Form 29.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Secondary Residence Questionnaire, Phase 2g

OMB Specification

Secondary Residence Questionnaire

Event Category:	Trigger-Based
Event:	Secondary Residence
Administration:	36M, 48M, 60M
Instrument Target:	Child's Secondary Residence
Instrument Respondent:	Secondary Residence Caregiver
Domain:	Environmental
Document Category:	Questionnaire
Method:	Data Collector Administered
Mode (for this instrument*):	In-Person, CAI; Phone, CAI
OMB Approved Modes:	In-Person, CAI; Phone, CAI; Web-Based, CAI
Estimated Administration Time:	13 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	N/A
Version:	1.0
MDES Release:	4.0

*This instrument is OMB-approved for multi-mode administration, but his version of the instrument is designed for administration in this/these mode(s) only.

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Secondary Residence Questionnaire

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

HOUSING CHARACTERISTICS 3

PESTICIDE APPLICATIONS IN PAST SIX MONTHS 14

PETS 17

SMOKING IN HOME 22

NEIGHBORHOOD CHARACTERISTICS 24

NOISE EXPOSURE IN HOME 29

OCCUPATIONAL/HOBBY EXPOSURES 34

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Secondary Residence Questionnaire

GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:

DATA ELEMENT FIELDS	MAXIMUM CHARACTERS PERMITTED	DATA TYPE	PROGRAMMER INSTRUCTIONS
ADDRESS AND EMAIL FIELDS	100	CHARACTER
UNIT AND PHONE FIELDS	10	CHARACTER
_OTH AND COMMENT FIELDS	255	CHARACTER	Limit text to 255 characters
FIRST NAME AND LAST NAME	30	CHARACTER	Limit text to 30 characters
ALL ID FIELDS	36	CHARACTER
ZIP CODE	5	NUMERIC
ZIP CODE LAST FOUR	4	NUMERIC
CITY	50	CHARACTER
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)	10	NUMERIC CHARACTER	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: MM MUST EQUAL 01 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.
TIME VARIABLES	TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION	NUMERIC	HARD EDITS: HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59

Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).

POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.

A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.

HOUSING CHARACTERISTICS

(TIME_STAMP_HC_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• PRELOAD DWELLING_UNIT_ID FOR THE DWELLING UNIT

• PRELOAD SECONDARY_RESIDENCE_ID FOR THE SECONDARY RESIDENCE.

• PRELOAD THE PARTICIPANT (P_ID) FOR CHILD AND THE RESPONDENT ID (R_P_ID) FOR CAREGIVER.

• PRELOAD C_FNAME AND DISPLAY APPROPRIATE NAME IN “C_FNAME” THROUGHOUT THE INSTRUMENT.

• OTHERWISE, IF C_FNAME = -1 OR -2, DISPLAY “the child” IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT.

• PRELOAD MULT_CHILD AND CHILD_QNUM FROM PVST INSTRUMENT.

• IF CHILD_SEX IN PVST INSTRUMENT = 1, DISPLAY “his”, “he”, OR “himself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT.

• IF CHILD_SEX IN PVST INSTRUMENT = 2, DISPLAY “her”, “she”, OR “herself” IN APPROPRIATE FIELDS THROUGHOUT INSTRUMENT

HC01000/(STAFF_ID). ENTER STAFF ID

__________________________________________

STAFF ID

HC02000. We would now like to ask you some questions about your home.

SOURCE

 

HC03000. How long has {C_FNAME/the child} been living in this home?

INTERVIEWER INSTRUCTIONS

• RECORD LENGTH OF TIME IN WEEKS IF CHILD HAS LIVED IN HOME FOR LESS THAN ONE MONTH.

• IF CHILD HAS LIVED IN HOME FOR LESS THAN ONE WEEK , ENTER 1.

• RECORD LENGTH OF TIME IN MONTHS IF CHILD HAS LIVED IN HOME FOR AT LEAST ONE MONTH BUT LESS THAN 12 MONTHS.

• OTHERWISE, RECORD LENGTH OF TIME IN YEARS.

SOURCE

The National Survey of Lead and Allergens in Housing (NSLAH)

(LENGTH_RESIDE) |___|___|

  NUMBER

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

(LENGTH_RESIDE_UNIT)

Label	Code	Go To
WEEKS	1
MONTHS	2
YEARS	3

HC04000/(AGE_HOME). Which of these categories best describes when your home or building was built?

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, REFER PARENT/CAREGIVER TO SHOWCARD. 

• OTHERWISE, READ RESPONSE CATEGORIES TO PARENT/CAREGIVER.

Label	Code	Go To
2001 OR LATER	1
1981 TO 2000	2
1961 TO 1980	3
1941 TO 1960	4
1940 OR BEFORE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Survey of Lead and Allergens in Housing (modified)

PROGRAMMER INSTRUCTIONS

• IF USING SHOWCARDS, DISPLAY “We have a showcard we can provide to help with your answer” AND DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS.

• OTHERWISE, DISPLAY RESPONSE CATEGORIES IN MIXED UPPER/LOWER CASE.

HC05000/(BUILD_TYPE). How would you describe the building in which you live? 

Label	Code	Go To
Single family home	1
Apartment building or other multifamily building	2
Townhouse	3
Duplex, Triplex, Quadplex	4
Trailer	5
Group home, Dormitory, etc.	6
Hotel/Motel	7
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Vanguard Phase (Core)

HC06000/(HOME_SF). About how many square feet is your home or apartment? 

Label	Code	Go To
Less than 500,	1	HOME_GARAGE
500 – 999,	2	HOME_GARAGE
1000 – 1999,	3	HOME_GARAGE
2000 – 2999, or	4	HOME_GARAGE
3000 square feet or more	5	HOME_GARAGE
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Vanguard Phase (Core)

HC07000/(HOME_BEDROOMS). How many bedrooms are there in your home? Include any room that was planned as a bedroom even if it is being used for another purpose, for example as an office.

|___|___|

NUMBER OF BEDROOMS

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

SOURCE

National Children’s Study, Vanguard Phase (Core)

PROGRAMMER INSTRUCTIONS

• INCLUDE SOFT EDIT IF HOME_BEDROOMS > 4.

HC08000/(HOME_STORIES). How many stories are there in the house, including the basement?

|___|___|

NUMBER OF STORIES

INTERVIEWER INSTRUCTIONS

• IF SPLIT LEVEL OR PARTIAL BASEMENT, INCLUDE AND COUNT THE GREATEST NUMBER OF STORIES ON TOP OF EACH OTHER.

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

SOURCE

National Children’s Study, Vanguard Phase (Core)

HC09000/(HOME_GARAGE). Is there a garage attached to your home?

Label	Code	Go To
YES	1
NO	2	WATER
REFUSED	-1	WATER
DON'T KNOW	-2	WATER

SOURCE

National Children’s Study, Legacy Phase

HC10000/(GARAGE_WARMUP). On a cold day, how long do you normally let your vehicle warm up in the garage? 

Label	Code	Go To
Less than 1 minute,	1
1-2 minutes,	2
3-5 minutes,	3
More than 5 minutes, or	4
Never	5
NOT APPLICABLE - DOES NOT HAVE VEHICLE/VEHICLE NOT KEPT IN GARAGE	-7
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase

HC11000/(WATER). In the past six months, have you seen any water damage inside your home?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase

HC12000/(MOLD). In the past six months, have you seen any mold or mildew on walls or other surfaces, other than the shower or bathtub, inside your home?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase

HC13000/(RENOVATE). The next few questions ask about any recent additions or renovations to your home. 

In the past 6 months,  have any additions or renovations been done to your home? Include only major projects that made your home larger or involved construction. Do not count smaller projects such as painting or wallpapering, carpeting, or refinishing floors.

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

American Healthy Homes Survey, The National Survey of Lead and Allergens in Housing (NSLAH) (modified)

HC14000/(DECORATE). In the past 6 months, were any smaller projects done on your home, such as painting, wallpapering, refinishing floors, or installing new carpet?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

Avon Longitudinal Survey of Parents And Children (ALSPAC)

HC15000/(CARPET). About what proportion of rooms in your home are carpeted rooms or have room-size rugs? By room size, I mean a rug that covers at least half of the floor in that room. 

Label	Code	Go To
More than half,	1
About half, or	2
Less than half	3
REFUSED	-1
DON’T KNOW	-2

SOURCE

American Healthy Homes Survey

HC16000/(MAIN_HEAT). What is the main heating source in your home? 

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, REFER PARENT/CAREGIVER TO SHOWCARD. 

• OTHERWISE, READ RESPONSE CATEGORIES TO PARENT/CAREGIVER.

Label	Code	Go To
GAS-HEATED FORCED AIR (VENTS)	1	COOL
ELECTRIC-HEATED FORCED AIR (VENTS) (INCLUDES HEAT PUMPS)	2	COOL
OIL/KEROSENE-FIRED FURNACE	3	COOL
ELECTRIC BASEBOARD HEAT	4	COOL
RADIATORS (STEAM OR HOT WATER)	5	COOL
GAS STOVE/WALL FURNACE	6	COOL
WOOD BURNING STOVE/FIREPLACE	7	COOL
KEROSENE SPACE HEATER	8	COOL
RADIANT/CERAMIC HEATER	9	COOL
ELECTRIC SPACE HEATER	10	COOL
SOME OTHER SOURCE	-5
NOT APPLICABLE - NO SOURCE OF HEAT	-7	COOL
REFUSED	-1	COOL
DON’T KNOW	-2	COOL

SOURCE

American Healthy Homes Survey

PROGRAMMER INSTRUCTIONS

• IF USING SHOWCARDS, DISPLAY “We have a showcard we can provide to help with your answer” AND DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS. 

• OTHERWISE, DISPLAY RESPONSE CATEGORIES AS MIXED UPPER/LOWER CASE.

HC17000/(MAIN_HEAT_OTH). SPECIFY  _________________________________

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

SOURCE

American Healthy Homes Survey

HC18000/(COOL). Which of these cooling systems are regularly used in your home? 

INTERVIEWER INSTRUCTIONS

• SELECT ALL THAT APPLY.

• PROBE: “Any others?”

• IF NECESSARY, REMIND RESPONDENT THAT FANS DO NOT COUNT.

Label	Code	Go To
Window or wall air conditioners,	1
Central air conditioning,	2
Evaporative cooler (swamp cooler), or	3
Some other cooling system?	4
NOT APPLICABLE - NO COOLING OR AIR CONDITIONING REGULARLY USED	-7
REFUSED	-1
DON’T KNOW	-2

SOURCE

American Healthy Homes Survey

PROGRAMMER INSTRUCTIONS

• IF COOL = -7, -1, OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES.

HC19000/(OPEN_WINDOW). In the past six months, approximately how many hours a day were the windows or doors open in your home?  Would you say...

Label	Code	Go To
Less than 1 hour per day,	1
1-3 hours per day,	2
4-12 hours per day,	3
More than 12 hours per day, or	4
Not at all?	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

American Healthy Homes Survey

HC20000/(DEHUMIDIFIER). In the past six months, has a dehumidifier been used in your home?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

American Healthy Homes Survey

HC21000/(AIR_CLEANING). What type of air cleaning device(s) is used in your home? 

INTERVIEWER INSTRUCTIONS

• SELECT ALL THAT APPLY.

• PROBE: “Any others?”

• IF USING SHOWCARDS, REFER PARENT/CAREGIVER TO SHOWCARD HC002. 

• OTHERWISE, READ RESPONSE CATEGORIES TO PARENT/CAREGIVER.

Label	Code	Go To
FILTER	1
ELECTROSTATIC PRECIPITATOR	2
OZONE GENERATOR	3
OTHER	-5
NOT APPLICABLE - NO AIR CLEANING DEVICE USED IN HOME	-7
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase

PROGRAMMER INSTRUCTIONS

• IF USING SHOWCARDS, DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS AND DISPLAY “You may refer to the card for your answer(s).”

• OTHERWISE, DISPLAY RESPONSE CATEGORIES AS MIXED UPPER/LOWER CASE.

• IF AIR_CLEANING = ANY COMBINATION OF 1 - 3, GO TO AIR_FILTER. 

• IF AIR_CLEANING = -5 OR ANY COMBINATION OF -5 AND  1 - 3, GO TO AIR_CLEANING_OTH. 

• OTHERWISE, IF AIR_CLEANING = -7, -1, OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO AIR_FILTER.

HC22000/(AIR_CLEANING_OTH). SPECIFY  _________________________________

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

SOURCE

National Children’s Study, Legacy Phase 

HC23000/(AIR_FILTER). Does your furnace or air conditioning system use a special HEPA (High Efficiency Particulate Air) or other type of allergy filter to filter the air?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase

HC24000/(FRESHENERS). In the past six months, have scented products such as plug-ins, gels or solids, or sprays been used in your home?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

American Healthy Homes Survey (Modified)

HC25000/(CANDLES). In the past six months, have candles, scented candles or incense been used in your home?  

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

American Healthy Homes Survey (Modified)

HC26000/(WELL_WATER). Is the tap water in your home from a private well?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase

HC27000/(WATER_DRINK). What water source in your home is used most of the time for drinking?  

Label	Code	Go To
Tap water,	1	WATER_COOK
Filtered tap water,	2	WATER_COOK
Bottled water, or	3	WATER_COOK
Some other source	-5
REFUSED	-1	WATER_COOK
DON’T KNOW	-2	WATER_COOK

SOURCE

National Human Exposure Assessment Survey (NHEXAS)

HC28000/(WATER_DRINK_OTH). SPECIFY  _________________________________

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

SOURCE

National Human Exposure Assessment Survey (NHEXAS)

HC29000/(WATER_COOK). What water source in your home is used most of the time for cooking?

Label	Code	Go To
Tap water,	1	TIME_STAMP_HC_ET
Filtered tap water,	2	TIME_STAMP_HC_ET
Bottled water, or	3	TIME_STAMP_HC_ET
Some other source	-5
REFUSED	-1	TIME_STAMP_HC_ET
DON’T KNOW	-2	TIME_STAMP_HC_ET

SOURCE

National Human Exposure Assessment Survey (NHEXAS)

HC30000/(WATER_COOK_OTH). SPECIFY  _________________________________

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

SOURCE

National Children’s Study, Vanguard Phase (Core)

(TIME_STAMP_HC_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

PESTICIDE APPLICATIONS IN PAST SIX MONTHS

(TIME_STAMP_PAI_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

PAI01000. I would now like to ask about products that may have been used in your home or yard to control for mice, rats, ants, termites, cockroaches, bees, wasps, moths, or other insects and rodents during the past 6 months.

SOURCE

American Healthy Homes Survey, FNSEHCCC

PAI02000/(WHEN_PEST). When were any pesticides last used inside or outside the residence to control for pests?  Was it:

Label	Code	Go To
Within the last month,	1
1-3 months ago,	2
4-6 months ago,or	3
Not within the past 6 months?	4	TIME_STAMP_PAI_ET
REFUSED	-1	TIME_STAMP_PAI_ET
DON’T KNOW	-2	TIME_STAMP_PAI_ET

SOURCE

American Healthy Homes Survey

PAI03000/(PEST_TYPE). What type of pests did you treat for?

INTERVIEWER INSTRUCTIONS

• SELECT ALL THAT APPLY

• PROBE: “Any others?”

Label	Code	Go To
Pests of plants and trees such as gypsy moths, Japanese beetles, aphids, etc.	1
Flying insects such as flies, mosquitoes, bees, wasps, hornets, moths, etc.	2
Crawling insects such as ants, roaches, silverfish, spiders, etc.	3
Rodents such as mice, rats, squirrels, etc.	4
Fleas and ticks,	5
Termites and carpenter ants.	6
OTHER	-5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Categories taken from the Non-Hodgkin’s Lymphoma Study

PROGRAMMER INSTRUCTIONS

• IF PEST_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO TIME_STAMP_PAI_ET.

• IF PEST_TYPE = ANY COMBINATION OF 1 – 6, GO TO APPLY_AREAS AND LOOP THROUGH FOR EACH PEST_TYPE UNTIL NUMBER OF LOOPS = NUMBER OF RESPONSES SELECTED IN PEST_TYPE.

• IF PEST_TYPE = -5, OR ANY COMBINATION OF 1 – 6 AND -5, GO TO PEST_TYPE_OTH.

PAI04000/(PEST_TYPE_OTH). SPECIFY  _____________________________

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

SOURCE

Categories taken from the Non-Hodgkin’s Lymphoma Study

PAI05000/(APPLY_AREAS). Where did you treat for the {PEST_TYPE}? Was it…

Label	Code	Go To
Inside your home,	1
Outside your home, or	2
Both inside and outside your home?	3
REFUSED	-1
DON’T KNOW	-2

SOURCE

American Healthy Homes Survey (Modified), Center for the Health Assessment of Mothers and Children of Salinas, FNSEHCCC

PROGRAMMER INSTRUCTIONS

• LOOP THROUGH APPLY_AREAS FOR EACH PEST_TYPE UNTIL NUMBER OF LOOPS = NUMBER OF RESPONSES SELECTED IN PEST_TYPE.

• IF NUMBER OF LOOPS = NUMBER OF RESPONSES SELECTED IN PEST_TYPE, GO TO TIME_STAMP_PAI_ET.

• DISPLAY APPROPRIATE PEST_TYPE FOR EACH LOOP:

• IF PEST_TYPE = 1, DISPLAY “Pests of plants and trees such as, gypsy moths, Japanese beetles, aphids  etc”.

• IF PEST_TYPE = 2, DISPLAY “Flying insects such as, flies, mosquitoes, bees, wasps, hornets, moths”.

• IF PEST_TYPE = 3, DISPLAY “Crawling insects such as, ants, roaches, silverfish, spiders”.

• IF PEST_TYPE = 4, DISPLAY “Rodents such as, mice, rats, squirrels. etc”.

• IF PEST_TYPE = 5, DISPLAY “Fleas and ticks”.

• IF PEST_TYPE = 6, DISPLAY “Termites and carpenter ants”.

• IF PEST_TYPE = -5, DISPLAY "Other pest".

(TIME_STAMP_PAI_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

PETS

(TIME_STAMP_PT_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

PT01000. Now I would like to ask you a few questions about any pets in the home.        

SOURCE

 

PT02000/(PETS_HOME). Are there any pets that spend any time inside the home?

INTERVIEWER INSTRUCTIONS

• YOU MAY READ TO PARENT/CAREGIVER THIS MORE DETAILED EXPLANATION, AS NEEDED: “These pets include those that live indoors; pets that come indoors on a somewhat regular basis, such as an outside cat that comes inside during the winter; pets that spend more than 50 percent of their time indoors at this household, such as areas of the home where people spend time, not a garage or mudroom; and other people's pets that spend 50 percent of their time in your home. Do not include pets that have been inside only a handful of times, such as an outdoor pet that sneaks into the house; or agricultural animals that are pets, but do not come inside your home."

Label	Code	Go To
YES	1
NO	2	LIVESTOCK
REFUSED	-1	LIVESTOCK
DON'T KNOW	-2	LIVESTOCK

SOURCE

Avon Longitudinal Survey of Parents and Children (ALSPAC)

PT03000/(PET_TYPE). What kind of pets are these? 

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, REFER PARENT/CAREGIVER TO SHOWCARD PT001. 

• OTHERWISE, READ RESPONSE CATEGORIES TO PARENT/CAREGIVER.

• PROBE: Anything else?

• SELECT ALL THAT APPLY. 

Label	Code	Go To
DOG	1
CAT	2
SMALL MAMMAL, SUCH AS A RABBIT, GERBIL, HAMSTER, GUINEA PIG, FERRET, OR MOUSE	3
BIRD	4
FISH OR REPTILE, SUCH AS A TURTLE, SNAKE, OR LIZARD	5
OTHER	-5
REFUSED	-1
DON'T KNOW	-2

SOURCE

Avon Longitudinal Survey of Parents and Children (ALSPAC)

PROGRAMMER INSTRUCTIONS

• IF USING SHOWCARDS, DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS AND DISPLAY “You may refer to the card for your answer(s).”

• OTHERWISE, DISPLAY RESPONSE CATEGORIES AS MIXED UPPER/LOWER CASE.

• IF PET_TYPE = ANY COMBINATION OF VALUES 1 – 5, GO TO PET_MEDS.

• IF PET_TYPE = -5, OR ANY COMBINATION OF VALUES 1 – 5 AND -5, GO TO PET_TYPE_OTH.

• IF PET_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO PET_MEDS.

PT04000/(PET_TYPE_OTH). What kind of pets are these?

 

SPECIFY: ________________________

INTERVIEWER INSTRUCTIONS

• RECORD MORE THAN ONE TYPE OF PET SEPARATED BY A COMMA OR “AND.”

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

SOURCE

Avon Longitudinal Survey of Parents and Children (ALSPAC)

PT05000/(PET_MEDS). Are any products ever used on your pets to control fleas, ticks, or mites? Please include flea collars, powders, shampoos, or other flea, tick, and mite control products, but do not include pills given to your pet to control for fleas or other insects.

Label	Code	Go To
YES	1
NO	2	PET_ROOM_SLEEP
REFUSED	-1	PET_ROOM_SLEEP
DON'T KNOW	-2	PET_ROOM_SLEEP

SOURCE

National Human Exposure Assessment Survey (NHEXAS)

PT06000/(PET_MED_TIME). When were any of these products last used on any of the pets? 

Label	Code	Go To
Within the last month,	1
1-3 months ago,	2
4-6 months ago, or	3
More than 6 months ago	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Human Exposure Assessment Survey (NHEXAS)

PT07000/(PET_ROOM_SLEEP). Do any of the pets go in the room where the {C_FNAME/the child} sleeps when {she/he} is here? 

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Human Exposure Assessment Survey (NHEXAS)

PROGRAMMER INSTRUCTIONS

• IF PET_ROOM_SLEEP = 1, GO TO PET_BEDDING.

• ?IF PET_ROOM_SLEEP = 2, -1, OR -2, AND MULT_CHILD = 1, AND

• IF CHILD_QNUM < CHILD_NUM, GO TO PET_ROOM_SLEEP.

• IF CHILD_NUM = CHILD_QNUM, GO TO LIVESTOCK.

• IF PET_ROOM_SLEEP = 2, -1, OR -2, AND MULT_CHILD = 2, GO TO LIVESTOCK.

PT08000/(PET_BEDDING). Do any of the pets sleep on the same bedding as {C_FNAME/the child}?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase (6M)

PROGRAMMER INSTRUCTIONS

• ?IF MULT_CHILD = 1, AND
  
  

• IF CHILD_QNUM < CHILD_NUM, GO TO PET_ROOM_SLEEP.

• IF CHILD_NUM = CHILD_QNUM, GO TO LIVESTOCK.

• IF MULT_CHILD = 2, GO TO LIVESTOCK.

PT09000/(LIVESTOCK). Now I’d like to ask about any other animals located at your home.  Are there any poultry, livestock, or farm animals that live outdoors or in outbuildings on the property? 

Label	Code	Go To
YES	1
NO	2	TIME_STAMP_PT_ET
REFUSED	-1	TIME_STAMP_PT_ET
DON'T KNOW	-2	TIME_STAMP_PT_ET

SOURCE

National Children’s Study, Vanguard Phase (Core)

PT10000/(LIVESTOCK_TYPE). What types of animals are these?  Please include all poultry, livestock, and farm animals that live outdoors as well as those that live in outbuildings. 

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, REFER PARENT/CAREGIVER TO SHOWCARD PT002. 

• OTHERWISE, READ RESPONSE CATEGORIES TO PARENT/CAREGIVER.

• PROBE: Anything else?

• SELECT ALL THAT APPLY. 

Label	Code	Go To
CHICKENS	1
COWS	2
DUCKS	3
GEESE	4
GOATS	5
GUINEAFOWL	6
HENS	7
HORSES	8
MULES	9
PEAFOWL	10
PIGS	11
PIGEONS	12
RABBITS	13
ROOSTERS	14
SHEEP	15
TURKEYS	16
OTHER	-5
REFUSED	-1
DON'T KNOW	-2

SOURCE

National Children’s Study, Vanguard Phase (Core)

PROGRAMMER INSTRUCTIONS

• IF USING SHOWCARDS, DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS AND DISPLAY “You may refer to the card for your answer(s).”

• OTHERWISE, DISPLAY RESPONSE CATEGORIES AS MIXED UPPER/LOWER CASE.

• IF LIVESTOCK_TYPE = ANY COMBINATION OF VALUES 1 – 16, GO TO TIME_STAMP_PT_ET.

• IF LIVESTOCK_TYPE = -5, OR ANY COMBINATION OF VALUES 1 – 16 AND -5, GO TO LIVESTOCK_TYPE_OTH.

• IF LIVESTOCK_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO TIME_STAMP_PT_ET.

PT11000/(LIVETOCK_TYPE_OTH). What kind of poultry, livestock, or farm animals are these?

 

SPECIFY: ________________________

INTERVIEWER INSTRUCTIONS

• RECORD MORE THAN ONE TYPE OF POULTRY, LIVESTOCK, OR FARM ANIMAL SEPARATED BY A COMMA OR “AND.”

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

SOURCE

Avon Longitudinal Study of Parents And Children

(TIME_STAMP_PT_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

SMOKING IN HOME

(TIME_STAMP_SIH_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

SIH01000. Now I would like to ask you a few questions about smoking in your home. 

INTERVIEWER INSTRUCTIONS

• IF NECESSARY, REMIND THE PARENT/CAREGIVER THAT THE RESPONSES TO THIS SECTION SHOULD BE IN REFERENCE TO THE CHILD’S SECONDARY  RESIDENCE.

SOURCE

National Children’s Study, Vanguard Phase (Core)

SIH02000/(SMOKE). Currently, do you or others in the household smoke cigarettes, cigarillos, cigars, pipes, or other tobacco products?

Label	Code	Go To
YES	1
NO	2	TIME_STAMP_SIH_ET
REFUSED	-1	TIME_STAMP_SIH_ET
DON'T KNOW	-2	TIME_STAMP_SIH_ET

SOURCE

National Survey of Family Growth (Modified)

SIH03000/(SMOKE_HOME). Do you or anyone else smoke inside your home?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

HERALD/CAPS (Modified)

SIH04000/(SMOKE_RULES). Which of the following statements best describes smoking inside your home now?

Label	Code	Go To
No one is allowed to smoke anywhere inside the child’s home,	1
Smoking is allowed at some times or in some rooms in the child’s home, or	2
Smoking is allowed anywhere inside the child’s home	3
REFUSED	-1
DON’T KNOW	-2

SOURCE

HERALD/CAPS (Modified)

(TIME_STAMP_SIH_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

NEIGHBORHOOD CHARACTERISTICS

(TIME_STAMP_NC_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

NC01000. Now I’d like to ask a few questions about your neighborhood

SOURCE

Los Angeles Family and Neighborhood Survey

NC02000/(NEIGH_DEFN). When you are talking to someone about your neighborhood, what do you mean? Is it...

Label	Code	Go To
The block or street you live on	1
Several blocks or streets in each direction	2
The area within a 15 minutes walk from your home	3
An area larger than a 15 minutes walk from your home	4
REFUSED	-1
DON'T KNOW	-2

SOURCE

Los Angeles Family and Neighborhood Survey

NC03000/(NEIGH_FAM). How many of your relatives or in-laws live in your neighborhood? Would you say …

Label	Code	Go To
None,	1
A few,	2
Many, or	3
Most?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Los Angeles Family and Neighborhood Survey

NC04000/(NEIGH_FRIEND). How many of your friends live in your neighborhood? Would you say…

Label	Code	Go To
None,	1
A few,	2
Many, or	3
Most?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Los Angeles Family and Neighborhood Survey

NC05000/(NEIGHBORS). About how many adults do you recognize or know by sight in this neighborhood? Would you say you recognize...

Label	Code	Go To
None,	1
A few,	2
Many, or	3
Most?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Los Angeles Family and Neighborhood Survey

NC06000/(NEIGH_NUM_TALK). In the past 30 days, that is since {DATE 30 DAYS PRIOR TO INTERVIEW DATE}, how many of your neighbors have you talked with for 10 minutes or more? Would you say …

Label	Code	Go To
None,	1
1 or 2,	2
3 to 5, or	3
6 or more?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Los Angeles Family and Neighborhood Survey

PROGRAMMER INSTRUCTIONS

• CALCULATE AND DISPLAY DATE 30 DAYS PRIOR TO INTERVIEW DATE.

NC07000/(NEIGH_HELP). About how often do you and people in your neighborhood do favors for each other? By favors, we mean such things as watching each other’s children, helping with shopping, lending garden or house tools. Would you say …

Label	Code	Go To
Often,	1
Sometimes,	2
Rarely, or	3
Never?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Project on Human Development in Chicago Neighborhoods

NC08000/(NEIGH_TALK). How often do you and other people in your neighborhood visit in each other’s homes or speak with each other on the street? Would you say …

Label	Code	Go To
Often,	1
Sometimes,	2
Rarely, or	3
Never?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Project on Human Development in Chicago Neighborhoods

NC09000/(NEIGH_WATCH_1). If children were skipping school and hanging out, how likely is it that your neighbors would do something about it? Would you say it is …

Label	Code	Go To
Very Likely,	1
Likely,	2
Unlikely, or	3
Very Unlikely?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Los Angeles Family and Neighborhood Survey, Project on Human Development in Chicago Neighborhoods

NC10000/(NEIGH_WATCH_2). If children were showing disrespect to an adult, how likely is it that your neighbors would do something about it? Would you say it is…

Label	Code	Go To
Very Likely,	1
Likely,	2
Unlikely, or	3
Very Unlikely?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Project on Human Development in Chicago Neighborhoods

NC11000. Please tell me how much you agree or disagree with the following statements.

SOURCE

National Children’s Study, Vanguard Phase (Core)

NC12000/(NEIGH_CLOSE). This is a close-knit neighborhood. Would you say you….

Label	Code	Go To
Strongly agree,	1
Agree,	2
Disagree, or	3
Strongly disagree?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Project on Human Development in Chicago Neighborhoods

NC13000/(NEIGH_TRUST). People in this neighborhood can be trusted. Would you say you…

Label	Code	Go To
Strongly agree,	1
Agree,	2
Disagree, or	3
Strongly disagree?	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Project on Human Development in Chicago Neighborhoods

NC14000/(NEIGH_SAFE_1). I feel safe walking in my neighborhood, day or night. 

Label	Code	Go To
Strongly agree,	1
Agree,	2
Disagree, or	3
Strongly disagree	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Mujahid, et al. Assessing the Measurement Properties of Neighborhood Scales:  From Psychometrics to Ecometrics. Amer J. Epidemiol. 2007: 165; 858-67.

NC15000/(NEIGH_SAFE_2). Violence is not a problem in my neighborhood. 

Label	Code	Go To
Strongly agree,	1
Agree,	2
Disagree, or	3
Strongly disagree	4
REFUSED	-1
DON’T KNOW	-2

SOURCE

Mujahid, et al. Assessing the Measurement Properties of Neighborhood Scales:  From Psychometrics to Ecometrics. Amer J. Epidemiol. 2007: 165; 858-67.

NC16000/(NEIGH_SAFE_3). My neighborhood is safe from crime.  

Label	Code	Go To
Strongly agree,	1
Agree,	2
Disagree,	3
Strongly disagree	4
REFUSED	-1
DON'T KNOW	-2

SOURCE

Mujahid, et al. Assessing the Measurement Properties of Neighborhood Scales:  From Psychometrics to Ecometrics. Amer J. Epidemiol. 2007: 165; 858-67.

(TIME_STAMP_NC_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

NOISE EXPOSURE IN HOME

(TIME_STAMP_NEI_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

NEI01000. We would now like to ask you some questions about noise in and around your home.

NEI02000/(NOISE_OUTSIDE). When you are here at home, how much does noise from outdoor sources bother, disturb, or annoy you? 

Label	Code	Go To
Extremely	1
Very much	2
Moderately	3
Slightly	4
Not at all	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

 ICBEN's Community Response to Noise Team, Cohen/Bronzaft airport studies 

NEI03000/(NOISE_OUTSIDE_SCALE). What number from zero to ten best describes how much you are bothered, disturbed, or annoyed by noise from outdoor sources?  Zero means you are not bothered at all and ten means you are extremely bothered. 

Label	Code	Go To
0	0	NOISE_OUTSIDE
1	1
2	2
3	3
4	4
5	5
6	6
7	7
8	8
9	9
10	10
REFUSED	-1
DON'T KNOW	-2

SOURCE

ICBEN's Community Response to Noise Team, Cohen/Bronzaft airport studies

NEI04000/(NOISE_OUTSIDE_TYPE). What types of outdoor noises bother, disturb, or annoy you?

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, REFER RESPONDENT TO SHOWCARD. 

• OTHERWISE, READ RESPONSE CATEGORIES TO PARENT/CAREGIVER.

• SELECT ALL THAT APPLY.

Label	Code	Go To
AIRPLANE	1
CAR/TRUCK	2
GARDEN EQUIPMENT	3
DOGS BARKING	4
LOUD MUSIC	5
NEIGHBOR NOISE	6
ROWDY PASSERBY	7
NO PARTICULAR SOURCE	8
SOME OTHER SOURCE	-5
REFUSED	-1
DON'T KNOW	-2

SOURCE

 ICBEN's Community Response to Noise Team, Cohen/Bronzaft airport studies

PROGRAMMER INSTRUCTIONS

• IF USING SHOWCARDS, DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS AND DISPLAY “You may refer to the card for your answer(s).”

• OTHERWISE, DISPLAY RESPONSE CATEGORIES AS MIXED UPPER/LOWER CASE.

• IF NOISE_OUTSIDE_TYPE = ANY COMBINATION OF VALUES 1 – 8, GO TO NOISE_INSIDE.

• IF NOISE_OUTSIDE_TYPE = -5, OR ANY COMBINATION OF VALUES 1 – 8 AND -5, GO TO NOISE_OUTSIDE_TYPE_OTH.

• IF NOISE_OUTSIDE_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO NOISE_INSIDE.

NEI05000/(NOISE_OUTSIDE_TYPE_OTH). SPECIFY  _________________________________

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

SOURCE

National Children’s Study, Vanguard Phase (Core)

NEI06000/(NOISE_INSIDE). When you are here at home, how much does noise from indoor sources bother, disturb, or annoy you?  

Label	Code	Go To
Extremely	1
Very much	2
Moderately	3
Slightly	4
Not at all	5
REFUSED	-1
DON'T KNOW	-2

SOURCE

ICBEN's Community Response to Noise Team, Cohen/Bronzaft airport studies

NEI07000/(NOISE_INSIDE_SCALE). What number from zero to ten best describes how much you are bothered, disturbed, or annoyed by noise from indoor sources? Zero means you are not bothered at all and ten means you are extremely bothered.

Label	Code	Go To
0	0	NOISE_INTERFERE
1	1
2	2
3	3
4	4
5	5
6	6
7	7
8	8
9	9
10	10
REFUSED	-1
DON'T KNOW	-2

SOURCE

ICBEN's Community Response to Noise Team, Cohen/Bronzaft airport studies

NEI08000/(NOISE_INSIDE_TYPE). What types of indoor noise bother, disturb or annoy you?

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, REFER PARENT/CAREGIVER TO SHOWCARD. 

• OTHERWISE, READ RESPONSE CATEGORIES TO PARENT/CAREGIVER.

• SELECT ALL THAT APPLY.

Label	Code	Go To
BUILDING OR MECHANICAL NOISE SUCH AS A FAN, AIR CONDITIONING, ETC.	1
LOUD MUSIC	2
LOUD TALKING, CRYING, ETC. BY HOUSEHOLD MEMBERS, INCLUDING CHILDREN	3
DOGS BARKING	4
SOME OTHER SOURCE FROM INDOORS	-5
REFUSED	-1
DON'T KNOW	-2

SOURCE

ICBEN's Community Response to Noise Team, Cohen/Bronzaft airport studies

PROGRAMMER INSTRUCTIONS

• IF USING SHOWCARDS, DISPLAY RESPONSE CATEGORIES IN ALL CAPITAL LETTERS AND DISPLAY “You may refer to the card for your answer(s).”

• OTHERWISE, DISPLAY RESPONSE CATEGORIES AS MIXED UPPER/LOWER CASE.

• IF NOISE_INSIDE_TYPE = ANY COMBINATION OF VALUES 1 – 4, GO TO NOISE_INTERFERE.

• IF NOISE_INSIDE_TYPE = -5, OR ANY COMBINATION OF VALUES 1 – 4 AND -5, GO TO NOISE_INSIDE_TYPE_OTH.

• IF NOISE_INSIDE_TYPE = -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO NOISE_INTERFERE.

NEI09000/(NOISE_INSIDE_TYPE_OTH). SPECIFY  _________________________________

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

SOURCE

National Children’s Study, Vanguard Phase (Core)

NEI10000/(NOISE_INTERFERE). How does noise interfere with your life activities here at home? 

INTERVIEWER INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
Prevents you from opening windows	1
Disturbs your sleep	2
Interferes with your radio/TV listening	3
Interferes with your talking on the phone	4
Interferes with your talking to others	5
Does not interfere with your life activities	6
Interferes with your life activities in some other way	-5
REFUSED	-1
DON’T KNOW	-2

SOURCE

ICBEN's Community Response to Noise Team, Cohen/Bronzaft airport studies (modified)

PROGRAMMER INSTRUCTIONS

• IF NOISE_INTERFERE = ANY COMBINATION OF VALUES 1 – 5, GO TO NOISE_COMPLAIN.

• IF NOISE_INTERFERE = -5, OR ANY COMBINATION OF VALUES 1 – 5 AND -5, GO TO NOISE_INTERFERE_OTH.

• IF NOISE_INTERFERE  = 6, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO NOISE_COMPLAIN.

NEI11000/(NOISE_INTERFERE_OTH). SPECIFY  _________________________________

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

SOURCE

National Children’s Study, Vanguard Phase (Core)

NEI11100/(NOISE_COMPLAIN). Since our last interview on {DATE OF LAST INTERVIEW}, have you complained to police or government officials about noise in your area?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

ICBEN's Community Response to Noise Team, Cohen/Bronzaft airport studies

(TIME_STAMP_NEI_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

OCCUPATIONAL/HOBBY EXPOSURES

(TIME_STAMP_OE_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

OE01000/(HOBBIES_WORK_INSIDE_HOME). Does anyone in your home have a hobby or business inside your home that uses solvents, greases, paint, or glue, or that generates dusts or fumes, such as woodworking, soldering or welding?

INTERVIEWER INSTRUCTIONS

• HOBBIES OR BUSINESS IN DETACHED GARAGES OR THAT ARE DONE OUTSIDE ARE NOT INCLUDED.

Label	Code	Go To
YES	1
NO	2	OE03000
REFUSED	-1	OE03000
DON'T KNOW	-2	OE03000

SOURCE

National Children’s Study, Legacy Phase (12M)

OE02000/(HOBBY_BUSINESS_NAME). What do you or someone in your home make or do in this hobby or business?

 

________________________________

HOBBY/BUSINESS

PROGRAMMER INSTRUCTIONS

• ALLOW FOR 5 ENTRIES SEPARATED BY A COMMA OR “AND”.

• ALLOW 100 CHARACTERS.

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

SOURCE

National Children’s Study, Legacy Phase (12M)

OE03000. Some people have jobs or hobbies where their skin, clothes, or shoes get dirty or stained.  By “dirty” or “stained,” we mean their skin or clothes have dust, grease, fibers, or other visible chemical spots on them. Think about everyone in your household. 

OE04000/(ANY_DIRTY_CLOTHES). Does anyone routinely come into your home from their work or hobbies with dirty or stained skin, clothes, or shoes? 

Label	Code	Go To
Yes	1
No	2	TIME_STAMP_OE_ET
REFUSED	-1	TIME_STAMP_OE_ET
DON'T KNOW	-2	TIME_STAMP_OE_ET

SOURCE

National Children’s Study, Legacy Phase (12M) (Modified)

OE05000. The following questions are about those who come into your home with dirty or stained skin, work clothes, or shoes. 

SOURCE

National Children’s Study, Legacy Phase (12M)

OE06000/(FREQ_DIRTY_HANDS). How often do you or anyone in your household, come into your home from work or hobbies with dirty hands or skin? 

Label	Code	Go To
Never	1
1-2 times a Week	2
3-4 times a Week	3
5-6 times a Week	4
Every day	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase (Modified) (12M)

OE07000/(FREQ_DIRTY_SHOES). How often do you or anyone in your household wear dirty shoes inside your home? 

Label	Code	Go To
Never	1
1-2 times a Week	2
3-4 times a Week	3
5-6 times a Week	4
Every day	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase (12M)

OE08000/(FREQ_DIRTY_CLOTHES). How often do you or anyone in your household wear dirty clothes inside your home? 

Label	Code	Go To
Never	1	BRING_HOME_MATERIAL
1-2 times a Week	2
3-4 times a Week	3
5-6 times a Week	4
Every day	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase (12M)

OE09000/(WASH_SEPARATE). Are these dirty clothes washed separately from other clothes?

Label	Code	Go To
YES	1
NO	2
SOMETIMES	3
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase (12M)

OE10000/(BRING_HOME_MATERIAL). What types of materials have you or anyone in your household brought into the home from work or hobbies on clothes or shoes?  

INTERVIEWER INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
Dirt,	1
Wood dust,	2
Grease,	3
Pesticides,	4
Metal dust,	5
Coal or mining dust,	6
Animal hair, or	7
Fibers (such as asbestos or fiberglass)?	8
REFUSED	-1
DON’T KNOW	-2

SOURCE

National Children’s Study, Legacy Phase (12M)

PROGRAMMER INSTRUCTIONS

• IF BRING_HOME_MATERIAL= -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES.

(TIME_STAMP_OE_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 13 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.