita o toma
medicamentos recetados por un médico, aparte de vitaminas?
Sí

Nombre, Iniciales, o Apodo del (de la) siguiente niño(a)
más joven

¿Qué edad tiene este(a) niño(a)? Si el(la) niño(a) tiene menos
de un mes de edad, redondee la edad de meses a 1.

Años O

Sí

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Meses

Femenino

¿Necesita o utiliza este(a) niño(a) más servicios de atención
médica, salud mental o educativos de los que normalmente
requiren la mayoría de los(as) niños(as) de su misma edad?
Sí

➜

NOTA: Responda AMBAS PREGUNTAS, la pregunta 4
sobre el origen hispano Y la pregunta 5 sobre la raza.
Para esta encuesta, origen hispano no es una raza.

¿Es este(a) niño(a) de origen hispano, latino o español?

Si la respuesta es sí, la necesidad de servicios de
atención médica, salud mental o educativos de
este(a) niño(a), ¿se debe a ALGUNA condición
médica, de conducta u otro problema de salud?
Sí

No, no es de origen hispano, latino o español

Sí

Sí, puertorriqueño(a)

9
Sí, cubano(a)
Sí, de otro origen hispano, latino o español

¿Hay algo que le limite o le impida de alguna manera a
este(a) niño(a) hacer las cosas que hacen la mayoría de
los(as) niños(as) de su misma edad?
Sí

Si la respuesta es sí, la limitación en las capacidades
de este(a) niño(a), ¿se debe a ALGUNA condición
médica, de conducta, o alguna otra condición de salud?

¿Cuál es la raza de este(a) niño(a)? Marque (X) una o más
casillas.
Vietnamita

Sí

Negra o afroamericana

Otra asiática

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Indígena de las Américas
o nativa de Alaska

Nativa de Hawaii

Blanca

Guameña o Chamorro
India asiática
China

Sí

10 ¿Necesita o recibe este(a) niño(a) alguna terapia especial,
como terapia física, ocupacional o del habla?

Samoana

Filipina

Otra de las Islas
del Pacífico

Japonesa

Alguna otra raza

Sí

Si la respuesta es sí, ¿se debe a ALGUNA condición
médica, de conducta, o alguna otra condición de salud?
Sí

Conteste la siguiente pregunta sólo si este(a) niño(a) tiene al
menos 4 años de edad. De lo contrario pase a la pregunta 7 .
¿Qué tan bien habla inglés este(a) niño(a)?

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Coreana

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Sí, mexicano(a), mexicano(a) americano(a), chicano(a)

Sí

¿Cuál es el sexo de este(a) niño(a)?
Masculino

Si la respuesta es sí, la necesidad de medicamentos
recetados para este(a) niño(a), ¿se debe a ALGUNA
condición médica, de conducta o alguna otra condición
de salud?

Sí

11 ¿Tiene este(a) niño(a) algún tipo de problema emocional, de
desarrollo o de conducta para el cual necesita tratamiento o
consejería?

Muy bien
Bien

Sí

Regular

Si la respuesta es sí, este problema emocional, de
desarrollo o de conducta, ¿ha durado 12 meses o se
espera que dure más de 12 meses?

No habla inglés

Sí

NSCH-S-S1

§;+qL¤

26108035

NIÑO(A) 4

(siguiente niño(a) más joven)

¿ACTUALMENTE este(a) niño(a) necesita o toma
medicamentos recetados por un médico, aparte de vitaminas?
Sí

Nombre, Iniciales, o Apodo del (de la) siguiente niño(a)
más joven

¿Qué edad tiene este(a) niño(a)? Si el(la) niño(a) tiene menos
de un mes de edad, redondee la edad de meses a 1.

Años O

Sí

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Meses

Femenino

¿Necesita o utiliza este(a) niño(a) más servicios de atención
médica, salud mental o educativos de los que normalmente
requiren la mayoría de los(as) niños(as) de su misma edad?
Sí

➜

NOTA: Responda AMBAS PREGUNTAS, la pregunta 4
sobre el origen hispano Y la pregunta 5 sobre la raza.
Para esta encuesta, origen hispano no es una raza.

¿Es este(a) niño(a) de origen hispano, latino o español?

Si la respuesta es sí, la necesidad de servicios de
atención médica, salud mental o educativos de
este(a) niño(a), ¿se debe a ALGUNA condición
médica, de conducta u otro problema de salud?
Sí

No, no es de origen hispano, latino o español

Sí

Sí, puertorriqueño(a)

9
Sí, cubano(a)
Sí, de otro origen hispano, latino o español

¿Hay algo que le limite o le impida de alguna manera a
este(a) niño(a) hacer las cosas que hacen la mayoría de
los(as) niños(as) de su misma edad?
Sí

Si la respuesta es sí, la limitación en las capacidades
de este(a) niño(a), ¿se debe a ALGUNA condición
médica, de conducta, o alguna otra condición de salud?

¿Cuál es la raza de este(a) niño(a)? Marque (X) una o más
casillas.
Vietnamita

Sí

Negra o afroamericana

Otra asiática

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Indígena de las Américas
o nativa de Alaska

Nativa de Hawaii

Blanca

Guameña o Chamorro
India asiática
China

Sí

10 ¿Necesita o recibe este(a) niño(a) alguna terapia especial,
como terapia física, ocupacional o del habla?

Samoana

Filipina

Otra de las Islas
del Pacífico

Japonesa

Alguna otra raza

Sí

Si la respuesta es sí, ¿se debe a ALGUNA condición
médica, de conducta, o alguna otra condición de salud?
Sí

Conteste la siguiente pregunta sólo si este(a) niño(a) tiene al
menos 4 años de edad. De lo contrario pase a la pregunta 7 .
¿Qué tan bien habla inglés este(a) niño(a)?

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Coreana

Si la respuesta es sí, ¿es ésta una condición
que ha durado 12 meses o se espera que dure
más de 12 meses?

Sí, mexicano(a), mexicano(a) americano(a), chicano(a)

Sí

¿Cuál es el sexo de este(a) niño(a)?
Masculino

Si la respuesta es sí, la necesidad de medicamentos
recetados para este(a) niño(a), ¿se debe a ALGUNA
condición médica, de conducta o alguna otra condición
de salud?

Sí

11 ¿Tiene este(a) niño(a) algún tipo de problema emocional, de
desarrollo o de conducta para el cual necesita tratamiento o
consejería?

Muy bien
Bien

Sí

Regular

Si la respuesta es sí, este problema emocional, de
desarrollo o de conducta, ¿ha durado 12 meses o se
espera que dure más de 12 meses?

No habla inglés

Sí

NSCH-S-S1

§;+qD¤

26108027

➜

Si hay más de cuatro niños(as) de 0 a 17 años que usualmente viven o se quedan en esta dirección, escriba el nombre, las
iniciales o el apodo de cada niño(a), y también su edad y sexo.
No repita la información de los(as) niños(as) 1 a 4 ya incluídos anteriormente.
Nombre, Iniciales, o Apodo

NIÑO(A) 5
▲

((siguiente niño(a)
más joven)

Edad

Años O

Meses

Sexo

Masculino

Femenino

Años O

Meses

Sexo

Masculino

Femenino

Meses

Sexo

Masculino

Femenino

Meses

Sexo

Masculino

Femenino

Meses

Sexo

Masculino

Femenino

Nombre, Iniciales, o Apodo

NIÑO(A) 8
▲

Edad

Años O

Nombre, Iniciales, o Apodo

NIÑO(A) 9
▲

Edad

NIÑO(A) 10

Años O

Nombre, Iniciales, o Apodo

▲

(siguiente niño(a)
más joven)

Femenino

▲
Edad

(siguiente niño(a)
más joven)

Masculino

Nombre, Iniciales, o Apodo

NIÑO(A) 7

(siguiente niño(a)
más joven)

Sexo

▲
Edad

(siguiente niño(a)
más joven)

Meses

Nombre, Iniciales, o Apodo

NIÑO(A) 6
(siguiente niño(a)
más joven)

Años O

Edad

Años O

NSCH-S-S1

§;+q<¤

26108019

➜ Asegúrese de que:
• Escribió todos los nombres, iniciales o apodos de los(as) niños(as) de 0 a 17 años de edad en el hogar
• Contestó todas las preguntas para cada uno(a) de los(as) niños(as) incluídos(as)

➜ Coloque el cuestionario completado en el sobre con franqueo pagado. Si el sobre se ha extraviado, envíe
el cuestionario por correo a:
U.S. Census Bureau
ATTN: DCB 60-A
1201 E. 10th Street
Jeffersonville, IN 47132-0001
También puede llamar al 1-800-845-8241 para solicitar un sobre de reemplazo.

Se calcula que el tiempo promedio necesario para recopilar esta información es de 5 minutos por respuesta, que incluye el tiempo para revisar
las instrucciones, buscar las fuentes de datos existentes, recopilar y mantener los datos necesarios, y completar y revisar la recopilación de la
información. Para realizar comentarios sobre este cálculo o sobre cualquier otro aspecto de esta recopilación de información, incluyendo sugerencias
para reducir el tiempo que toma, escriba a: Paperwork Project 0607-0990, U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington,
DC 20233. Puede enviar sus comentarios por correo electrónico a DEMO.Paperwork@census.gov; escriba como asunto "Paperwork Project
0607-0990".

NSCH-S-S1

§;+q4¤

26118240
OMB No. 0607-0990: Aprobado hasta el 05/31/2019

NSCH-S-T1
(05/02/2018)

§;,sI¤

26118232

Comienze Aquí

¿Con qué frecuencia...
Siempre

Recientemente, usted completó una encuesta con
preguntas sobre los(as) niños(as) que usualmente
viven o se quedan en esta dirección. Gracias por
tomar de su tiempo para completar esta encuesta.

A veces

Nunca

a. Este(a) niño(a)
es cariñoso(a) y
tierno(a) con usted?
b. Este(a) niño(a)
se recupera
rápidamente cuando
las cosas no salen
como él o ella
quiere?

Ahora le haremos algunas preguntas de seguimiento
sobre:

Si el nombre que aparece anteriormente es incorrecto
o no corresponde a un(a) niño(a) que viva en este
hogar, llame al 1-800-845-8241.

c. Este(a) niño(a)
muestra interés y
curiosidad por
aprender cosas
nuevas?

Hemos seleccionado solamente a un(a) niño(a) por
hogar con el fin de minimizar la cantidad de tiempo
que necesitará para responder a las preguntas de
seguimiento.

d. Este(a) niño(a)
sonríe y se ríe
mucho?

La encuesta deberá ser completada por un adulto
familiarizado con la salud y atención médica de
este(a) niño(a).

Casi
siempre

DURANTE LOS ÚLTIMOS 12 MESES, ¿este(a) niño(a)
ha tenido dificultades CRÓNICAS o FRECUENTES con
cualquiera de los(as) siguientes?
Sí

Su participación es importante. Gracias.

a. Respirar u otros problemas
respiratorios (como respiración
sibilante o falta de aire)

A. La salud de este(a) niño(a)

b. Comer o tragar debido a una
condición médica
c. Digerir la comida, incluyendo
problemas estomacales o
intestinales, estreñimiento
o diarrea

A1 En general, ¿cómo describiría la salud de este(a) niño(a)

(cuyo nombre aparece más arriba)?
Excelente
Muy buena

d. Dolor físico crónico o recurrente,
incluyendo dolor de cabeza, dolor
de espalda o dolor corporal.

Buena

e. Usando sus manos

Regular

f. Coordinación o moviéndose

Deficiente

g. Dolor de muelas
h. Sangrado en las encías

A2 ¿Cómo describiría la salud dental de este(a) niño(a)?

Este(a) niño(a) no tiene dientes
Excelente

Muy buena

Dientes deteriorados o caries

¿Presenta este(a) niño(a) alguno de los siguientes
problemas?
Sí

Buena

a. Sordera o problemas de audición

Regular

b. Ceguera o problemas de la vista,
incluso cuando usa anteojos o
lentes

Deficiente

NSCH-S-T1

§;,sA¤

26118224

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A6 ¿Alergias (incluyendo alimentos, medicamentos,

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A11 ¿Diabetes?

insectos o de otro tipo)?
Sí

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Sí

Moderada

Si la respuesta es sí, la condición es:

Si la respuesta es sí, la condición es:
Leve

Leve

Grave

Moderada

Grave

A12 ¿Epilepsia o trastornos convulsivos?

A7 ¿Artritis?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Sí
Sí

Si la respuesta es sí, la condición es:

Si la respuesta es sí, la condición es:
Leve

Moderada

Leve

Moderada

Grave

Grave
A13 ¿Condición o problemas cardiacos?

A8 ¿Asma?

Sí
Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Sí
Sí

Si la respuesta es sí, la condición es:

Si la respuesta es sí, la condición es:
Leve

Moderada

Leve

Moderada

Grave

Grave
A14 ¿Dolores de cabeza frecuentes o intensos, incluyendo

migrañas?

A9 ¿Lesión cerebral, contusión o lesión en la cabeza?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Sí

Moderada

Leve

Grave

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, la condición es:
Leve

Grave

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Moderada

A15 ¿Síndrome de Tourette?

A10 ¿Parálisis cerebral?

Sí

Si la respuesta es sí, la condición es:

Si la respuesta es sí, la condición es:
Leve

Moderada

Si la respuesta es sí, la condición es:
Leve

Grave

NSCH-S-T1

Moderada

Grave

§;,s9¤

26118216

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A16 ¿Problemas de ansiedad?

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A20 ¿Fibrosis quística?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Si la respuesta es sí, la condición es:
Leve

Sí

Moderada

Grave

Sí

A17 ¿Depresión?

A21 ¿Otra condición genética o hereditaria?

Sí

Grave

Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se
llaman pruebas de detección para recién nacidos.

Si la respuesta es sí, la condición es:
Leve

Moderada

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Sí

Si la respuesta es sí, especifique:C

Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

La condición es:

Grave

Leve

A18 ¿Síndrome de Down?

Sí

Moderada

Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se
llaman pruebas de detección para recién nacidos.

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Sí
Sí

Grave

Si la respuesta es sí, la condición es:
Leve

Moderada

ALGUNA VEZ un médico, otro proveedor de atención
médica o un educador le ha dicho a usted que este(a)
niño(a) padece de...
Algunos ejemplos de educadores son maestros(as) y
enfermeros(as) escolares.

Grave

A19 ¿Trastornos sanguíneos (como enfermedad de anemia

drepanocítica o de células falciformes, talasemia o
hemofilia)?
Sí

A22 ¿Problemas de comportamiento o conducta?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave
No

Sí
Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se
llaman pruebas de detección para recién nacidos.
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave

A23 ¿Retraso en el desarrollo?

Si la respuesta es sí, ¿fue este(a) niño(a)
diagnosticado(a) con:
Sí
No

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Enfermedad de anemia
drepanocítica

Sí
Talasemia

Si la respuesta es sí, la condición es:

Hemofilia

Leve

Moderada

Grave

Otros trastornos
sanguíneos
NSCH-S-T1

§;,s1¤

26118208

A28 ¿ALGUNA VEZ le ha dicho a usted un médico u otro

proveedor de atención médica que este(a) niño(a)
padece de Autismo o Trastorno del Espectro Autista
(TEA)? Incluya los diagnósticos de Síndrome de Asperger
o Trastorno Generalizado del Desarrollo (TGD).

A24 ¿Discapacidad intelectual (anteriormente conocida

No ➔ PASE a la pregunta A33 en la
página 6
Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

como retraso mental)?
No

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
discapacidad ACTUALMENTE?

Sí

Si la respuesta es sí, la condición es:

Sí

Leve

Si la respuesta es sí, la discapacidad es:
Leve

Moderada

Grave

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
No

Edad en años

médica fue el PRIMERO en decirle a usted que este(a)
niño(a) tenía Autismo, Trastornos del Espectro Autista
(TEA), Síndrome de Asperger, o Trastorno Generalizado
del Desarrollo (TGD)? Marque (X) sólo UNA opción.

Moderada

Grave

A26 ¿Discapacidades del aprendizaje?

Sí

Proveedor de atención primaria

Especialista

Si la respuesta es sí, ¿padece este(a) niño(a) la
discapacidad ACTUALMENTE?
Sí

Psicólogo(a)/consejero(a) escolar

Otro(a) psicólogo(a) (no escolar)

Si la respuesta es sí, la discapacidad es:
Leve

No sabe

A30 ¿Qué tipo de médico u otro proveedor de atención

Si la respuesta es sí, la condición es:
Leve

Grave

otro proveedor de atención médica le dijo a usted por
PRIMERA VEZ que este(a) niño(a) tenía Autismo,
Trastornos del Espectro Autista (TEA), Síndrome de
Asperger o Trastorno Generalizado del Desarrollo (TGD)?

Sí

Moderada

A29 ¿Qué edad tenía este(a) niño(a) cuando un médico u

A25 ¿Trastorno del habla u otro trastorno del lenguaje?

Sí

Moderada

Psiquiatra

Grave
Otro(a), especifique:

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A27 ¿Cualquier otra condición de salud mental?

Sí

No sabe

A31 ¿Toma este(a) niño(a) ACTUALMENTE medicamentos

para tratar el Autismo, los Trastornos del Espectro
Autista(TEA), Síndrome de Asperger, o el Trastorno
Generalizado del Desarrollo (TGD)?

Si la respuesta es sí, especifique:C

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave

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B. Este(a) niño(a) cuando
era bebé

A32 En algún momento DURANTE LOS ÚLTIMOS 12 MESES,

¿recibió este(a) niño(a) tratamiento de la conducta por
Autismo, Trastornos del Espectro Autista (TEA),
Síndrome de Asperger, o Trastorno Generalizado del
Desarrollo (TGD), tal como alguna capacitación o
intervención que haya recibido usted o este(a) niño(a)
para ayudar con su conducta?
Sí

¿Nació este(a) niño(a) más de 3 semanas antes de la
fecha para la cual se esperaba el parto?

Sí
No

A33 ¿ALGUNA VEZ le dijo a usted un médico u otro

proveedor de atención médica que este(a) niño(a)
padece del Trastorno por Déficit de Atención o del
Trastorno por Déficit de Atención e Hiperactividad,
es decir, TDA or TDAH?

¿Cuánto pesó al nacer?
Responda utilizando libras y onzas O kilogramos y gramos.
Puede proveer su mejor aproximación o estimación.

No ➔ PASE a la pregunta A36

Sí

libras Y

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

onzas

kilogramos Y

gramos

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave

¿Qué edad tenía la madre cuando nació este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.

A34 ¿Toma este(a) niño(a) ACTUALMENTE medicamentos

para tratar el Trastorno por Déficit de Atención (TDA) o
el Trastorno por Déficit de Atención con Hiperactividad
(TDAH)?
Sí

Edad en años
B4

ALGUNA VEZ, ¿fue amamantado(a) o tomó leche
materna este(a) niño(a)?

A35 En algún momento DURANTE LOS ÚLTIMOS 12 MESES,

¿recibió este(a) niño(a) tratamiento de la conducta por
el Trastorno por Déficit de Atención (TDA) o Trastorno
por Déficit de Atención e Hiperactividad (TDAH), tal
como alguna capacitación o intervención que haya
recibido usted o este(a) niño(a) para ayudar con su
conducta?
Sí

Sí
No ➔ PASE a la pregunta B6 en la página 7
B5

Si la respuesta es sí, ¿qué edad tenía este(a) niño(a)
cuando dejó COMPLETAMENTE de ser amamantado(a)
o de tomar leche materna?

A36 DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué

días

frecuencia las condiciones o los problemas de salud
de este(a) niño(a) afectaron su capacidad para hacer
actividades que realizan otros(as) niños(as) de su edad?

Este(a) niño(a) no padece ninguna
condición médica ➔ PASE a la pregunta B1

semanas
O

Nunca
meses

A veces
O

Casi siempre

Marque esta casilla si este(a) niño(a) aún está
amamantando

Siempre
A37 ¿En qué medida las condiciones o problemas de salud

de este(a) niño(a) afectan su capacidad de hacer
actividades?
Muy poco
Algo
En gran medida
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¿Qué edad tenía este(a) niño(a) cuando tomó leche de
fórmula por PRIMERA VEZ?

Marque esta casilla si este(a) niño(a) nunca tomó
leche de fórmula
O
Al nacer

Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12
MESES, ¿cuántas veces tuvo este(a) niño(a) una
consulta con un médico, enfermero(a) u otro(a)
profesional de la salud para realizarse un chequeo
PREVENTIVO? El chequeo preventivo se realiza cuando
este(a) niño(a) no ha estado enfermo(a) ni lesionado(a), tal
como un chequeo preventivo anual o un examen físico para
hacer deporte o la visita de niño sano.

0 visitas
1 visita

días

2 visitas o más

O
semanas

O
meses

Pensando en la ÚLTIMA VEZ que llevó al (a la) niño
a un chequeo PREVENTIVO, ¿aproximadamente
cuánto tiempo en el consultorio estuvo con usted el
médico o proveedor de atención médica que examinó
a este(a) niño(a)? Puede proveer su mejor aproximación
o estimación.
Menos de 10 minutos

B7 ¿Qué edad tenía este(a) niño(a) cuando ingirió por

PRIMERA VEZ otros alimentos aparte de leche materna
o de fórmula? Incluya jugo, leche de vaca, agua con
azúcar, alimento para bebé o cualquier otra cosa que haya
ingerido este(a) niño(a), incluso agua.

De 10 a 20 minutos
Más de 20 minutos

Marque esta casilla si este(a) niño(a) nunca ingirió otro
alimento aparte de leche materna o de fórmula
C4 ¿Cuál es la estatura ACTUAL de este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.
O
Al nacer

pies Y

pulgadas

O
días

metros Y

centímetros

O
C5

semanas

¿Cuál es el peso ACTUAL de este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.

libras Y

onzas

O
meses
kilogramos Y

C. Servicios de atención
médica

gramos

¿Le preocupa el peso de este(a) niño(a)?
Sí, este(a) niño(a) pesa mucho

C1 DURANTE LOS ÚLTIMOS 12 MESES, ¿vio este(a) niño(a)

a algún médico, enfermero(a) u otro profesional de la
salud para recibir atención médica (por ejemplo, para
cuidado preventivo, cuidado médico, hospitalizaciones)?

Sí, este(a) niño(a) pesa muy poco
No, no me preocupa

Sí
No ➔ PASE a la pregunta C4

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C7 ¿Alguna vez un médico u otro proveedor de atención

C11 Si la respuesta es sí, ¿adónde NORMALMENTE va

médica le ha dicho a usted que este(a) niño(a) tiene
sobrepeso?

este(a) niño(a) primero? Marque (X) SÓLO una opción.
Consultorio del médico

Sí
Sala de emergencias del hospital
No
Departamento de pacientes ambulatorios del hospital
C8

DURANTE LOS ÚLTIMOS 12 MESES, ¿le preguntaron los
médicos o proveedores de atención médica de este(a)
niño(a) si usted estaba preocupado(a) por el aprendizaje,
el desarrollo o la conducta de este(a) niño(a)?

Clínica o centro de salud
Clínica ambulatoria dentro de un negocio o
"Minute Clinic"

Sí

Escuela (enfermería, oficina del entrenador atlético)

Algún otro lugar

Conteste la siguiente pregunta sólo si este(a) niño(a)
tiene al menos 9 meses de edad. De lo contrario pase
a la pregunta C10 .

C12 ¿Hay algún lugar a donde este(a) niño(a) USUALMENTE

va cuando necesita atención preventiva de rutina, como
un examen físico o un chequeo de niño sano?

DURANTE LOS ÚLTIMOS 12 MESES, ¿le pidió un
Sí
médico u otro proveedor de atención médica a usted
u otro cuidador que completara un cuestionario sobre
No ➔ PASE a la pregunta C14
las inquietudes u observaciones que pudiera tener sobre
el desarrollo, la comunicación o el comportamiento
social de este(a) niño(a)? A veces el médico u otro
C13 Si la respuesta es sí, ¿es éste el mismo lugar a donde
proveedor de atención médica le solicitará al padre o la
el(la) niño(a) va cuando está enfermo(a)?
madre que complete éste en casa o durante la visita de
este(a) niño(a).
Sí
Sí

Si la respuesta es sí, y este(a) niño(a) tiene entre
9 y 23 meses:
Incluyó el cuestionario preguntas sobre sus
inquietudes u observaciones acerca de:
Marque (X) TODAS las que apliquen.

No
C14 DURANTE LOS ÚLTIMOS 12 MESES, ¿se le hizo a

este(a) niño(a) un examen de la vista, utilizando
imágenes, formas o letras?
Sí

¿Cómo habla este(a) niño(a) o emite los sonidos
del habla?

No ➔ PASE a la pregunta C16 en la página 9

¿Cómo interactúa este(a) niño(a) con usted y
los demás?
Si la respuesta es sí, y este(a) niño(a) tiene entre
2 y 5 años:

C15 Si la respuesta es sí, ¿dónde se le examinó la vista a

este(a) niño(a)? Marque (X) TODAS las que apliquen.

Incluyó el cuestionario preguntas sobre sus
inquietudes u observaciones acerca de:
Marque (X) TODAS las que apliquen.

Consultorio de un oculista o especialista en ojos
(oftalmólogo, optometrista)

¿Palabras y frases que este(a) niño(a) usa y
comprende?

Consultorio del pediatra u otro médico generalista

¿Cómo se comporta y se lleva con usted y los
demás este(a) niño(a)?

Clínica o centro de salud
Escuela

C10 ¿Hay algún lugar en donde usted u otro cuidador

Otro(a), especifique:

USUALMENTE lleva a este(a) niño(a) cuando está
enfermo(a) o necesita asesoramiento sobre la salud
de este(a) niño(a)?

Sí
No ➔ PASE a la pregunta C12

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C16 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

C20 ¿Qué tan difícil le resultó obtener el tratamiento,

consejería o asesoría de salud mental que este(a)
niño(a) necesitaba?

niño(a) al dentista u otro profesional de la salud oral
para recibir algún tipo de atención o cuidado dental
u oral?

No fue difícil
Sí, fue al dentista
Algo difícil
Sí, fue a otro(a) profesional de la salud oral
Muy difícil
No ➔ PASE a la pregunta C19
No fue posible obtenerlo
C17 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

MESES, ¿fue este(a) niño(a) al dentista u otro(a)
profesional de la salud oral para recibir atención
preventiva, como chequeos, limpiezas dentales,
selladores dentales o tratamientos de fluoruro?

C21 DURANTE LOS ÚLTIMOS 12 MESES, ¿tomó este(a)

niño(a) algún medicamento debido a dificultades con
sus emociones, concentración o conducta?
Sí

No tuvo visitas preventivas en los
últimos 12 meses ➔ PASE a la pregunta C19

Sí, 1 visita
C22 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

niño(a) a algún especialista aparte de un profesional
de la salud mental? Los especialistas son médicos como
cirujanos, cardiólogos(as), alergistas, dermatólogos y otros
médicos que se especializan en una sola área de la
atención médica.

Sí, 2 visitas o más
C18 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

MESES, ¿qué servicio(s) dental(es) preventivo(s)
recibió este(a) niño(a)? Marque (X) TODAS las que
apliquen.

Sí

Chequeo

No, pero este(a) niño(a) necesitó ver a un especialista

Limpieza

No, este(a) niño(a) no necesitó ver
a un especialista ➔ PASE a la pregunta C24

Instrucciones sobre cepillado de dientes y cuidado
de la salud oral

C23 ¿Qué tan difícil le resultó a usted que este(a) niño(a)

recibiera la atención del especialista que necesitaba?

Radiografías

No fue difícil

Tratamiento de fluoruro

Algo difícil

Sellador (sellador plástico en muelas posteriores)

Muy difícil

No sabe

No fue posible obtenerla
C19 DURANTE LOS ÚLTIMOS 12 MESES, ¿recibió este(a)

niño(a) algún tratamiento, consejería o asesoría por
parte de un profesional de la salud mental?
Los profesionales de salud mental incluyen psiquiátras,
psicólogos(as), enfermeros(as) psiquiátricos(as) y
trabajadores sociales clínicos.

C24 DURANTE LOS ÚLTIMOS 12 MESES, ¿utilizó este(a)

niño(a) algún tipo de cuidado médico o tratamiento
alternativo? El cuidado médico o tratamiento alternativo
puede incluir acupuntura, atención quiropráctica, terapias
de relajación, suplementos a base de hierbas y otros
tratamientos. Algunas terapias implican ver a un proveedor
de atención médica, mientras que otras se pueden realizar
por cuenta propia.

Sí
No, pero este(a) niño(a) necesitaba ver a un
profesional de la salud mental

Sí

No, este(a) niño(a) no necesitó ver a un profesional
de la salud mental ➔ PASE a la pregunta C21

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C25 DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó este(a)

C28 DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué

niño(a) atención médica en alguna ocasión pero no la
recibió? Por atención médica nos referimos a la atención
médica así como atención dental, de la vista y de salud
mental.

frecuencia se sintió frustrado(a) en sus esfuerzos
para obtener servicios para este(a) niño(a)?
Nunca

Sí

A veces

No ➔ PASE a la pregunta C28

Casi siempre
Siempre

C26 Si la respuesta es sí, ¿qué tipo de atención no recibió?

Marque (X) TODAS las que apliquen.
C29 DURANTE LOS ÚLTIMOS 12 MESES, ¿cuántas veces

fue este(a) niño(a) a la sala de emergencias de un
hospital?

Atención médica
Atención dental

Nunca

Atención de la vista

1 vez

Atención de la audición

2 o más veces

Servicios de salud mental
Otro(a), especifique:

C30 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

niño(a) admitido(a) al hospital para quedarse ahí
por lo menos una noche?
Sí
No

C27 ¿Cuáles de las siguientes razones contribuyeron a

que este(a) niño(a) no recibiera los servicios de salud
necesarios? Marque (X) Si o No en cada categoría.
Sí

C31 ¿Recibió este(a) niño(a) ALGUNA VEZ un plan de

educación especial o de intervención temprana?
Los(as) niños(as) que reciben estos servicios a menudo
cuentan con un Plan de Servicio Familiar Individualizado
(IFSP) o Plan de Educación Individualizado (IEP).

a. Este(a) niño(a) no era elegible
para recibir los servicios
b. Los servicios que necesitaba
este(a) niño(a) no estaban
disponibles en su área

Sí
No ➔ PASE a la pregunta C34 en la página 11

c. Hubo problemas para programar u
obtener una cita cuando este(a)
niño(a) la necesitó.

C32 Si la respuesta es sí, ¿qué edad tenía este(a) niño(a)

cuando se estableció el PRIMER plan?

d. Hubo problemas para obtener
transporte o cuidado de los niños
e. El consultorio (del médico o la
clínica) no estaba abierto(a) cuando
este(a) niño(a) necesitó atención
f. Hubo problemas relacionados
con el costo

Años Y

Meses

C33 ¿Recibe este(a) niño(a) ACTUALMENTE servicios bajo

alguno de estos planes?
Sí
No

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C34 ¿Recibió este(a) niño(a) ALGUNA VEZ servicios

especiales para cumplir con sus necesidades del
desarrollo, tales como terapia del habla, ocupacional
o de la conducta?

¿Qué tan difícil le resultó a usted obtener referidos?
No fue difícil
Algo difícil

Sí

Muy difícil

No ➔ PASE a la pregunta D1

No fue posible obtener referidos
C35 Si la respuesta es sí, ¿qué edad tenía este(a) niño(a)

cuando comenzó a recibir estos servicios especiales?
Años Y

Meses

Responda las siguientes preguntas sólo si este(a)
niño(a) tuvo una visita de atención médica EN LOS
ÚLTIMOS 12 MESES. De lo contrario vaya a la
pregunta E1 en la página 12.
DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué
frecuencia los médicos u otros proveedores de
atención médica de este(a) niño(a) hicieron lo
siguiente...

C36 ¿Recibe este(a) niño(a) ACTUALMENTE estos servicios

especiales?
Sí

Siempre

Casi
siempre

A veces

Nunca

a. ¿Estuvieron tiempo
suficiente con
este(a) niño(a)?
b. ¿Lo(a) escucharon
a usted con
atención?

D. Experiencia con los
proveedores de atención
médica de este(a) niño(a)

c. ¿Mostraron
sensibilidad por
sus valores y
costumbres
familiares?

D1 ¿Tiene usted a una o más personas a quienes

considera como médico o enfermera(o) de cabecera de
este(a) niño(a)? Un médico o enfermo(a) es un profesional
de la salud quien conoce bien al (a la) niño(a) y está
familiarizado con la historia de salud de este(a) niño(a).
Puede ser un médico de medicina general, un pediatra,
un médico especialista, un(a) enfermero(a) practicante o
asociado médico.

d. ¿Le brindaron la
información
específica que
necesitaba con
relación a este(a)
niño(a)?
e. ¿Lo(a) hicieron
sentir como un(a)
participante en la
atención y cuidado
de este(a) niño(a)?

Sí, a una persona
Sí, a más de una persona
No
D5
D2 DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó este(a)

niño(a) un referido para ver a algún médico o recibir
algún servicio?

DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó tomar
alguna decisión sobre el cuidado de salud de este(a)
niño(a), tal como obtener medicamentos recetados,
referidos o algún otro procedimiento médico?

Sí

No ➔ PASE a la pregunta D4

No ➔ PASE a la pregunta D7 en la página 12

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D6 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

D10 DURANTE LOS ÚLTIMOS 12 MESES, ¿cuán

MESES, ¿con qué frecuencia los médicos u otros
proveedores de atención médica de este(a) niño(a)...
Siempre

Casi
siempre

A veces

satisfecho(a) estuvo con respecto a la comunicación
entre los médicos de este(a) niño(a) y los demás
proveedores de atención médica?

Nunca

Muy satisfecho

a. ¿Analizaron con
usted la variedad
de opciones a
considerar para la
atención médica o
el tratamiento de
este(a) niño(a)?
b. ¿Le dieron lugar
para expresar sus
dudas o desacuerdo
con las
recomendaciones
sobre la atención
médica de este(a)
niño(a)?
c. ¿Trabajaron con
usted para decidir
cuáles serían las
mejores opciones
para este(a) niño(a)
en lo que se refiere
a cuidado de salud
y opciones de
tratamiento?

Algo satisfecho
Algo insatisfecho
Muy insatisfecho

D11 DURANTE LOS ÚLTIMOS 12 MESES, ¿el proveedor de

atención médica de este(a) niño(a) se comunicó con la
escuela, el proveedor de cuidado de niños o el programa
de educación especial de este(a) niño(a)?
Sí
No ➔ PASE a la pregunta E1
No fue necesario que el proveedor de atención médica
se comunicara con estos proveedores ➔ PASE a la
pregunta E1
D12 Si la respuesta es sí, durante este tiempo, ¿qué tan

satisfecho(a) se ha sentido con respecto a la
comunicación que el proveedor de atención médica de
este(a) niño(a) ha tenido con la escuela, el proveedor
de cuidado de niños o el programa de educación
especial?

D7 DURANTE LOS ÚLTIMOS 12 MESES, ¿le ayudó

alguien a organizar o coordinar el cuidado de este(a)
niño(a) entre los diferentes médicos y servicios que
este(a) niño(a) utiliza?

Muy satisfecho

Sí

Algo satisfecho

Algo insatisfecho

No vio a más de un proveedor de atención
médica en los ÚLTIMOS 12 MESES

Muy insatisfecho

D8 DURANTE LOS ÚLTIMOS 12 MESES, ¿sintió que

E. Cobertura de seguro
médico de este(a) niño(a)

podría haber usado ayuda adicional para hacer
arreglos o coordinar la atención médica de este(a)
niño(a) entre los diferentes proveedores o servicios
de atención médica?
E1

Sí
No ➔ PASE a la pregunta D10

DURANTE LOS ÚLTIMOS 12 MESES, ¿estuvo este(a)
niño(a) cubierto(a) por ALGÚN tipo de seguro médico
o plan de cobertura de salud?
Sí, este(a) niño(a) tuvo cobertura durante los
12 meses ➔ PASE a la pregunta E4 en la página 13

D9 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

Sí, pero este(a) niño(a) tuvo una interrupción
en la cobertura

MESES, ¿con qué frecuencia obtuvo la ayuda que
deseaba para hacer arreglos o coordinar la atención
médica de este(a) niño(a)?

Casi siempre
A veces
Nunca

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Indique si algunos de los siguientes es un motivo por
el cual este(a) niño(a) no tuvo cobertura de salud
DURANTE LOS ÚLTIMOS 12 MESES:
Sí

¿Con qué frecuencia el seguro de salud de este(a)
niño(a) ofrece beneficios o cubre servicios que
satisfacen las necesidades de este(a) niño(a)?
Siempre

a. Cambio de empleador o de
situación laboral

Casi siempre
b. Cancelación por primas vencidas
A veces
c. Renunció a la cobertura porque
costaba demasiado

Nunca

d. Renunció a la cobertura porque los
beneficios eran inadecuados

e. Renunció a la cobertura porque
las opciones de proveedores de
atención médica eran inadecuadas

¿Con qué frecuencia el seguro de salud de este(a)
niño(a) le permite ver a los proveedores de atención
médica que necesita?
Siempre

f. Problemas con el proceso de solicitud
o renovación de la cobertura

Casi siempre

g. Otro(a), especifique:

A veces

Nunca
E7
E3

¿Está este(a) niño(a) cubierto(a) ACTUALMENTE por
ALGÚN tipo de seguro de salud o plan de cobertura
de salud?
Sí

Pensando específicamente en las necesidades de
salud mental o de conducta de este(a) niño(a), ¿con
qué frecuencia el seguro de salud de este(a) niño(a)
ofrece beneficios o cubre servicios que satisfacen
estas necesidades?
Este(a) niño(a) no utiliza servicios de salud mental
o de la conducta

No ➔ PASE a la pregunta F1
Siempre
E4

¿Está este(a) niño(a) ACTUALMENTE cubierto(a) por
alguno de los siguientes tipos de seguro de salud o
planes de cobertura de salud? Marque (X) Sí o No en
CADA categoría.
Sí

Casi siempre
A veces

Nunca

a. Seguro a través de un empleador
actual o previo o a través de un
sindicato

F. Proveyendo para el
cuidado de salud de este(a)
niño(a)

b. Seguro adquirido directamente de
una compañía de seguros
c. Medicaid, Medical Assistance, o
cualquier tipo de plan de asistencia
del gobierno para personas con
bajos ingresos o una discapacidad

d. TRICARE u otros servicios de
atención médica de las Fuerzas
Armadas
e. Servicio de Salud Indio (Indian
Health Services)
f. Otro(a), especifique:

Incluyendo co-pagos y cantidades reembolsables de
las Cuentas de Ahorros de Salud (HAS) y Cuentas de
Gastos Flexibles (FSA), ¿cuánto dinero pagó por los
cuidados médicos, de salud, dentales y de visión de
este(a) niño(a) DURANTE LOS ÚLTIMOS 12 MESES?
No incluya las primas o los costos del seguro que fueron
o serán reembolsados por el seguro u otra fuente.
$0 (Sin gastos médicos o gastos relacionados con la
salud) ➔ PASE a la pregunta F4 en la página 14

De $1 a $249
De $250 a $499
De $500 a $999
De $1,000 a $5,000
Más de $5,000
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G. El aprendizaje de este(a)
niño(a)

¿Con qué frecuencia son razonables estos costos?
Siempre
Casi siempre

Conteste la siguiente pregunta sólo si este(a) niño(a)
tiene al menos 1 año de edad. De lo contrario pase a
la pregunta H1 en la página 17.

A veces
G1

Nunca
F3

DURANTE LOS ÚLTIMOS 12 MESES, ¿tuvo su familia
problemas para pagar las facturas médicas o de
atención médica de este(a) niño(a)?

a. Decir al menos una palabra como
"hola" o "perro"?

Sí

b. Utilizar 2 palabras juntas como
"carro ve"?

c. Utilizar 3 palabras juntas en una
oración como "Mamá ven ahora"?

DURANTE LOS ÚLTIMOS 12 MESES, ¿usted u otro
miembro de la familia...
Sí

d. Hacer preguntas como "quién,"
"qué", "cuándo", "dónde"?
No

e. Hacer preguntas como "por qué"
y "cómo"?

a. ¿Dejó el trabajo o se ausentó unos
cuantos días debido a la salud o
condición(es) médica(s) de este(a)
niño(a)?

f. Contar una historia que tiene
principio, desarrollo y fin?
g. Entender el significado de la
palabra "no"?

b. ¿Redujo la cantidad de horas
que trabaja debido a la salud o
condición(es) médica(s) de este(a)
niño(a)?
c. ¿Evitó cambiar de trabajo para
mantener el seguro de salud para
este(a) niño(a)?
F5

¿Puede este(a) niño(a) hacer lo siguiente... Marque (X)
Sí o No en cada pregunta.
Sí
No

h. Seguir una instrucción verbal sin
tener que hacer gestos con las
manos como "lávese las manos"?

EN UNA SEMANA PROMEDIO, ¿cuántas horas dedica
usted u otros miembros de la familia a la atención
médica de este(a) niño(a) en su hogar? El cuidado puede
incluir cambiar vendajes o dar medicamentos y terapias
cuando sea necesario.
Este(a) niño(a) no necesita atención médica en el
hogar cada semana

Señalar cosas de un libro cuando
se le pregunta?

Seguir instrucciones que constan
de 2 pasos como "Consigue tus
zapatos y colócalos en la canasta"?

k. Entender palabras como "en,"
"debajo"?
G2

¿Es este(a) niño(a) de 3 años de edad o más?

Menos de 1 hora por semana

Sí

De 1 a 4 horas por semana

No ➔ PASE a la pregunta H1 en la página 17

De 5 a 10 horas por semana

¿Comenzó este(a) niño(a) la escuela? Incluya cualquier
programa formal de enseñanza en el hogar (homeschooling).

11 horas o más por semana
Sí, preescolar
F6

EN UNA SEMANA PROMEDIO, ¿cuántas horas dedica
usted u otros miembros de la familia haciendo arreglos
o coordinando la atención médica o de la salud de
este(a) niño(a), tal como programar citas o localizar
servicios?

Sí, kindergarten
Sí, primer grado
No

Este(a) niño(a) no necesita atención médica
coordinada cada semana
G4

Menos de 1 hora por semana

¿Está usted preocupado(a) acerca de cómo este(a)
niño(a) está aprendiendo a hacer cosas por su cuenta?

De 1 a 4 horas por semana

Sí, algo preocupado(a)

De 5 a 10 horas por semana

Sí, muy preocupado(a)

11 horas o más por semana

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G5 ¿Cuán seguro(a) está de que este(a) niño(a) está listo(a) G10 ¿Con qué frecuencia puede escribir este(a) niño(a) su

para ir a la escuela?

nombre incluso si algunas de las letras no están del
todo bien o están al revés?

Completamente seguro(a)
Siempre
Casi seguro(a)
Casi siempre
Un poco seguro(a)
A veces
Para nada seguro(a)
En raras ocasiones
G6 ¿Con qué frecuencia puede reconocer este(a) niño(a)

el sonido inicial de una palabra? Por ejemplo, ¿puede
este(a) niño(a) decirle que la palabra “pelota” comienza
con el sonido de la letra “p”?

Nunca
G11 ¿Hasta qué número puede contar este(a) niño(a)?

Siempre

Este(a) niño(a) no sabe contar

Casi siempre

Hasta cinco

A veces

Hasta diez

En raras ocasiones

Hasta 20

Nunca

Hasta 50
Hasta 100 o más

G7 ¿Aproximadamente cuántas letras del alfabeto puede

reconocer este(a) niño(a)?
G12 ¿Con qué frecuencia puede identificar este(a) niño(a)

Todas

formas básicas, como un triángulo, círculo o cuadrado?

Casi todas

Siempre

Aproximadamente la mitad

Casi siempre

Algunas

A veces

Ninguna

En raras ocasiones
Nunca

G8 ¿Puede este(a) niño(a) decir palabras que rimen?

Sí

G13 ¿Puede este(a) niño(a) identificar los colores rojo, amarillo,

azul y verde por sus nombres?

Sí, todos

G9 ¿Con qué frecuencia puede explicar este(a) niño(a) lo

Sí, algunos

que ha visto o hecho para que usted tenga una idea
bastante clara de lo que pasó?

No, ninguno

Siempre
G14 ¿Con qué frecuencia se distrae fácilmente este(a)

niño(a)?

Casi siempre
A veces

Siempre

En raras ocasiones

Casi siempre

Nunca

A veces
En raras ocasiones
Nunca

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G15 ¿Con qué frecuencia sigue trabajando este(a) niño(a)

G20 ¿Con qué frecuencia este(a) niño(a) muestra

en algo hasta terminarlo?

preocupación cuando otros(as) están heridos(as)
o infelices?

Siempre
Siempre
Casi siempre
Casi siempre
A veces
A veces
En raras ocasiones
En raras ocasiones
Nunca
Nunca
G16 Cuando este(a) niño(a) está prestando atención, ¿con

qué frecuencia puede seguir instrucciones para
completar una tarea simple?

G21 Cuando está emocionado(a) o alterado(a), ¿con qué

frecuencia puede este(a) niño(a) calmarse rápidamente?

Siempre

Casi siempre

A veces

En raras ocasiones

Nunca

G17 Generalmente, ¿cómo sostiene un lápiz este(a) niño(a)? G22 ¿Con qué frecuencia pierde este(a) niño(a) el control

de su temperamento cuando las cosas no salen a su
manera?

Usa los dedos para sostener el lápiz
Agarra el lápiz con todo el puño

Siempre

Este(a) niño(a) no puede sostener un lápiz

Casi siempre
A veces

G18 ¿Con qué frecuencia este(a) niño(a) juega bien con

los(as) demás?
En raras ocasiones
Siempre
Nunca
Casi siempre
G23 En comparación con otros(as) niños(as) de la misma

A veces

edad, ¿cuánta dificultad tiene este(a) niño(a) para hacer
o mantener amistades?

En raras ocasiones
Ninguna dificultad
Nunca
Algo de dificultad
G19 ¿Con qué frecuencia este(a) niño(a) se enfada o se

siente ansioso(a) cuando pasa de una actividad a otra?
Siempre

Mucha dificultad
G24 En comparación con otros(as) niños(as) de la misma

edad, ¿con qué frecuencia puede permanecer este(a)
niño(a) quieto(a) mientras está sentado(a)?

Casi siempre
A veces

Siempre

En raras ocasiones

Casi siempre

Nunca

A veces
En raras ocasiones
Nunca

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H. Acerca de usted y
este(a) niño(a)
H1

Responda la siguiente pregunta sólo si este(a) niño(a)
tiene MENOS DE 12 MESES DE EDAD. De lo contrario,
PASE a la pregunta H7 .
¿En qué posición acuesta con mayor frecuencia al bebé
para dormir? Marque (X) sólo UNA opción.

¿Nació este(a) niño(a) en los Estados Unidos?
Sí ➔ PASE a la pregunta H3

De costado

Boca arriba
Boca abajo

Si la respuesta es no, ¿cuánto tiempo ha vivido este(a)
niño(a) en los Estados Unidos?
Años Y

Meses

¿Cuántas veces se ha mudado este(a) niño(a) a una
dirección nueva desde que nació?

EN LA MAYORÍA DE LOS DÍAS DE LA SEMANA,
¿aproximadamente cuánto tiempo pasó este(a) niño(a)
frente a una televisión, computadora, teléfono celular u
otro dispositivo electrónico viendo programas, jugando
juegos, accesando la internet, o utilizando los medios
de comunicación social? No incluya el tiempo dedicado
a hacer tareas escolares.
Menos de 1 hora

Cantidad de veces

1 hora
2 horas

¿Con qué frencuencia este(a) niño(a) se va a dormir
aproximadamente a la misma hora durante las noches
entre semana?

3 horas
4 horas o más

Siempre
Casi siempre

DURANTE LA SEMANA PASADA, ¿cuántos días usted u
otros miembros de la familia le leyeron a este(a) niño(a)?

A veces
0 días
En raras ocasiones
De 1 a 3 días
Nunca
De 4 a 6 días
H5

DURANTE LA SEMANA PASADA, ¿cuántas horas
durmió este(a) niño(a) en un día normal o promedio
(incluya sueño durante las noches y las siestas)?

Todos los días
H9

Menos de 7 horas

DURANTE LA SEMANA PASADA, ¿cuántos días usted u
otros miembros de la familia le contaron un cuento o le
cantaron canciones a este(a) niño(a)?

7 horas

0 días

8 horas

De 1 a 3 días

9 horas

De 4 a 6 días

10 horas

Todos los días

11 horas

H10 ¿Cómo considera que sobrelleva las obligaciones

cotidianas de la crianza de los(as) niños(as)?
12 horas o más
Muy bien
Algo bien
No muy bien
Nada de bien

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H11 DURANTE EL MES PASADO, ¿con qué frecuencia

H14 ¿Recibe este(a) niño(a) cuidado, por lo menos 10 horas

sintió...
En raras
A
Nunca ocasiones veces

semanales, de otra persona que no sea su padre,
madre o tutor? Pueder ser una guardería infantil, centro
de educación preescolar, programa Head Start, hogar de
cuidado de niños, niñera, au pair o pariente.

Casi
siempre Siempre

a. ¿Qué este(a)
niño(a) es
mucho más
difícil de
cuidar que la
mayoría de
los(as)
niños(as) de
su edad?

Sí
No

H15 DURANTE LOS ÚLTIMOS 12 MESES, ¿usted o alguien

de la familia tuvo que renunciar al trabajo, no aceptar
un trabajo o cambiar de su trabajo radicalmente por
problemas con el cuidado de niños para este(a) niño(a)?

b. ¿Qué este(a)
niño(a) hace
cosas que
realmente le
molestan
mucho a
usted?

Sí
No

c. ¿Qué estaba
enojado(a)
con este(a)
niño(a)?

I. Acerca de su familia y
su hogar

H12 DURANTE LOS ÚLTIMOS 12 MESES, ¿hubo alguien a

quién usted pudiera recurrir regularmente en busca de
apoyo emocional relacionado con la crianza de los(as)
niños(as)?

Sí

DURANTE LA SEMANA PASADA, ¿cuántos días se
reunieron todos los miembros de la familia que viven
en el hogar para comer juntos?
0 días

No ➔ PASE a la pregunta

De 1 a 3 días

H14

De 4 a 6 días
H13 Si la respuesta es sí, ¿recibió usted apoyo emocional

de...

Sí

a. ¿Esposo(a) o compañero(a) de
casa?

Todos los días

b. ¿Otro familiar o amigo(a)
cercano(a)?

¿Alguien que vive en su hogar fuma cigarrillos,
cigarros o tabaco de pipa?
Sí

c. ¿Un proveedor de atención médica?
No ➔ PASE a la pregunta I4 en la página 19
d. ¿Un lugar de culto o un líder
religioso?
e. ¿Un grupo de apoyo o asistencia
relacionado con una condición de
salud específica?

Si la respuesta es sí, ¿alguien fuma dentro del hogar?
Sí

f. ¿Un grupo de apoyo?

g. Un consejero u otro profesional de
la salud mental?
h. Otra persona, especifique:

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DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué
frecuencia se utilizaron pesticidas dentro de su
residencia para controlar los insectos? Si la frecuencia
cambió durante el año, indique la frecuencia más alta.

¿Cuál de estas afirmaciones describe mejor la
capacidad de su hogar para poder costear los alimentos
que necesitaba DURANTE LOS ÚLTIMOS 12 MESES?
Siempre pudimos costear buenas comidas nutritivas.

Más de una vez a la semana
Una vez a la semana

Siempre pudimos costear lo suficiente para comer,
pero no siempre la clase de alimentos que debemos
comer.

Una vez al mes

A veces no pudimos costear lo suficiente para comer.

Una vez cada 2 a 5 meses

Con frecuencia no pudimos costear lo suficiente para
comer.

Una vez cada 6 meses

Nunca

En algún momento, DURANTE LOS ÚLTIMOS 12
MESES, aunque fuera durante un mes, ¿algún miembro
de la familia recibió lo siguiente...
Sí
No

No sé

a. ¿Ayuda en efectivo de un programa
de asistencia social del gobierno?

Una vez durante los últimos 12 meses

b. ¿Cupones para alimentos o
beneficios del Programa de
Asistencia Nutricional
Suplementaria (SNAP)?

DURANTE LOS ÚLTIMOS 12 MESES, aparte de en una
ducha o bañera ¿ha visto moho, hongos u otros signos
de daños por agua en las paredes u otras superficies
dentro de su casa?

c. ¿Desayunos o almuerzos gratuitos
o de costo reducido en la escuela?

Sí

d. ¿Beneficios del Programa Especial
de Nutrición Suplementaria para
Mujeres, Infantes y Niños (WIC)?

No
I6

Cuando su familia enfrenta problemas, ¿con qué
frecuencia es probable que hagan lo siguiente?
Siempre

Casi
siempre

A veces

I10 ¿En su vecindario hay...
Nunca

a. ¿Aceras o paseos peatonales?

a. Hablar juntos
sobre qué hacer

b. ¿Un parque o área de juegos?

b. Trabajar juntos
para resolver
nuestros problemas

c. ¿Un centro de recreación, centro
comunitario o club "boys and girls"?
d. ¿Una biblioteca o biblioteca
ambulante?

c. Saber que
tenemos fuerzas
en donde
ayoyarnos

e. ¿Basura o desperdicios en las
calles o aceras?
f. ¿Hogares deteriorados o mal
conservados?

d. Mantener la
esperanza aún en
tiempos difíciles
I7

Sí

g. ¿Vandalismo, como ventanas
rotas o grafitis?

DESDE QUE ESTE(A) NIÑO(A) NACIÓ, ¿con qué
frecuencia ha sido muy difícil cubrir los gastos
básicos, como alimentos y vivienda, utilizando sus
ingresos familiares?
Nunca
En raras ocasiones
En algunas ocasiones
En muchas ocasiones

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J. Cuidador(es) de este(a)
niño(a)

I11 ¿En qué medida está de acuerdo con estas afirmaciones

sobre su vecindario o comunidad?
Definitivamente
de acuerdo

Algo de
acuerdo

Algo en Definitivamente
desacuerdo en desacuerdo

a. La gente de
este vecindario
se ayuda
mutuamente
b. En este
vecindario
cuidamos
mutuamente
de nuestros(as)
hijos(as)

➜

Complete las siguientes preguntas hasta un máximo
de dos adultos por hogar para cada uno de los
cuidadores primarios de este(a) niño(a). Si sólo un
adulto es el cuidador primario, conteste las preguntas
solamente para ese adulto.

¿Qué parentesco tiene con este(a) niño(a)?
Padre o madre biológica o adoptiva
Padrastro o madrastra

c. Este(a) niño(a)
está seguro(a)
en nuestro
vecindario
d. Cuando
enfrentamos
dificultades,
sabemos a
donde acudir
para buscar
ayuda en
nuestra
comunidad

Abuelo(a)
Padre o madre de crianza a través del programa
Foster del gobierno
Otro(a): Pariente
Otro(a): No pariente

¿Cuál es su sexo?
Masculino

I12 Las siguientes preguntas son sobre eventos que

pueden haber ocurrido durante la vida del (de la)
niño(a). Éstos pueden suceder en cualquier familia,
pero algunas personas quizás se sientan incómodas
con estas preguntas. Usted puede omitir cualquier
pregunta que no desee responder.

Femenino

¿Qué edad tiene?

A su entender, ¿el(la) niño(a) experimentó ALGUNA
VEZ algunas de las siguientes situaciones?
Sí
No
a. Los padres o tutores se
divorciaron o separaron

Edad en años

¿Dónde nació?

b. Los padres o tutores murieron

En los Estados Unidos ➔ PASE a la pregunta J6 en
la página 21

c. Los padres o tutores estuvieron
en la cárcel

Fuera de los Estados Unidos

d. Vio u oyó a sus padres o adultos
abofetearse, golpearse, patearse
o pegarse en el hogar

¿Cuándo vino a vivir a los Estados Unidos?
Año

e. Fue víctima o testigo de violencia
en su vecindario
f. Vivió con alguna persona que
tenía una enfermedad mental,
estaba suicida o tenía depresión
grave o severa
g. Vivió con alguna persona con
problemas de alcohol o drogas
h.

Fue tratado(a) o juzgado(a)
injustamente por su raza o
grupo étnico

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¿Cuál es el grado o nivel escolar más alto que usted ha J10 ¿Tuvo trabajo por lo menos 50 semanas de las últimas
completado? Marque (X) sólo UNA opción.
52 semanas?
Grado 8 o menos

Sí

Grado 9 al 12; sin diploma

Completé secundaria o GED

J11 ¿Ha prestado usted alguna vez servicio militar activo

en las Fuerzas Armadas, la Reserva Militar, o la Guardia
Nacional de los Estados Unidos?
Marque (X) sólo UNA opción.

Completé un programa de escuela vocacional,
comercial o de negocios
Algunos créditos universitarios, pero sin título

Nunca estuvo en el servicio
militar ➔ PASE a la pregunta J13

Título asociado universitario (AA, AS)
Título de licenciatura universitaria (BA, BS, AB)

Servicio activo solamente para
entrenamiento de la Reserva Militar o la
Guardia Nacional l ➔ PASE a la pregunta J13

Título de maestría (MA, MS, MSW, MBA)

En servicio activo ahora

Título de doctorado (PhD, EdD) o título profesional
(MD, DDS, DVM, JD)

En servicio activo en el pasado, pero no ahora
J12 ¿Fue mobilizado(a) en algún momento durante la vida

de este(a) niño(a)?

¿Cuál es su estado civil?
Casado(a)

Sí

No casado(a), pero vivo con una pareja

Nunca me he casado

➜

Divorciado(a)
Separado(a)

J13 ¿Qué parentesco tiene este cuidador primario adulto

que vive en este hogar con este(a) niño(a)?

Viudo(a)

Las preguntas J13 a la J24 tratan sobre otro cuidador
primario adulto que puede estar viviendo en este hogar
además de usted.

Sólo hay un cuidador primario en este hogar
para este(a) niño(a) ➔ PASE a la pregunta K1 en
la página 22.

En general, ¿cómo está su salud física?

Padre o madre biológica o adoptiva

Excelente

Padrastro o madrastra

Muy buena

Abuelo(a)

Buena

Padre o madre de crianza a través del programa
Foster del gobierno

Regular

Otro(a): Pariente

Deficiente

Otro(a): No pariente
J9

En general, ¿cómo está su salud mental o emocional?

J14 ¿Cuál es el sexo de este cuidador primario?

Excelente

Masculino

Muy buena

Femenino

Buena
J15 ¿Qué edad tiene este cuidador primario?

Regular
Edad en años

Deficiente

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J16 ¿Dónde nació este cuidador primario?

J21 En general, ¿cómo está la salud mental o emocional

de este cuidador primario?
En los Estados Unidos ➔ PASE a la pregunta J18

Excelente

Fuera de los Estados Unidos

Muy buena

J17 ¿Cuándo vino este cuidador primario a vivir a los

Estados Unidos?

Buena

Año

Regular
Deficiente

J18 ¿Cuál es el grado o nivel escolar más alto que este

J22 ¿Tuvo trabajo este cuidador primario por lo menos

50 semanas de las últimas 52 semanas?

cuidador primario ha completado?
Marque (X) SÓLO una opción.

Sí

Grado 8 o menos
Grado 9 al 12; sin diploma

No
J23 Este cuidador primario, ¿ha prestado alguna vez

servicio militar activo en las Fuerzas Armadas, la
Reserva Militar, o la Guardia Nacional de los Estados
Unidos? Marque (X) sólo UNA opción.

Completó secundaria o GED
Completó un programa de escuela vocacional,
comercial o de negocios

Nunca estuvo en el servicio
militar ➔ PASE a la pregunta K1

Algunos créditos universitarios, pero sin título
Título asociado universitario (AA, AS)

Servicio activo solamente para entrenamiento
de la Reserva Militar o la Guardia Nacional ➔ PASE
a la pregunta K1

Título de licenciatura universitaria (BA, BS, AB)

En servicio activo ahora

Título de maestría (MA, MS, MSW, MBA)

En servicio activo en el pasado, pero no ahora

Título de doctorado (PhD, EdD) o título profesional
(MD, DDS, DVM, JD)

J24 ¿Fue este cuidador primario mobilizado en algún

momento durante la vida de este(a) niño(a)?

J19 ¿Cuál es el estado civil de este cuidador primario?

Sí

Casado(a)

No casado(a), pero vive con una pareja

K. Información del Hogar

Nunca se ha casado
Divorciado(a)

Separado(a)
Viudo(a)
J20 En general, ¿cómo está la salud física de este cuidador

¿Cuántas personas viven o se quedan en esta
dirección? Incluya a todas las personas que usualmente
viven o se quedan en esta dirección. NO incluya a
personas que están viviendo en otro lugar desde hace
más de dos meses, como estudiantes universitarios que
viven afuera o personas de las Fuerzas Armadas en
despliegue.

primario?
Cantidad de personas

Excelente
Muy buena

Buena
Regular

¿Cuántas de estas personas en su hogar son
miembros de su familia? Familia se define como
cualquier persona que tenga parentesco con este(a)
niño(a) por consanguinidad, matrimonio, adopción o
por el programa de cuidado Foster del gobierno.

Deficiente
Cantidad de personas

NSCH-S-T1

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26118026

Ingreso en 2017
Marque (X) la casilla "Sí" para los tipos de ingresos
recibidos por la familia y dé la mejor aproximación de la
CANTIDAD TOTAL EN EL ÚLTIMO AÑO CALENDARIO.
Marque (X) la casilla "No" para mostrar los tipos de
ingresos NO recibidos.

a. Jornales, sueldos o salarios, comisiones, bonos o
propinas de todos los empleos
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

La siguiente pregunta se refiere a sus ingresos en el
año 2017. Piense en su ingreso familiar total EN EL
ÚLTIMO AÑO CALENDARIO para todos los miembros
de la familia. ¿Cuál es la cantidad antes de impuestos?
Incluya dinero del trabajo, pensión para hijos menores,
seguro social, ingresos por jubilación, pagos por desempleo,
asistencia pública y demás. También, incluya ingresos de
intereses, dividendos, ingresos netos por negocios,
actividades agrícolas o alquileres y cualquier otro dinero
recibido como ingreso.

.00

CANTIDAD TOTAL
en el último año calendario

b. Ingreso de empleo por cuenta propia en su
negocio no agrícola o finca comercial, ya sea
como propietario único o en sociedad
Sí ➔

.00

Pérdida

CANTIDAD TOTAL
en el último año calendario

c. Intereses, dividendos, ingreso neto por rentas,
ingreso por derechos de autor, o ingreso por
herencias y fideicomisos
Sí ➔

.00

Pérdida

CANTIDAD TOTAL
en el último año calendario

d. Seguro social o retiro para personal de ferrocarriles;
pensión por retiro, pensión para viudos(as) y
dependientes de fallecidos; o pensión para
incapacidad
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

e. Seguridad de Ingreso Suplementario (Supplemental
Security Income, SSI); cualquier asistencia pública
o pagos de asistencia social del estado o la oficina
de asistencia social local
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

f. Alguna otra fuente de ingreso recibido regularmente,
tal como pagos de la Administración de Veteranos
(Veterans Administration, VA), compensación por
desempleo, pensión para hijos menores o pensión
alimenticia
Sí ➔
No

.00

CANTIDAD TOTAL
en el último año calendario

NSCH-S-T1

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26118018

Instrucciones de envío postal
Gracias por su participación.
En nombre del Departamento de Salud y Servicios Humanos de los EE.UU., queremos agradecerle por
su esfuerzo y el tiempo que dedicó para compartir esta información sobre este(a) niño(a) y su familia.
Sus respuestas son importantes para nosotros y facilitarán que investigadores, personas encargadas
de formular políticas públicas y defensores de la familia comprendan mejor las necesidades en materia
de salud y atención médicas de los(as) niños(as) de nuestra población diversa.
Coloque el cuestionario completado en el sobre con franqueo pagado. Si el sobre se ha
extraviado, envíe el cuestionario por correo a:
U.S. Census Bureau
ATTN: DCB 60-A
1201 E. 10th Street
Jeffersonville, IN 47132-0001
También puede llamar al 1-800-845-8241 para solicitar un sobre de reemplazo.

Se calcula que el tiempo promedio necesario para recopilar esta información es de 33 minutos por respuesta, que
incluye el tiempo para revisar las instrucciones, buscar las fuentes de datos existentes, recopilar y mantener los
datos necesarios, y completar y revisar la recopilación de la información. Para realizar comentarios sobre este
cálculo o sobre cualquier otro aspecto de esta recopilación de información, incluyendo sugerencias para reducir el
tiempo que toma, escriba a: Paperwork Project 0607-0990, U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590,
Washington, DC 20233. Puede enviar sus comentarios por correo electrónico a DEMO.Paperwork@census.gov;
escriba como asunto "Paperwork Project 0607-0990."

NSCH-S-T1

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26128249
OMB No. 0607-0990: Aprobado hasta el 05/31/2019

NSCH-S-T2
(05/02/2018)

§;-sR¤

26128231

Comienze Aquí

¿Con qué frecuencia este(a) niño(a)...
Siempre

Recientemente, usted completó una encuesta con
preguntas sobre los(as) niños(as) que usualmente
viven o se quedan en esta dirección. Gracias por
tomar de su tiempo para completar esta encuesta.

Casi
siempre

A veces

Nunca

a. Muestra interés y
curiosidad por
aprender cosas
nuevas?
b. Trabaja para
terminar las tareas
que comienza?

Ahora le haremos algunas preguntas de seguimiento
sobre:

c. Se mantiene
tranquilo(a) y en
control cuando
enfrenta un desafío?
Si el nombre que aparece anteriormente es incorrecto
o no corresponde a un(a) niño(a) que viva en este
hogar, llame al 1-800-845-8241.

d. Le importa que le
vaya bien en la
escuela?
e. Hace toda la tarea
requerida?

Hemos seleccionado solamente a un(a) niño(a) por
hogar con el fin de minimizar la cantidad de tiempo
que necesitará para responder a las preguntas de
seguimiento.
La encuesta deberá ser completada por un adulto
familiarizado con la salud y atención médica de este(a)
niño(a).

f. Discute demasiado?

Su participación es importante. Gracias.

DURANTE LOS ÚLTIMOS 12 MESES, ¿cuántas veces
este(a) niño(a) fue víctima de acoso escolar, burlas o
fue excluído(a) por otros(as) niños(as)? Si la cantidad
de veces cambió durante el año, reporte la cantidad más
alta.
Nunca (en los últimos 12 meses)

A. La salud de este(a) niño(a)

1-2 veces (en los últimos 12 meses)
A1 En general, ¿cómo describiría la salud de este(a) niño(a)

1-2 veces por mes

(cuyo nombre aparece más arriba)?

1-2 veces por semana

Excelente

Casi todos los días

Muy buena
Buena

Regular
Deficiente

DURANTE LOS ÚLTIMOS 12 MESES, ¿cuántas veces
este(a) niño(a) hostigó a otros(as) en el entorno
escolar, se burló de los(as) demás o los(as) excluyó(a)?
Si la cantidad de veces cambió durante el año, reporte la
cantidad más alta.
Nunca (en los últimos 12 meses)

A2 ¿Cómo describiría la salud dental de este(a) niño(a)?

1-2 veces (en los últimos 12 meses)
Excelente
1-2 veces por mes
Muy buena
1-2 veces por semana
Buena
Casi todos los días
Regular
Deficiente

NSCH-S-T2

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26128223

A6 DURANTE LOS ÚLTIMOS 12 MESES, ¿este(a) niño(a)

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...

ha tenido dificultades CRÓNICAS o FRECUENTES con
cualquiera de los(as) siguientes?
Sí

a. Respirar u otros problemas
respiratorios (como respiración
sibilante o falta de aire)

¿Alergias (incluyendo alimentos, medicamentos,
insectos o de otro tipo)?
Sí

b. Comer o tragar debido a una
condición médica

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

c. Digerir la comida, incluyendo
problemas estomacales o
intestinales, estreñimiento
o diarrea

Sí

Si la respuesta es sí, la condición es:
Leve

d. Dolor físico crónico o recurrente,
incluyendo dolor de cabeza, dolor
de espalda o dolor corporal
A9

e. Dolor de muelas

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

g. Dientes deteriorados o caries

Sí

problemas?
Sí

Leve

Moderada

Grave

A10 ¿Asma?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

b. Dificultades serias para caminar
o subir escaleras

Sí

c. Dificultades para vestirse o
bañarse

Si la respuesta es sí, la condición es:

d. Sordera o problemas de
audición
e. Ceguera o problemas de la
vista, incluso cuando usa
anteojos o lentes

Si la respuesta es sí, la condición es:

A7 ¿Presenta este(a) niño(a) alguno de los siguientes

a. Dificultades serias para
concentrarse, recordar o tomar
decisiones debido a una
condición física, mental o
emocional

Grave

¿Artritis?
Sí

f. Sangrado en las encías

Moderada

Leve
A11

Moderada

Grave

¿Lesión cerebral, contusión o lesión en la cabeza?
Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, la condición es:
Leve

NSCH-S-T2

Moderada

Grave

§;-s8¤

26128215

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A12 ¿Parálisis cerebral?

A16 ¿Dolores de cabeza frecuentes o intensos, incluyendo

migrañas?
Sí

No
Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

No
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Si la respuesta es sí, la condición es:

Grave

Leve

Moderada

Grave

A13 ¿Diabetes?
A17 ¿Síndrome de Tourette?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

No
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Si la respuesta es sí, la condición es:

Grave

Leve

Moderada

Grave

A14 ¿Epilepsia o trastornos convulsivos?
A18 ¿Problemas de ansiedad?

Sí

No
No

Sí
Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Leve

Moderada

Sí

Si la respuesta es sí, la condición es:

Grave

Leve

Moderada

Grave

A15 ¿Condición o problemas cardiacos?
A19 ¿Depresión?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Leve

Moderada

Sí

Si la respuesta es sí, la condición es:

Grave

Leve

NSCH-S-T2

Moderada

Grave

§;-s0¤

26128207

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...

A23 ¿Otra condición genética o hereditaria?

A20 ¿Síndrome de Down?

Sí

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...

Sí

Si la respuesta es sí, especifique:C

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

No
La condición es:

Si la respuesta es sí, la condición es:
Leve

Moderada

Leve

Grave

drepanocítica o de células falciformes, talasemia o
hemofilia)?

Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) el
trastorno ACTUALMENTE?

Si la respuesta es sí, el trastorno es:
Leve

Talasemia

Grave

A25 ¿Problemas de comportamiento o conducta?

Hemofilia

Sí

Otros trastornos
sanguíneos

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

A22 ¿Fibrosis quística?

Sí

Si la respuesta es sí, la condición es:

Si la respuesta es sí, la condición es:
Moderada

Leve

Grave

Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se llaman
pruebas de detección para recién nacidos.
Sí

Moderado

Enfermedad de anemia
drepanocítica

Leve

Sí

Si la respuesta es sí, ¿fue este(a) niño(a)
diagnosticado(a) con:
Sí
No

Sí

A24 ¿Trastornos por uso de drogas?

Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se
llaman pruebas de detección para recién nacidos.
Sí

Grave

Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se
llaman pruebas de detección para recién nacidos.

A21 ¿Trastornos sanguíneos (como enfermedad de anemia

Sí

Moderada

Grave

A26 ¿Retraso en el desarrollo?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Sí

Si la respuesta es sí, la condición es:
Leve

NSCH-S-T2

Moderada

Grave

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26128199

A31 ¿ALGUNA VEZ le ha dicho a usted un médico u otro

A27 ¿Discapacidad intelectual (anteriormente conocida

No ➔ PASE a la pregunta A36 en la
página 7
Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

como retraso mental)?
No

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
discapacidad ACTUALMENTE?

Sí

Si la respuesta es sí, la condición es:

Sí

Leve

Si la respuesta es sí, la discapacidad es:
Leve

Moderada

Grave

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
No

Edad en años

Moderada

Grave

A29 ¿Discapacidades del aprendizaje?

Sí

Proveedor de atención primaria

Especialista

Si la respuesta es sí, ¿padece este(a) niño(a) la
discapacidad ACTUALMENTE?
Sí

Psicólogo(a)/consejero(a) escolar

Otro(a) psicólogo(a) (no escolar)

Si la respuesta es sí, la discapacidad es:
Leve

No sabe

A33 ¿Qué tipo de médico u otro proveedor de atención

Si la respuesta es sí, la condición es:
Leve

Grave

Sí

Moderada

A32 ¿Qué edad tenía este(a) niño(a) cuando un médico u

A28 ¿Trastorno del habla u otro trastorno del lenguaje?

Sí

Moderada

Psiquiatra

Grave
Otro(a), especifique:

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A30 ¿Cualquier otra condición de salud mental?

Sí

No sabe

A34 ¿Toma este(a) niño(a) ACTUALMENTE medicamentos

para tratar el Autismo, los Trastornos del Espectro
Autista(TEA), Síndrome de Asperger, o el Trastorno
Generalizado del Desarrollo (TGD)?

Si la respuesta es sí, especifique:C

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave

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26128181

A35 En algún momento DURANTE LOS ÚLTIMOS 12 MESES, A40 ¿En qué medida las condiciones o problemas de salud

¿recibió este(a) niño(a) tratamiento de la conducta por
Autismo, Trastornos del Espectro Autista (TEA) ,
Síndrome de Asperger, o Trastorno Generalizado del
Desarrollo (TGD), tal como alguna capacitación o
intervención que haya recibido usted o este(a) niño(a)
para ayudar con su conducta?
Sí

de este(a) niño(a) afectan su capacidad de hacer
actividades?
Muy poco
Algo

En gran medida

A36 ¿ALGUNA VEZ le dijo a usted un médico u otro

proveedor de atención médica que este(a) niño(a)
padece del Trastorno por Déficit de Atención o del
Trastorno por Déficit de Atención e Hiperactividad,
es decir, TDA or TDAH?

B. Este(a) niño(a) cuando
era bebé

No ➔ PASE a la pregunta A39

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

¿Nació este(a) niño(a) más de 3 semanas antes de la
fecha para la cual se esperaba el parto?
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave
B2

A37 ¿Toma este(a) niño(a) ACTUALMENTE medicamentos

para tratar el Trastorno por Déficit de Atención (TDA) o
el Trastorno por Déficit de Atención con Hiperactividad
(TDAH)?
Sí

libras Y

onzas

A38 En algún momento DURANTE LOS ÚLTIMOS 12 MESES,

¿Cuánto pesó al nacer?
Responda utilizando libras y onzas O kilogramos y gramos.
Puede proveer su mejor aproximación o estimación.

kilogramos Y
B3

gramos

¿Qué edad tenía la madre cuando nació este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.
Edad en años

Sí

A39 DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué

frecuencia las condiciones o los problemas de salud
de este(a) niño(a) afectaron su capacidad para hacer
actividades que realizan otros(as) niños(as) de su edad?
Este(a) niño(a) no padece ninguna
condición médica ➔ PASE a la pregunta B1
Nunca
A veces
Casi siempre
Siempre

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26128173

C. Servicios de atención
médica
C1

Sí, este(a) niño(a) pesa mucho
Sí, este(a) niño(a) pesa muy poco

DURANTE LOS ÚLTIMOS 12 MESES, ¿vio este(a) niño(a)
a algún médico, enfermero(a) u otro profesional de la
salud para recibir atención médica (por ejemplo, para
cuidado preventivo, cuidado médico, hospitalizaciones)?

No, no me preocupa
C7

Sí

¿Le preocupa el peso de este(a) niño(a)?

No ➔ PASE a la pregunta C4

¿Alguna vez un médico u otro proveedor de atención
médica le ha dicho a usted que este(a) niño(a) tiene
sobrepeso?
Sí

Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12
No
MESES, ¿cuántas veces tuvo este(a) niño(a) una
consulta con un médico, enfermero(a) u otro(a)
profesional de la salud para realizarse un chequeo
C8 ¿Hay algún lugar en donde usted u otro cuidador
PREVENTIVO? El chequeo preventivo se realiza cuando
USUALMENTE lleva a este(a) niño(a) cuando está
este(a) niño(a) no ha estado enfermo(a) ni lesionado(a), tal
enfermo(a) o necesita asesoramiento sobre la salud de
como un chequeo preventivo anual o un examen físico para
este(a) niño(a)?
hacer deporte o la visita de niño sano.
0 visitas

Sí

1 visita

No ➔ PASE a la pregunta C10

2 visitas o más
C3

Consultorio del médico
Sala de emergencias del hospital
Departamento de pacientes ambulatorios del hospital

Menos de 10 minutos

Clínica o centro de salud

De 10 a 20 minutos

Clínica ambulatoria dentro de un negocio o
"Minute Clinic"

Más de 20 minutos
C4

Si la respuesta es sí, ¿adónde NORMALMENTE va
este(a) niño(a) primero? Marque (X) SÓLO una opción.

Escuela (enfermería, oficina del entrenador atlético)

¿Cuál es la estatura ACTUAL de este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.

Algún otro lugar
C10 ¿Hay algún lugar a donde este(a) niño(a) USUALMENTE

pies Y

pulgadas

va cuando necesita atención preventiva de rutina, como
un examen físico o un chequeo de niño sano?

Sí
metros Y

centímetros
No ➔ PASE a la pregunta C12 en la página 9

¿Cuál es el peso ACTUAL de este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.
libras Y

onzas

O
kilogramos Y

gramos

NSCH-S-T2

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26128165

C11

Si la respuesta es sí, ¿es éste el mismo lugar a donde
el(la) niño(a) va cuando está enfermo(a)?

C16 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

MESES, ¿qué servicio(s) dental(es) preventivo(s)
recibió este(a) niño(a)? Marque (X) TODAS las que
apliquen.

Sí

Chequeo

Limpieza
C12 DURANTE LOS ÚLTIMOS 12 MESES, ¿se le hizo a

Instrucciones sobre cepillado de dientes y cuidado
de la salud oral

este(a) niño(a) un examen de la vista, utilizando
imágenes, formas o letras?
Sí

Radiografías

No ➔ PASE a la pregunta C14

Tratamiento de fluoruro
Sellador (sellador plástico en muelas posteriores)

C13 Si la respuesta es sí, ¿dónde se le examinó la vista a

No sabe

este(a) niño(a)? Marque (X) TODAS las que apliquen.
Consultorio de un oculista o especialista en ojos
(oftalmólogo, optometrista)

C17 DURANTE LOS ÚLTIMOS 12 MESES, ¿recibió este(a)

Consultorio del pediatra u otro médico generalista
Clínica o centro de salud
Escuela
Otro(a), especifique:

Sí
C

No, pero este(a) niño(a) necesitaba ver a un
profesional de la salud mental
No, este(a) niño(a) no necesitó ver a un profesional
de la salud mental ➔ PASE a la pregunta C19

C14 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

niño(a) al dentista u otro profesional de la salud oral
para recibir algún tipo de atención o cuidado dental
u oral?

C18 ¿Qué tan difícil le resultó obtener el tratamiento,

consejería o asesoría de salud mental que este(a)
niño(a) necesitaba?

Sí, fue al dentista

No fue difícil

Sí, fue a otro(a) profesional de la salud oral

Algo difícil

No ➔ PASE a la pregunta C17

Muy difícil
No fue posible obtenerlo

C15 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

MESES, ¿fue este(a) niño(a) al dentista u otro(a)
profesional de la salud oral para recibir atención
preventiva, como chequeos, limpiezas dentales,
selladores dentales o tratamientos de fluoruro?

C19 DURANTE LOS ÚLTIMOS 12 MESES, ¿tomó este(a)

niño(a) algún medicamento debido a dificultades con
sus emociones, concentración o conducta?

No tuvo visitas preventivas en los
últimos 12 meses ➔ PASE a la pregunta C17

Sí

Sí, 1 visita

Sí, 2 visitas o más

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C20 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

C24 Si la respuesta es sí, ¿qué tipo de atención no recibió?

Marque (X) TODAS las que apliquen.
Atención médica
Atención dental

Sí

Atención de la vista

No, pero este(a) niño(a) necesitó ver a un especialista

Atención de la audición

No, este(a) niño(a) no necesitó ver
a un especialista ➔ PASE a la pregunta C22

Servicios de salud mental
Otro(a), especifique:

C21 ¿Qué tan difícil le resultó a usted que este(a) niño(a)

recibiera la atención del especialista que necesitaba?
No fue difícil
Algo difícil

C25 ¿Cuáles de las siguientes razones contribuyeron a

que este(a) niño(a) no recibiera los servicios de salud
necesarios? Marque (X) Sí o No en cada categoría.

Muy difícil

Sí

No fue posible obtenerla

a. Este(a) niño(a) no era elegible
para recibir los servicios

C22 DURANTE LOS ÚLTIMOS 12 MESES, ¿utilizó este(a)

b. Los servicios que necesitaba
este(a) niño(a) no estaban
disponibles en su área

c. Hubo problemas para programa u
obtener una cita cuando este(a)
niño(a) la necesitó

Sí

d. Hubo problemas para obtener
transporte o cuidado de los niños

e. El consultorio (del médico o la
clínica) no estaba abierto(a) cuando
este(a) niño(a) necesitó atención

C23 DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó este(a)

niño(a) atención médica en alguna ocasión pero no la
recibió? Por atención médica nos referimos a la atención
médica así como atención dental, de la vista y de salud
mental.
Sí

f. Hubo problemas relacionados
con el costo
C26 DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué

frecuencia se sintió frustrado(a) en sus esfuerzos
para obtener servicios para este(a) niño(a)?

No ➔ PASE a la pregunta C26

Nunca
A veces
Casi siempre
Siempre

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C27 DURANTE LOS ÚLTIMOS 12 MESES, ¿cuántas veces

C33 Si la respuesta es sí, ¿qué edad tenía este(a) niño(a)

fue este(a) niño(a) a la sala de emergencias de un
hospital?

cuando comenzó a recibir estos servicios especiales?

Nunca

Años Y

Meses

1 vez
C34 ¿Recibe este(a) niño(a) ACTUALMENTE estos servicios

2 o más veces

especiales?
Sí

C28 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

niño(a) admitido(a) al hospital para quedarse ahí
por lo menos una noche?

Sí

D. Experiencia con los
proveedores de atención
médica de este(a) niño(a)

No
C29 ¿Recibió este(a) niño(a) ALGUNA VEZ un plan de

D1 ¿Tiene usted a una o más personas a quienes

Sí
No ➔ PASE a la pregunta C32

Sí, a una persona

C30 Si la respuesta es sí, ¿qué edad tenía este(a) niño(a)

cuando se estableció el PRIMER plan?

Años Y

Sí, a más de una persona
No

Meses

C31 ¿Recibe este(a) niño(a) ACTUALMENTE servicios bajo

D2 DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó este(a)

niño(a) un referido para ver a algún médico o recibir
algún servicio?

alguno de estos planes?
Sí

Sí

No ➔ PASE a la pregunta D4 en la página 12

C32 ¿Recibió este(a) niño(a) ALGUNA VEZ servicios

D3 ¿Qué tan difícil le resultó a usted obtener referidos?

especiales para cumplir con sus necesidades del
desarrollo, tales como terapia del habla, ocupacional
o de la conducta?

No fue difícil
Algo difícil

Sí
Muy difícil
No ➔ PASE a la pregunta D1
No fue posible obtener referidos

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D4 Responda las siguientes preguntas sólo si este(a)

niño(a) tuvo una visita de atención médica EN LOS
ÚLTIMOS 12 MESES. De lo contrario vaya a la
pregunta E1 en la página 13.

Siempre

DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué
frecuencia los médicos u otros proveedores de
atención médica de este(a) niño(a) hicieron lo
siguiente...
Siempre

Casi
siempre

A veces

Nunca

A veces

Nunca

b. ¿Le dieron lugar
para expresar sus
dudas o desacuerdo
con las
recomendaciones
sobre la atención
médica de este(a)
niño(a)?

b. ¿Lo(a) escucharon
a usted con
atención?
c. ¿Mostraron
sensibilidad por
sus valores y
costumbres
familiares?

c. ¿Trabajaron con
usted para decidir
cuáles serían las
mejores opciones
para este(a) niño(a)
en lo que se refiere
a cuidado de salud
y opciones de
tratamiento?

d. ¿Le brindaron la
información
específica que
necesitaba con
relación a este(a)
niño(a)?
e. ¿Lo(a) hicieron
sentir como un(a)
participante en la
atención y cuidado
de este(a) niño(a)?

Casi
siempre

a. ¿Analizaron con
usted la variedad
de opciones a
considerar para la
atención médica o
el tratamiento de
este(a) niño(a)?

a. ¿Estuvieron tiempo
suficiente con
este(a) niño(a)?

DURANTE LOS ÚLTIMOS 12 MESES, ¿le ayudó
alguien a organizar o coordinar el cuidado de este(a)
niño(a) entre los diferentes médicos y servicios que
este(a) niño(a) utiliza?

Sí

D5 DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó tomar

alguna decisión sobre el cuidado de salud de este(a)
niño(a), tal como obtener medicamentos recetados,
referidos o algún otro procedimiento médico?

No
No vio a más de un proveedor de atención
médica en los ÚLTIMOS 12 MESES

Sí
No ➔ PASE a la pregunta D7

Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12
MESES, ¿con qué frecuencia los médicos u otros
proveedores de atención médica de este(a) niño(a)...

DURANTE LOS ÚLTIMOS 12 MESES, ¿sintió que
podría haber usado ayuda adicional para hacer
arreglos o coordinar la atención médica de este(a)
niño(a) entre los diferentes proveedores o servicios
de atención médica?
Sí
No ➔ PASE a la pregunta D10 en la página 13

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E. Cobertura de seguro
médico de este(a) niño(a)

D9 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

MESES, ¿con qué frecuencia obtuvo la ayuda que
deseaba para hacer arreglos o coordinar la atención
médica de este(a) niño(a)?
Casi siempre

A veces

Sí, este(a) niño(a) tuvo cobertura durante los
12 meses ➔ PASE a la pregunta E4 en la página 14

Nunca

Sí, pero este(a) niño(a) tuvo una interrupción
en la cobertura

D10 DURANTE LOS ÚLTIMOS 12 MESES, ¿cuán

satisfecho(a) estuvo con respecto a la comunicación
entre los médicos de este(a) niño(a) y los demás
proveedores de atención médica?
Muy satisfecho

DURANTE LOS ÚLTIMOS 12 MESES, ¿estuvo este(a)
niño(a) cubierto(a) por ALGÚN tipo de seguro médico
o plan de cobertura de salud?

No
E2

Algo satisfecho

Indique si algunos de los siguientes es un motivo por
el cual este(a) niño(a) no tuvo cobertura de salud
DURANTE LOS ÚLTIMOS 12 MESES:
Sí

a. Cambio de empleador o de
situación laboral

Algo insatisfecho
Muy insatisfecho

b. Cancelación por primas vencidas
c. Renunció a la cobertura porque
costaba demasiado

D11 DURANTE LOS ÚLTIMOS 12 MESES, ¿el proveedor de

atención médica de este(a) niño(a) se comunicó con la
escuela, el proveedor de cuidado de niños o el programa
de educación especial de este(a) niño(a)?

d. Renunció a la cobertura porque los
beneficios eran inadecuados
e. Renunció a la cobertura porque
las opciones de proveedores de
atención médica eran inadecuadas

Sí
No ➔ PASE a la pregunta E1

f. Problemas con el proceso de solicitud
o renovación de la cobertura

No fue necesario que el proveedor de atención médica
se comunicara con estos proveedores ➔ PASE a la
pregunta E1

g. Otro(a), especifique:

D12 Si la respuesta es sí, durante este tiempo, ¿qué tan

satisfecho(a) se ha sentido con respecto a la
comunicación que el proveedor de atención médica
de este(a) niño(a) ha tenido con la escuela, el
proveedor de cuidado de niños o el programa de
educación especial?

¿Está este(a) niño(a) cubierto(a) ACTUALMENTE por
ALGÚN tipo de seguro de salud o plan de cobertura de
salud?

Muy satisfecho

Sí

Algo satisfecho

No ➔ PASE a la pregunta F1 en la página 14

Algo insatisfecho
Muy insatisfecho

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F. Proveyendo para el
cuidado de salud de este(a)
niño(a)

¿Está este(a) niño(a) ACTUALMENTE cubierto(a) por
alguno de los siguientes tipos de seguro de salud o
planes de cobertura de salud? Marque (X) Sí o No en
CADA categoría.
Sí
No
a. Seguro a través de un empleador
actual o previo o a través de un
sindicato

b. Seguro adquirido directamente de
una compañía de seguros
c. Medicaid, Medical Assistance, o
cualquier tipo de plan de asistencia
del gobierno para personas con
bajos ingresos o una discapacidad

$0 (Sin gastos médicos o gastos
relacionados con la salud) ➔ PASE a la pregunta F4

d. TRICARE u otros servicios de
atención médica de las Fuerzas
Armadas
e. Servicio de Salud Indio (Indian
Health Services)
f. Otro(a), especifique:

De $1 a $249
De $250 a $499
De $500 a $999

De $1,000 a $5,000
Más de $5,000
E5

¿Con qué frecuencia el seguro de salud de este(a)
niño(a) ofrece beneficios o cubre servicios que
satisfacen las necesidades de este(a) niño(a)?

Siempre

Casi siempre

A veces

Nunca

Nunca
F3
E6

¿Con qué frecuencia el seguro de salud de este(a)
niño(a) le permite ver a los proveedores de atención
médica que necesita?

DURANTE LOS ÚLTIMOS 12 MESES, ¿tuvo su familia
problemas para pagar las facturas médicas o de
atención médica de este(a) niño(a)?
Sí

Siempre

Casi siempre
A veces

¿Con qué frecuencia son razonables estos costos?

DURANTE LOS ÚLTIMOS 12 MESES, ¿usted u otro
miembro de la familia...
Sí

Nunca
E7

a. ¿Dejó el trabajo o se ausentó unos
cuantos días debido a la salud o
condición(es) médica(s) de este(a)
niño(a)?

b. ¿Redujo la cantidad de horas
que trabaja debido a la salud o
condición(es) médica(s) de este(a)
niño(a)?
c. ¿Evitó cambiar de trabajo para
mantener el seguro de salud para
este(a) niño(a)?

Este(a) niño(a) no utiliza servicios de salud mental
o de la conducta
Siempre
Casi siempre
A veces
Nunca
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G. La educación y las
actividades de este(a) niño(a)
G1

Este(a) niño(a) no necesita atención médica en el
hogar cada semana
Menos de 1 hora por semana

DURANTE LOS ÚLTIMOS 12 MESES,
¿aproximadamente cuántos días se ausentó de la
escuela este(a) niño(a) por una enfermedad o lesión?
Si el(la) niño(a) recibe educación formal en el hogar,
incluya los días en los que él(ella) se ausentó.

De 1 a 4 horas por semana

No se ausentó ningún día

De 5 a 10 horas por semana

De 1 a 3 días

11 horas o más por semana

De 4 a 6 días
De 7 a 10 días

11 días o más
Este(a) niño(a) no estaba inscrito(a) en la escuela
G2

Menos de 1 hora por semana

DURANTE LOS ÚLTIMOS 12 MESES, ¿cuántas veces
se comunicó la escuela de este(a) niño(a) con usted u
otro adulto de su casa por algún problema del (de la)
niño(a) en la escuela?

De 1 a 4 horas por semana

Nunca

De 5 a 10 horas por semana

1 vez

11 horas o más por semana

2 veces o más
G3

DESDE QUE COMENZÓ KINDERGARTEN, ¿alguna vez
ha repetido este(a) niño(a) algún grado?
Sí
No

DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué
frecuencia asistió usted a eventos o actividades en las
que este(a) niño(a) participaba?
Siempre
Casi siempre
A veces
En raras ocasiones
Nunca

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H. Acerca de usted y
este(a) niño(a)

G5 DURANTE LOS ÚLTIMOS 12 MESES, ¿participó este(a)

niño(a) en...
Sí

a. ¿Un equipo deportivo o clases
de algún deporte después de la
escuela o los fines de semana?

Sí ➔ PASE a la pregunta H3

b. ¿Clubes u organizaciones después
de la escuela o los fines de semana?
c. ¿Alguna otra actividad organizada o
clases, tal como música, baile, otro
idioma u otras artes?

No
H2

d. ¿Algún tipo de servicio comunitario
o trabajo voluntario en la escuela,
lugar de culto o comunidad?
e. ¿Alguna actividad con paga,
incluyendo trabajos usuales como
cuidando niños(as), cortando el
césped u otro trabajo ocasional?

Si la respuesta es no, ¿cuánto tiempo ha vivido este(a)
niño(a) en los Estados Unidos?
Años Y

Meses

¿Cuántas veces se ha mudado este(a) niño(a) a una
dirección nueva desde que nació?
Cantidad de veces

G6 DURANTE LA SEMANA PASADA, ¿cuántos días hizo

este(a) niño(a) ejercicio, practicó un deporte o participó
en actividades físicas durante al menos 60 minutos?

¿Nació este(a) niño(a) en los Estados Unidos?

0 días

¿Con qué frencuencia este(a) niño(a) se va a dormir
aproximadamente a la misma hora durante las noches
entre semana?

De 1 a 3 días

Siempre

De 4 a 6 días

Casi siempre

Todos los días

A veces
En raras ocasiones

G7 En comparación con otros(as) niños(as) de la misma

edad, ¿qué dificultad tiene este(a) niño(a) para hacer
o mantener amistades?
Ninguna dificultad

Nunca

Un poco de dificultad

DURANTE LA SEMANA PASADA, ¿cuántas horas
durmió este(a) niño(a) la mayoría de las noches
entre semana?
Menos de 6 horas

Mucha dificultad

6 horas
7 horas
8 horas
9 horas
10 horas
11 horas o más

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H6 EN LA MAYORÍA DE LOS DÍAS DE LA SEMANA,

¿aproximadamente cuánto tiempo pasó este(a) niño(a)
frente a una televisión, computadora, teléfono celular u
otro dispositivo electrónico viendo programas, jugando
juegos, accesando la internet, o utilizando los medios
de comunicación social? No incluya el tiempo dedicado
a hacer tareas escolares.

DURANTE EL MES PASADO, ¿con qué frecuencia
sintió...
En raras
A
Nunca ocasiones veces

Casi
siempre Siempre

a. ¿Qué este(a)
niño(a) es
mucho más
difícil de
cuidar que la
mayoría de
los(as)
niños(as) de
su edad?

Menos de 1 hora
1 hora
2 horas

b. ¿Qué este(a)
niño(a) hace
cosas que
realmente le
molestan
mucho a
usted?

3 horas
4 horas o más
H7 ¿Qué tan bien pueden usted y este(a) niño(a) compartir

ideas o hablar sobre cosas realmente importantes?

c. ¿Qué estaba
enojado(a)
con este(a)
niño(a)?

Muy bien
Algo bien
No muy bien

H10 DURANTE LOS ÚLTIMOS 12 MESES, ¿hubo alguien a

quién usted pudiera recurrir regularmente en busca de
apoyo emocional relacionado con la crianza de los(as)
niños(as)?

Nada de bien

Sí

H8 ¿Cómo considera que sobrelleva las obligaciones

cotidianas de la crianza de los(as) niños(as)?

No ➔ PASE a la pregunta

en la página 18

Muy bien
Algo bien

H11 Si la respuesta es sí, ¿recibió usted apoyo emocional

de...

Sí

No muy bien

a. ¿Esposo(a) o compañero(a) de
casa?

Nada de bien

b. ¿Otro familiar o amigo(a)
cercano(a)?
c. ¿Un proveedor de atención médica?
d. ¿Un lugar de culto o un líder
religioso?
e. ¿Un grupo de apoyo o asistencia
relacionado con una condición de
salud específica?
f. ¿Un grupo de apoyo?
g. Un consejero u otro profesional de
la salud mental?
h. Otra persona, especifique:

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I. Acerca de su familia y
su hogar

Cuando su familia enfrenta problemas, ¿con qué
frecuencia es probable que hagan lo siguiente?
Siempre

DURANTE LA SEMANA PASADA, ¿cuántos días se
reunieron todos los miembros de la familia que viven
en el hogar para comer juntos?

Nunca

b. Trabajar juntos
para resolver
nuestros problemas

De 1 a 3 días

c. Saber que
tenemos fuerzas
en donde
ayoyarnos

De 4 a 6 días
Todos los días

d. Mantener la
esperanza aún en
tiempos difíciles

¿Alguien que vive en su hogar fuma cigarrillos,
cigarros o tabaco de pipa?
I7

Sí
No ➔ PASE a la pregunta I4
I3

A veces

a. Hablar juntos
sobre qué hacer

0 días

Casi
siempre

DESDE QUE ESTE(A) NIÑO(A) NACIÓ, ¿con qué
frecuencia ha sido muy difícil cubrir los gastos
básicos, como alimentos y vivienda, utilizando sus
ingresos familiares?
Nunca

Si la respuesta es sí, ¿alguien fuma dentro del hogar?

En raras ocasiones

Sí

En algunas ocasiones

En muchas ocasiones
I4

Más de una vez a la semana

Siempre pudimos costear buenas comidas nutritivas.

Una vez a la semana

Siempre pudimos costear lo suficiente para comer,
pero no siempre la clase de alimentos que debemos
comer.

Una vez al mes

A veces no pudimos costear lo suficiente para comer.

Una vez cada 2 a 5 meses

Con frecuencia no pudimos costear lo suficiente para
comer.

Una vez cada 6 meses
Una vez durante los últimos 12 meses

Nunca
No sé
I5

¿Cuál de estas afirmaciones describe mejor la
capacidad de su hogar para poder costear los alimentos
que necesitaba DURANTE LOS ÚLTIMOS 12 MESES?

En algún momento, DURANTE LOS ÚLTIMOS 12
MESES, aunque fuera durante un mes, ¿algún miembro
de la familia recibió lo siguiente...
Sí
No
a. ¿Ayuda en efectivo de un programa
de asistencia social del gobierno?
b. ¿Cupones para alimentos o
beneficios del Programa de
Asistencia Nutricional
Suplementaria (SNAP)?

DURANTE LOS ÚLTIMOS 12 MESES, aparte de en una
ducha o bañera ¿ha visto moho, hongos u otros signos
de daños por agua en las paredes u otras superficies
dentro de su casa?

c. ¿Desayunos o almuerzos gratuitos
o de costo reducido en la escuela?

Sí

d. ¿Beneficios del Programa Especial
de Nutrición Suplementaria para
Mujeres, Infantes y Niños (WIC)?

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I10 ¿En su vecindario hay...

Sí

I12 Además de usted o los demás adultos en su hogar,

¿hay al menos otro adulto en la escuela, vecindario
o comunidad del (de la) niño(a) que conozca bien
al (a la) niño(a) y en quien el (la) niño(a) pueda
depender para recibir consejo u orientación?

a. ¿Aceras o paseos peatonales?
b. ¿Un parque o área de juegos?

Sí
c. ¿Un centro de recreación, centro
comunitario o club "boys and girls"?

d. ¿Una biblioteca o biblioteca
ambulante?
I13 Las siguientes preguntas son sobre eventos que

e. ¿Basura o desperdicios en las
calles o aceras?

f. ¿Hogares deteriorados o mal
conservados?
g. ¿Vandalismo, como ventanas
rotas o grafitis?

A su entender, ¿este(a) niño(a) experimentó ALGUNA
VEZ algunas de las siguientes situaciones?
Sí
No

I11 ¿En qué medida está de acuerdo con estas afirmaciones

sobre su vecindario o comunidad?
Definitivamente
de acuerdo

Algo de
acuerdo

a. Los padres o tutores se
divorciaron o separaron

Algo en Definitivamente
desacuerdo en desacuerdo

b. Los padres o tutores murieron

a. La gente de
este vecindario
se ayuda
mutuamente

c. Los padres o tutores estuvieron
en la cárcel
d. Vio u oyó a sus padres o adultos
abofetearse, golpearse, patearse
o pegarse en el hogar

b. En este
vecindario
cuidamos
mutuamente
de nuestros(as)
hijos(as)

e. Fue víctima o testigo de violencia
en su vecindario
f. Vivió con alguna persona que
tenía una enfermedad mental,
estaba suicida o tenía depresión
grave o severa

c. Este(a) niño(a)
está seguro(a)
en nuestro
vecindario

g. Vivió con alguna persona con
problemas de alcohol o drogas

d. Cuando
enfrentamos
dificultades,
sabemos a
donde acudir
para buscar
ayuda en
nuestra
comunidad

Fue tratado(a) o juzgado(a)
injustamente por su raza o
grupo étnico

e. Este(a) niño(a)
está seguro(a)
en la escuela

NSCH-S-T2

§;-qc¤

26128058

J. Cuidador(es) de este(a)
niño(a)
➜

Grado 8 o menos

Grado 9 al 12; sin diploma
Completé secundaria o GED

¿Qué parentesco tiene con este(a) niño(a)?

Completé un programa de escuela vocacional,
comercial o de negocios

Padre o madre biológica o adoptiva

Algunos créditos universitarios, pero sin título

Padrastro o madrastra

Título asociado universitario (AA, AS)

Abuelo(a)

Título de licenciatura universitaria (BA, BS, AB)

Padre o madre de crianza a través del programa
Foster del gobierno

Título de maestría (MA, MS, MSW, MBA)
Título de doctorado (PhD, EdD) o título profesional
(MD, DDS, DVM, JD)

Otro(a): Pariente
Otro(a): No pariente

¿Cuál es el grado o nivel escolar más alto que usted ha
completado? Marque (X) sólo UNA opción.

¿Cuál es su estado civil?
Casado(a)

¿Cuál es su sexo?

No casado(a), pero vivo con una pareja

Masculino

Nunca me he casado

Femenino

Divorciado(a)
J3

¿Qué edad tiene?

Separado(a)
Viudo(a)

Edad en años

¿Dónde nació?

En general, ¿cómo está su salud física?

En los Estados Unidos ➔ PASE a la pregunta J6

Excelente

Fuera de los Estados Unidos

Muy buena
Buena

¿Cuándo vino a vivir a los Estados Unidos?

Regular

Año
Deficiente

NSCH-S-T2

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26128041

En general, ¿cómo está su salud mental o emocional?

J14 ¿Cuál es el sexo de este cuidador primario?

Excelente

Masculino

Muy buena

Femenino

Buena
J15 ¿Qué edad tiene este cuidador primario?

Regular
Edad en años

Deficiente
J10 ¿Tuvo trabajo por lo menos 50 semanas de las últimas

52 semanas?

J16 ¿Dónde nació este cuidador primario?

Sí

En los Estados Unidos ➔ PASE a la pregunta J18

Fuera de los Estados Unidos

J11 ¿Ha prestado usted alguna vez servicio militar activo

en las Fuerzas Armadas, la Reserva Militar, o la
Guardia Nacional de los Estados Unidos?
Marque (X) sólo UNA opción.

J17 ¿Cuándo vino este cuidador primario a vivir a los

Estados Unidos?
Año

Nunca estuvo en el servicio
militar ➔ PASE a la pregunta J13
Servicio activo solamente para
entrenamiento de la Reserva Militar o la
Guardia Nacional l ➔ PASE a la pregunta J13

J18 ¿Cuál es el grado o nivel escolar más alto que este

cuidador primario ha completado?
Marque (X) SÓLO una opción.

En servicio activo ahora
En servicio activo en el pasado, pero no ahora

Grado 8 o menos
Grado 9 al 12; sin diploma

J12 ¿Fue mobilizado(a) en algún momento durante la vida

de este(a) niño(a)?
Completó secundaria o GED
Sí
Completó un programa de escuela vocacional,
comercial o de negocios

➜

Algunos créditos universitarios, pero sin título

Las preguntas J13 a la J24 tratan sobre otro cuidador
primario adulto que puede estar viviendo en este hogar
además de usted.

Título asociado universitario (AA, AS)
Título de licenciatura universitaria (BA, BS, AB)

J13 ¿Qué parentesco tiene este cuidador primario adulto

que vive en este hogar con este(a) niño(a)?

Título de maestría (MA, MS, MSW, MBA)

Sólo hay un cuidador primario en este hogar
para este(a) niño(a) ➔ PASE a la pregunta K1 en
la página 22.

Título de doctorado (PhD, EdD) o título profesional
(MD, DDS, DVM, JD)

Padre o madre biológica o adoptiva
Padrastro o madrastra
Abuelo(a)
Padre o madre de crianza a través del programa
Foster del gobierno
Otro(a): Pariente
Otro(a): No pariente

NSCH-S-T2

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26128033

J19 ¿Cuál es el estado civil de este cuidador primario?

J23 Este cuidador primario, ¿ha prestado alguna vez

servicio militar activo en las Fuerzas Armadas, la
Reserva Militar, o la Guardia Nacional de los Estados
Unidos? Marque (X) sólo UNA opción.

Casado(a)
No casado(a), pero vive con una pareja

Nunca estuvo en el servicio
militar ➔ PASE a la pregunta K1

Nunca se ha casado
Divorciado(a)

Servicio activo solamente para entrenamiento
de la Reserva Militar o la Guardia Nacional ➔ PASE
a la pregunta K1

Separado(a)

En servicio activo ahora

Viudo(a)

En servicio activo en el pasado, pero no ahora

J20 En general, ¿cómo está la salud física de este cuidador

primario?

J24 ¿Fue este cuidador primario mobilizado en algún

momento durante la vida de este(a) niño(a)?

Excelente

Sí

Muy buena

Buena
Regular

K. Información del Hogar

Deficiente

J21 En general, ¿cómo está la salud mental o emocional

de este cuidador primario?
Excelente
Muy buena

Buena
Cantidad de personas
Regular
Deficiente

J22 ¿Tuvo trabajo este cuidador primario por lo menos

50 semanas de las últimas 52 semanas?

Sí
Cantidad de personas

NSCH-S-T2

§;-qB¤

26128025

a. Jornales, sueldos o salarios, comisiones, bonos
o propinas de todos los empleos
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

.00

CANTIDAD TOTAL
en el último año calendario

b. Ingreso de empleo por cuenta propia en su
negocio no agrícola o finca comercial, ya sea
como propietario único o en sociedad
Sí ➔

.00

Pérdida

CANTIDAD TOTAL
en el último año calendario

c. Intereses, dividendos, ingreso neto por rentas,
ingreso por derechos de autor, o ingreso por
herencias y fideicomisos
Sí ➔

.00

Pérdida

CANTIDAD TOTAL
en el último año calendario

d. Seguro social o retiro para personal de
ferrocarriles; pensión por retiro, pensión para
viudos(as) y dependientes de fallecidos; o
pensión para incapacidad
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

e. Seguridad de Ingreso Suplementario (Supplemental
Security Income, SSI); cualquier asistencia pública
o pagos de asistencia social del estado o la oficina
de asistencia social local
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

.00

CANTIDAD TOTAL
en el último año calendario

NSCH-S-T2

§;-q:¤

26128017

NSCH-S-T2

§;-q2¤

26138248
OMB No. 0607-0990: Aprobado hasta el 05/31/2019

NSCH-S-T3
(05/02/2018)

§;.sQ¤

26138230

Comienze Aquí

¿Con qué frecuencia este(a) niño(a)...
Siempre

Recientemente, usted completó una encuesta con
preguntas sobre los(as) niños(as) que usualmente
viven o se quedan en esta dirección. Gracias por
tomar de su tiempo para completar esta encuesta.

Casi
siempre

A veces

Nunca

a. Muestra interés y
curiosidad por
aprender cosas
nuevas?
b. Trabaja para
terminar las tareas
que comienza?

Ahora le haremos algunas preguntas de seguimiento
sobre:

d. Le importa que le
vaya bien en la
escuela?
e. Hace toda la tarea
requerida?

f. Discute demasiado?

Su participación es importante. Gracias.

A. La salud de este(a) niño(a)

1-2 veces (en los últimos 12 meses)
A1 En general, ¿cómo describiría la salud de este(a) niño(a)

1-2 veces por mes

(cuyo nombre aparece más arriba)?

1-2 veces por semana

Excelente

Casi todos los días

Muy buena
Buena

Regular
Deficiente

A2 ¿Cómo describiría la salud dental de este(a) niño(a)?

1-2 veces (en los últimos 12 meses)
Excelente
1-2 veces por mes
Muy buena
1-2 veces por semana
Buena
Casi todos los días
Regular
Deficiente

NSCH-S-T3

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26138222

A6 DURANTE LOS ÚLTIMOS 12 MESES, ¿este(a) niño(a)

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...

ha tenido dificultades CRÓNICAS o FRECUENTES con
cualquiera de los(as) siguientes?
Sí

a. Respirar u otros problemas
respiratorios (como respiración
sibilante o falta de aire)

¿Alergias (incluyendo alimentos, medicamentos,
insectos o de otro tipo)?
Sí

b. Comer o tragar debido a una
condición médica

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

c. Digerir la comida, incluyendo
problemas estomacales o
intestinales, estreñimiento
o diarrea

Sí

Si la respuesta es sí, la condición es:
Leve

d. Dolor físico crónico o recurrente,
incluyendo dolor de cabeza, dolor
de espalda o dolor corporal
A9

e. Dolor de muelas

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

g. Dientes deteriorados o caries

Sí

problemas?
Sí

Leve

Moderada

Grave

A10 ¿Asma?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

b. Dificultades serias para caminar
o subir escaleras

Sí

c. Dificultades para vestirse o
bañarse
d. Dificultades para hacer
diligencias solo o sola, como
visitar el consultorio u oficina
del médico o ir de compras,
debido a una condición física,
mental o emocional

Si la respuesta es sí, la condición es:

A7 ¿Presenta este(a) niño(a) alguno de los siguientes

a. Dificultades serias para
concentrarse, recordar o tomar
decisiones debido a una
condición física, mental o
emocional

Grave

¿Artritis?
Sí

f. Sangrado en las encías

Moderada

Si la respuesta es sí, la condición es:
Leve
A11

Grave

¿Lesión cerebral, contusión o lesión en la cabeza?
Sí

e. Sordera o problemas de
audición

Moderada

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

f. Ceguera o problemas de la
vista, incluso cuando usa
anteojos o lentes

Sí

Si la respuesta es sí, la condición es:
Leve

NSCH-S-T3

Moderada

Grave

§;.s7¤

26138214

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A12 ¿Parálisis cerebral?

A16 ¿Dolores de cabeza frecuentes o intensos, incluyendo

migrañas?
Sí

No
Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

No
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Si la respuesta es sí, la condición es:

Grave

Leve

Moderada

Grave

A13 ¿Diabetes?
A17 ¿Síndrome de Tourette?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

No
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Si la respuesta es sí, la condición es:

Grave

Leve

Moderada

Grave

A14 ¿Epilepsia o trastornos convulsivos?
A18 ¿Problemas de ansiedad?

Sí

No
No

Sí
Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Leve

Moderada

Sí

Si la respuesta es sí, la condición es:

Grave

Leve

Moderada

Grave

A15 ¿Condición o problemas cardiacos?
A19 ¿Depresión?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Leve

Moderada

Sí

Si la respuesta es sí, la condición es:

Grave

Leve

NSCH-S-T3

Moderada

Grave

§;.s/¤

26138206

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...

A23 ¿Otra condición genética o hereditaria?

A20 ¿Síndrome de Down?

Sí

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...

Sí

Si la respuesta es sí, especifique:C

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

No
La condición es:

Si la respuesta es sí, la condición es:
Leve

Moderada

Leve

Grave

drepanocítica o de células falciformes, talasemia o
hemofilia)?

Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) el
trastorno ACTUALMENTE?

Si la respuesta es sí, el trastorno es:
Leve

Talasemia

Grave

A25 ¿Problemas de comportamiento o conducta?

Hemofilia

Sí

Otros trastornos
sanguíneos

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

A22 ¿Fibrosis quística?

Sí

Si la respuesta es sí, la condición es:

Si la respuesta es sí, la condición es:
Moderada

Leve

Grave

Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se llaman
pruebas de detección para reción nacidos.
Sí

Moderado

Enfermedad de anemia
drepanocítica

Leve

Sí

Si la respuesta es sí, ¿fue este(a) niño(a)
diagnosticado(a) con:
Sí
No

Sí

A24 ¿Trastornos por uso de drogas?

Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se
llaman pruebas de detección para recién nacidos.
Sí

Grave

Esta condición, ¿fue identificada por medio de
una prueba de sangre realizada poco después
del nacimiento? Estas pruebas a veces se
llaman pruebas de detección para recién nacidos.

A21 ¿Trastornos sanguíneos (como enfermedad de anemia

Sí

Moderada

Grave

A26 ¿Retraso en el desarrollo?

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?

Sí

Si la respuesta es sí, la condición es:
Leve

NSCH-S-T3

Moderada

Grave

§;.s’¤

26138198

A31 ¿ALGUNA VEZ le ha dicho a usted un médico u otro

A27 ¿Discapacidad intelectual (anteriormente conocida

No ➔ PASE a la pregunta A36 en la
página 7
Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

como retraso mental)?
No

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
discapacidad ACTUALMENTE?

Sí

Si la respuesta es sí, la condición es:

Sí

Leve

Si la respuesta es sí, la discapacidad es:
Leve

Moderada

Grave

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
No

Edad en años

Moderada

Grave

A29 ¿Discapacidades del aprendizaje?

Sí

Proveedor de atención primaria

Especialista

Si la respuesta es sí, ¿padece este(a) niño(a) la
discapacidad ACTUALMENTE?
Sí

Psicólogo(a)/consejero(a) escolar

Otro(a) psicólogo(a) (no escolar)

Si la respuesta es sí, la discapacidad es:
Leve

No sabe

A33 ¿Qué tipo de médico u otro proveedor de atención

Si la respuesta es sí, la condición es:
Leve

Grave

Sí

Moderada

A32 ¿Qué edad tenía este(a) niño(a) cuando un médico u

A28 ¿Trastorno del habla u otro trastorno del lenguaje?

Sí

Moderada

Psiquiatra

Grave
Otro(a), especifique:

ALGUNA VEZ un médico u otro(a) profesional de la
salud le ha dicho a usted que este(a) niño(a) padece
de...
A30 ¿Cualquier otra condición de salud mental?

Sí

No sabe

A34 ¿Toma este(a) niño(a) ACTUALMENTE medicamentos

para tratar el Autismo, los Trastornos del Espectro
Autista(TEA), Síndrome de Asperger, o el Trastorno
Generalizado del Desarrollo (TGD)?

Si la respuesta es sí, especifique:C

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave

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26138180

A35 En algún momento DURANTE LOS ÚLTIMOS 12 MESES, A40 ¿En qué medida las condiciones o problemas de salud

¿recibió este(a) niño(a) tratamiento de la conducta por
Autismo, Trastornos del Espectro Autista (TEA) ,
Síndrome de Asperger, o Trastorno Generalizado del
Desarrollo (TGD), tal como alguna capacitación o
intervención que haya recibido usted o este(a) niño(a)
para ayudar con su conducta?
Sí

de este(a) niño(a) afectan su capacidad de hacer
actividades?
Muy poco
Algo

En gran medida

A36 ¿ALGUNA VEZ le dijo a usted un médico u otro

proveedor de atención médica que este(a) niño(a)
padece del Trastorno por Déficit de Atención o del
Trastorno por Déficit de Atención e Hiperactividad,
es decir, TDA or TDAH?

B. Este(a) niño(a) cuando
era bebé

No ➔ PASE a la pregunta A39

Sí

Si la respuesta es sí, ¿padece este(a) niño(a) la
condición ACTUALMENTE?
Sí

¿Nació este(a) niño(a) más de 3 semanas antes de la
fecha para la cual se esperaba el parto?
Sí

Si la respuesta es sí, la condición es:
Leve

Moderada

Grave
B2

A37 ¿Toma este(a) niño(a) ACTUALMENTE medicamentos

para tratar el Trastorno por Déficit de Atención (TDA) o
el Trastorno por Déficit de Atención con Hiperactividad
(TDAH)?
Sí

libras Y

onzas

A38 En algún momento DURANTE LOS ÚLTIMOS 12 MESES,

¿Cuánto pesó al nacer?
Responda utilizando libras y onzas O kilogramos y gramos.
Puede proveer su mejor aproximación o estimación.

kilogramos Y
B3

gramos

¿Qué edad tenía la madre cuando nació este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.
Edad en años

Sí

A39 DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué

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26138172

C. Servicios de atención
médica
C1

¿Cuál es el peso ACTUAL de este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.
libras Y

onzas

O
kilogramos Y

Sí
No ➔ PASE a la pregunta C5

gramos

¿Le preocupa el peso de este(a) niño(a)?
Sí, este(a) niño(a) pesa mucho

Si la respuesta es sí, en su ÚLTIMA visita de atención
médica, ¿tuvo el (la) niño(a) la oportunidad de hablar
con un médico u otro proveedor de atención médica
en privado, sin que usted u otro adulto estuviera
presente?

Sí, este(a) niño(a) pesa muy poco
No, no me preocupa
C8

Sí
No

¿Alguna vez un médico u otro proveedor de atención
médica le ha dicho a usted que este(a) niño(a) tiene
sobrepeso?
Sí

DURANTE LOS ÚLTIMOS 12 MESES, ¿cuántas veces
tuvo este(a) niño(a) una consulta con un médico,
enfermero(a) u otro(a) profesional de la salud para
realizarse un chequeo PREVENTIVO? El chequeo
preventivo se realiza cuando este(a) niño(a) no ha estado
enfermo(a) ni lesionado(a), tal como un chequeo
preventivo anual o un examen físico para hacer deporte
o la visita de niño sano.

No
C9

¿Hay algún lugar en donde usted u otro cuidador
USUALMENTE lleva a este(a) niño(a) cuando está
enfermo(a) o necesita asesoramiento sobre la salud
de este(a) niño(a)?

0 visitas

Sí

1 visita

No ➔ PASE a la pregunta C11

2 visitas o más

C10 Si la respuesta es sí, ¿adónde NORMALMENTE va

este(a) niño(a) primero? Marque (X) SÓLO una opción.
C4

Pensando en la ÚLTIMA VEZ que llevó al (a la) niño(a) a
un chequeo PREVENTIVO, ¿aproximadamente cuánto
tiempo en el consultorio estuvo con usted el médico
o proveedor de atención médica que examinó a este(a)
niño(a)? Puede proveer su mejor aproximación o estimación

Consultorio del médico
Sala de emergencias del hospital
Departamento de pacientes ambulatorios del hospital

Menos de 10 minutos
Clínica o centro de salud
De 10 a 20 minutos
Clínica ambulatoria dentro de un negocio o
"Minute Clinic"

Más de 20 minutos

Escuela (enfermería, oficina del entrenador atlético)
C5

¿Cuál es la estatura ACTUAL de este(a) niño(a)?
Puede proveer su mejor aproximación o estimación.
pies Y

pulgadas

Algún otro lugar
C11 ¿Hay algún lugar a donde este(a) niño(a) USUALMENTE

va cuando necesita atención preventiva de rutina, como
un examen físico o un chequeo de niño sano?

O
metros Y

Sí

centímetros

No ➔ PASE a la pregunta C13 en la página 9

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26138164

C12 Si la respuesta es sí, ¿es éste el mismo lugar a donde

C17 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

el(la) niño(a) va cuando está enfermo(a)?

MESES, ¿qué servicio(s) dental(es) preventivo(s)
recibió este(a) niño(a)? Marque (X) TODAS las que
apliquen.

Sí

Chequeo

Limpieza
C13 DURANTE LOS ÚLTIMOS 12 MESES, ¿se le hizo a

este(a) niño(a) un examen de la vista, utilizando
imágenes, formas o letras?

Instrucciones sobre cepillado de dientes y cuidado
de la salud oral

Sí

Radiografías

No ➔ PASE a la pregunta C15

Tratamiento de fluoruro
Sellador (sellador plástico en muelas posteriores)

C14 Si la respuesta es sí, ¿dónde se le examinó la vista a

este(a) niño(a)? Marque (X) TODAS las que apliquen.
Consultorio de un oculista o especialista en ojos
(oftalmólogo, optometrista)

No sabe
C18 DURANTE LOS ÚLTIMOS 12 MESES, ¿recibió este(a)

Consultorio del pediatra u otro médico generalista
Clínica o centro de salud
Escuela
Otro(a), especifique:

Sí
C

No, pero este(a) niño(a) necesitaba ver a un profesional
de la salud mental
No, este(a) niño(a) no necesitó ver a un profesional de
la salud mental ➔ PASE a la pregunta C20

C15 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

niño(a) al dentista u otro profesional de la salud oral
para recibir algún tipo de atención o cuidado dental
u oral?

C19 ¿Qué tan difícil le resultó obtener el tratamiento,

consejería o asesoría de salud mental que este(a)
niño(a) necesitaba?

Sí, fue al dentista

No fue difícil

Sí, fue a otro(a) profesional de la salud oral

Algo difícil

No ➔ PASE a la pregunta C18

Muy difícil
No fue posible obtenerlo

C16 Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12

MESES, ¿fue este(a) niño(a) al dentista u otro(a)
profesional de la salud oral para recibir atención
preventiva, como chequeos, limpiezas dentales,
selladores dentales o tratamientos de fluoruro?

C20 DURANTE LOS ÚLTIMOS 12 MESES, ¿tomó este(a)

niño(a) algún medicamento debido a dificultades con
sus emociones, concentración o conducta?

No tuvo visitas preventivas en los
últimos 12 meses ➔ PASE a la pregunta C18

Sí

Sí, 1 visita

Sí, 2 visitas o más

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C21 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

C25 Si la respuesta es sí, ¿qué tipo de atención no recibió?

Marque (X) TODAS las que apliquen.
Atención médica
Atención dental

Sí

Atención de la vista

No, pero este(a) niño(a) necesitó ver a un especialista

Atención de la audición

No, este(a) niño(a) no necesitó ver
a un especialista ➔ PASE a la pregunta C23

Servicios de salud mental
Otro(a), especifique:

C22 ¿Qué tan difícil le resultó a usted que este(a) niño(a)

recibiera la atención del especialista que necesitaba?
No fue difícil
Algo difícil

C26 ¿Cuáles de las siguientes razones contribuyeron a

que este(a) niño(a) no recibiera los servicios de salud
necesarios? Marque (X) Sí o No en cada categoría.

Muy difícil

Sí

No fue posible obtenerla

a. Este(a) niño(a) no era elegible
para recibir los servicios

C23 DURANTE LOS ÚLTIMOS 12 MESES, ¿utilizó este(a)

b. Los servicios que necesitaba
este(a) niño(a) no estaban
disponibles en su área

c. Hubo problemas para programar
u obtener una cita cuando este(a)
niño(a) la necesitó

Sí

d. Hubo problemas para obtener
transporte o cuidado de los niños

e. El consultorio (del médico o la
clínica) no estaba abierto(a) cuando
este(a) niño(a) necesitó atención

C24 DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó este(a)

niño(a) atención médica en alguna ocasión pero no la
recibió? Por atención médica nos referimos a la atención
médica así como atención dental, de la vista y de salud
mental.
Sí

f. Hubo problemas relacionados
con el costo
C27 DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué

frecuencia se sintió frustrado(a) en sus esfuerzos
para obtener servicios para este(a) niño(a)?

No ➔ PASE a la pregunta C27

Nunca
A veces
Casi siempre
Siempre

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C28 DURANTE LOS ÚLTIMOS 12 MESES, ¿cuántas veces

C34 Si la respuesta es sí, ¿qué edad tenía este(a) niño(a)

fue este(a) niño(a) a la sala de emergencias de un
hospital?

cuando comenzó a recibir estos servicios especiales?

Nunca

Años Y

Meses

1 vez
C35 ¿Recibe este(a) niño(a) ACTUALMENTE estos servicios

2 o más veces

especiales?
Sí

C29 DURANTE LOS ÚLTIMOS 12 MESES, ¿fue este(a)

niño(a) admitido(a) al hospital para quedarse ahí
por lo menos una noche?

Sí

D. Experiencia con los
proveedores de atención
médica de este(a) niño(a)

No
C30 ¿Recibió este(a) niño(a) ALGUNA VEZ un plan de

D1 ¿Tiene usted a una o más personas a quienes

Sí
No ➔ PASE a la pregunta C33

Sí, a una persona

C31 Si la respuesta es sí, ¿qué edad tenía este(a) niño(a)

cuando se estableció el PRIMER plan?

Años Y

Sí, a más de una persona
No

Meses

C32 ¿Recibe este(a) niño(a) ACTUALMENTE servicios bajo

D2 DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó este(a)

niño(a) un referido para ver a algún médico o recibir
algún servicio?

alguno de estos planes?
Sí

Sí

No ➔ PASE a la pregunta D4 en la página 12

C33 ¿Recibió este(a) niño(a) ALGUNA VEZ servicios

D3 ¿Qué tan difícil le resultó a usted obtener referidos?

especiales para cumplir con sus necesidades del
desarrollo, tales como terapia del habla, ocupacional
o de la conducta?

No fue difícil
Algo difícil

Sí
Muy difícil
No ➔ PASE a la pregunta D1
No fue posible obtener referidos

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D4 Responda las siguientes preguntas sólo si este(a)

niño(a) tuvo una visita de atención médica EN LOS
ÚLTIMOS 12 MESES. De lo contario vaya a la pregunta
D13 en la página 13.

Siempre

DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué
frecuencia los médicos u otros proveedores de
atención médica de este(a) niño(a) hicieron lo
siguiente...
Siempre

Casi
siempre

A veces

Nunca

A veces

Nunca

b. ¿Le dieron lugar
para expresar sus
dudas o desacuerdo
con las
recomendaciones
sobre la atención
médica de este(a)
niño(a)?

b. ¿Lo(a) escucharon
a usted con
atención?
c. ¿Mostraron
sensibilidad por
sus valores y
costumbres
familiares?

c. ¿Trabajaron con
usted para decidir
cuáles serían las
mejores opciones
para este(a) niño(a)
en lo que se refiere
a cuidado de salud
y opciones de
tratamiento?

d. ¿Le brindaron la
información
específica que
necesitaba con
relación a este(a)
niño(a)?
e. ¿Lo(a) hicieron
sentir como un(a)
participante en la
atención y cuidado
de este(a) niño(a)?

Casi
siempre

a. ¿Analizaron con
usted la variedad
de opciones a
considerar para la
atención médica o
el tratamiento de
este(a) niño(a)?

a. ¿Estuvieron tiempo
suficiente con
este(a) niño(a)?

DURANTE LOS ÚLTIMOS 12 MESES, ¿le ayudó
alguien a organizar o coordinar el cuidado de este(a)
niño(a) entre los diferentes médicos y servicios que
este(a) niño(a) utiliza?

Sí

D5 DURANTE LOS ÚLTIMOS 12 MESES, ¿necesitó tomar

alguna decisión sobre el cuidado de salud de este(a)
niño(a), tal como obtener medicamentos recetados,
referidos o algún otro procedimiento médico?

No
No vio a más de un proveedor de atención
médica en los ÚLTIMOS 12 MESES

Sí
No ➔ PASE a la pregunta D7

Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12
MESES, ¿con qué frecuencia los médicos u otros
proveedores de atención médica de este(a) niño(a)...

Si la respuesta es sí, DURANTE LOS ÚLTIMOS 12
MESES, ¿con qué frecuencia obtuvo la ayuda que
deseaba para hacer arreglos o coordinar la atención
médica de este(a) niño(a)?
Casi siempre
A veces
Nunca

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D10 DURANTE LOS ÚLTIMOS 12 MESES, ¿cuán

D15 El médico de este(a) niño(a) u otro proveedor de

satisfecho(a) estuvo con respecto a la comunicación
entre los médicos de este(a) niño(a) y los demás
proveedores de atención médica?

atención médica, ¿ha trabajado con este(a) niño(a)
para...
Sí

No
sabe

a. ¿Hacer elecciones positivas
para la salud? Por ejemplo,
comer saludable, hacer
actividad física periódicamente,
no consumir tabacol, alcohol u
otras drogas, o posponer la
actividad sexual.

Muy satisfecho
Algo satisfecho
Algo insatisfecho
Muy insatisfecho

b. ¿Adquirir habilidades
para controlar su salud
y atención médica?
Por ejemplo, comprender
sus necesidades actuales
de salud, saber qué hacer
en caso de una emergencia
médica, o tomar los
medicamentos que necesita.

D11 DURANTE LOS ÚLTIMOS 12 MESES, ¿el proveedor de

atención médica de este(a) niño(a) se comunicó con la
escuela, el proveedor de cuidado de niños o el programa
de educación especial de este(a) niño(a)?
Sí
No ➔ PASE a la pregunta D13

c. ¿Comprender los cambios
en la atención médica que
ocurren a los 18 años?
Por ejemplo, comprender
los cambios con respecto
a la privacidad, dar
consentimiento, acceso a
la información o la toma
de decisiones.

No fue necesario que el proveedor de
atención médica se comunicara con
estos proveedores ➔ PASE a la pregunta D13
D12 Si la respuesta es sí, durante este tiempo, ¿qué tan

satisfecho(a) se ha sentido con respecto a la
comunicación que el proveedor de atención médica
de este(a) niño(a) ha tenido con la escuela, el
proveedor de cuidado de niños o el programa de
educación especial?

D16 ¿Recibieron usted y este(a) niño(a) un resumen médico

sobre el historial médico de su hijo(a) (por ejemplo,
condiciones médicas, alergias, medicamentos,
inmunizaciones)?

Muy satisfecho
Algo satisfecho

Sí

Algo insatisfecho

Muy insatisfecho

D17 El médico u otros proveedores de atención médica de

este(a) niño(a), ¿han trabajado con usted y el (la) niño(a)
para crear un plan de cuidado con el fin de alcanzar las
metas y necesidades de salud del (de la) niño(a)?

D13 ¿Acaso algunos de los médicos o proveedores de

atención médica de este(a) niño(a) tratan solamente
a niños(as)?

Sí

Sí
No ➔ PASE a la pregunta D15

No ➔ PASE a la pregunta D20 en la página 14
D18 Si la respuesta es sí, ¿usted y este(a) niño(a) tienen

acceso a este plan de cuidado?
D14 Si la respuesta es sí, ¿han hablado ellos(as) con usted

sobre cuando este(a) niño(a) necesitará ver a médicos
u otros proveedores de atención médica que tratan a
adultos?
Sí

Sí
No
D19 ¿Acaso este plan de cuidado aborda la transición a

médicos y otros proveedores de atención médica que
tratan a adultos?

Sí
No
No, este(a) niño(a) ya ve a proveedores que
tratan a adultos
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D20 La elegibilidad para el seguro de salud a menudo

cambia en la adultez temprana. ¿Sabe cómo este(a)
niño(a) estará asegurado(a) cuando pase a ser adulto?

¿Está este(a) niño(a) ACTUALMENTE cubierto(a) por
alguno de los siguientes tipos de seguro de salud o
planes de cobertura de salud? Marque (X) Sí o No en
CADA categoría.
Sí

Sí ➔ PASE a la pregunta E1
a. Seguro a través de un empleador
actual o previo o a través de un
sindicato

No
D21 Si la respuesta es no, ¿alguien ha hablado con usted

b. Seguro adquirido directamente de
una compañía de seguros

acerca de cómo obtener o mantener algún tipo de
cobertura de seguro de salud cuando este(a) niño(a)
pase a ser adulto?

c. Medicaid, Medical Assistance, o
cualquier tipo de plan de asistencia
del gobierno para personas con
bajos ingresos o una discapacidad

Sí
No

d. TRICARE u otros servicios de
atención médica de las Fuerzas
Armadas

E. Cobertura de seguro
médico de este(a) niño(a)

e. Servicio de Salud Indio (Indian
Health Services)
f. Otro(a), especifique:

Sí, pero este(a) niño(a) tuvo una interrupción
en la cobertura

¿Con qué frecuencia el seguro de salud de este(a)
niño(a) ofrece beneficios o cubre servicios que
satisfacen las necesidades de este(a) niño(a)?
Siempre

No
E2

Casi siempre

Indique si algunos de los siguientes es un motivo por
el cual este(a) niño(a) no tuvo cobertura de salud
DURANTE LOS ÚLTIMOS 12 MESES:
Sí

A veces

a. Cambio de empleador o de
situación laboral

Nunca
E6

b. Cancelación por primas vencidas

¿Con qué frecuencia el seguro de salud de este(a)
niño(a) le permite ver a los proveedores de atención
médica que necesita?

c. Renunció a la cobertura porque
costaba demasiado

Siempre

d. Renunció a la cobertura porque los
beneficios eran inadecuados

Casi siempre

e. Renunció a la cobertura porque
las opciones de proveedores de
atención médica eran inadecuadas

A veces

f. Problemas con el proceso de solicitud
o renovación de la cobertura
g. Otro(a), especifique:

Nunca
E7

E3 ¿Está este(a) niño(a) cubierto(a) ACTUALMENTE por

Siempre

ALGÚN tipo de seguro de salud o plan de cobertura de
salud?

Casi siempre
Sí
A veces
No ➔ PASE a la pregunta F1 en la página 15
Nunca
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F. Proveyendo para el
cuidado de salud de este(a)
niño(a)
F1

Este(a) niño(a) no necesita atención médica en el
hogar cada semana

Menos de 1 hora por semana
De 1 a 4 horas por semana
De 5 a 10 horas por semana

$0 (Sin gastos médicos o gastos
relacionados con la salud) ➔ PASE a la pregunta F4
De $1 a $249

11 horas o más por semana
F6

De $250 a $499
De $500 a $999

De $1,000 a $5,000

Este(a) niño(a) no necesita atención médica
coordinada cada semana

Más de $5,000

Menos de 1 hora por semana

¿Con qué frecuencia son razonables estos costos?

De 1 a 4 horas por semana

Siempre

De 5 a 10 horas por semana

Casi siempre

11 horas o más por semana

A veces

G. La educación y las
actividades de este(a) niño(a)

Nunca
F3

DURANTE LOS ÚLTIMOS 12 MESES, ¿tuvo su familia
problemas para pagar las facturas médicas o de
atención médica de este(a) niño(a)?

Sí

De 1 a 3 días
F4 DURANTE LOS ÚLTIMOS 12 MESES, ¿usted u otro

miembro de la familia...
Sí

De 4 a 6 días

a. ¿Dejó el trabajo o se ausentó unos
cuantos días debido a la salud o
condición(es) médica(s) de este(a)
niño(a)?

De 7 a 10 días

b. ¿Redujo la cantidad de horas
que trabaja debido a la salud o
condición(es) médica(s) de este(a)
niño(a)?

Este(a) niño(a) no estaba inscrito(a) en la escuela

11 días o más

c. ¿Evitó cambiar de trabajo para
mantener el seguro de salud para
este(a) niño(a)?

DURANTE LOS ÚLTIMOS 12 MESES, ¿cuántas veces
se comunicó la escuela de este(a) niño(a) con usted u
otro adulto de su casa por algún problema del (de la)
niño(a) en la escuela?
Nunca
1 vez
2 veces o más

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H. Acerca de usted y
este(a) niño(a)

DESDE QUE COMENZÓ KINDERGARTEN, ¿alguna vez
ha repetido este(a) niño(a) algún grado?
Sí
H1

¿Nació este(a) niño(a) en los Estados Unidos?

No
Sí ➔ PASE a la pregunta H3
G4

DURANTE LOS ÚLTIMOS 12 MESES, ¿con qué
frecuencia asistió usted a eventos o actividades en las
que este(a) niño(a) participaba?

No
H2

Siempre
Casi siempre

Si la respuesta es no, ¿cuánto tiempo ha vivido este(a)
niño(a) en los Estados Unidos?
Años Y

Meses

A veces
H3

En raras ocasiones

¿Cuántas veces se ha mudado este(a) niño(a) a una
dirección nueva desde que nació?

Nunca
Cantidad de veces
G5

DURANTE LOS ÚLTIMOS 12 MESES, ¿participó este(a)
niño(a) en...
Sí

a. ¿Un equipo deportivo o clases
de algún deporte después de la
escuela o los fines de semana?

Siempre

b. ¿Clubes u organizaciones después
de la escuela o los fines de semana?

Casi siempre

c. ¿Alguna otra actividad organizada o
clases, tal como música, baile, otro
idioma u otras artes?

A veces
En raras ocasiones

¿Con qué frecuencia este(a) niño(a) se va a dormir
aproximadamente a la misma hora durante las noches
entre semana?

Nunca
H5

DURANTE LA SEMANA PASADA, ¿cuántas horas
durmió este(a) niño(a) la mayoría de las noches entre
semana?
Menos de 6 horas

DURANTE LA SEMANA PASADA, ¿cuántos días hizo
este(a) niño(a) ejercicio, practicó un deporte o participó
en actividades físicas durante al menos 60 minutos?

6 horas
7 horas

0 días
8 horas
De 1 a 3 días
9 horas
De 4 a 6 días
10 horas
Todos los días
11 horas o más
G7

En comparación con otros(as) niños(as) de la misma
edad, ¿qué dificultad tiene este(a) niño(a) para hacer
o mantener amistades?
Ninguna dificultad
Un poco de dificultad
Mucha dificultad

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H6 EN LA MAYORÍA DE LOS DÍAS DE LA SEMANA,

H10 DURANTE LOS ÚLTIMOS 12 MESES, ¿hubo alguien a

quién usted pudiera recurrir regularmente en busca de
apoyo emocional relacionado con la crianza de los(as)
niños(as)?

Sí
No ➔ PASE a la pregunta

Menos de 1 hora
H11 Si la respuesta es sí, ¿recibió usted apoyo emocional

1 hora

de...

Sí

2 horas

a. ¿Esposo(a) o compañero(a) de
casa?

3 horas

b. ¿Otro familiar o amigo(a)
cercano(a)?

4 horas o más

c. ¿Un proveedor de atención médica?
H7

¿Qué tan bien pueden usted y este(a) niño(a) compartir
ideas o hablar sobre cosas realmente importantes?

d. ¿Un lugar de culto o un líder
religioso?

Muy bien
Algo bien

e. ¿Un grupo de apoyo o asistencia
relacionado con una condición de
salud específica?

No muy bien

f. ¿Un grupo de apoyo?

Nada de bien

g. Un consejero u otro profesional de
la salud mental?
h. Otra persona, especifique:

H8 ¿Cómo considera que sobrelleva las obligaciones

cotidianas de la crianza de los(as) niño(a)s?
Muy bien
Algo bien

I. Acerca de su familia y
su hogar

No muy bien
Nada de bien
I1
H9 DURANTE EL MES PASADO, ¿con qué frecuencia

sintió...
a. ¿Qué este(a)
niño(a) es
mucho más
difícil de
cuidar que la
mayoría de
los(as)
niños(as) de
su edad?

En raras
A
Nunca ocasiones veces

Casi
siempre Siempre

DURANTE LA SEMANA PASADA, ¿cuántos días se
reunieron todos los miembros de la familia que viven
en el hogar para comer juntos?
0 días
De 1 a 3 días
De 4 a 6 días
Todos los días

b. ¿Qué este(a)
niño(a) hace
cosas que
realmente le
molestan
mucho a
usted?

¿Alguien que vive en su hogar fuma cigarrillos,
cigarros o tabaco de pipa?
Sí
No ➔ PASE a la pregunta I4 en la página 18

c. ¿Qué estaba
enojado(a)
con este(a)
niño(a)?

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I3

Si la respuesta es sí, ¿alguien fuma dentro del hogar?

Sí
No
I4

DESDE QUE ESTE(A) NIÑO(A) NACIÓ, ¿con qué
frecuencia ha sido muy difícil cubrir los gastos
básicos, como alimentos y vivienda, utilizando sus
ingresos familiares?
Nunca

En raras ocasiones
En algunas ocasiones
En muchas ocasiones

Más de una vez a la semana
I8

Una vez a la semana
Una vez al mes

¿Cuál de estas afirmaciones describe mejor la
capacidad de su hogar para poder costear los alimentos
que necesitaba DURANTE LOS ÚLTIMOS 12 MESES?

Una vez cada 2 a 5 meses

Siempre pudimos costear buenas comidas nutritivas.

Una vez cada 6 meses

Siempre pudimos costear lo suficiente para comer,
pero no siempre la clase de alimentos que debemos
comer.

Una vez durante los últimos 12 meses
A veces no pudimos costear lo suficiente para comer.
Nunca
Con frecuencia no pudimos costear lo suficiente para
comer.

No sé
I9
I5

DURANTE LOS ÚLTIMOS 12 MESES, aparte de en una
ducha o bañera ¿ha visto moho, hongos u otros signos
de daños por agua en las paredes u otras superficies
dentro de su casa?

a. ¿Ayuda en efectivo de un programa
de asistencia social del gobierno?

Sí

b. ¿Cupones para alimentos o
beneficios del Programa de
Asistencia Nutricional
Suplementaria (SNAP)?

No
I6

En algún momento, DURANTE LOS ÚLTIMOS 12
MESES, aunque fuera durante un mes, ¿algún miembro
de la familia recibió lo siguiente...
Sí
No

Cuando su familia enfrenta problemas, ¿con qué
frecuencia es probable que hagan lo siguiente?
Siempre

Casi
siempre

A veces

c. ¿Desayunos o almuerzos gratuitos
o de costo reducido en la escuela?
d. ¿Beneficios del Programa Especial
de Nutrición Suplementaria para
Mujeres, Infantes y Niños (WIC)?

Nunca

a. Hablar juntos
sobre qué hacer
b. Trabajar juntos
para resolver
nuestros problemas
c. Saber que
tenemos fuerzas
en donde
apoyarnos
d. Mantener la
esperanza aún en
tiempos difíciles

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I10 ¿En su vecindario hay...

I12 Además de usted o los demás adultos en su hogar,

Sí

a. ¿Aceras o paseos peatonales?
b. ¿Un parque o área de juegos?

Sí

c. ¿Un centro de recreación, centro
comunitario o club "boys and girls"?

d. ¿Una biblioteca o biblioteca
ambulante?

I13 Las siguientes preguntas son sobre eventos que

e. ¿Basura o desperdicios en las
calles o aceras?

f. ¿Hogares deteriorados o mal
conservados?
g. ¿Vandalismo, como ventanas
rotas o grafitis?

A su entender, ¿este(a) niño(a) experimentó ALGUNA
VEZ algunas de las siguientes situaciones?
Sí
No

I11 ¿En qué medida está de acuerdo con estas afirmaciones

a. Los padres o tutores se
divorciaron o separaron

sobre su vecindario o comunidad?
Definitivamente
de acuerdo

Algo de
acuerdo

Algo en Definitivamente
desacuerdo en desacuerdo

b. Los padres o tutores murieron

a. La gente de
este vecindario
se ayuda
mutuamente

c. Los padres o tutores estuvieron
en la cárcel

b. En este
vecindario
cuidamos
mutuamente
de nuestros(as)
hijos(as)

e. Fue víctima o testigo de violencia
en su vecindario

d. Vio u oyó a sus padres o adultos
abofetearse, golpearse, patearse
o pegarse en el hogar

f. Vivió con alguna persona que
tenía una enfermedad mental,
estaba suicida o tenía depresión
grave o severa
g. Vivió con alguna persona con
problemas de alcohol o drogas

c. Este(a) niño(a)
está seguro(a)
en nuestro
vecindario
d. Cuando
enfrentamos
dificultades,
sabemos a
donde acudir
para buscar
ayuda en
nuestra
comunidad

h. Fue tratado(a) o juzgado(a)
injustamente por su raza o
grupo étnico

e. Este(a) niño(a)
está seguro(a)
en la escuela

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J. Cuidador(es) de este(a)
niño(a)
➜

Grado 8 o menos

Grado 9 al 12; sin diploma
Completé secundaria o GED

¿Qué parentesco tiene con este(a) niño(a)?

Completé un programa de escuela vocacional,
comercial o de negocios

Padre o madre biológica o adoptiva

Algunos créditos universitarios, pero sin título

Padrastro o madrastra

Título asociado universitario (AA, AS)

Abuelo(a)

Título de licenciatura universitaria (BA, BS, AB)

Padre o madre de crianza a través del programa
Foster del gobierno

Título de maestría (MA, MS, MSW, MBA)
Título de doctorado (PhD, EdD) o título profesional
(MD, DDS, DVM, JD)

Otro(a): Pariente
Otro(a): No pariente

¿Cuál es el grado o nivel escolar más alto que usted ha
completado? Marque (X) sólo UNA opción.

¿Cuál es su estado civil?
Casado(a)

¿Cuál es su sexo?

No casado(a), pero vivo con una pareja

Masculino

Nunca me he casado

Femenino

Divorciado(a)
J3

¿Qué edad tiene?

Separado(a)
Viudo(a)

Edad en años

¿Dónde nació?

En general, ¿cómo está su salud física?

En los Estados Unidos ➔ PASE a la pregunta J6

Excelente

Fuera de los Estados Unidos

Muy buena
Buena

¿Cuándo vino a vivir a los Estados Unidos?

Regular

Año
Deficiente

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En general, ¿cómo está su salud mental o emocional?

J14 ¿Cuál es el sexo de este cuidador primario?

Excelente

Masculino

Muy buena

Femenino

Buena
J15 ¿Qué edad tiene este cuidador primario?

Regular
Edad en años

Deficiente
J10 ¿Tuvo trabajo por lo menos 50 semanas de las últimas

52 semanas?

J16 ¿Dónde nació este cuidador primario?

Sí

En los Estados Unidos ➔ PASE a la pregunta J18

Fuera de los Estados Unidos

J11 ¿Ha prestado usted alguna vez servicio militar activo

en las Fuerzas Armadas, la Reserva Militar, o la
Guardia Nacional de los Estados Unidos?
Marque (X) sólo UNA opción.

J17 ¿Cuándo vino este cuidador primario a vivir a los

Estados Unidos?
Año

Nunca estuvo en el servicio
militar ➔ PASE a la pregunta J13
Servicio activo solamente para
entrenamiento de la Reserva Militar o la
Guardia Nacional l ➔ PASE a la pregunta J13

J18 ¿Cuál es el grado o nivel escolar más alto que este

cuidador primario ha completado?
Marque (X) SÓLO una opción.

En servicio activo ahora
En servicio activo en el pasado, pero no ahora

Grado 8 o menos
Grado 9 al 12; sin diploma

J12 ¿Fue mobilizado(a) en algún momento durante la vida

de este(a) niño(a)?
Completó secundaria o GED
Sí
Completó un programa de escuela vocacional,
comercial o de negocios

➜

Algunos créditos universitarios, pero sin título

Las preguntas J13 a la J24 tratan sobre otro cuidador
primario adulto que puede estar viviendo en este hogar
además de usted.

Título asociado universitario (AA, AS)
Título de licenciatura universitaria (BA, BS, AB)

J13 ¿Qué parentesco tiene este cuidador primario adulto

que vive en este hogar con este(a) niño(a)?

Título de maestría (MA, MS, MSW, MBA)

Sólo hay un cuidador primario en este hogar
para este(a) niño(a) ➔ PASE a la pregunta K1 en
la página 22.

Título de doctorado (PhD, EdD) o título profesional
(MD, DDS, DVM, JD)

Padre o madre biológica o adoptiva
Padrastro o madrastra
Abuelo(a)
Padre o madre de crianza a través del programa
Foster del gobierno
Otro(a): Pariente
Otro(a): No pariente

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J19 ¿Cuál es el estado civil de este cuidador primario?

J23 Este cuidador primario, ¿ha prestado alguna vez

servicio militar activo en las Fuerzas Armadas, la
Reserva Militar, o la Guardia Nacional de los Estados
Unidos? Marque (X) sólo UNA opción.

Casado(a)
No casado(a), pero vive con una pareja

Nunca estuvo en el servicio
militar ➔ PASE a la pregunta K1

Nunca se ha casado
Divorciado(a)

Servicio activo solamente para entrenamiento
de la Reserva Militar o la Guardia Nacional ➔ PASE
a la pregunta K1

Separado(a)

En servicio activo ahora

Viudo(a)

En servicio activo en el pasado, pero no ahora

J20 En general, ¿cómo está la salud física de este cuidador

primario?

J24 ¿Fue este cuidador primario mobilizado en algún

momento durante la vida de este(a) niño(a)?

Excelente

Sí

Muy buena

Buena
Regular

K. Información del Hogar

Deficiente

J21 En general, ¿cómo está la salud mental o emocional

de este cuidador primario?
Excelente
Muy buena

Buena
Cantidad de personas
Regular
Deficiente

J22 ¿Tuvo trabajo este cuidador primario por lo menos

50 semanas de las últimas 52 semanas?

Sí
Cantidad de personas

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a. Jornales, sueldos o salarios, comisiones, bonos
o propinas de todos los empleos
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

.00

CANTIDAD TOTAL
en el último año calendario

b. Ingreso de empleo por cuenta propia en su
negocio no agrícola o finca comercial, ya sea
como propietario único o en sociedad
Sí ➔

.00

Pérdida

CANTIDAD TOTAL
en el último año calendario

c. Intereses, dividendos, ingreso neto por rentas,
ingreso por derechos de autor, o ingreso por
herencias y fideicomisos
Sí ➔

.00

Pérdida

CANTIDAD TOTAL
en el último año calendario

d. Seguro social o retiro para personal de
ferrocarriles; pensión por retiro, pensión para
viudos(as) y dependientes de fallecidos; o
pensión para incapacidad
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

e. Seguridad de Ingreso Suplementario (Supplemental
Security Income, SSI); cualquier asistencia pública
o pagos de asistencia social del estado o la oficina
de asistencia social local
Sí ➔

.00

CANTIDAD TOTAL
en el último año calendario

.00

CANTIDAD TOTAL
en el último año calendario

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Attachment F – Infographic

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