[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]
Relationship to sample child ____
Mark first appropriate box.
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?
2[] No (Arrange callback, then Cover Page)
Check Item 2
Mark first appropriate box.
2[] Person in Check Item 1 not available (arrange callback, then Cover Page)
Section P2 -- Child Care
Check Item 3
Mark box and enter person number of respondent.
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.
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?
2[] Yes, first grade
3[] No (2)
b. At what time of day does the (kindergarten/first grade) start?
2[] p.m
3[] noon
4[] DK
c. At what time does the (kindergarten/first grade) end?
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?
2[] No (Check Item 5)
9[] DK (Check Item 5)
e. How many hours per week does -- spend in this program?
99[] DK (check item 5)
2a. During the past four weeks has -- attended nursery or preschool?
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?
2[] No
c. How many hours per week did -- spend in the (nursery school/preschool (with day care))?
99[] DK
Check Item 5
Refer to Check Item 1.
Mark first appropriate box.
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?
2[] No (4)
b. How many hours a week do you usually work?
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?
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?
2[] No (4)
e. How many hours a week did she work?
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?
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?
2[] No (Check item 6)
Hand Card P1, read list if telephone interview.
Card P1
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.
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
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.
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 --?
2[] Grandparent
8[] Other relative
9[] DK
d. Where does this person usually care for --, in (sample child) home or somewhere else?
2[] Somewhere else
e. About how many hours per week was -- usually cared for [by/at] (arrangement)?
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?
2[] No (Check Item 6)
Hand Card P1, read list if telephone interview.
Card P1
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.
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 --?
2[] Grandparent
8[] Other relative
9[] DK
d. Where does this person usually care for --, in (sample child) home or somewhere else?
2[] Somewhere else
e. About how many hours per week was -- usually cared for [by/at] (arrangement)?
99[] DK
7a. Were any other child care arrangements used on a regular basis?
2[] No (Check Item 6)
b. How many additional hours a week was child care used?
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.
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.
99[] DK
9. How many adults usually supervise the children in the same group as --?
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?
2[] No (13)
9[] DK (13)
11. Was -- ever cared for in any regular child care arrangement?
2[] No (Section P3, page 91)
12. When did -- last receive care in a regular child care arrangement?
2[] Prior to last 12 months (15)
13. How many times has -- main child care arrangement changed in the past year?
Times ____
Hand Card P2, read list if telephone interview.
Card P2
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.
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 --?
2[] Grandparent
8[] Other relative
9[] DK
c. Where did this person usually care for --, in (sample child) home or somewhere else?
2[] Somewhere else
d. About how many hours per week was -- usually cared for [by/at] (arrangement)?
99[] DK
[p.228]
Section P2 -- Child Care -- Continued
15. How old was --when regular child care was begun?
Age ____
2[] Years ____
Hand Card P2, read list if telephone interview
Card P2
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.
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 --?
2[] Grandparent
8[] Other relative
9[] DK
c. Where did this person usually care for --, in (sample child) home or somewhere else?
2[] Somewhere else
d. About how many hours per week was -- usually cared for [by/at] (arrangement)?
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?
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.
Number ____
99[] DK
3. Was -- the first born (or) second born (or third, etc.)?
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?
99[] DK
Check Item 7
Refer to Q. 1, page 86.
8[] Other (5)
5a. Has -- ever lived with [his/her] biological mother for at least 4 consecutive months?
2[] No (6)
3[]DK (6)
b. In what month and year did -- last live with her?
Year 19____
9999[] DK
6. Is she now living or deceased?
2[] Deceased (check item 11)
9[] DK (check item 11)
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?
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?
9[] DK
[p.230]
Section P3 -- Relationships and Mobility -- Continued
Check Item 8
Refer to Q. 1, page 86 and Q. 8, page 91.
8[] Other (10a)
10a. Was -- (biological mother) ever married to [his/her] (biological father)?
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)?
Year 19____
9999[] DK
Check Item 9
Refer to 8 and 9.
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?
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)?
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?
Year 19____
9999[] DK
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?
Year 19____
9999[] DK
[p.231]
Section P3 -- Relationships and Mobility -- Continued
Check Item 11
Refer to Q. 1, page 86.
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?
1[] Yes
2[] No (16)
9[] DK (16)
b. In what month and year did -- last live with him?
Year 19____
9999[] DK
14. Is he now living or deceased?
2[] Deceased (16)
9[] DK (16)
15. How often does -- see him?
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?
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?
2[] 1--50 miles
3[] 50+ miles
9[] DK
18. Altogether, how many times has -- ever moved?
99[] DK
19. In what month and year did -- begin living with you?
Check Item 12
8[] Other (19)
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?
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?
Nights ____
99[] DK
c. How many nights was -- in the (hospital/birthing center) during this stay?
Nights ____
99[] DK
2a. How much did -- weigh at birth?
Probe for ounces if not reported.
Oz ____ (3)
9999[] DK
b. Did -- weigh more than 5 1/2 or less?
1[] Less than 5 1/2 lbs. (3)
7[] DK (3)
c. Did weigh -- more than 9 pounds or less?
3[] Less than 9 lbs.
8[] DK
3a. How many months pregnant was --'s (biological mother) when -- was born?
99[] DK
b. Was -- born about when expected, or was it earlier or later?
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?
Weeks ____
99[] DK
4. How many weeks pregnant were you when you first thought you were pregnant with --?
Check Item 13
8[] Other (Section P5, page 96)
99[] DK
5a. Did you see or talk to a doctor to find out if you were pregnant?
2[] No (5c)
b. About how many weeks pregnant were you when you first found out from a doctor that you were pregnant?
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?
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?
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
2[] Lost
7a. Did -- receive any newborn care in an intensive care unit, premature nursery, or any other type of special care unit?
2[] No (8)
b. How many nights did -- stay in the special care unit?
Nights ____
[p.233]
Section P4 -- Birth -- Continued
8. Do you now have diabetes or sugar diabetes?
2[] No
9[] DK
9a. At any time during your pregnancy with --, did you have --
2[] No (Next column)
2[] no (next column)
2[] No (Section P5)
b. When did you first notice it -- was it during your pregnancy with -- or before?
2[] Before
2[] Before
2[] Before
Mark box or ask:
c. Did you have the (condition) for at least 3 months after -- was born?
1[] Yes (9a)
2[] No (9a)
1[] Yes (9a)
2[] No (9a)
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?
2[] No (2)
9[] DK (2)
b. How many accidents, injuries, or poisonings did -- have in the last 12 months that required medical attention?
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.
1[] ________
Hand Card P3, read list if telephone interview.
Card P3
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.
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
[] No
f. Where did this accident or injury or poisoning happen?
Do not read categories
Mark only one box.
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.
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)
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)
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)
2[] No
9[] DK
[p. 235-236]
Section P5 -- Childhood Conditions -- Continued
The next questions are about other health conditions -- may have ever had.
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
1[] Yes
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
Group C
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
Group E
If "Yes," ask: Is it one or both ears?
2[] Yes, both ears
9[] No/DK
If "Yes," ask: Is it one or both eyes?
2[] Yes, both eyes
9[] No/DK
2[] No/DK
1[] Yes
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
2[] No/DK
Child under 3, go to group I
Group H
2[] No/DK
1[] Yes
2[] No/DK
Child under 6, go to Group I
2[] No/DK
1[] Yes
2[] No/DK
1[] Yes
2[] No/DK
2[] No/DK
2[] No/DK
1[] Yes
2[] No/DK
1[] Yes (enter on Cond. Page)
2[] No/DK
List below and reask.
b[] ____
c[] ____
Ask if Yes in 3.
4a. Did -- have (condition) in the last 12 months?
Group B
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] Yes (4b)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] Yes (4b)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
Child under 3, go to Group I
Group H
[] No/DK (Next Yes)
[] Yes (4b)
[] No/DK (Next Yes)
Child under 6, go to Group I
[] No/DK (Next Yes)
[] Yes (4b)
[] No/DK (Next Yes)
[] Yes (4b)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
List below and reask.
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
4b. Has -- had (condition) for at least 3 months in [his/her] lifetime?
Group B
[] No/DK (Next Yes)
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] No/DK (4c)
[] No/DK (4c)
[] Yes (Enter on Cond. Page)
[] No/DK (4c)
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] Yes (Enter on Cond. Page)
[] No/DK (4c)
[] Yes (Enter on Cond. Page)
[] No/DK (4c)
[] 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
[] No/DK (Next Yes)
[] No/DK (Next Yes)
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] Yes (Enter on Cond. Page)
[] No/DK (Next Yes)
[] 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 letter ____
The next questions are about -- (condition/AIP).
1. How old was -- when (condition/AIP) (happened/was first noticed)?
Age ____
2[] Years
Refer to Check Item 14
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?
2[] No (3)
b. During the past 12 months, did -- (condition/AIP) cause [him/her] to miss any time from school?
2[] No (3)
9[] DK (3)
c. How many days in the past 12 months did -- miss all or part of the day?
999[] DK
3a. During the past 12 months, did -- (condition/AIP) cause [him/her] to stay in bed more than half of the day?
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?
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?
2[] No
9[] DK
4. During the past 12 months, about how many nights did -- spend in the hospital because of (condition/AIP)?
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.)
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?
2[] No
9[] DK
Check Item 16
Refer to Check Item 14.
8[] All others (7)
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?
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?
2[]Some
3[] Very little
Check Item 17
Refer to Check Item 14.
8[] Other (9)
Section P6 -- Supplemental Condition Page -- Continued
9a. Did the (condition) result from an accident, injury or poisoning?
2[] No (NC)
9[] DK (NC)
b. Did this occur within the last 12 months?
2[] No
c. Did you already tell me about this accident, injury or poisoning?
2[] No (9e)
d. Which accident, injury, or poisoning was it?
e. What kind of accident or injury or poisoning was it?
Hand Card P3, read list if telephone interview.
Card P3
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.
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.
[] No
h. Where did this accident or injury or poisoning happen?
Do not read categories
Mark only one box.
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?
Year 19____
9999[] DK
[p.239]
Section P7 -- General Health Status
Check Item 18
Refer to age of sample child.
2[] Under 3 years old (3)
1. Does -- wear glasses or contact lenses?
2[] No
2. About how long has it been since -- last saw someone for dental care?
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?
2[] Some of the time
3[] Once in a while
0[] Never
9[] DK
Check Item 19
Refer to age of sample child.
8[] Other (6)
4a. Did you smoke cigarettes at all during the year before -- was born?
2[] No (4e)
b. Did you continue to smoke during the entire pregnancy?
2[] No
c. Did you stop during the first three months of the pregnancy or later?
2[] 1st three months
3[] Later
9[] DK
d. About how many cigarettes a day did you usually smoke?
99[] DK
2[] No
number
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?
2[] Often
3[] Always
0[] Never
9[] DK
6a. Has anyone in your household smoked regularly since -- was born?
2[] No (7)
9[] DK (7)
b. Is anyone in the household currently smoking cigarettes?
2[] No (6c)
9[] DK (7)
c. How long has it been since anyone in the household smoked cigarettes?
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.)
2[] Mostly false
2[] Mostly false
2[] Mostly false
2[] Mostly false
2[] Mostly false
2[] Mostly false
2[] Mostly false
2[] Mostly false
2[] Mostly false
Check Item 20
Refer to age of sample child.
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?
2[] Bedtime varies (9c)
b. About what time does -- usually go to bed?
Round time to nearest quarter hour.
2[] pm ____: ____ (10)
99999[] DK
c. What is the latest time that -- goes to bed on weekdays?
Round time to nearest quarter hour.
2[] pm ____: ____ (10)
99999[] DK
10a. Does -- usually sleep in one room or in different rooms?
2[] Different rooms
b. Does -- usually sleep alone in a room or share a room?
2[] Shares
c. Who usually sleeps in the room with --?
Mark all that apply.
Anyone else?
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.
1[] 5+ years old
1. Has -- ever attended school?
2[] No (Section P9)
2. Is -- now either going to school or on vacation from 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.
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?
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.
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?
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?
Days ____
7a. Has -- repeated any grades for any reasons?
2[] No (8)
b. What grade or grades did -- repeat?
c. Why did -- repeat the (grades in 7b) grade(s)?
Mark all that apply.
2[] Immature/acted too young
3[] Frequently absent
4[] Moved into more difficult school
8[] Other -- Specify____
9[] DK
d. Any other reasons?
[] No
8a. Has -- ever been suspended, excluded, or expelled from school?
2[] No (9)
b. How many times has this happened?
c. How long ago was the last time?
number
2[] Weeks
3[] Months
4[] Years
d. Was it for health or behavior reasons?
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?
2[] No (Section P9)
b. How long ago was the last time?
number
2[] Weeks
3[] Months
4[] Years
[p.242]
Section P9 -- Development, Learning, Behavior
2[] No
2[] No
2[] No
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?
Age ____
2[] Years
Age ____
2[] Years
Age ____
2[] Years
b. Has -- ever received treatment or counseling for the (condition)?
2[] No (2e)
2[] No (2e)
2[] No (2e)
c. Has -- received any such treatment or counseling during the past 12 months?
2[] No (2e)
2[] No (2e)
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?
999[] DK
999[] DK
999[] DK
Mark box or ask:
e. During the past 12 months, did the (condition) cause -- to miss any time from school?
2[] No (2g)
2[] No (2g)
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?
999[] DK
999[] DK
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?
2[] No
2[] No
2[] No
h. During the past 12 months, has -- been taking any medicine for the (condition)?
(Col. (2) or Section P10)
2[] No
(Col. (3) or section P10)
2[] No
(Section P10)
2[] No
Check Item 23
Refer to age of sample child.
1[] 3+ years old (3)
3a. Has -- ever seen a psychiatrist, psychologist, doctor, or counselor about any emotional, mental, or behavior problem?
2[] No (3c)
b. When was the last time -- saw this person?
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?
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?
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?
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?
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?
2[] No (8)
5. Is this the same (place in 3) or is it somewhere else?
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?
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?
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?
2[] No (9)
9[] DK (9)
Hand Card P4. Read categories if telephone interview.
Card P4
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).
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?
2[] No
9[] DK
b. During the past 12 months, was -- covered at any time by Medicaid?
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?
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?
2[] No
9[] DK
11a. Has -- ever been enrolled in the "Head Start" program?
2[] No (P11)
9[] DK (P11)
b. In which "Head Start" program was -- enrolled, the Center based or the Home based program?
2[] Home based
9[] DK
[p.245]
Section P11 -- Behavior Problems Index
Check Item 24
Refer to age of sample child.
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.
2[] Sometimes true
3[] Not true
2. Feels or complains that no one loves [him/her].
2[] Sometimes true
3[] Not true
3. Is rather high strung, tense, or nervous.
2[] Sometimes true
3[] Not true
2[] Sometimes true
3[] Not true
2[] Sometimes true
3[] Not true
2[] Sometimes true
3[] Not true
7. Has difficulty concentrating, cannot pay attention for long.
2[] Sometimes true
3[] Not true
8. Is easily confused, seems to be in a fog.
2[] Sometimes true
3[] Not true
9. Bullies, or is cruel or mean to others.
2[] Sometimes true
3[] Not true
2[] Sometimes true
3[] Not true
2[] Sometimes true
3[] Not true
12. Does not seem to feel sorry after [his/her] misbehaves.
2[] Sometimes true
3[] Not true
13. Has trouble getting along with other children.
2[] Sometimes true
3[] Not true
14. Has trouble getting along with teachers.
2[] Sometimes true
3[] Not true
15. Is impulsive, or acts without thinking.
2[] Sometimes true
3[] Not true
16. Feels worthless or inferior.
2[] Sometimes true
3[] Not true
17. Is not liked by other children.
2[] Sometimes true
3[] Not true
18. Has a lot of difficulty getting [his/her] mind off certain thoughts, has obsessions.
2[] Sometimes true
3[] Not true
19. Is restless or overly active, cannot sit still.
2[] Sometimes true
3[] Not true
20. Is stubborn, sullen, or irritable.
2[] Sometimes true
3[] Not true
21. Has a very strong temper and loses it easily.
2[] Sometimes true
3[] Not true
22. Is unhappy, sad or depressed.
2[] Sometimes true
3[] Not true
23. Is withdrawn, does not get involved with others.
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.
2[] Sometimes true
3[] Not true
2[] Sometimes true
3[] Not true
2[] Sometimes true
3[] Not true
27. Demands a lot of attention.
2[] Sometimes true
3[] Not true
28. Is too dependent on others.
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].
2[] Sometimes true
3[] Not true
[p.246]
Section P11 -- Behavior Problems Index -- Continued
30. Hangs around with kids who get into trouble.
2[] Sometimes true
3[] Not true
31. Is secretive, keeps things to (himself/herself).
2[] Sometimes true
3[] Not true
2[] Sometimes true
3[] Not true