Demography

Form Approved

OMB No. 0923-0041

Exp. Date 01/31/2023

APPENDIX E3

DEMOGRAPHY

ATSDR estimates the average public reporting burden for this collection of information as 2 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering, and maintaining the data/information 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-0041).

3.1 FEMALE REPRODUCTIVE HISTORY

Follow-up questions are based on:

Q: What is your gender?

ITEM	VARIABLE CODE	RESPONSE	DESCRIPTION	FOLLOW-UP QUESTIONS (SEE BELOW)
R15	R_GENDER	2	Female	APPENDIX E 3.1.1 – 3.1.6

The following questions are about your menstrual periods and pregnancy and childbirth history.

APPENDIX ITEM	VARIABLE CODE	RESPONSE	DESCRIPTION
3.1.1	S12_Q01		How old were you when you first had your first menstrual period?
			ENTER:
3.1.2	S12_Q02		Have you had at least one menstrual period in the past 12 months? Please do not include bleedings caused by medical conditions, hormone therapy, or surgeries.
		1	Yes
		2	No
			GO TO: APPENDIX ITEM 3.1.2.1
		9	Don’t know
3.1.2.1			IF NO What is the reason that you have not had a period in the past 12 months?
	S12_Q02A	1	Pregnancy
	S12_Q02B	2	Breast feeding
	S12_Q02C	3	Menopause/Hysterectomy
	S12_Q02D	4	Medical conditions/ Treatments
	S12_Q02E	5	Other: Please specify ___
	S12_Q02F		ENTER:
	S12_Q02G	9	Don’t know
3. 1.3	S12_Q03		How old were you when you had your LAST menstrual period?
			ENTER
3. 1.4	S12_Q04		Have you ever been pregnant?
		1	Yes
			GO TO: APPENDIX ITEM 3.1.4.1
		2	No
		9	Don’t know
3. 1.4.1	S12_Q04A		IF YES How many times have you been pregnant? Please count all pregnancies including, live births, miscarriages, stillbirths, tubal pregnancies or abortions) Number of pregnancies
			ENTER
3. 1.5	S12_Q04B		Are you currently pregnant?
		1	Yes
		2	No
		9	Don’t know
3. 1.6	S12_Q04C		How many deliveries resulted in a live birth?
			ENTER:
3.1.6.1	S12_Q04D		How old were you at the time of your FIRST live birth?
			ENTER:
3.1.6.2	S12_Q04E		How old were you at the time of your LAST live birth?
			ENTER: