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[p.224]

Section P -- Child Health

Section P1 -- Introduction

The next questions will be used to study the health of the Nation's children. (It would be best if I could ask these questions in private.)
Arrange to conduct supplement in private if possible.
If more than one child in family read: The only child I will ask the rest of my question about is--.

Ask or very for each HH member.
1. How is (Name on HIS-1) related to --?
If parent, ask: Is (Name of parent) -- biological (natural), adoptive, step, or foster (mother/father)?
If brother/sister, ask: Is (Name of sibling) -- full, half, adoptive, step or foster (brother/sister)?
Enter "sample child" on appropriate line.
Enter "unrelated" for persons not related to the sample child.

[option for 10 entries in the original document not presented here]

1. Person number on HIS-1
Relationship to sample child ____
Check Item 1
Mark first appropriate box.

1[] Biological or adoptive mother in hhld (Check Item 2)
2[] Biological father or step or foster mother in hhld. (Check item 2)
3[] One adult relative in hhld. (Check Item 2)
4[] 2+ adult relatives in hhld. (2)
5[] No eligible respondent in household (Cover Page)

2a. Which family member knows the most about the health related matters of --? ____

b. Is (person named in 2a) available?

1[] Yes (Section P2)
2[] No (Arrange callback, then Cover Page)

Check Item 2
Mark first appropriate box.

1[] Person in Check Item 1 available (Section P2)
2[] Person in Check Item 1 not available (arrange callback, then Cover Page)
[p.225]

Section P2 -- Child Care

Check Item 3
Mark box and enter person number of respondent.

1[] Same as respondent in Section P1
Person number (Check Item 4) ____
2[] New respondent
Person number (Intro) ____

These questions will be used to study the health of the Nation's children. (It would be best if I could ask these questions in private.) I will be asking you about --.
Arrange to conduct supplement in private if possible.

Check Item 4
Refer to age of sample child.

1[] Under 2 years old (Check Item 5)
2[] 2 or 3 years old (2)
3[] 4 or 5 years old (1)
4[] 6+ years old (Section P3, page 91)

1a. Is --currently attending either kindergarten or first grade?

1[] Yes, kindergarten
2[] Yes, first grade
3[] No (2)


b. At what time of day does the (kindergarten/first grade) start?

____
1[] a.m
2[] p.m


3[] noon
4[] DK


c. At what time does the (kindergarten/first grade) end?

____
1[] a.m
2[] p.m


3[] noon
4[] DK


If in first grade, go to 3
d. Does the kindergarten have a day care or extended day program that -- also takes part in?

1[] Yes
2[] No (Check Item 5)
9[] DK (Check Item 5)


e. How many hours per week does -- spend in this program?

Hours ____ (check item 5)
99[] DK (check item 5)


2a. During the past four weeks has -- attended nursery or preschool?

1[] Yes, Nursery
2[] Yes, Preschool
3[] No (Check Item 5)


b. Did the (nursery school/preschool) have a day care or extended day program that -- also took part in?

1[] Yes
2[] No


c. How many hours per week did -- spend in the (nursery school/preschool (with day care))?

Hours per week ____
99[] DK


Check Item 5
Refer to Check Item 1.
Mark first appropriate box.

1[] Biological mother respondent (3a)
2[] Biological/adoptive/step or foster mother in hhld., NOT respondent (3d)
8[] Other (3a)

3a. Have you worked at a job or business for pay in the last four weeks?

1[] Yes
2[] No (4)


b. How many hours a week do you usually work?

Hours per week ____
999[] DK


Mark box or ask:
c. Do you only work while -- is in (school level in 1a or 2a) or do you work during other hours?

0[] Child under 2 or "No" or blank in 1a and "No" in 2a (5b)
1[] Only while child is in school (4)
8[] Other hours (5b)


d. Has --'s (mother) worked at a job or business for pay in the last 4 weeks?

1[] Yes
2[] No (4)


e. How many hours a week did she work?

Hours per week ____
999[] DK


Mark box or ask:
f. Does she work only while -- is in (school level in 1a or 2a) or does she work other hours?

0[] "No" or blank in 1a AND "No" in 2a (5b)
1[] Only while child is in school (4)
8[] Other hours (5b)

[p. 226]

Section P2 -- Child Care -- Continued


4. (Other than (nursery school/preschool)), In the past four weeks, has -- been cared for in any kind of regular child care arrangement such as a day care center, playgroup, by a babysitter, relative, or some other regular arrangement?

1[] Yes
2[] No (Check item 6)


Hand Card P1, read list if telephone interview.

Card P1

01.Day care center
02. Babysitter in child's home
03. In babysitter's home
04. Father cares for child
05. Mother cares for child while working at home
06. Mother cares for child while working outside of home
07. Child cares for self
08. Other relative cares for child
09. Day camp
88. Other (Specify)

5a. How was -- usually cared for during the hours that child care was used?
Mark only one box.

01[] Day care center (5e)
02[] Babysitter in child's home (5e)
03[] In babysitter's home (5e)
04[] Father cares for child (5e)
05[] Mother cares for child while working at home (5e)
06[] Mother cares for child while working outside of home (5e)
07[] Child cares for self (5e)
08[] Other relative cares for child (5c)
09[] Day camp (5e)
88[] Other -- Specify ____ (5e)


Hand Card P1, read list if telephone interview.

Card P1

01.Day care center
02. Babysitter in child's home
03. In babysitter's home
04. Father cares for child
05. Mother cares for child while working at home
06. Mother cares for child while working outside of home
07. Child cares for self
08. Other relative cares for child
09. Day camp
88. Other (Specify)

b. (Other than (kindergarten/first grade/nursery school/preschool)) How was -- usually cared for while you worked?
Mark only one box.

01[] Day care center (5e)
02[] Babysitter in child's home (5e)
03[] In babysitter's home (5e)
04[] Father cares for child (5e)
05[] Mother cares for child while working at home (5e)
06[] Mother cares for child while working outside of home (5e)
07[] Child cares for self (5e)
08[] Other relative cares for child (5c)
09[] Day camp (5e)
88[] Other -- Specify ____ (5e)


c. How is this person related to --?

1[] Sibling
2[] Grandparent
8[] Other relative
9[] DK


d. Where does this person usually care for --, in (sample child) home or somewhere else?

1[] At home
2[] Somewhere else


e. About how many hours per week was -- usually cared for [by/at] (arrangement)?

Hours per week ____
99[] DK


6a. Besides (nursery or preschool (and)/(child care arrangements in 5a/b)), during the past four weeks, has -- been cared for in any other regular child care arrangement?

1[] Yes
2[] No (Check Item 6)


Hand Card P1, read list if telephone interview.

Card P1

01.Day care center
02. Babysitter in child's home
03. In babysitter's home
04. Father cares for child
05. Mother cares for child while working at home
06. Mother cares for child while working outside of home
07. Child cares for self
08. Other relative cares for child
09. Day camp
88. Other (Specify)

b. Other than (nursery or preschool (and) (child care arrangement in 5a/b)), how was -- usually cared for during most of the other hours that child care was used?
Mark only one box.

01[] Day care center (6e)
02[] Babysitter in child's home (6e)
03[] In babysitter's home (6e)
04[] Father cares for child (6e)
05[] Mother cares for child while working at home (6e)
06[] Mother cares for child while working outside of home (6e)
07[] Child cares for self (6e)
08[] Other relative cares for child (6c)
09[] Day camp (6e)
88[] Other -- Specify ____ (6e)


c. How is this person related to --?

1[] Sibling
2[] Grandparent
8[] Other relative
9[] DK


d. Where does this person usually care for --, in (sample child) home or somewhere else?

1[] At home
2[] Somewhere else


e. About how many hours per week was -- usually cared for [by/at] (arrangement)?

Hours per week ____
99[] DK


7a. Were any other child care arrangements used on a regular basis?

1[] Yes
2[] No (Check Item 6)


b. How many additional hours a week was child care used?

Hours per week ____
99[] DK

[p.227]

Section P2 -- Child Care -- Continued


Check Item 6
Refer to id[Says id but probably supposed to say 1d], 2a, 5a/5b, 6b.

1[] No blank in 1d and No in 2a and blank in 5a/5b (11) (No nursery school or child care)
2[] Box 4, 5, 6, or 7 in 5a/5b and blank or box 4, 5, 6, or 7 in 6b (13) (Mother, Father, self care only)
8[] Other (8)

8. Now I would like to ask you about ("Main" child care arrangement).
Including --, how many children are usually cared for together, in the same group, at the same time? Do not include children in the entire school or program.

Children ____
99[] DK


9. How many adults usually supervise the children in the same group as --?

Adults ____
99[] DK


10. Has the main person responsible for caring for -- received education or training specifically related to young children, such as early childhood or elementary education, or child psychology?

1[] Yes (13)
2[] No (13)
9[] DK (13)


11. Was -- ever cared for in any regular child care arrangement?

1[] Yes
2[] No (Section P3, page 91)


12. When did -- last receive care in a regular child care arrangement?

1[] Within last 12 months
2[] Prior to last 12 months (15)


13. How many times has -- main child care arrangement changed in the past year?

000[] None (15)
Times ____


Hand Card P2, read list if telephone interview.

Card P2

01. Nursery school or preschool
02. Nursery school or preschool with day care
03. Day care center
04. Babysitter in child's home
05. In babysitter's home
06. Father cares for child
07. Mother cares for child while working at home
08. Mother cares for child while working outside of home
09. Summer day camp
10. Child cares for self
11. Other relative cares for child
88. Other (Specify)

14a. What was the last type of care used before -- changed to the type of care [he/she] is using now?
Mark only one box.

01[] Nursery school or preschool (14d)
02[] Nursery school or preschool with day care (14d)
03[] Day care center (14d)
04[] Babysitter in child's home (14d)
05[] In babysitter's home (14d)
06[] Father cares for child (14d)
07[] Mother cares for child while working at home (14d)
08[] Mother cares for child while working outside of home (14d)
09[] Summer day camp (14d)
10[] Child cares for self (14d)
11[] Other relative cares for child (14b)
88[] Other -- Specify ____ (14d)
99[] DK (15)


b. How is this person related to --?

1[] Sibling
2[] Grandparent
8[] Other relative
9[] DK


c. Where did this person usually care for --, in (sample child) home or somewhere else?

1[] At home
2[] Somewhere else


d. About how many hours per week was -- usually cared for [by/at] (arrangement)?

Hours per week ____
99[] DK

[p.228]

Section P2 -- Child Care -- Continued


15. How old was --when regular child care was begun?

000[] Less than 1 month
Age ____
1[] Months ____
2[] Years ____
999[] DK


Hand Card P2, read list if telephone interview

Card P2

01. Nursery school or preschool
02. Nursery school or preschool with day care
03. Day care center
04. Babysitter in child's home
05. In babysitter's home
06. Father cares for child
07. Mother cares for child while working at home
08. Mother cares for child while working outside of home
09. Summer day camp
10. Child cares for self
11. Other relative cares for child
88. Other (Specify)

16a. What type of child care arrangement was first used for --?
Mark only one box.

01[] Nursery school or preschool (16d)
02[] Nursery school or preschool with day care (16d)
03[] Day care center (16d)
04[] Babysitter in child's home (16d)
05[] In babysitter's home (16d)
06[] Father cares for child (16d)
07[] Mother cares for child while working at home (16d)
08[] Mother cares for child while working outside of home (16d)
09[] Summer day camp (16d)
10[] Child cares for self (16d)
11[] Other relative cares for child (16b)
88[] Other -- Specify ____ (16d)
99[] DK (Section P3)


b. How is this person related to --?

1[] Sibling
2[] Grandparent
8[] Other relative
9[] DK


c. Where did this person usually care for --, in (sample child) home or somewhere else?

1[] At home
2[] Somewhere else


d. About how many hours per week was -- usually cared for [by/at] (arrangement)?

Hours per week ____
99[] DK

[p. 229]

Section P3 -- Relationships and Mobility


These next few questions are about -- (biological mother).
1. How old was --'s (biological mother) when [he/she] was born?

Age ____
88[] Respondent knows nothing about biological mother (Check Item 7)
99[] DK


2. Including --, how many children has [his/her] (biological mother) ever had? Do not count miscarriages or stillbirths.

01[] One/sample child only (Check item 7)
Number ____
99[] DK


3. Was -- the first born (or) second born (or third, etc.)?

1[] First (Check Item 7)
2[] Second
3[] Third
4[] Fourth
5[] Fifth
6[] Sixth or Later
9[] DK (Check Item 7)


4. How old was -- (biological mother) when the first child was born?

Age ____
99[] DK


Check Item 7
Refer to Q. 1, page 86.

1[] Biological mother in hhld. (8)
8[] Other (5)

5a. Has -- ever lived with [his/her] biological mother for at least 4 consecutive months?

1[] Yes
2[] No (6)
3[]DK (6)


b. In what month and year did -- last live with her?

Month ____
Year 19____
9999[] DK


6. Is she now living or deceased?

1[] Living
2[] Deceased (check item 11)
9[] DK (check item 11)


7. How often does -- see her?

01[] Everyday
02[] Almost every day
03[] Several times a week
04[] About once a week
05[] Two or three times a month
06[] About once a month
07[] Several times a year
08[] Once a year or less
00[] Never
99[] DK


8. Is --'s (biological mother) now married, widowed, divorced, separated, or has -- (biological mother) never been married?

1[] Married
2[] Widowed
3[] Divorced
4[] Separated
0[] Never married (Check Item 11)
9[] DK (Check Item 11)


9. How many times altogether has --'s (biological mother) been married?

Times ____
9[] DK

[p.230]

Section P3 -- Relationships and Mobility -- Continued


Check Item 8
Refer to Q. 1, page 86 and Q. 8, page 91.

1[] Biological mother and biological father in household, and now married to each other (10b)
8[] Other (10a)

10a. Was -- (biological mother) ever married to [his/her] (biological father)?

1[] Yes (10b)
2[] No (Check Item 10)
9[] DK (Check Item 11)


b. In what month and year was --'s (biological mother) married to [his/her] (biological father)?

Month ____
Year 19____
9999[] DK


Check Item 9
Refer to 8 and 9.

1[] Married only once and now married (Check Item 11)
2[] Married only once and now separated or divorced (11b)
3[] Married only once and now widowed (11c)
4[] Married more than once and marriage to child's father is current marriage (Check Item 11)
8[] Other (11)

11a. Was -- (biological mother) marriage to (biological father) ended by death, divorce, separation, or annulment?

1[] Separation
2[] Divorce
3[] Death (11c)
4[] Annulment
9[] DK (Check Item 11)


b. In what month and year did --'s (biological mother) stop living with [his/her](biological father)?

Month ____
Year 19____
9999[] DK


If biological mother now separated, go to Check Item 11.
c. In what month and year did the marriage to --'s (biological father) (legally) end?

Month ____
Year 19____
9999[] DK


Check Item 10
Refer to 8.

1[] Biological mother now widowed, divorced, separated, never married, or don't know (Check Item 11)
2[] Biological mother now married to someone other than biological father (12)

12. In what month and year did --'s (biological mother) current marriage begin?

Month ____
Year 19____
9999[] DK

[p.231]

Section P3 -- Relationships and Mobility -- Continued


Check Item 11
Refer to Q. 1, page 86.

1[] Biological father in household (16)
8[] Other (13)

These next few questions are about --'s (biological father).
13a. Has -- ever lived with [his/her] biological father for at least 4 consecutive months?

0[] Respondent knows nothing about father (16)
1[] Yes
2[] No (16)
9[] DK (16)


b. In what month and year did -- last live with him?

Month ____
Year 19____
9999[] DK


14. Is he now living or deceased?

1[] Living
2[] Deceased (16)
9[] DK (16)


15. How often does -- see him?

01[] Everyday
02[] Almost every day
03[] Several times a week
04[] About once a week
05[] Two or three times a month
06[] About once a month
07[] Several times a year
08[]Once a year or less
00[] Never
99[] DK


16. In what month and year did (sample child) move to this address or has -- lived here since birth?

0000[] Lived here since birth (Check item 12)
Month ____
Year 19____
9999[] DK


17. About how far from here is the home (sample child) lived in before -- moved to this home -- less than a mile, 1 to 50 miles, or more than 50 miles?

1[] Less than 1 mile
2[] 1--50 miles
3[] 50+ miles
9[] DK


18. Altogether, how many times has -- ever moved?

Times ____
99[] DK


Check Item 12

1[] Respondent is biological mother or biological father (Section P3)
8[] Other (19)

19. In what month and year did -- begin living with you?

0000[] Since birth
Month ____
Year 19____
8888[] Does not live with respondent
9999[] DK

[p.232]

Section P4 -- Birth


1a. Was -- born in a hospital or some other place?

1[] Hospital (1b)
2[] Birthing center (1b)
3[] Home (2)
4[] In transit to hospital (1b)
8[] Other -- Specify ____ (2)
9[] DK


b. How many nights was --'s (biological mother) in the (hospital/birthing center) during this stay?

00[] None
Nights ____
99[] DK


c. How many nights was -- in the (hospital/birthing center) during this stay?

00[] None
Nights ____
99[] DK


2a. How much did -- weigh at birth?
Probe for ounces if not reported.

Lbs ____ (3)
Oz ____ (3)
9999[] DK


b. Did -- weigh more than 5 1/2 or less?

[] More than 5 1/2 lbs.
1[] Less than 5 1/2 lbs. (3)
7[] DK (3)

c. Did weigh -- more than 9 pounds or less?

2[] More than 9 lbs.
3[] Less than 9 lbs.
8[] DK


3a. How many months pregnant was --'s (biological mother) when -- was born?

Months ____
99[] DK


b. Was -- born about when expected, or was it earlier or later?

1[] Earlier than expected
2[] When expected (Check item 13)
3[] Later than expected
9[] DK (Check item 13)


c. About how many weeks (earlier/later) than expected was -- born?

00[] Less than one week
Weeks ____
99[] DK


Check Item 13

1[] Under 6 years old and biological mother respondent (4)
8[] Other (Section P5, page 96)

4. How many weeks pregnant were you when you first thought you were pregnant with --?

Weeks ____
99[] DK


5a. Did you see or talk to a doctor to find out if you were pregnant?

1[] Yes
2[] No (5c)


b. About how many weeks pregnant were you when you first found out from a doctor that you were pregnant?

1[] 4 weeks or less
2[] 5-13 weeks
3[] 14-27 weeks
4[] 28 weeks or more
9[] DK


c. Did you see or talk to a doctor about your pregnancy at any (other) time during that pregnancy?

1[] Yes
2[] No (6)


If "Yes" in 5a, go to 6
d. How many weeks or months pregnant were you when you first saw a doctor about your pregnancy?

1[] 4 weeks or less
2[] 5-13 weeks
3[] 14-27 weeks
4[] 28 weeks or more
9[] DK


6. Altogether, how many pounds did you either gain or lose during that pregnancy?

____
pounds
1[] Gained
2[] Lost


7a. Did -- receive any newborn care in an intensive care unit, premature nursery, or any other type of special care unit?

1[] Yes
2[] No (8)


b. How many nights did -- stay in the special care unit?

00[] None
Nights ____

[p.233]

Section P4 -- Birth -- Continued


8. Do you now have diabetes or sugar diabetes?

1[] Yes
2[] No
9[] DK


9a. At any time during your pregnancy with --, did you have --


1[] Sugar in the urine?
1[] Yes (9b and c)
2[] No (Next column)


2[] High sugar in the blood?
1[] yes (9b and c)
2[] no (next column)


3[] Diabetes?
1[] Yes (9b and c)
2[] No (Section P5)


b. When did you first notice it -- was it during your pregnancy with -- or before?


1[] Sugar in the urine?
1[] During
2[] Before


2[] High sugar in the blood?
1[] During
2[] Before


3[] Diabetes?
1[] During
2[] Before


Mark box or ask:
c. Did you have the (condition) for at least 3 months after -- was born?


1[] Sugar in the urine?
0[] Child und. 3 mon
1[] Yes (9a)
2[] No (9a)


2[] High sugar in the blood?
0[] Child und. 3 mon
1[] Yes (9a)
2[] No (9a)


3[] Diabetes?
0[] Child und. 3 mon
1[] Yes
2[] No

[p. 234]

Section P5 -- Childhood Conditions

1a. During the past 12 months, did --'s have an accident, injury, or poisoning that required medical attention?

1[] Yes
2[] No (2)
9[] DK (2)

b. How many accidents, injuries, or poisonings did -- have in the last 12 months that required medical attention?

Number ____

c. (Beginning with the most recent,) what caused the accident, injury, or poisoning?
For example, was -- hit by a car while riding a bike, or burned by hot liquid or did -- swallow an object or pills?
Enter each in a separate column.

Group A (Brief Description)
1[] ________

Hand Card P3, read list if telephone interview.

Card P3

01. Broken or dislocated bones
02. Sprain, strain or pulled muscle
03. Cuts, scrapes, or puncture wounds
04. Head injury, concussion
05. Bruise, contusion, or internal bleeding
06. Burn, scald
07. Poisoning from chemicals, medicines, drugs
08. Respiratory problem, such as breathing, cough, pneumonia
88. Other
99. Don't know type of condition
00. None

d. Which of the conditions on this list or any other conditions resulted from the (entry in 1c)?
Mark all that apply and ask 1e.

01[] Broken or dislocated bones
02[] Sprain, strain, or pulled muscle
03[] Cuts, scrapes, or puncture wounds
04[] Head injury, concussion
05[] Bruise, contusion, or internal bleeding
06[] Burn, scald
07[] Poisoning from chemicals, medicines, drugs
08[] Respiratory problem such as breathing, cough, pneumonia
88[] Other
99[] Don't know type of condition (1f)
00[] None (1f)

e. Were there any other conditions that resulted from this accident, injury or poisoning?
Mark any additional conditions

[] Yes (Reask 1d, then 1f)
[] No

f. Where did this accident or injury or poisoning happen?
Do not read categories
Mark only one box.

1[] Home (not necessarily child's)
2[] Day care location (preschool/nursery)
3[] School (including grounds and athletic areas)
4[] Street or highway
5[] Public building or space (other than street or school)
6[] Farm or agricultural area, except farm home
7[] Place of recreation or sports, except at school
8[] Other
9[] Don't know

g. In what month and year did the accident, injury, or poisoning occur?
List each accident, injury, or poisoning which resulted in at least one condition (Codes 01--88) on a condition page as group A and a short name for the accident, injury, or poisoning from 1c. Then go to 1c in next column or question 2.

Month ____
Year 19____
9999[] DK

2. Does -- now have --
a. a missing finger, hand, arm, toe, foot, or leg?
If "Yes," ask: Which is it?
Is --missing [1 or both/more than one] (body part)?
(Enter on a Condition page, Group J)

1[] Yes (Ask probe questions)
2[] No
9[] DK

b. permanent impairment, stiffness or any deformity of the back, foot, or leg?
If "Yes," ask: Which is it?
Is [1 or both/more than one] (body part) affected?
(Enter on a Condition page, Group J)

1[] Yes (Ask probe questions)
2[] No
9[] DK

c. permanent impairment, stiffness or any deformity of the fingers, hand, or arm?
If "Yes," ask: Which is it?
Is [1 or both/more than one] (body part) affected?
(Enter on a Condition page, Group J)

1[] Yes (Ask probe questions)
2[] No
9[] DK

[p. 235-236]

Section P5 -- Childhood Conditions -- Continued


The next questions are about other health conditions -- may have ever had.

3. Did -- ever have
Group B

[] Repeated tonsillitis or enlargement of the tonsils or adenoids?
1[] Yes
2[] No/DK
[] Frequent or repeated ear infections?
1[] Yes
2[] No/DK
[]Any kind of food or digestive allergy?
1[] Yes
2[] No/DK
[] Frequent or repeated diarrhea or colitis?
1[] Yes
2[] No/DK
[] Any other persistent bowel trouble?
Specify ____
1[] Yes
2[] No/DK
[] Diabetes?

1[] Yes
2[] No/DK
[] Sickle cell anemia?
1[] Yes
2[] No/DK
[] Anemia?
1[] Yes
2[] No/DK

[] Asthma?
1[] Yes
2[] No/DK

Group C

[] Mononucleosis?

1[] Yes
2[] No/DK
[] Hepatitis?
1[] Yes
2[] No/DK
[] Meningitis or spinal meningitis?
1[] Yes
2[] No/DK
[] Bladder Infection or urinary tract infection?
1[] Yes
2[] No/DK
[] Rheumatic fever?
1[] Yes
2[] No/DK
[] Pneumonia?
1[] Yes
2[] No/DK
Group D
[] Hay fever?

1[] Yes
2[] No/DK
[] Any (other) kind of respiratory allergy?

1[] Yes
2[] No/DK

Group E
[] Deafness or trouble hearing with one or both ears?
If "Yes," ask: Is it one or both ears?
1[] Yes, one ear
2[] Yes, both ears
9[] No/DK

[] Blindness in one or both eyes?
If "Yes," ask: Is it one or both eyes?
1[] Yes, one eye
2[] Yes, both eyes
9[] No/DK
[] Crossed eyes?
1[] Yes
2[] No/DK
[] Any other trouble seeing with one or both eyes, even when wearing glasses?
Specify ____
1[] Yes
2[] No/DK
Group F
[] Eczema or any kind of skin allergy?
1[] Yes
2[] No/DK
Group G
[] Epilepsy or repeated convulsions or seizures not associated with fever?
1[] Yes
2[] No/DK
[] Seizures associated with fever?

1[] Yes
2[] No/DK
[] Frequent or severe headaches, including migraines?
1[] Yes
2[] No/DK

Child under 3, go to group I
Group H

[] Stammering or stuttering?
1[] Yes
2[] No/DK
[] Any other speech defect?
Specify ____
1[] Yes
2[] No/DK

Child under 6, go to Group I

[] Enuresis or bedwetting problem?
1[] Yes
2[] No/DK
Group I
[] Arthritis or any other joint disease or joint problem?
Specify ____
1[] Yes
2[] No/DK
[] Any other condition affecting the bone, cartilage, muscle, or tendon?
Specify ____
1[] Yes
2[] No/DK


[] Cerebral palsy?
1[] Yes
2[] No/DK

[] Congenital heart disease?
1[] Yes
2[] No/DK
[] Any other heart disease or condition?

Specify ____
1[] Yes
2[] No/DK
[] Any other condition that required surgery in past 12 months?
Specify ____
1[] Yes (enter on Cond. Page)
2[] No/DK
[] Any other condition that lasted three months or more?
List below and reask.
[] Yes
a[] ____
b[] ____
c[] ____
9[] No/DK

Ask if Yes in 3.
4a. Did -- have (condition) in the last 12 months?
Group B

[] Repeated tonsillitis or enlargement of the tonsils or adenoids?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Frequent or repeated ear infections?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any kind of food or digestive allergy?
[] Yes (4b)
[] No/DK (Next Yes)
[] Frequent or repeated diarrhea or colitis?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any other persistent bowel trouble?
Specify ____
[] Yes (4b)
[] No/DK (Next Yes)
[] Diabetes
[] Yes (4b)
[] No/DK (Next Yes)
[] Sickle cell anemia?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Anemia?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Asthma?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
Group C
[] Mononucleosis?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Hepatitis?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Meningitis or spinal meningitis?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Bladder infection or urinary tract infection?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Rheumatic fever?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Pneumonia?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
Group D
[] Hay fever?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any (other) kind of respiratory allergy?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
Group E
[] Deafness or trouble hearing with one or both ears?
[] Yes (4b)
[] No/DK (Next Yes)
[] Blindness in one or both eyes?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Crossed eyes?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any other trouble seeing with one or both eyes, even when wearing glasses?
Specify ____
[] Yes (4b)
[] No/DK (Next Yes)
Group F
[] Eczema or any kind of skin allergy?
[] Yes (4b)
[] No/DK (Next Yes)
Group G
[] Epilepsy or repeated convulsions or seizures not associated with fever?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Seizures associated with fever?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Frequent or severe headaches, including migraines?
[] Yes (4b)
[] No/DK (Next Yes)

Child under 3, go to Group I
Group H

[] Stammering or stuttering?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any other speech defect?
Specify ____
[] Yes (4b)
[] No/DK (Next Yes)

Child under 6, go to Group I

[] Enuresis or bedwetting problem?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
Group I
[] Arthritis or any other joint disease or joint problem?
Specify ____
[] Yes (4b)
[] No/DK (Next Yes)
[] Any other condition affecting the bone, cartilage, muscle, or tendon?
Specify ____
[] Yes (4b)
[] No/DK (Next Yes)
[] Cerebral palsy?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Congenital heart disease?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any other heart disease or condition? --
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any other condition that lasted three months or more?
List below and reask.
a[] ____
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
b[] ____
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
c[] ____
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)

4b. Has -- had (condition) for at least 3 months in [his/her] lifetime?
Group B

[] Any kind of food or digestive allergy?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any other persistent bowel trouble?
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Diabetes?
[] Yes (Enter on Cond. Page)
[] No/DK (4c)
Group E
[] Deafness or trouble hearing with one or both ears?
[] Yes (Enter on Cond. Page)
[] No/DK (4c)
[] Any other trouble seeing with one or both eyes, even when wearing glasses?
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (4c)
Group F
[] Eczema or any kind of skin allergy?
[] Yes (Enter on Cond Page)
[] No/DK (Next Yes)
Group G
[] Frequent or severe headaches, including migraines?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
Group H
[] Any other speech defect?
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (4c)
Group I
[] Arthritis or any other joint disease or joint problem?
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (4c)
[] Any other condition affecting the bone, cartilage, muscle, or tendon?
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (4c)

Mark without asking
4c. Is it an obviously permanent condition that began less than 3 months ago?
Group B

[] Diabetes?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
Group E
[] Deafness or trouble hearing with one or both ears?
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any other trouble seeing with one or both eyes, even when wearing glasses?
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
Group H
[] Any other speech defect?
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
Group I
[] Arthritis or any other joint disease or joint problem?
Specify ____
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Any other condition affecting the bone, cartilage, muscle, or tendon?
Specify ____
[] Yes (Enter on Cond Page)
[] No/DK (Next Yes)

[p.237]

Section P6 -- Supplemental Condition Page

Check Item 14
[] No conditions reported (Section P7, page 104).
Enter condition/AIP name and group letter:
Condition 1

Group/AIP: ____
Group letter ____

The next questions are about -- (condition/AIP).
1. How old was -- when (condition/AIP) (happened/was first noticed)?

000[] Less than 1 month

Age ____
3[] Months
2[] Years
999[] DK
Check Item 15
Refer to Check Item 14

1[] Group E (4)
2[] Group F or H (5)
8[] All others (2)

If not known, ask:
2a. (Including nursery or preschool) Did -- attend school at all during the past 12 months?

1[] Yes
2[] No (3)

b. During the past 12 months, did -- (condition/AIP) cause [him/her] to miss any time from school?

1[] Yes
2[] No (3)
9[] DK (3)

c. How many days in the past 12 months did -- miss all or part of the day?

Days ____
999[] DK

3a. During the past 12 months, did -- (condition/AIP) cause [him/her] to stay in bed more than half of the day?

1[] Yes
2[] No (3c)
9[] DK (3c)

b. How many days in the past 12 months did -- stay in bed more than half of the day?

Days ____
999[] DK

c. During the past 12 months, did -- (condition/AIP) limit or prevent --form doing usual childhood activities, such as playing with other children or participating in games or sports?

1[] Yes
2[] No
9[] DK

4. During the past 12 months, about how many nights did -- spend in the hospital because of (condition/AIP)?

000[] None
Number of nights ____
999[] DK

5. During the past 12 months, about how many times did [--/anyone] see or talk to a medical doctor or assistant about this (condition/AIP)? (Do not count doctors seen while an overnight patient in a hospital.)

000[] None
Number of doctor's visits ____
999[] DK

6. During the past 12 months, did this (condition/AIP) make it necessary for -- to use any medicine, other than vitamins, that a doctor prescribed or told -- to take?

1[] Yes
2[] No
9[] DK

Check Item 16
Refer to Check Item 14.

1[] Group D or F or H (8)
8[] All others (7)
7. During the past 12 months did -- have any surgery performed, including bone settings and stitches for this (condition/AIP)?

1[] Yes
2[] No
9[] DK

8a. In the last 12 months, how often did (this condition/the conditions resulting from the (AIP)) cause -- pain or discomfort or upset -- all of the time, often, once in a while, or never?

1[] All of the time
2[] Often
3[] Once in a while
4[] Never (Check Item 17)

b. When this condition did bother --, was [he/she] bothered a great deal, some, or very little?

1[] Great deal
2[]Some
3[] Very little

Check Item 17
Refer to Check Item 14.

1[] Group A or B or D or F (NC)
8[] Other (9)
[p.238]

Section P6 -- Supplemental Condition Page -- Continued

9a. Did the (condition) result from an accident, injury or poisoning?

1[] Yes
2[] No (NC)
9[] DK (NC)

b. Did this occur within the last 12 months?

1[] Yes
2[] No

c. Did you already tell me about this accident, injury or poisoning?

1[] Yes
2[] No (9e)

d. Which accident, injury, or poisoning was it?

Condition No. ____ (NC)

e. What kind of accident or injury or poisoning was it?

Brief description ________

Hand Card P3, read list if telephone interview.

Card P3

01. Broken or dislocated bones
02. Sprain, strain or pulled muscle
03. Cuts, scrapes, or puncture wounds
04. Head injury, concussion
05. Bruise, contusion, or internal bleeding
06. Burn, scald
07. Poisoning from chemicals, medicines, drugs
08. Respiratory problem, such as breathing, cough, pneumonia
88. Other
99. Don't know type of condition
00. None

f. Which of the conditions on this list or any other conditions resulted from the (entry in 9e). [This is a period, probably an error in the original survey.]
Mark all that apply in chart and ask 9g.

01[] Broken or dislocated bones
02[] Sprain, strain, or pulled muscle
03[] Cuts, scrapes, or puncture wounds
04[] Head injury, concussion
05[] Bruise, contrusion, or internal bleeding
06[] Burn, scald
07[] Poisoning from chemicals, medicines, drugs
08[] Respiratory problem, such as breathing, cough, pneumonia
88[] Other
99[] Don't know type of condition (9h)
00[] None (9h)

g. Were there any other conditions that resulted from this accident, injury or poisoning?
Mark any additional conditions.

[] Yes (Reask 9f, then 9h)
[] No

h. Where did this accident or injury or poisoning happen?
Do not read categories
Mark only one box.

1[] Home (not necessarily child's)
2[] Day care location (preschool/nursery)
3[] School (including grounds and athletic areas)
4[] Street or highway
5[] Public building or space (other than street or school)
6[] Farm or agricultural area, except farm home
7[] Place of recreation or sports, except at school
8[] Other
9[] Don't know

i. In what month and year did the accident, injury, or poisoning happen?

Month ____
Year 19____
9999[] DK

[p.239]

Section P7 -- General Health Status


Check Item 18
Refer to age of sample child.

1[] 3+ years old (1)
2[] Under 3 years old (3)


1. Does -- wear glasses or contact lenses?

1[] Yes
2[] No


2. About how long has it been since -- last saw someone for dental care?

1[] 6 Months ago or less
2[] Over 6 months to 12 months
3[] Over 12 months to 2 years
4[] Over 2 years to 5 years
5[] More than 5 years
0[] Never
9[] DK


3. When riding in a car, does -- wear a seat belt or restraint all or most of the time, some of the time, once in a while, or never?

1[] All/most of time
2[] Some of the time
3[] Once in a while
0[] Never
9[] DK

Check Item 19
Refer to age of sample child.

1[] Under 6 years old and biological mother is respondent (4)
8[] Other (6)

4a. Did you smoke cigarettes at all during the year before -- was born?

1[] Yes
2[] No (4e)


b. Did you continue to smoke during the entire pregnancy?

1[] Yes (4d)
2[] No


c. Did you stop during the first three months of the pregnancy or later?

1[] Before pregnancy
2[] 1st three months
3[] Later
9[] DK


d. About how many cigarettes a day did you usually smoke?

Number ____
99[] DK


e. Do you now smoke?

1[] Yes (5)
2[] No


f. How long ago did you stop?

_____
number
1[] Days
2[] Months
3[] Years


000[] Never smoked


5. During most of your pregnancy, would you say you were in contact with persons who smoked cigarettes such as friends, co-workers or family members -- occasionally, often, always or never?

1[] Occasionally
2[] Often
3[] Always
0[] Never
9[] DK


6a. Has anyone in your household smoked regularly since -- was born?

1[] Yes
2[] No (7)
9[] DK (7)


b. Is anyone in the household currently smoking cigarettes?

1[] Yes (7)
2[] No (6c)
9[] DK (7)


c. How long has it been since anyone in the household smoked cigarettes?

1[] During the last 12 months
2[] More than 12 months ago

[p. 240]

Section P7 -- General Health Status -- Continued


7. Please tell me whether each of the following statements about --'s health is mostly true or mostly false.


The first statement is: "(sample child) health is excellent." Has this been mostly true or mostly false?
(Record response and continue with statement b.)

a. --'s health is excellent
1[] Mostly true
2[] Mostly false


b. --'s seems to resist illness very well
1[] Mostly true
2[] Mostly false


c. --'s seems less healthy than other children I know
1[] Mostly true
2[] Mostly false


d. When there is something going around, --'s usually catches it
1[] Mostly true
2[] Mostly false


e. --'s is somewhat clumsy
1[] Mostly true
2[] Mostly false


f. --'s seems accident-prone
1[] Mostly true
2[] Mostly false


g. When --'s is sick or injured, [he/she] usually recovers quickly
1[] Mostly true
2[] Mostly false


8a. Has --'s ever been seriously ill?
1[] Mostly true
2[] Mostly false


b. Was -- ever so sick that you thought [he/she]might die?
1[] Mostly true
2[] Mostly false


Check Item 20
Refer to age of sample child.

1[] Under 1 year (10)
2[] 1+ years old (9)

9a. On weeknights (if 4+: during the school year), does -- usually go to bed at about the same time each night, or does [his/her] bedtime vary a lot from night to night?

1[] Has usual bedtime
2[] Bedtime varies (9c)


b. About what time does -- usually go to bed?
Round time to nearest quarter hour.

1[] am ____:____ (10)
2[] pm ____: ____ (10)
99999[] DK


c. What is the latest time that -- goes to bed on weekdays?
Round time to nearest quarter hour.

1[] am ____:____ (10)
2[] pm ____: ____ (10)
99999[] DK


10a. Does -- usually sleep in one room or in different rooms?

1[] One room
2[] Different rooms


b. Does -- usually sleep alone in a room or share a room?

1[] Alone (Seciton P8)
2[] Shares


c. Who usually sleeps in the room with --?
Mark all that apply.
Anyone else?

1[] Brother(s)
2[] Sister(s)
3[] Other child(ren)
4[] Father
5[] Mother
8[] Other adult(s)
9[] DK

[p.241]

Section P8 -- School

Check Item 21
Refer to age of sample child.

0[] Under 5 years old (Section P9)
1[] 5+ years old

1. Has -- ever attended school?

1[] Yes
2[] No (Section P9)


2. Is -- now either going to school or on vacation from school?

1[] Going to school
2[] On vacation from school
0[] Neither (5)


3. What grade (is -- in now?/will -- be in?)
If child is between grades, enter grade promoted to.

21[] Nursery school or preschool (Section P9)
22[] Kindergarten (Section P9)
Grade ____


4. Overall what kind of student would you say -- is now? Is -- one of the best in the class, above the middle, in the middle, below the middle, or near the bottom of the class?

1[] One of the best (6)
2[] Above the middle (6)
3[] In the middle (6)
4[] Below the middle (6)
5[] Near the bottom (6)


5a. Why did -- stop going to school?
Mark first applicable box.

0[] Never went -- health reasons (Section P9)
1[] Never went -- other reasons (Section P9)
2[] Graduated
3[] Health problem
4[] Dropped out
8[] Other -- Specify ____




b. How long ago did -- stop going to school?

1[] Less than 12 months
2[] 12 months -- less than 2 years (7)
3[] 2+ years (7)


6. During the past 12 months, that is, since (12 month date) a year ago, about how many days was -- absent from school because of illness?

00[] None
Days ____


7a. Has -- repeated any grades for any reasons?

1[] Yes
2[] No (8)


b. What grade or grades did -- repeat?

Grade(s) ____


c. Why did -- repeat the (grades in 7b) grade(s)?
Mark all that apply.

1[] Academic failure
2[] Immature/acted too young
3[] Frequently absent
4[] Moved into more difficult school
8[] Other -- Specify____
9[] DK

d. Any other reasons?

[] Yes (Reask 7c and d)
[] No


8a. Has -- ever been suspended, excluded, or expelled from school?

1[] Yes
2[] No (9)


b. How many times has this happened?

Number ____


c. How long ago was the last time?

____
number
1[] Days
2[] Weeks
3[] Months
4[] Years


d. Was it for health or behavior reasons?

1[] Health
2[] Behavior
8[] Other
9[] DK


9a. Not counting routine conferences, has anyone from --'s school ever asked someone to come in and talk about problems [he/she] was having?

1[] Yes
2[] No (Section P9)


b. How long ago was the last time?

____
number
1[] Days
2[] Weeks
3[] Months
4[] Years

[p.242]

Section P9 -- Development, Learning, Behavior



1. Has -- ever had --


a. a delay in [his/her] growth or development?
1[] Yes
2[] No


Mark box or ask:

0[] Child under 3 (Check item 22)


b. a learning disability?
1[] Yes
2[] No


c. an emotional or behavioral problem that lasted 3 months or more?
1[] Yes
2[] No


Check Item 22
Refer to 1.

1[] 1 or more "Yes" in 1 a--c (2)
8[] All other (Check Item 23)

Ask 2a--h for each "Yes" in 1a--c.


2a. How old was -- when the (condition) was first noticed?


1[] Delay in growth/Development
000[] Since birth
Age ____
1[] Months
2[] Years


2[] Learning Disability
000[] Since birth
Age ____
1[] Months
2[] Years


3[] Emotional/Behavioral Problem
000[] Since birth
Age ____
1[] Months
2[] Years


b. Has -- ever received treatment or counseling for the (condition)?


1[] Delay in growth/Development
1[] Yes
2[] No (2e)


2[] Learning Disability
1[] Yes
2[] No (2e)


3[] Emotional/Behavioral Problem
1[] Yes
2[] No (2e)


c. Has -- received any such treatment or counseling during the past 12 months?


1[] Delay in growth/Development
1[] Yes
2[] No (2e)


2[] Learning Disability
1[] Yes
2[] No (2e)


3[] Emotional/Behavioral Problem
1[] Yes
2[] No (2e)


d. During the past 12 months, about how many times did anyone see or talk to a doctor, psychologist, or counselor about this problem?


1[] Delay in growth/Development
Times ____
999[] DK


2[] Learning Disability
Times ____
999[] DK


3[] Emotional/Behavioral Problem
Times ____
999[] DK


Mark box or ask:
e. During the past 12 months, did the (condition) cause -- to miss any time from school?


1[] Delay in growth/Development
1[] Yes
2[] No (2g)


2[] Learning Disability
1[] Yes
2[] No (2g)


3[] Emotional/Behavioral Problem
1[] Yes
2[] No (2g)


f. On how many days in the past 12 months did -- miss part or all of the school day because of this problem?


1[] Delay in growth/Development
Days ____
999[] DK


2[] Learning Disability
Days ____
999[] DK


3[] Emotional/Behavioral Problem
Days ____
999[] DK


g. During the past 12 months, did the (condition) make it necessary for -- to attend special classes, or a special school, or get special help at school?


1[] Delay in growth/Development
1[] Yes
2[] No


2[] Learning Disability
1[] Yes
2[] No


3[] Emotional/Behavioral Problem
1[] Yes
2[] No


h. During the past 12 months, has -- been taking any medicine for the (condition)?


1[] Delay in growth/Development
1[] Yes
2[] No

(Col. (2) or Section P10)


2[] Learning Disability
1[] Yes
2[] No

(Col. (3) or section P10)


3[] Emotional/Behavioral Problem
1[] Yes
2[] No

(Section P10)


Check Item 23
Refer to age of sample child.

0[] Under 3 years old (Section P10)
1[] 3+ years old (3)

3a. Has -- ever seen a psychiatrist, psychologist, doctor, or counselor about any emotional, mental, or behavior problem?

1[] Yes
2[] No (3c)


b. When was the last time -- saw this person?

1[] More than 12 months ago
2[] Within the past 12 months (Section P10)


c. During the past 12 months, have you felt, or has anyone suggested, that -- needed help for any emotional, mental, or behavioral problem?

1[] Yes
2[] No

[p. 243]

Section P10 -- Health Services


Now I will ask about routine care, including routine checkups and immunizations when nothing is wrong.

1. How long has it been since -- last visit to a clinic, health center, hospital, doctor's office or other place for routine health care?

1[] Less than 6 months
2[] 6 months, less than 1 year
3[] 1 year, less than 2 years
4[] 2 years, less than 5 years
5[] 5 or more years
9[] DK
0[] Never (4)


2. Is there a particular clinic, health center, hospital, doctor's office or other place that -- usually goes to for routine health care?

1[] Yes
2[] No (4)


3. What kind of place is it -- a clinic, a health center, a hospital, a doctor's office, or some other place?
Probe if clinic:
Is this a private clinic, a hospital outpatient clinic, a company or school clinic, a migrant clinic, or some other kind of clinic?
Probe if health center:
Is this a community health center, neighborhood health center, a family health center, a rural health center, or some other kind of health center?
Probe if hospital:
Is this an outpatient clinic or emergency room?

01[] Home
02[] Doctor's office or private clinic
03[] Company or school clinic
04[] Hospital or outpatient clinic
05[] Migrant clinic
06[] Other clinic -- Specify ____
07[] Hospital emergency room
08[] Community, neighborhood, or family health center
09[] Walk-in/emergency care center
10[] Rural health center
11[] HMO/prepaid group
88[] Other place -- Specify ____


Now I will ask about -- visits for health care when -- is sick or injured.
4. Is there a particular clinic, health center, hospital, doctor's office or other place that -- usually goes to when [he/she] is sick or injured?

1[] Yes
2[] No (8)


5. Is this the same (place in 3) or is it somewhere else?

1[] Same place
2[] Somewhere else


If "Same place" in 5, refer to 3 and mark without asking, otherwise ask:
6. What kind of place is it -- a clinic, a health center, a hospital, a doctor's office, or some other place?
Probe if clinic:
Is this a private clinic, a hospital outpatient clinic, a company or school clinic, a migrant clinic, or some other kind of clinic?
Probe if health center:
Is this a community health center, neighborhood health center, a family health center, a rural health center, or some other kind of health center?
Probe if hospital:
Is this an outpatient clinic or emergency room?

01[] Home
02[] Doctor's office or private clinic (9)
03[] Company or school clinic
04[] Hospital or outpatient clinic
05[] Migrant clinic
06[] Other clinic -- Specify ____
07[] Hospital emergency room
08[] Community, neighborhood, or family health center
09[] Walk-in/emergency care center
10[] Rural health center
11[] HMO/prepaid group
88[] Other place -- Specify ____


7a. Is there a particular medical person -- usually sees at the (place in 6) when [he/she] is sick?

1[] Yes
2[] No (9)


b. Is there someone at (the place in 6), that knows about --'s health history who will give you advice over the telephone?

1[] Yes (9)
2[] No (9)
9[] DK (9)


Hand Card P4. Read categories if telephone interview.

Card P4

1. Has two or more usual doctors or places depending on what is wrong
2. Has not needed a doctor
3. Previous doctor no longer available
4. Have not been able to find the right doctor
5. Recently moved to area
8. Other reason (Specify)

8. Many people do not have a particular place they usually go when they are sick. (Could you please give me the number of the statement) which is the main reason -- does not have a particular place [he/she] usually goes?
1. Has two or more usual doctors or places depending on what is wrong.
2. Has not needed a doctor.
3. Previous doctor no longer available.
4. Have not been able to find the right doctor.
5. Recently moved to area.
8. Other reason (Specify).

1[]
2[]
3[]
4[]
5[]
8[] specify ____

[p.244]

Section P10 -- Health Services -- Continued


9a. During the past 12 months, that is since (12 month date) a year ago, did -- receive any health care which has been or will be paid for by Medicaid?

1[] Yes (9c)
2[] No
9[] DK


b. During the past 12 months, was -- covered at any time by Medicaid?

1[] Yes
2[] No
9[] DK


c. During the past 12 months, did-- receive assistance through the "Aid to Families with Dependent Children" program, sometimes called AFDC or ADC?

1[] Yes
2[] No
9[] DK


10. Is --now covered by a health insurance plan which pays any part of a hospital, doctor's or surgeons bill?

1[] Yes (9c)
2[] No
9[] DK


11a. Has -- ever been enrolled in the "Head Start" program?

1[] Yes
2[] No (P11)
9[] DK (P11)


b. In which "Head Start" program was -- enrolled, the Center based or the Home based program?

1[] Center based
2[] Home based
9[] DK



[p.245]


Section P11 -- Behavior Problems Index

Check Item 24
Refer to age of sample child.

1[] Under 5 years old (Cover Page)
2[] 5+ years old (intro)

Intro
Now I am going to read some statements that describe the behavior of many children. Please tell me whether each statement has been often true, sometimes true, or not true of -- during the past 3 months?
The first statement is: "Has sudden changes in mood or feelings." Has that been often true, sometimes true, or not true of -- in the past 3 months.
Record response and continue with statement 2.
Read list repeating categories and/or time reference as needed.


1. Has sudden changes in mood or feelings.

1[] Often true
2[] Sometimes true
3[] Not true


2. Feels or complains that no one loves [him/her].

1[] Often true
2[] Sometimes true
3[] Not true


3. Is rather high strung, tense, or nervous.

1[] Often true
2[] Sometimes true
3[] Not true


4. Cheats or tells lies.

1[] Often true
2[] Sometimes true
3[] Not true


5. Is too fearful or anxious.

1[] Often true
2[] Sometimes true
3[] Not true


6. Argues too much.

1[] Often true
2[] Sometimes true
3[] Not true


7. Has difficulty concentrating, cannot pay attention for long.

1[] Often true
2[] Sometimes true
3[] Not true


8. Is easily confused, seems to be in a fog.

1[] Often true
2[] Sometimes true
3[] Not true


9. Bullies, or is cruel or mean to others.

1[] Often true
2[] Sometimes true
3[] Not true


10. Is disobedient at home.

1[] Often true
2[] Sometimes true
3[] Not true


11. Is disobedient at school.

1[] Often true
2[] Sometimes true
3[] Not true


12. Does not seem to feel sorry after [his/her] misbehaves.

1[] Often true
2[] Sometimes true
3[] Not true


13. Has trouble getting along with other children.

1[] Often true
2[] Sometimes true
3[] Not true


14. Has trouble getting along with teachers.

1[] Often true
2[] Sometimes true
3[] Not true


15. Is impulsive, or acts without thinking.

1[] Often true
2[] Sometimes true
3[] Not true


16. Feels worthless or inferior.

1[] Often true
2[] Sometimes true
3[] Not true


17. Is not liked by other children.

1[] Often true
2[] Sometimes true
3[] Not true


18. Has a lot of difficulty getting [his/her] mind off certain thoughts, has obsessions.

1[] Often true
2[] Sometimes true
3[] Not true


19. Is restless or overly active, cannot sit still.

1[] Often true
2[] Sometimes true
3[] Not true


20. Is stubborn, sullen, or irritable.

1[] Often true
2[] Sometimes true
3[] Not true


21. Has a very strong temper and loses it easily.

1[] Often true
2[] Sometimes true
3[] Not true


22. Is unhappy, sad or depressed.

1[] Often true
2[] Sometimes true
3[] Not true


23. Is withdrawn, does not get involved with others.

1[] Often true
2[] Sometimes true
3[] Not true


If child is 12+ years old, go to 29.
24. Breaks things on purpose, deliberately destroys [his/her] own or others' things.

1[] Often true
2[] Sometimes true
3[] Not true


25. Clings to adults.

1[] Often true
2[] Sometimes true
3[] Not true


26. Cries too much.

1[] Often true
2[] Sometimes true
3[] Not true


27. Demands a lot of attention.

1[] Often true
2[] Sometimes true
3[] Not true



28. Is too dependent on others.

1[] Often true
2[] Sometimes true
3[] Not true


If child is under 12 years, go to Cover Page
29. Feels others are out to get [him/her].

1[] Often true
2[] Sometimes true
3[] Not true

[p.246]

Section P11 -- Behavior Problems Index -- Continued


30. Hangs around with kids who get into trouble.

1[] Often true
2[] Sometimes true
3[] Not true


31. Is secretive, keeps things to (himself/herself).

1[] Often true
2[] Sometimes true
3[] Not true


32. Worries too much.

1[] Often true
2[] Sometimes true
3[] Not true