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IMSDTP
Source of DTP vaccine information
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Survey Text

1996
1995
1994
1993
1992
1991
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1996
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

ITEM I4
Refer to shot record.

1[] Available (2)
2[] Not available (1)

1. Ask only on initial interview. On callback, skip to 9.
We will need the shot record to complete this section of the interview.
If I called you within the next few days, would you be able to have --'s shot record available?

1[] Yes (Arrange callback, then I5 on page 4)
2[] No (9)
9[] DK (9)

2. Transcribe from shot record - If telephone ask: Looking at the shot record, please tell me how many times -- has received (name of vaccines)?
Record number of times for each vaccine. What is the date on the record for (first) (vaccine)? Repeat for second, third, etc. shots.

(1) A DTP/DT shot (sometimes called a DPT shot, diptheria-tetanus-pertussis-shot, baby shot or three-in-one shot)?

Shots ____ (Record dates)
[] 00 None (Next vaccine)
[] 99 DK (Next vaccine)

4a. Has -- ever received an additional DTP shot (sometimes called a DPT shot, baby shot, or three-in-one shot)?

1[] Yes (4b)
2[] No (5)
9[] DK (5)

10a. Has -- ever received:

(1) A DTP/DT shot (sometimes called a DPT shot, diptheria-tetanus-pertussis-shot, baby shot or three-in-one shot)?
1[] Yes (10b)
2[] No (Next vaccine)
9[] DK (Next vaccine)

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1995
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

ITEM I4
Refer to shot record.

1[] Available (2)
2[] Not available (1)

1. Ask only on initial interview. On callback, skip to 9.
We will need the shot record to complete this section of the interview.
If I called you within the next few days, would you be able to have --'s shot record available?

1[] Yes (Arrange callback, then I5 on page 6)
2[] No (9)
9[] DK (9)

2. Transcribe from shot record - If telephone ask: Looking at the shot record, please tell me how many times -- has received (name of vaccines)?
Record number of times for each vaccine. What is the date on the record for (first) (vaccine)? Repeat for second, third, etc. shots.

(1) A DTP/DT shot (sometimes called a DPT shot, diptheria-tetanus-pertussis-shot, baby shot or three-in-one shot)?

Shots ____ (Record dates)
[] 00 None (Next vaccine)
[] 99 DK (Next vaccine)

4a. Has -- ever received an additional DTP shot (sometimes called a DPT shot, baby shot, or three-in-one shot)?

1[] Yes (4b)
2[] No (5)
9[] DK (5)

10a. Has -- ever received:

(1) A DTP/DT shot (sometimes called a DPT shot, diptheria-tetanus-pertussis-shot, baby shot or three-in-one shot)?
1[] Yes (10b)
2[] No (Next vaccine)
9[] DK (Next vaccine)

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1994
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to [his/her] shot record.

ITEM I4
Refer to shot record.

[] 1 Available (2)
[] 2 Not available (1)

1. Ask only on initial interview. On callback, skip to 9.
We will need the shot record to complete this section of the interview. If I called you within the next few days, would you be able to have --'s shot record available?

[] 1 Yes (Arrange callback, then I5 on page 6)
[] 2 No (9)
[] 9 DK (9)

2. Transcribe from shot record -- If telephone ask: Looking at the shot record, please tell me how many times -- have received (names of vaccines)? Record number of times for each vaccine. What is the date on the record for (first) (vaccine)? Repeat for second, third [and other] shots.

Shots ____ (Record dates)
[] 00 None (Next vaccine)
[] 99 DK (Next vaccine)

3. Are all the immunizations that -- ever received included on this shot record?

[] 1 Yes (11)
[] 2 No (4)
[] 9 DK (4)

4a. Has -- ever received an additional DTP shot (sometimes called a DPT shot, diptheria-tetanus-pertussis shot, baby shot, or three-in-one-shot)?

[] 1 Yes (4b)
[] 2 No (5)
[] 9 DK (5)

10a. Has -- ever received:

(1) A DTP/DT shot (sometimes called a DPT shot, diptheria-tetanus-pertussis-shot, baby shot, or three-in-one shot)?
[] 1 Yes (10b)
[] 2 No (Next vaccine)
[] 9 DK (Next vaccine)

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1993
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

ITEM IZ2
Refer to shot record.

1 [] Available (1)
2 [] Not available (8)

DTP/DT (Shot)

1 [] Yes (Record dates)
2 [] No (Next vaccine)

3a. Has -- ever received an additional DTP shot (sometimes called a DPT shot, diptheria-tetanus-pertussis shot, baby shot, or three-in-one-shot)?

1 [] Yes (3b)
2 [] No (4)
9 [] DK (4)

9a. Has -- ever received --

(1) A DTP/DT shot (sometimes called a DPT shot, diptheria-tetanus-pertussis-shot, baby shot, or three-in-one shot)?
1 [] Yes (9b)
2 [] No (Next vaccine)
9 [] DK (Next vaccine)

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1992
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

ITEM IZ2
Refer to shot record.

1 [] Available (1)
2 [] Not available (8)

About how often did the respondent appear to answer the questions in Immunization accurately?

1 [] All the time
2 [] Most of the time
3 [] Some of the time
4 [] Rarely or never
9 [] DK
ITEM IZ4
About how often did the respondent appear to answer the questions in Immunization honestly?

1 [] All the time
2 [] Most of the time
3 [] Some of the time
4 [] Rarely or never
9 [] DK

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1991
Survey form view entire document:  text  image
These questions refer to (read name), and are about various health topics, including immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

Item D4
Refer to shot record

1[] Available (1)
2[] Not available (7)