Childhood National Immunization Coverage Survey - 2017

Record Linkage Statement 2 (RLS2) - Question identifier:RLS2_Q01

To enhance the data from this survey and to reduce the reporting burden, Statistics Canada may combine your responses from this survey with information from other surveys or from administrative data sources.

• 1: Continue
• 2: Respondent does not want his responses combined with other sources
• 3: Other [e.g. respondent hung up, interview suspended / interrupted]

Record Linkage Statement 2 (RLS2) - Question identifier:RLS2_Q02

To enhance the data from this survey and to reduce the reporting burden, Statistics Canada will combine your responses from this survey with information from ^FNAME's immunization records.

• 1: Continue
• 2: Respondent does not want his responses combined with other sources
• 3: Other [e.g. respondent hung up, interview suspended / interrupted]

Record Linkage Statement 2 (RLS2) - Question identifier:RLS2_R05

Sharing ^FNAME's personal information, such as name, gender, address, birth date and health number with [the Government of Newfoundland and Labrador Department of Health and Community Services and/or your regional health authority/the Prince Edward Island Department of Health and Wellness and/or Health PEI/the Nova Scotia Department of Health and Wellness and/or Nova Scotia Health Authority/the provincial ministry of health and/or your regional health authority/the 'ministère de la Santé et des Services sociaux du Québec' and/or the 'Institut national de santé publique du Québec'/the Ontario Ministry of Health and Long-Term Care, Public Health Ontario and/or your public health unit/Manitoba Health, Seniors and Active Living and/or your regional health authority/the Saskatchewan Ministry of Health and/or your regional health authority/Alberta Health and/or Alberta Health Services/the British Columbia Centre for Disease Control and/or Vancouver Coastal Health/the Government of Yukon Department of Health and Social Services and/or your community health centre/the Northwest Territories Department of Health and Social Services and/or your Health and Social Services Authority/territorial ministry of health and/or your regional health authority/provincial or territorial ministry of health and/or your regional health authority] will allow us to link to immunization records. [These organizations] must agree to keep this information confidential before receiving it.

Record Linkage Statement 2 (RLS2) - Question identifier:RLS2_Q05

Do you agree to share ^FNAME's information with the provincial/territorial authority responsible for the Immunization registry?

• 1: Yes
• 2: No

Record Linkage Statement 2 (RLS2) - Question identifier:RLS2_Q10

Having a provincial or territorial health number will assist us in linking to this other information.

Does ^FNAME have [a Newfoundland and Labrador/a Prince Edward Island/a Nova Scotia/a New Brunswick/a Quebec/an Ontario/a Manitoba/a Saskatchewan/an Alberta/a British Columbia/a Yukon/a Northwest Territories/a Nunavut] health number?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Record Linkage Statement 2 (RLS2) - Question identifier:RLS2_Q15

For which province or territory is ^FNAME's health number?

• 10: Newfoundland and Labrador
• 11: Prince Edward Island
• 12: Nova Scotia
• 13: New Brunswick
• 24: Quebec
• 35: Ontario
• 46: Manitoba
• 47: Saskatchewan
• 48: Alberta
• 59: British Columbia
• 60: Yukon
• 61: Northwest Territories
• 62: Nunavut
• 88: Does not have a Canadian health number
• 98: RF
• 99: DK

Record Linkage Statement 2 (RLS2) - Question identifier:RLS2_Q25

Statistics Canada may also add information from other surveys or administrative sources.

• 1: Continue
• 2: Respondent does not want his responses combined with other sources

Status of Records (SOR) - Question identifier:SOR_R01

The following questions are about childhood immunizations.

Status of Records (SOR) - Question identifier:SOR_Q01

Has ^FNAME ever been vaccinated?

• 1: Yes
• 2: No

Status of Records (SOR) - Question identifier:SOR_Q02

What are the reasons that ^FNAME has not been vaccinated?

• 01: Did not consider it necessary for my child
• 02: Concerns about the risk of side effects of vaccines
• 03: Not confident in the usefulness or the effectiveness of vaccines
• 04: Religious reasons
• 05: Philosophical reasons
• 06: I did not know which vaccine my child needed
• 07: I did not know where to get my child vaccinated
• 08: I could not contact the health facility or clinic
• 09: I could not get an appointment
• 10: Transportation to get to the appointment was a problem
• 11: No one could take care of my other children during the appointment
• 12: I could not get a leave from my employer
• 13: My child has/had a pre-existing medical condition
• 14: Other - Specify
• 98: RF
• 99: DK

Status of Records (SOR) - Question identifier:SOR_R03

You may recall receiving an introductory package in the mail describing the purpose of the Childhood National Immunization Coverage Survey. In our letter to you, we asked that you have your child's immunization record close at hand during the interview.

Status of Records (SOR) - Question identifier:SOR_Q03

Do you have a copy of ^FNAME's official Immunization Card or booklet or a print-out from the [territorial/provincial] immunization registry?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q04

Do you have it on hand?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q07

Were you able to find an immunization record?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q09

It is important that we have the most accurate information about your child's immunizations. Do you think that you could find an immunization record in the next few days?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_R10

DT_SORR10E
Now I would like to ask you some questions that may be answered without the immunization record.

Identify Record Status 2 (REC2) - Question identifier:REC2_Q01

From which province or territory is ^FNAME's immunization booklet?

• 10: Newfoundland and Labrador
• 11: Prince Edward Island
• 12: Nova Scotia
• 13: New Brunswick
• 24: Quebec
• 35: Ontario
• 46: Manitoba
• 47: Saskatchewan
• 48: Alberta
• 59: British Columbia
• 60: Yukon
• 61: Northwest Territories
• 62: Nunavut
• 76: U.S.A.
• 77: Outside of Canada and U.S.A.

Identify Record Status 2 (REC2) - Question identifier:REC2_R01

I need to record the name and date of each immunization listed on your immunization record. Let's start with the first immunization on your child's record.

First I will ask you to read [the vaccine followed by the date on which it was received./the date, and then the vaccines that were received on that date.]

Have Immunization Record 2 (HIR2) - Question identifier:HIR2_Q01

What was the year of the immunization?

Min = 1870; Max = 2100

Have Immunization Record 2 (HIR2) - Question identifier:HIR2_Q02

Are you unable to provide the year of the immunization because it is blank, illegible or for some other reason?

• 1: Year is blank
• 2: Year is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Have Immunization Record 2 (HIR2) - Question identifier:HIR2_Q03

What was the month?

• 01: January
• 02: February
• 03: March
• 04: April
• 05: May
• 06: June
• 07: July
• 08: August
• 09: September
• 10: October
• 11: November
• 12: December
• 98: RF
• 99: DK

Have Immunization Record 2 (HIR2) - Question identifier:HIR2_Q04

Are you unable to provide the month of the immunization because it is blank, illegible or for some other reason?

• 1: Month is blank
• 2: Month is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Have Immunization Record 2 (HIR2) - Question identifier:HIR2_Q05

What was the day?

Min = 01; Max = 31

Have Immunization Record 2 (HIR2) - Question identifier:HIR2_Q06

Are you unable to provide the day of the immunization because it is blank, illegible or for some other reason?

• 1: Day is blank
• 2: Day is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Have Immunization Record 2 (HIR2) - Question identifier:HIR2_Q09

Are there any other dates listed on the immunization record?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Immunizations Received (IMR) - Question identifier:IMR_Q07

What immunization(s) did ^FNAME receive on that date?

• 1: Search
• 2: Other - Specify
• 8: RF
• 9: DK

Immunizations Received (IMR) - Question identifier:IMR_Q08

Are you unable to provide the name of the immunization because it is blank, illegible or for some other reason?

• 1: Immunization is blank
• 2: Immunization is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Immunizations Received (IMR) - Question identifier:IMR_N08A

Are there any other vaccines listed on the immunization record for this date?

• 1: Yes
• 2: No

Have Immunization Record 3 (HIR3) - Question identifier:HIR3_Q07

What immunization did ^FNAME receive?

• 1: Search
• 2: Other - Specify
• 8: RF
• 9: DK

Have Immunization Record 3 (HIR3) - Question identifier:HIR3_Q08

Are you unable to provide the name of the immunization because it is blank, illegible or for some other reason?

• 1: Immunization is blank
• 2: Immunization is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Have Immunization Record 3 (HIR3) - Question identifier:HIR3_Q10

Are there any other vaccines listed on the immunization record ?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Immunizations Received Dates (IRD) - Question identifier:IRD_R01

Please provide the [first/second/third/fourth/fifth/sixth/seventh] date for the ^DT_VACCINE_E vaccine.

Immunizations Received Dates (IRD) - Question identifier:IRD_Q01

What was the year of the immunization?

Min = 1870; Max = 2100

Immunizations Received Dates (IRD) - Question identifier:IRD_Q02

Are you unable to provide the year of the immunization because it is blank, illegible or for some other reason?

• 1: Year is blank
• 2: Year is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Immunizations Received Dates (IRD) - Question identifier:IRD_Q03

What was the month?

• 01: January
• 02: February
• 03: March
• 04: April
• 05: May
• 06: June
• 07: July
• 08: August
• 09: September
• 10: October
• 11: November
• 12: December
• 98: RF
• 99: DK

Immunizations Received Dates (IRD) - Question identifier:IRD_Q04

Are you unable to provide the month of the immunization because it is blank, illegible or for some other reason?

• 1: Month is blank
• 2: Month is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Immunizations Received Dates (IRD) - Question identifier:IRD_Q05

What was the day?

Min = 01; Max = 31

Immunizations Received Dates (IRD) - Question identifier:IRD_Q06

Are you unable to provide the day of the immunization because it is blank, illegible or for some other reason?

• 1: Day is blank
• 2: Day is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Immunizations Received Dates (IRD) - Question identifier:IRD_Q09

Are there any other dates listed on the immunization record for the ^DT_VACCINE_E vaccine?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Not on Immunization Record (NOR) - Question identifier:NOR_Q01

Has ^FNAME received any other immunizations that are not listed on your immunization record [, for example, shots received elsewhere, such as at school]?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations (OTH) - Question identifier:OTH_Q01

What was the year of the immunization?

Min = 1870; Max = 2100

Other Immunizations (OTH) - Question identifier:OTH_Q02

What was the month?

• 01: January
• 02: February
• 03: March
• 04: April
• 05: May
• 06: June
• 07: July
• 08: August
• 09: September
• 10: October
• 11: November
• 12: December
• 98: RF
• 99: DK

Other Immunizations (OTH) - Question identifier:OTH_Q03

What was the day?

Min = 1; Max = 31

Other Immunizations (OTH) - Question identifier:OTH_Q05

Are there any other dates when ^FNAME received an immunization?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations sub-block (OTHS) - Question identifier:OTHS_Q04

What immunization(s) did ^FNAME receive on that date?

• 1: Search
• 2: Other - Specify
• 8: RF
• 9: DK

Other Immunizations sub-block (OTHS) - Question identifier:OTHS_N04A

Are there any other vaccines listed on the immunization record for this date?

• 1: Yes
• 2: No

Other Immunizations Received (OIR) - Question identifier:OIR_Q30

Based on your immunization record, has ^FName received the booster vaccine for tetanus-diphtheria-pertussis, or Tdap, since your 11th birthday? It may also be listed as Adacel or Boostrix.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations Received (OIR) - Question identifier:OIR_Q35

[Even though you do not have your record,/Even though it is not indicated in your record,] to your knowledge, has ^FName received the booster vaccine for tetanus-diphtheria-pertussis, or Tdap, since your 11th birthday? This vaccine may also be called Adacel or Boostrix.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations Received (OIR) - Question identifier:OIR_Q40

Based on your immunization record, has ^FName received the Human Papillomavirus or HPV vaccine? It may also be listed under Gardasil or Cervarix.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations Received (OIR) - Question identifier:OIR_Q45

[Even though you do not have your record,/Even though it is not indicated in your record,] to your knowledge, has ^FName ever received the Human Papillomavirus or HPV vaccine? It may also be called Gardasil or Cervarix.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations Received (OIR) - Question identifier:OIR_Q50

Based on your immunization record, has ^FName received the Hepatitis B vaccine since your 6th birthday? It may also be listed under Engerix, Recombivax or Twinrix.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations Received (OIR) - Question identifier:OIR_Q55

[Even though you do not have your record,/Even though it is not indicated in your record,] to your knowledge, has ^FName received the Hepatitis B vaccine since your 6th birthday? It may also be called Engerix, Recombivax or Twinrix.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations Received sub-block (OIRS) - Question identifier:OIRS_Q51

Are there any other dates listed on the immunization record?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 1 (KAB1) - Question identifier:KAB1_Q01

Have you ever encountered any challenges that prevented you from having ^FNAME vaccinated?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 1 (KAB1) - Question identifier:KAB1_Q02

What challenges prevented you from having ^FNAME vaccinated?

• 01: I did not know which vaccine my child needed
• 02: I did not know where to get my child vaccinated
• 03: I could not contact the health facility or clinic
• 04: I could not get an appointment
• 05: Transportation to get to the appointment was a problem
• 06: No one could take care of my other children during the appointment
• 07: I could not get a leave from my employer
• 08: Other - Specify
• 98: RF
• 99: DK

Knowledge, Attitudes and Beliefs 2017 - Part 1 (KAB1) - Question identifier:KAB1_Q03

Have you ever decided not to immunize ^FNAME with a particular vaccine?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 1 (KAB1) - Question identifier:KAB1_Q04

Which vaccine(s) did you decide not to give to ^FNAME?

• 01: Chickenpox (Varicella)
• 02: Diphtheria
• 03: Haemophilus influenzae type b (Hib)
• 04: Hepatitis B
• 05: Human Papilloma Virus (HPV)
• 06: Influenza (flu)
• 07: Measles
• 08: Meningococcal
• 09: MMR (Measles, Mumps, Rubella)
• 10: MMRV (Measles, Mumps, Rubella, Varicella)
• 11: Mumps
• 12: Pertussis (Whooping cough)
• 13: Pneumococcal
• 14: Polio (IPV) (Poliomyelitis)
• 15: Rotavirus
• 16: Rubella (German measles)
• 17: Tetanus (Lock jaw)
• 18: Other - Specify
• 98: RF
• 99: DK

Reasons not Immunized (RNI) - Question identifier:RNI_Q01

What is the main reason that you decided not to immunize ^FNAME with ^DT_KAB1_Q04E?

• 01: Did not consider it necessary for my child
• 02: Concerns about the risk of side effects of vaccines
• 03: Not confident in the effectiveness of vaccines
• 04: Religious reasons
• 05: Philosophical reasons
• 06: [Not needed because my child is not sexually active yet/empty]
• 08: Other - Specify
• 98: RF
• 99: DK

Knowledge, Attitudes and Beliefs 2017 - Part 2 (KAB2) - Question identifier:KAB2_Q01

[Other than the vaccines that you decided not to give, have/Have] you ever been reluctant or hesitated to get a vaccination for ^FNAME?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 2 (KAB2) - Question identifier:KAB2_Q02

Which vaccine(s) were you reluctant to get for ^FNAME?

• 01: Chickenpox (Varicella)
• 02: Diphtheria
• 03: Haemophilus influenzae type b (Hib)
• 04: Hepatitis B
• 05: Human Papilloma Virus (HPV)
• 06: Influenza (flu)
• 07: Measles
• 08: Meningococcal
• 09: MMR (Measles, Mumps, Rubella)
• 10: MMRV (Measles, Mumps, Rubella, Varicella)
• 11: Mumps
• 12: Pertussis (Whooping cough)
• 13: Pneumococcal
• 14: Polio (IPV) (Poliomyelitis)
• 15: Rotavirus
• 16: Rubella (German measles)
• 17: Tetanus (Lock jaw)
• 18: Other - Specify
• 98: RF
• 99: DK

Knowledge, Attitudes and Beliefs 2017 - Part 2 (KAB2) - Question identifier:KAB2_Q03

For which reasons were you reluctant to vaccinate ^FNAME with [this vaccine/these vaccines]?

• 01: Did not consider it necessary for my child
• 02: Concerns about the risk of side effects of vaccines
• 03: Not confident in the effectiveness of vaccines
• 04: Religious reasons
• 05: Philosophical reasons
• 06: [Not needed because my child is not sexually active yet/empty]
• 08: Other - Specify
• 98: RF
• 99: DK

Knowledge, Attitudes and Beliefs 2017 - Part 2 (KAB2) - Question identifier:KAB2_Q04

What made you decide to have ^FNAME vaccinated despite your initial reluctance?

• 01: Advice from my doctor or health care professional
• 02: Advice from a friend or a family member
• 03: To protect him/her from disease
• 04: To protect others from disease
• 05: Benefits are more important than risks
• 06: I know or knew someone who got a vaccine-preventable disease
• 07: I fear I may regret it later if I don't
• 08: Need it for day care or school entry
• 09: Other - Specify
• 98: RF
• 99: DK

Knowledge, Attitudes and Beliefs 2017 - Part 2 (KAB2) - Question identifier:KAB2_Q05

Have you ever decided to delay any vaccines for ^FNAME?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 2 (KAB2) - Question identifier:KAB2_Q06

Why did you decide to delay some vaccines for ^FNAME?

• 1: My child was too young to receive vaccines
• 2: There are too many vaccines given to children at the same time
• 3: I wanted to take more time to decide about some vaccines
• 4: My child had a health issue / was sick
• 5: Other - Specify
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_R01

For each of the following statements, please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree.

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q01

In general, childhood vaccines are safe.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q02

In general, childhood vaccines are effective.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q03

In general, vaccines help to protect my child's health.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q04

In general, I am concerned about the potential side effects from vaccines.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q05

In general, a vaccine can give you a serious case of the very same disease it was meant to prevent.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q06

In general, the use of alternative practices, such as homeopathy or chiropractic, can eliminate the need for vaccination.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q07

In general, a healthy lifestyle such as healthy nutrition and hygiene can replace the need for vaccination.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q08

Please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree with the following statements.

Having my child vaccinated helps to protect the health of others in my family.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q09

Having my child vaccinated helps to protect the health of others in my community.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q10

Most parents in my community have their children vaccinated with all recommended vaccines.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q11

Children receive too many vaccines at the same visit.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q12

Children receive too many vaccines overall.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q13

It is better for children to develop their immunity from natural infections rather than from vaccines.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q14

Delaying child vaccines causes risks to their health.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 3 (KAB3) - Question identifier:KAB3_Q15

Unvaccinated children are at higher risk of getting some serious diseases.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q01

To what extent do you trust the following sources of information on immunization?

Medical doctors

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q02

(To what extent do you trust the following sources of information on immunization?)

Nurses

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q03

(To what extent do you trust the following sources of information on immunization?)

Pharmacists

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q04

(To what extent do you trust the following sources of information on immunization?)

Alternative health providers (naturopaths, chiropractors, etc.)

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q05

(To what extent do you trust the following sources of information on immunization?)

Family

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q06

(To what extent do you trust the following sources of information on immunization?)

Friends

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q07

(To what extent do you trust the following sources of information on immunization?)

Medical associations such as the Canadian Paediatric Society (including their websites)

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q08

(To what extent do you trust the following sources of information on immunization?)

My local public health clinic (including their website)

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q09

(To what extent do you trust the following sources of information on immunization?)

My CLSC

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q10

(To what extent do you trust the following sources of information on immunization?)

The Ministry of Health of my province or territory (including their website)

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q11

(To what extent do you trust the following sources of information on immunization?)

The Public Health Agency of Canada and Health Canada (including their websites)

• 1: Really trust
• 2: Trust
• 3: Somewhat trust
• 4: Do not trust at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Beliefs 2017 - Part 4 (KAB4) - Question identifier:KAB4_Q12

Where do you seek information on immunizations for ^FNAME?

• 01: Medical doctors
• 02: Nurses
• 03: Pharmacists
• 04: Alternative health providers (naturopaths, chiropractors, etc.)
• 05: Family
• 06: Friends
• 07: Medical associations such as the Canadian Paediatric Society (including their websites)
• 08: My local public health clinic (including their website)
• 09: My CLSC
• 10: The Ministry of Health of my province or territory (including their website)
• 11: The Public Health Agency of Canada and Health Canada (including their websites)
• 12: Social media (Facebook, Twitter)
• 13: I do not seek information on immunization.
• 14: Other - Specify
• 98: RF
• 99: DK

Education Highest Degree Block v.1 (EHG1) - Question identifier:EHG1_R01

Now, I would like to ask you some general background questions.

Education Highest Degree Block v.1 (EHG1) - Question identifier:EHG1_Q01

What is the highest certificate, diploma or degree that you have completed?

• 1: Less than high school diploma or its equivalent
• 2: High school diploma or a high school
  equivalency certificate
• 3: Trade certificate or diploma
• 4: College, CEGEP or other non-university
  certificate or diploma (other than trades
  certificates or diplomas)
• 5: University certificate or diploma below the
  bachelor's level
• 6: Bachelor's degree (e.g. B.A., B.Sc., LL.B.)
• 7: University certificate, diploma, degree above the
  bachelor's level
• 8: RF
• 9: DK

Education of Respondent's Spouse/Partner (EOP) - Question identifier:EOP_R01

The next question refers to your [spouse/partner]'s education.

Education of Respondent's Spouse/Partner (EOP) - Question identifier:EOP_Q01

What is the highest level of education that your [spouse/partner] has attained?

• 1: Less than high school diploma or its equivalent
• 2: High school diploma or a high school
  equivalency certificate
• 3: Trade certificate or diploma
• 4: College, CEGEP or other non-university
  certificate or diploma (other than trades
  certificates or diplomas)
• 5: University certificate or diploma below the
  bachelor's level
• 6: Bachelor's degree (e.g. B.A., B.Sc., LL.B.)
• 7: University certificate, diploma, degree above the
  bachelor's level
• 8: RF
• 9: DK

CNICS-Household members questions (CNHQ) - Question identifier:CNHQ_Q05

How old were you when ^FNAME was born?

Min = 10; Max = 100

CNICS-Household members questions (CNHQ) - Question identifier:CNHQ_Q10

How many people currently live at this address?

Min = 1; Max = 100

CNICS-Household members questions (CNHQ) - Question identifier:CNHQ_Q15

How many children aged 4 and younger live at this address?

Min = 0; Max = 100

CNICS-Household members questions (CNHQ) - Question identifier:CNHQ_Q20

How many children aged 5 to 9 live at this address?

Min = 0; Max = 100

CNICS-Household members questions (CNHQ) - Question identifier:CNHQ_Q25

How many children aged 10 to 14 live at this address?

Min = 0; Max = 100

CNICS-Household members questions (CNHQ) - Question identifier:CNHQ_Q30

How many children aged 15 to 17 live at this address?

Min = 0; Max = 100

Immigration minimum block (IMM) - Question identifier:IMM_Q01

In what country were you born?

• 1: Search
• 2: Other - Specify
• 8: RF
• 9: DK

Immigration minimum block (IMM) - Question identifier:IMM_Q05

In what year did you first come to Canada to live?

Min = 1870; Max = 2100

Immigration minimum block (IMM2) - Question identifier:IMM2_Q01

In what country was your child, ^FNAME, born?

• 1: Search
• 2: Other - Specify
• 8: RF
• 9: DK

Immigration minimum block (IMM2) - Question identifier:IMM2_Q02

In which province or territory was ^FNAME born?

• 10: Newfoundland and Labrador
• 11: Prince Edward Island
• 12: Nova Scotia
• 13: New Brunswick
• 24: Quebec
• 35: Ontario
• 46: Manitoba
• 47: Saskatchewan
• 48: Alberta
• 59: British Columbia
• 60: Yukon
• 61: Northwest Territories
• 62: Nunavut
• 98: RF
• 99: DK

Immigration minimum block (IMM2) - Question identifier:IMM2_Q05

In what year did ^FNAME first come to Canada to live?

Min = 1870; Max = 2100

Aboriginal Minimum (AMB) - Question identifier:AMB_Q01

Is ^FNAME an Aboriginal person, that is, First Nations, Métis or Inuk (Inuit)? First Nations includes Status and Non-Status Indians.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Aboriginal Minimum (AMB) - Question identifier:AMB_Q02

Is ^FNAME First Nations, Métis or Inuk (Inuit)?

• 1: First Nations (North American Indian)
• 2: Métis
• 3: Inuk (Inuit)
• 8: RF
• 9: DK

Total Household Income (THI) - Question identifier:THI_Q01

Now a question about your total household income.

What is your best estimate of your total household income received by all household members, from all sources, before taxes and deductions, during the year ending December 31, ]?

Income can come from various sources such as from work, investments, pensions or government. Examples include Employment Insurance, Social Assistance, Child Tax Benefit and other income such as child support, spousal support (alimony) and rental income.

Min = -9000000; Max = 90000000

Total Household Income (THI) - Question identifier:THI_Q02

Can you estimate in which of the following groups your household income falls? Was the total household income during the year ending December 31, ]... ?

• 1: Less than $50,000, including income loss
• 2: $50,000 and more
• 8: RF
• 9: DK

Total Household Income (THI) - Question identifier:THI_Q03

Please stop me when I have read the category which applies to your household.

Was it... ?

• 1: Less than $5,000
• 2: $5,000 to less than $10,000
• 3: $10,000 to less than $15,000
• 4: $15,000 to less than $20,000
• 5: $20,000 to less than $30,000
• 6: $30,000 to less than $40,000
• 7: $40,000 to less than $50,000
• 8: RF
• 9: DK

Total Household Income (THI) - Question identifier:THI_Q04

Please stop me when I have read the category which applies to your household.

Was it... ?

• 1: $50,000 to less than $60,000
• 2: $60,000 to less than $70,000
• 3: $70,000 to less than $80,000
• 4: $80,000 to less than $90,000
• 5: $90,000 to less than $100,000
• 6: $100,000 to less than $150,000
• 7: $150,000 and over
• 8: RF
• 9: DK

Validation Recruitment (VAL) - Question identifier:VAL_R03

If you would like to have some time to find ^FNAME's immunization record, I can make an appointment to call you back.

Validation Recruitment (VAL) - Question identifier:VAL_N07

Set an appointment to call back the PMK. Select In Progress outcome code 24-Soft appointment; call-back required.

Press <1> to continue.

• 1: Continue

Validation sub-block (VALS) - Question identifier:VALS_R04

We would [also/empty] like to contact the health care provider(s) who have given ^FNAME the vaccines. All information obtained will be kept strictly confidential and is for research purposes only.

Validation sub-block (VALS) - Question identifier:VALS_R05

To do this, we need to get your written consent and the contact information for all of the health care providers in Canada who have given ^FNAME immunizations. [In the next couple of days you/You] will receive a package with a consent form to fill out the names and contact information for ^FNAME's immunization providers and a postage-paid return envelope. When you have filled out the form and signed it, please return it by mail at your earliest convenience.

Validation sub-block (VALS) - Question identifier:VALS_N06

Mail consent form to respondent?

• 1: Yes
• 2: No

Validation sub-block (VALS) - Question identifier:VALS_N07

This is the end of the component. Return to previously answered questions to make any necessary corrections, or select <Exit> to exit the component.

• 1: Exit