Survey Questions (variable name in public use data file) |
Survey Question Number |
0-5 Years Survey |
6-11 Years Survey |
12-17 Years Survey |
A. This Child's Health |
In general, how would you describe this child’s health? (K2Q01) |
A1 |
A1 |
A1 |
How would you describe the condition of this child’s teeth (K2Q01_D) |
A2 |
A2 |
A2 |
How often |
A3 |
A3 |
A3 |
*αIs this child is affectionate and tender with you (K6Q70_R)
|
A3a |
- |
- |
*αDoes this child bounce back quickly when things do not go his or her way (K6Q73_R)
|
A3b
|
- |
- |
*αDoes this child show interest and curiosity in learning new things (K6Q71_R)
|
A3c
|
A3a
|
A3a
|
*αDoes this child smile and laugh a lot (K6Q72_R)
|
A3d
|
- |
- |
*αDoes this child work to finish tasks he or she starts (K7Q84_R)
|
- |
A3b
|
A3b
|
*αDoes this child stay calm and in control when faced with a challenge (K7Q85_R)
|
- |
A3c
|
A3c
|
*αDoes this child care about doing well in school (K7Q82_R)
|
- |
A3d
|
A3d
|
*αDoes this child do all required homework (K7Q83_R)
|
- |
A3e
|
A3e
|
*αThis child argues too much (K7Q70_R)
|
- |
A3f
|
A3f
|
*α DURING THE PAST 12 MONTHS, how often was this child bullied, picked on, or excluded by other children? (BULLIED_R) |
- |
A4 |
A4 |
*α DURING THE PAST 12 MONTHS, how often did this child bully others, pick on them, or excludes them? (BULLY) |
- |
A5 |
A5 |
DURING THE PAST 12 MONTHS, has this child had FREQUENT or CHRONIC difficulty with any of the following? |
A4
|
A6
|
A6
|
Breathing or other respiratory problems (such as wheezing or shortness of breath) (BREATHING)
|
A4a
|
A6a |
A6a
|
Eating or swallowing because of a health condition (SWALLOWING)
|
A4b
|
A6b
|
A6b
|
Digesting food, including stomach/intestinal problems, constipation, or diarrhea (STOMACH)
|
A4c
|
A6c
|
A6c
|
Repeated or chronic physical pain, including headaches or other back or body pain (PHYSICALPAIN)
|
A4d
|
A6d
|
A6d
|
Using his or her hands (HANDS)
|
A4e
|
- |
- |
Coordination or moving around (COORDINATION)
|
A4f
|
- |
- |
Toothaches (TOOTHACHES)
|
A4g
|
A6e
|
A6e
|
Bleeding gums (GUMBLEED)
|
A4h
|
A6f
|
A6f
|
Decayed teeth or cavities (CAVITIES)
|
A4i
|
A6g
|
A6g
|
Does this child have any of the following? |
A5
|
A7
|
A7
|
Serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition (MEMORYCOND)
|
-
|
A7a
|
A7a
|
Serious difficulty walking or climbing stairs (WALKSTAIRS)
|
-
|
A7b
|
A7b
|
Difficulty dressing or bathing (DRESSING)
|
-
|
A7c
|
A7c
|
Difficulty doing errands alone, such as visiting a doctor’s office or shopping, because of a physical, mental, or emotional condition (ERRANDALONE)
|
-
|
-
|
A7d
|
Deafness or problems with hearing (K2Q43B)
|
A5a
|
A7d
|
A7e
|
Blindness or problems with seeing, even when wearing glasses (BLINDNESS)
|
A5b
|
A7e
|
A7f
|
Has a doctor or other health care provider EVER told you that this child has: |
x
|
x
|
x
|
Allergies (including food, drug, insect, or other)? (ALLERGIES)
|
A6 |
A8 |
A8 |
Arthritis? (ARTHRITIS)
|
A7 |
A9 |
A9 |
Asthma? (K2Q40A)
|
A8 |
A10 |
A10 |
Brain Injury, concussion or head injury? (K2Q46A)
|
A9 |
A11 |
A11 |
Cerebral Palsy? (K2Q61A)
|
A10 |
A12 |
A12 |
Diabetes? (K2Q41A)
|
A11 |
A13 |
A13 |
Epilepsy or Seizure Disorder? (K2Q42A)
|
A12 |
A14 |
A14 |
Heart Condition? (HEART)
|
A13 |
A15 |
A15 |
Frequent or severe headaches, including migraine? (HEADACHE)
|
A14 |
A16 |
A16 |
Tourette Syndrome? (K2Q38A)
|
A15 |
A17 |
A17 |
Anxiety Problems? (K2Q33A)
|
A16 |
A18 |
A18 |
Depression? (K2Q32A)
|
A17 |
A19 |
A19 |
Down Syndrome? (DOWNSYN)
|
A18 |
A20 |
A20 |
Substance Abuse Disorder? (SUBABUSE)
|
- |
A24 |
A24 |
Has a doctor, other health care provider, or educator EVER told you that this child has: |
x |
x |
x |
Behavioral or conduct problems? (K2Q34A)
|
A22 |
A25 |
A25 |
Developmental Delay? (K2Q36A)
|
A23 |
A26 |
A26 |
Intellectual Disability (formerly known as Mental Retardation)? (K2Q60A)
|
A24 |
A27 |
A27 |
Speech or other language disorder? (K2Q37A)
|
A25 |
A28 |
A28 |
Learning Disability? (K2Q30A)
|
A26 |
A29 |
A29 |
Has a doctor or other health care provider EVER told you that this child has any other mental health condition? If yes, specify (ANYOTHER) |
A27 |
A30 |
A30 |
If YES to items from A6 (0-5 yrs) or A8 (6-17 yrs) to this point, two follow up question are asked: |
x |
x |
x |
Does this child CURRENTLY have the condition? (variable name differs based on condition)
|
x |
x |
x |
If YES, is it Mild, Moderate, or Severe? (variable name differs based on condition)
|
x |
x |
x |
Has a doctor or other health care provider EVER told you that his child has: |
x |
x |
x |
Blood Disorders (such as Sickle Cell Disease, Thalassemia, or Hemophilia)? (BLOOD)
|
A19 |
A21 |
A21 |
Cystic Fibrosis? (CYSTFIB)
|
A20 |
A22 |
A22 |
Other genetic or inherited condition? (GENETIC)
|
A21 |
A23 |
A23 |
If YES to items from A19 to A21 (0-5 yrs) or A21 to A23 (6-17 yrs), a follow up question is asked: |
x |
x |
x |
^ Was this condition identified through a blood test done shortly after birth? (These tests are sometimes called newborn screening) (BLOOD_SCREEN, CYSTFIB_SCREEN, GENETIC_SCREEN)
|
x |
x |
x |
If YES to above question under A19 (0-5 yrs) or A21 (6-17 yrs), a follow up question is asked: |
x |
x |
x |
^If YES, was this child diagnosed with Sickle Cell Disease, Thalassemia, Hemophilia, Other Blood Disorders? (SICKLECELL, THALASSEMIA, HEMOPHILIA, BLOOD_OTHER)
|
x |
x |
x |
Has a doctor or other health care provider EVER told you that this child has Autism or Autism Spectrum Disorder (ASD)? Include diagnoses of Asperger’s Disorder or Pervasive Developmental Disorder (PDD). (K2Q35A) |
A28
|
A31
|
A31
|
Does this child CURRENTLY have the condition? (K2Q35B) |
If yes, is it Mild, Moderate, or Severe? (K2Q35C) |
How old was this child when a doctor or other health care provider FIRST told you that he or she had Autism, ASD, Asperger’s Disorder or PDD? (K2Q35A_1_YEARS) |
A29 |
A32 |
A32 |
What type of doctor or other health care provider was the FIRST to tell you that this child had Autism, ASD, Asperger’s Disorder or PDD? (K2Q35D) |
A30 |
A33 |
A33 |
Is this child CURRENTLY taking medication for Autism, ASD, Asperger’s Disorder or PDD? (AUTISMMED) |
A31 |
A34 |
A34 |
At any time DURING THE PAST 12 MONTHS, did this child receive behavioral treatment for Autism, ASD, Asperger’s Disorder or PDD, such as training or an intervention that you or this child received to help with his or her behavior? (AUTISMTREAT) |
A32 |
A35 |
A35 |
Has a doctor or other health care provider EVER told you that this child has Attention Deficit Disorder or Attention Deficit/Hyperactivity Disorder, that is, ADD or ADHD? (K2Q31A) |
A33
|
A36
|
A36
|
Does this child CURRENTLY have the condition? (K2Q31B) |
If yes, is it Mild, Moderate, or Severe? (K2Q31C) |
Is this child CURRENTLY taking medication for ADD or ADHD? (K2Q31D) |
A34 |
A37 |
A37 |
At any time DURING THE PAST 12 MONTHS, did this child receive behavioral treatment for ADD or ADHD, such as training or an intervention that you or this child received to help with his or her behavior? (ADDTREAT) |
A35 |
A38 |
A38 |
DURING THE PAST 12 MONTHS, how often have this child’s health conditions or problems affected his or her ability to do things other children his or her age do? (HCABILITY) |
A36 |
A39 |
A39 |
To what extent do this child’s health conditions or problems affect his or her ability to do things? (HCEXTENT) |
A37 |
A40 |
A40 |
B. This Child as an Infant |
Was this child born more than 3 weeks before his or her due date? (K2Q05) |
B1 |
B1 |
B1 |
How much did he or she weigh when born? (K2Q04R) |
B2 |
B2 |
B2 |
What was the age of the mother when this child was born? (MOMAGE) |
B3 |
B3 |
B3 |
Was this child EVER breastfed or fed breast milk? (K6Q40) |
B4 |
- |
- |
If yes, how old was this child when he or she COMPLETELY stopped breastfeeding or being fed breast milk? (BREASTFEDEND) (K6Q41R_STILL) |
B5 |
- |
- |
How old was this child when he or she was FIRST fed formula? (FRSTFORMULA) (K6Q42R_NEVER) |
B6 |
- |
- |
How old was this child when he or she was FIRST fed anything other than breast milk or formula? (FRSTSOLIDS) (K6Q43R_NEVER) |
B7 |
- |
- |
C. Health Care Services |
Health Care Visits |
*DURING THE PAST 12 MONTHS, did this child see a doctor, nurse, or other health care professional for medical care (for example, preventive care, sick are, hospitalizations)? (S4Q01)
|
C1 |
C1 |
C1 |
*if yes, at his or her LAST medical care visit, did this child have a chance to speak with a doctor or other health care provider privately, without you or another caregiver in the room? (DOCPRIVATE) |
- |
- |
C2 |
*If yes, DURING THE PAST 12 MONTHS, how many times did this child visit a doctor, nurse, or other health care professional to receive a PREVENTIVE check-up? (K4Q20R) |
C2 |
C2 |
C3 |
Thinking about the LAST TIME you took this child for a PREVENTIVE check-up, about how long was the doctor or health care provider who examined this child in the room with you? (DOCROOM) |
C3 |
C3 |
C4 |
Height and Weight |
What is this child’s CURRENT height? (HEIGHT) |
C4 |
C4 |
C5 |
How much does this child CURRENTLY weight? (WEIGHT)
[†Data from the items on height and weight is not released individually, but they are combined to create a variable BMICLASS (10-17 years only) which is released] |
C5 |
C5 |
C6 |
Are you concerned about this child’s weight? (WGTCONC)^ |
C6 |
C6 |
C7 |
^ Has a doctor or other health care provider ever told you that his child is overweight? (OVERWEIGHT) |
C7 |
C7 |
C8 |
Developmental Concerns & Screening |
DURING THE PAST 12 MONTHS, did this child’s doctors or other health care providers ask if you have concerns about this child’s learning, development, or behavior? (K6Q10)
[If child is <9 months, skip to C9] |
C8 |
- |
- |
DURING THE PAST 12 MONTHS, did a doctor or other health care provider have you or another caregiver fill out a questionnaire about specific concerns or observations you may have about this child’s development, communications, or social behaviors? (K6Q12) |
C9 |
- |
- |
If yes, [and child is 9-23 months], did the questionnaire ask about your concerns or observations about: [Mark ALL that apply] |
x |
- |
- |
How this child talks or makes speech sounds? (K6Q13A)
|
x |
- |
- |
How this child interacts with you and others? (K6Q13B)
|
x |
- |
- |
If yes, [and child is 2-5 years], did the questionnaire ask about your concerns or observations about: [Mark ALL that apply] |
x |
- |
- |
Words and phrases this child uses and understands? (K6Q14A)
|
x |
- |
- |
How this child behaves and gets along with you and others? (K6Q14B)
|
x |
- |
- |
Usual Source of Care |
Is there a place that this child USUALLY goes when he or she is sick or you or another caregiver needs advice about his or her health? (K4Q01) |
C10 |
C8 |
C9 |
If yes, where does this child USUALLY go first? (K4Q02_R) |
C11 |
C9 |
C10 |
Is there a place that this child USUALLY goes when he or she needs routine preventive care, such as a physical examination or well-child check-up? (USUALGO) |
C12 |
C10 |
C11 |
If yes, is this the same place this child goes when he or she is sick? (USUALSICK) |
C13 |
C11 |
C12 |
Vision Testing |
*DURING THE PAST 12 MONTHS, has this child had his or her vision tested with pictures, shapes, or letters? (K4Q31_R) |
C14 |
C12 |
C13 |
If yes, where was this child's vision tested? (K4Q32X) |
C15 |
C13 |
C14 |
Dental Health Care |
DURING THE PAST 12 MONTHS, did this child see a dentist or other oral health care provider for any kind of dental or oral health care? (K4Q30_R) |
C16 |
C14 |
C15 |
If yes, DURING THE PAST 12 MONTHS, did this child see a dentist or other oral health care provider for preventive dental care, such as check-ups, dental cleanings, dental sealants, or fluoride treatments? (DENTISTVISIT) |
C17 |
C15 |
C16 |
If yes, DURING THE PAST 12 MONTHS, what preventive dental services did this child receive? (DENTALSERV) |
C18 |
C16 |
C17 |
Mental Health Care and Other Types of Care |
DURING THE PAST 12 MONTHS, has this child received any treatment or counseling from a mental health professional? (K4Q22_R) |
C19 |
C17 |
C18 |
*αHow difficult was it to get the mental health treatment or counseling that this child needed? (TREATNEED) |
C20 |
C18 |
C19 |
DURING THE PAST 12 MONTHS, has this child taken any medication because of difficulties with his or her emotions, concentration, or behavior? (K4Q23) |
C21 |
C19 |
C20 |
DURING THE PAST 12 MONTHS, did this child see a specialist other than a mental health professional? (K4Q24_R) |
C22 |
C20 |
C21 |
*αHow difficult was it to get the specialist care that this child needed? (K4Q26) |
C23 |
C21 |
C22 |
DURING THE PAST 12 MONTHS, did this child use any type of alternative health care or treatment? (ALTHEALTH) |
C24 |
C22 |
C23 |
Forgone Health Care |
DURING THE PAST 12 MONTHS, was there any time when this child needed health care but it was not received? (K4Q27) |
C25 |
C23 |
C24 |
If yes, which types of care were not received? (K4Q28X) |
C26 |
C24 |
C25 |
Did any of the following reasons contribute to this child not receiving needed health services?: |
C27 |
C25 |
C26 |
This child was not eligible for the services (NOTELIG)
|
C27a |
C25a |
C26a |
The services this child needed were not available in your area (AVAILABLE)
|
C27b |
C25b |
C26b |
There were problems getting an appointment when this child needed one (APPOINTMENT)
|
C27c |
C25c |
C26c |
There were problems with getting transportation or child care(TRANSPORTCC)
|
C27d |
C25d |
C26d |
The clinic or doctor's office wasn’t open when this child needed care (NOTOPEN)
|
C27e |
C25e |
C26e |
There were issues related to cost (ISSUECOST)
|
C27f |
C25f |
C26f |
DURING THE PAST 12 MONTHS, how often were you frustrated in your efforts to get services for this child? (C4Q04) |
C28 |
C26 |
C27 |
ER Use |
DURING THE PAST 12 MONTHS, how many times did this child visit a hospital emergency room? (HOSPITALER) |
C29 |
C27 |
C28 |
^ DURING THE PAST 12 MONTHS, was this child admitted to the hospital to stay for at least one night? (HOSPITALSTAY) |
C30 |
C28 |
C29 |
Educational & Developmental Services |
Has this child EVER had a special education or early intervention plan? (K6Q15) |
C31 |
C29 |
C30 |
If yes, how old was this child at the time of the FIRST plan? (SESPLANYR, SESPLANMO) |
C32 |
C30 |
C31 |
Is this child CURRENTLY receiving services under one of these plans? (SESCURRSVC) |
C33 |
C31 |
C32 |
Has this child EVER received special services to meet his or her developmental needs such as speech, occupational, or behavioral therapy? (K4Q36) |
C34 |
C32 |
C33 |
If yes, how old was this child when he or she began receiving these special services? (K4Q37) |
C35 |
C33 |
C34 |
Is this child CURRENTLY receiving these special services? (K4Q38) |
C36 |
C34 |
C35 |
D. Experience with This Child's Health Care Providers |
Personal Doctor or Nurse |
Do you have one or more persons you think of as this child’s personal doctor or nurse? (K4Q04_R) |
D1 |
D1 |
D1 |
Referrals for Care |
DURING THE PAST 12 MONTHS, did this child need a referral to see any doctors or receive any services? (K5Q10) |
D2 |
D2 |
D2 |
*αIf yes, how difficult was it to get referrals? (K5Q11) |
D3 |
D3 |
D3 |
Family-Centered Care |
[Only answer questions D4-D12 if child had a health care visit in the past 12 months] DURING THE PAST 12 MONTHS, how often did this child’s doctors or other health care providers: |
D4
|
D4 |
D4 |
Spend enough time with this child? (K5Q40)
|
D4a
|
D4a
|
D4a
|
Listen carefully to you? (K5Q41)
|
D4b |
D4b |
D4b |
Show sensitivity to your family’s values and customs? (K5Q42)
|
D4c
|
D4c
|
D4c
|
Provide the specific information you needed concerning this child? (K5Q43)
|
D4d
|
D4d
|
D4d
|
Help you feel like a partner in this child’s care? (K5Q44)
|
D4e
|
D4e
|
D4e
|
Shared Decision Making |
*DURING THE PAST 12 MONTHS, did this child need any decisions to be made regarding his or her health care, such as whether to get prescription, referrals, or procedures? (DECISIONS) |
D5 |
D5 |
D5 |
If yes, DURING THE PAST 12 MONTHS, how often did this child’s doctors or other health care providers: |
D6 |
D6 |
D6 |
Discuss with you the range of options to consider for his or her health care or treatment? (DISCUSSOPT)
|
D6a
|
D6a
|
D6a
|
Make it easy for you to raise concerns or disagree with recommendations for the child’s health care? (RAISECONC)
|
D6b
|
D6b
|
D6b
|
Work with you to decide together which health care and treatment choices would be best for this child? (BESTFORCHILD)
|
D6c
|
D6c
|
D6c
|
Care Coordination |
DURING THE PAST 12 MONTHS, did anyone help you arrange or coordinate this child’s care among the different doctors or services that this child uses? (K5Q20_R) |
D7 |
D7 |
D7 |
DURING THE PAST 12 MONTHS, have you felt that you could have used extra help arranging or coordinating this child’s care among the different health care providers or services? (K5Q21) {If No, skip to D10} |
D8 |
D8 |
D8 |
If yes, DURING THE PAST 12 MONTHS, how often did you get as much help as you wanted with arranging or coordinating this child’s health care? (K5Q22) |
D9 |
D9 |
D9 |
DURING HTE PAST 12 MONTHS, how satisfied were you with the communication among this child’s doctors and other health care providers? (K5Q30) |
D10 |
D10 |
D10 |
DURING THE PAST 12 MONTHS, did this child’s health care provider communicate with the child’s school, child care provider, or special education program? {If No OR did not need these services within the past 12 months, skip to E1} (K5Q31_R) |
D11 |
D11 |
D11 |
If yes, overall, how satisfied are you with the health care provider’s communication with the school, child care provider, or special education program? (K5Q32) |
D12 |
D12 |
D12 |
Transition to Adult Health Care |
Do any of this child’s doctors or other health care providers treat only children? (TREATCHILD) |
- |
- |
D13 |
If yes, have they talked with you about having this child eventually see doctors or other health care providers who treat adults? (TREATADULT) |
- |
- |
D14 |
Has this child’s doctor or other health care provider actively worked with this child to: |
- |
- |
D15 |
Make positive choices about his or her heath? (POSCHOICE)
|
- |
- |
D15a |
Gain skills to manage his or her health and health care? (GAINSKILLS)
|
- |
- |
D15b |
Understand the changes in health care that happen at age 18? (CHANGEAGE)
|
- |
- |
D15c |
^ Did you and this child receive a summary of your child's medical history (for example, medical conditions, allergies, medications, immunizations)? (MEDHISTORY) |
- |
- |
D16 |
* Have this child’s doctors or other health care providers worked with you and this child to create a plan of care to meet his or her health goals and needs? (WRITEPLAN) |
- |
- |
D17 |
* If yes, do you and this child have access to this plan of care? (RECEIVECOPY) |
- |
- |
D18 |
^ Does this plan of care address transition to doctors and other health care providers who treat adults? (PLANNEEDS_R) |
- |
- |
D19 |
Eligibility for health insurance often changes in young adulthood. Do you know how this child will be insured as he or she becomes an adult? (HEALTHKNOW) |
- |
- |
D20 |
If no, has anyone discussed with you how to obtain or keep some type of health insurance coverage as this child becomes an adult? (KEEPINSADULT) |
- |
- |
D21 |
E. This Child's Health Insurance Coverage |
DURING THE PAST 12 MONTHS, was this child EVER covered by ANY kind of health insurance or health coverage plan? (K3Q04_R) {If child was covered all 12 months, skip to E4} |
E1 |
E1 |
E1 |
Indicate whether any of the following is a reason this child was not covered by health insurance DURING THE PAST 12 MONTHS: |
E2 |
E2 |
E2 |
Change in employer or employment status (K12Q01_A)
|
E2a
|
E2a
|
E2a
|
Cancellation due to overdue premiums (K12Q01_B)
|
E2b
|
E2b
|
E2b
|
Dropped coverage because it was unaffordable (K12Q01_C)
|
E2c
|
E2c
|
E2c
|
Dropped coverage because benefits were inadequate (K12Q01_D)
|
E2d
|
E2d
|
E2d
|
Dropped coverage because choice of health care providers was inadequate (K12Q01_E)
|
E2e
|
E2e
|
E2e
|
Problems with application or renewal process (K12Q01_F)
|
E2f
|
E2f
|
E2f
|
Other, specify (K12Q01_G)
|
E2g
|
E2g
|
E2g
|
Is this child CURRENTLY covered by ANY kind of health insurance or health coverage plan? {If child is not currently covered by any kind of health insurance or health coverage plan, skip to F1} (CURRCOV) |
E3 |
E3 |
E3 |
Is this child covered by any of the following types of health insurance or health coverage plans? |
E4 |
E4 |
E4 |
Insurance through a current or former employer or union (K12Q03)
|
E4a
|
E4a
|
E4a
|
Insurance purchased directly from an insurance company (K12Q04)
|
E4b
|
E4b
|
E4b
|
Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability (K12Q12)
|
E4c
|
E4c
|
E4c
|
TRICARE or other military health care (TRICARE)
|
E4d
|
E4d
|
E4d
|
Indian Health Service (K11Q03R)
|
E4e
|
E4e
|
E4e
|
Other, specify (HCCOVOTH)
|
E4f
|
E4f
|
E4f
|
How often does this child’s health insurance offer benefits or cover services that meet this child’s needs? (K3Q20) |
E5 |
E5 |
E5 |
How often does this child’s health insurance allow him or her to see the health care providers he or she needs? (K3Q22) |
E6 |
E6 |
E6 |
Thinking specifically about this child’s mental or behavioral health needs, how often does this child’s health insurance offer benefits or cover services that meet these needs? (MENBEVCOV) |
E7 |
E7 |
E7 |
F. Providing for This Child's Health |
How much money did you pay for this child’s medical, health, dental, and vision care DURING THE PAST 12 MONTHS? (HOWMUCH) |
F1 |
F1 |
F1 |
How often are these costs reasonable? (K3Q21B) |
F2 |
F2 |
F2 |
DURING THE PAST 12 MONTHS, did your family have problems paying for any of this child’s medical or health care bills? (K3Q25) |
F3 |
F3 |
F3 |
DURING THE PAST 12 MONTHS, have you or other family members: |
F4 |
F4 |
F4 |
Left a job or taken a leave of absence because of this child’s health or health conditions? (STOPWORK)
|
F4a
|
F4a
|
F4a
|
Cut down on the hours you work because of this child’s health or health conditions? (CUTHOURS)
|
F4b
|
F4b
|
F4b
|
Avoided changing jobs because of concerns about maintaining health insurance for this child? (AVOIDCHG)
|
F4c
|
F4c
|
F4c
|
IN AN AVERAGE WEEK, how many hours do you or other family members spend providing health care at home for this child? (ATHOMEHC) |
F5 |
F5 |
F5 |
IN AN AVERAGE WEEK, how many hours do you or other family members spend arranging or coordinating health or medical care for this child, such as making appointments or locating services? (ARRANGEHC) |
F6 |
F6 |
F6 |
G. This Child's Learning (0-5 years) |
^ Is this child able to do the following... {if child is <1 year, skip to section H} |
G1 |
- |
- |
^ Say at least one word, such as "hi" or "dog"? (ONEWORD)
|
G1a |
- |
- |
^ Use 2 words together, such as "hi" or "dog"? (TWOWORDS)
|
G1b |
- |
- |
^ Use 3 words together in a sentence, such as, "Mommy come now."? (THREEWORDS)
|
G1c |
- |
- |
^ Ask questions like "who," "what," "when," "where."? (ASKQUESTION)
|
G1d |
- |
- |
^ Ask questions like "why," and "how? (ASKQUESTION2)
|
G1e |
- |
- |
^ Tell a story with a beginning, middle, and end? (TELLSTORY)
|
G1f |
- |
- |
^ Understand the meaning of the word "no"? (UNDERSTAND)
|
G1g |
- |
- |
^ Follow a verbal direction without hand gestures, such as "Wash your hands."? (DIRECTIONS)
|
G1h |
- |
- |
^ Point to things in a book when asked? (POINT)
|
G1i |
- |
- |
^ Follow 2-step directions, such as "Get your shoes and put them in the basket."? (DIRECTIONS2)
|
G1j |
- |
- |
^ Understand words such as "in," "on," and "under"? (UNDERSTAND2)
|
G1k |
- |
- |
Is this child 3 years old or older? {If child is <3 years, skip to section H} |
G2 |
- |
- |
Has this child started school? (STARTSCHOOL) |
G3 |
- |
- |
Are you concerned about how this child is learning to do things for him or herself? (K6Q08_R) |
G4 |
|
|
How confident are you that this child is ready to be in school? (CONFIDENT) |
G5 |
- |
- |
How often can this child recognize the beginning sound of a word? (RECOGBEGIN) |
G6 |
- |
- |
About how many letters of the alphabet can this child recognize? (RECOGABC) |
G7 |
- |
- |
Can this child rhyme words? (RHYMEWORD) |
G8 |
- |
- |
How often can this child explain things he or she has seen or done so that you get a very good idea what happened? (CLEAREXP) |
G9 |
- |
- |
How often can this child write his or her first name, even if some of the letters aren’t quite right or are backwards? (WRITENAME) |
G10 |
- |
- |
How high can this child count? (COUNTTO) |
G11 |
- |
- |
How often can this child identify basic shapes such as a triangle, circle, or square? (RECSHAPES) |
G12 |
- |
- |
Can this child identify the colors red, yellow, blue, and green by name? (COLOR) |
G13 |
|
|
How often is this child easily distracted? (DISTRACTED) |
G14 |
- |
- |
How often does this child keep working at something until he or she is finished? (WORKTOFIN) |
G15 |
- |
- |
When this child is paying attention, how often can he or she follow instructions to complete a simple task? (SIMPLEINST) |
G16 |
- |
- |
How does this child usually hold a pencil? (USEPENCIL) |
G17 |
- |
- |
How often does this child play well with others? (PLAYWELL) |
G18 |
- |
- |
How often does this child become angry or anxious when going from one activity to another? (NEWACTIVITY) |
G19 |
- |
- |
How often does this child show concern when others are hurt or unhappy?(HURTSAD) |
G20 |
- |
- |
When excited or all wound up, how often can this child calm down quickly?(CALMDOWN) |
G21 |
- |
- |
How often does this child lose control of his or her temper when things do not go his or her way? (TEMPER) |
G22 |
- |
- |
Compared to other children his or her age, how much difficulty does this child have making or keeping friends? (MAKEFRIEND) |
G23 |
G7 |
G7 |
Compared to other children his or her age, how often is this child able to sit still? (SITSTILL) |
G24 |
- |
- |
G. This Child's Schooling and Activities (6-17 years) |
DURING THE PAST 12 MONTHS, about how many days did this child miss school because of illness or injury? (K7Q02R_R) |
- |
G1 |
G1 |
DURING THE PAST 12 MONTHS, how many times has this child’s school contacted you or another adult in your household about any problems he or she is having with school? (K7Q04R_R) |
- |
G2 |
G2 |
SINCE STARTING KINDERGARTEN, has this child repeated any grades? (REPEATED) |
- |
G3 |
G3 |
DURING THE PAST 12 MONTHS, how often did you attend events or activities that this child participated in? (K7Q33) |
- |
G4 |
G4 |
DURING THE PAST 12 MONTHS, did this child participate in: |
- |
G5 |
G5 |
A sports team or did he or she take sports lessons after school or on weekends? (K7Q30)
|
- |
G5a |
G5a |
Any clubs or organizations after school or on weekends? (K7Q31)
|
- |
G5b |
G5b |
Any other organized activities or lessons, such as music, dance, language, or other arts? (K7Q32)
|
- |
G5c |
G5c |
Any type of community service or volunteer work at school, church, or in the community? (K7Q37)
|
- |
G5d |
G5d |
Any paid work, including regular jobs as well as babysitting, cutting grass, or other occasional work? (K7Q38)
|
- |
G5e |
G5e |
DURING THE PAST WEEK, on how many days did this child exercise, play a sport, or participate in physical activity for at least 60 minutes? (PHYSACTIV) |
- |
G6 |
G6 |
Compared to other children his or her age, how much difficulty does this child have making or keeping friends? (MAKEFRIEND) |
G23 |
G7 |
G7 |
H. About You and This Child |
Was this child born in the United States? (If yes, skip to H3} (BORNUSA) |
H1 |
H1 |
H1 |
If no, how long has this child been living in the United States? (LIVEUSA_YR/LIVEUSA_MO) |
H2 |
H2 |
H2 |
How many times has this child moved to a new address since he or she was born? (K11Q43R) |
H3 |
H3 |
H3 |
How often does this child go to bed at about the same time on weeknights? (BEDTIME) |
H4 |
H4 |
H4 |
DURING THE PAST WEEK, how many hours of sleep did this child get [during an average day (count both nighttime sleep and naps) (HOURSLEEP05)/ on most weeknights]? (HOURSLEEP) |
H5 |
H5 |
H5 |
In which position do you most often lay this baby down to sleep now? {<12 months only} (SLEEPPOS) |
H6 |
-
|
-
|
* ON MOST WEEKDAYS, about how much time does this child usually spend in front of a TV, computer, cellphone or other electronic device watching programs, playing games, accessing the internet or using social media? (Do not include time spent doing schoolwork.) (SCREENTIME) |
H7 |
H6 |
H6 |
DURING THE PAST WEEK, how many days did you or other family members read to this child? (K6Q60_R) |
H8 |
- |
- |
DURING THE PAST WEEK, how many days did you or other family members tell stories or sing songs to this child? (K6Q61_R) |
H9 |
- |
- |
How well can you and this child share ideas or talk about things that really matter? (K8Q21) |
- |
H7 |
H7 |
How well do you think you are handling the day-to-day demands of raising children? (K8Q30) |
H10 |
H8 |
H8 |
DURING THE PAST MONTH, how often have you felt: |
H11 |
H9 |
H9 |
That this child is much harder to care for than most children his or her age? (K8Q31)
|
H11a
|
H9a
|
H9a
|
That this child does things that really bother you a lot? (K8Q32)
|
H11b
|
H9b
|
H9b
|
Angry with this child? (K8Q34)
|
H11c
|
H9c
|
H9c
|
DURING THE PAST 12 MONTHS, was there someone that you could turn to for day-to-day emotional support with parenting or raising children? (K8Q35) |
H12 |
H10 |
H10 |
If yes, did you receive emotional support from: |
H13 |
H11 |
H11 |
* Spouse or domestic partner? (EMOSUPSPO)
|
H13a
|
H11a
|
H11a
|
Other family member or close friend? (EMOSUPFAM)
|
H13b
|
H11b
|
H11b
|
Health care provider? (EMOSUPHCP)
|
H13c
|
H11c
|
H11c
|
Place of worship or religious leader? (EMOSUPWOR)
|
H13d
|
H11d
|
H11d
|
Support or advocacy group related to specific health condition? (EMOSUPADV)
|
H13e
|
H11e
|
H11e
|
Peer support group? (EMOSUPPEER)
|
H13f
|
H11f
|
H11f
|
Counselor or other mental health professional? (EMOSUPMHP)
|
H13g
|
H11g
|
H11g
|
Other person, specify (EMOSUPOTH)
|
H13h
|
H11h
|
H11h
|
Does this child receive care for at least 10 hours per week from someone other than his or her parent or guardian? (K6Q20) |
H14 |
- |
- |
DURING THE PAST 12 MONTHS, did you or anyone in the family have to quit a job, not take a job, or greatly change your job because of problems with child care for this child? (K6Q27) |
H15 |
- |
- |
I. About Your Family and Household |
DURING THE PAST WEEK, on how many days did all the family members who live in the household eat a meal together? (K8Q11) |
I1 |
I1 |
I1 |
Does anyone living in your household use cigarettes, cigars, or pipe tobacco? (K9Q40) |
I2 |
I2 |
I2 |
If yes, does anyone smoke inside your home? (K9Q41) |
I3 |
I3 |
I3 |
DURING THE PAST 12 MONTHS, how often were pesticides used inside your resident to control for insects? (PESTICIDE)
|
I4 |
I4 |
I4 |
DURING THE PAST 12 MONTHS, other than in a shower or bathtub, have you seen any mold, mildew or other signs of water damage on walls or other surfaces inside your home? (MOLD) |
I5 |
I5 |
I5 |
When your family faces problems, how often are you likely to do each of the following? |
I6 |
I6 |
I6 |
Talk together about what to do (TALKABOUT)
|
I6a
|
I6a
|
I6a
|
Work together to solve our problems (WKTOSOLVE)
|
I6b
|
I6b
|
I6b |
Know we have strengths to draw on (STRENGTHS)
|
I6c
|
I6c
|
I6c
|
Stay hopeful even in difficult times (HOPEFUL)
|
I6d
|
I6d
|
I6d
|
* SINCE THIS CHILD WAS BORN, how often has it been very hard to cover the basics, like food or housing, on your family's income? (ACE1) |
I7 |
I7 |
I7 |
Which of these statements best describes you household's ability to afford the food you need DURING THE PAST 12 MONTHS? (FOODSIT) |
I8 |
I8 |
I8 |
At any time DURING THE PAST 12 MONTHS, even for one month, did anyone in your family receive: |
I9 |
I9 |
I9 |
Cash assistance from a government welfare program? (K11Q60)
|
I9a
|
I9a
|
I9a
|
Food Stamps or Supplemental Nutrition Assistance Program benefits (SNAP) (K11Q61)?
|
I9b
|
I9b
|
I9b
|
Free or reduced-cost breakfasts or lunches at school? (K11Q62)
|
I9c
|
I9c
|
I9c
|
Benefits from the Women, Infants, and Children (WIC) Program? (S9Q34)
|
I9d
|
I9d
|
I9d
|
In your neighborhood, is/are there: |
I10 |
I10 |
I10 |
Sidewalks or walking paths? (K10Q11)
|
I10a
|
I10a
|
I10a
|
A park or playground? (K10Q12)
|
I10b
|
I10b
|
I10b
|
A recreation center, community center, or boys’ and girls’ club? (K10Q13)
|
I10c
|
I10c
|
I10c
|
A library or bookmobile? (K10Q14)
|
I10d
|
I10d
|
I10d
|
Litter or garbage on the street or sidewalk? (K10Q20)
|
I10e
|
I10e
|
I10e
|
Poorly kept or rundown housing? (K10Q22)
|
I10f
|
I10f
|
I10f
|
Vandalism such as broken windows or graffiti? (K10Q23)
|
I10g
|
I10g
|
I10g
|
To what extent do you agree with these statements about your neighborhood or community? |
I11 |
I11 |
I11 |
People in this neighborhood help each other out (K10Q30)
|
I11a
|
I11a
|
I11a
|
We watch out for each other’s children in this neighborhood (K10Q31)
|
I11b
|
I11b
|
I11b
|
This child is safe in our neighborhood (K10Q40_R)
|
I11c
|
I11c
|
I11c
|
When we encounter difficulties, we know where to go for help in our community (GOFORHELP)
|
I11d
|
I11d
|
I11d
|
This child is safe at school (K10Q41_R )
|
- |
I11e
|
I11e
|
Other than you or other adults in your home, is there at least one other adult in this child’s school, neighborhood, or community who knows this child well and who he or she can rely on for advice or guidance? (K9Q96) |
- |
I12 |
I12 |
To the best of your knowledge, has this child EVER experienced any of the following? |
I12 |
I13 |
I13 |
Parent or guardian divorced or separated (ACE3)
|
I12a
|
I13a
|
I13a
|
Parent or guardian died (ACE4)
|
I12b
|
I13b
|
I13b
|
Parent or guardian served time in jail (ACE5)
|
I12c
|
I13c
|
I13c
|
Saw or heard parents or adults slap, hit, kick punch one another in the home (ACE6)
|
I12d
|
I13d
|
I13d
|
Was a victim of violence or witnessed violence in neighborhood (ACE7)
|
I12e
|
I13e
|
I13e
|
Lived with anyone who was mentally ill, suicidal, or severely depressed (ACE8)
|
I12f
|
I13f
|
I13f
|
Lived with anyone who had a problem with alcohol or drugs (ACE9)
|
I12g
|
I13g
|
I13g
|
Treated or judged unfairly because of his or her race or ethnic group (ACE10)
|
I12h
|
I13h
|
I13h
|
J. About You |
* These questions are to be completed for each of the two adults in the household who are this child’s primary caregivers. If there is just one adult primary caregiver, provide answers for that adult. |
How are you related to this child? (A#_RELATION) |
J1/J13 |
J1/J13
|
J1/J13
|
What is your sex? (A#_SEX) |
J2/J14 |
J2/J14
|
J2/J14
|
What is your age? (A#_AGE) |
J3/J15 |
J3/J15
|
J3/J15
|
Where were you born? (A#_BORN) |
J4/J16 |
J4/J16
|
J4/J16
|
[If outside of the U.S.] When did you come to live in the United States? (A#_LIVEUSA) |
J5/J17 |
J5/J17
|
J5/J17
|
What is the highest grade or year of school you have completed? (A#_GRADE) |
J6/J18 |
J6/J18
|
J6/J18
|
What is your marital status? (A#_MARITAL) |
J7/J19 |
J7/J19
|
J7/J19
|
In general, how is your physical health? (A#_PHYSHEALTH) |
J8/J20 |
J8/J20
|
J8/J20
|
In general, how is your mental or emotional health? (A#_MENTHEALTH) |
J9/J21 |
J9/J21
|
J9/J21
|
Were you employed at least 50 out of the past 52 weeks? (A#_K11Q50_R) |
J10/J22 |
J10/J22
|
J10/J22
|
Have you ever served on active duty in the U.S. Armed forces, Reserves, or the National Guard? (A#_ACTIVE) |
J11/J23 |
J11/J23 |
J11/J23 |
Were you deployed at any time during this child’s life? (A#_DEPLSTAT) |
J12/J24 |
J12/J24 |
J12/J24 |
K. Household Information |
How many people are living or staying at this address? (HHCOUNT) |
K1 |
K1 |
K1 |
How many of these people in your household are family members? (FAMCOUNT) |
K2 |
K2 |
K2 |
Income in 2017 (The public use file does not include the following individual
variables# but are presented as an aggregate variable labeled FPL.) |
K3 |
K3 |
K3 |
IN THE LAST CALENDAR YEAR (2017). Mark Yes or No for each type of income this child's family received, and give best estimate of the total amount for those types marked Yes. |
- |
- |
- |
Wages, salary, commissions, bonuses, or tips from all jobs? (INCWAGES)#
|
K3a
|
K3a
|
K3a
|
Self-employment income from own nonfarm businesses or farm businesses, including proprietorships and partnerships? (INCSELFEMP)#
|
K3b
|
K3b
|
K3b
|
Interest, dividends, net rental income, royalty income, or income from estates and trusts? (INCINTDIV)#
|
K3c
|
K3c
|
K3c
|
Social security or railroad retirement; retirement, survivor, or disability pensions? (INCSSRR)
|
K3d
|
K3d
|
K3d
|
Supplemental security income (SSI); any public assistance or welfare payments from the state or local welfare office? (INCSSIPA)#
|
K3e
|
K3e
|
K3e
|
Any other sources of income received regularly such as Veterans’ (VA) payments, unemployment compensation, child support, or alimony? (INCOTHER)#
|
K3f
|
K3f
|
K3f
|
Think about your total combined family income IN THE LAST CALENDAR YEAR for all members of the family. What is that amount before taxes? (TOTINCOME)# |
K4 |
K4 |
K4 |