Ontario Child Health Study - Entry (CAPI) - 2014
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Person Most Knowledgeable (PMK)
- Dwelling Type (DW)
- Survey Introduction (INT)
- Roster Introduction (RS)
- Usual Roster (USU)
- Other Roster 1 (OTH1)
- Sex (SEX)
- HC: De-facto marital status without confirmation - MSNC
- Age without Confirmation (ANC)
- Relationship without Confirmation (RNC)
Person Most Knowledgeable (PMK)
Person Most Knowledgeable (PMK) - Question identifier:PMK_Q01
Who is the most knowledgeable about SELECTED_CHILD_NAME? (CHILDSEX, CHILDAGE)
- 01: Potential PMK [1]
- 02: Potential PMK [2]
- 03: Potential PMK [3]
- 04: Potential PMK [4]
- 05: Potential PMK [5]
- 06: Potential PMK [6]
- 07: Potential PMK [7]
- 08: Potential PMK [8]
- 09: Potential PMK [9]
- 10: Potential PMK [10]
- 98: RF
Dwelling Type (DW)
Dwelling Type (DW) - Question identifier:DW_Q01
What type of dwelling do you live in? Is it a ...
- 01: single detached?
- 02: double?
- 03: row or terrace?
- 04: duplex?
- 05: low-rise apartment of fewer than 5 stories or a flat?
- 06: high-rise apartment of 5 stories or more?
- 07: institution?
- 08: hotel; rooming/lodging house; camp?
- 09: mobile home?
- 10: Other - Specify
- 98: RF
- 99: DK
Dwelling Type (DW) - Question identifier:DW_N02
Select the dwelling type.
- 01: Single detached
- 02: Double
- 03: Row or Terrace
- 04: Duplex
- 05: Low-rise apartment (fewer than 5 stories) or flat
- 06: High-rise apartment (5 stories or more)
- 07: Institution
- 08: Hotel; rooming/lodging house; camp
- 09: Mobile home
- 10: Other - Specify
Survey Introduction (INT)
Survey Introduction (INT) - Question identifier:INT_R01
I'm contacting you about the 2014 Ontario Child Health Study. This study is being done with researchers at McMaster University in Hamilton with the purpose of collecting information on the health and well-being of children in Ontario. This study will ask about mental health disorders, access to mental health services, and the relationship between health, family, neighbourhood and school.
Survey Introduction (INT) - Question identifier:INT_R02
Your answers are collected under the authority of the Statistics Act and will be kept strictly confidential and used only for statistical purposes. While participation is voluntary, your cooperation is essential to ensure the information collected is as accurate and as comprehensive as possible.
Roster Introduction (RS)
Roster Introduction (RS) - Question identifier:RS_R01
The next few questions ask for important basic information about the people in your household.
Usual Roster (USU)
Usual Roster (USU) - Question identifier:USU_Q01
What are the names of all persons who usually live here?
Long Answer Length = 80
Other Roster 1 (OTH1)
Other Roster 1 (OTH1) - Question identifier:OTH1_Q01
Are there any other persons who usually live here but are now away at school, in hospital, or somewhere else?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Other Roster 1 (OTH1) - Question identifier:OTH1_Q02
What are the names of the other people who live or stay here?
Long Answer Length = 50
Sex (SEX)
Sex (SEX) - Question identifier:SEX_Q01
If necessary, ask: (Is RESPONDENT_NAME male or female?)
- 1: Male
- 2: Female
HC: De-facto marital status without confirmation - MSNC
HC: De-facto marital status without confirmation - MSNC - Question identifier:MSNC_Q01
What is [your/FNAME's] marital status? [Are/Is you/he/she]... ?
- 1: Married
- 2: Living common-law
- 3: Widowed
- 4: Separated
- 5: Divorced
- 6: Single, never married
- 9: Don't know
- 8: Refusal
Age without Confirmation (ANC)
Age without Confirmation (ANC) - Question identifier:ANC_Q02
So RESPONDENT_NAME's age on REFERENCE_DATE [will be/was] CALCULATE_AGE [EMPTY/months].
Is that correct?
- 1: Yes
- 2: No, return and correct date of birth
- 3: No, collect age
Age without Confirmation (ANC) - Question identifier:ANC_Q03
What is RESPONDENT_NAME's age?
Min = 0; Max = 121
Relationship without Confirmation (RNC)
Relationship without Confirmation (RNC) - Question identifier:RNC_Q1
What is the relationship...
of: RESPONDENT_NAME1 (AGE, [Male/Female])
to: RESPONDENT_NAME2 (AGE, [Male/Female])?
- 01: [Husband/Wife]
- 02: Common-law partner
- 03: [Father/Mother]
- 04: [Son/Daughter]
- 05: [Brother/Sister]
- 06: Foster [father/mother]
- 07: Foster [son/daughter]
- 08: [Grandfather/Grandmother]
- 09: [Grandson/Granddaughter]
- 10: In-law
- 11: Other related
- 12: Unrelated
- 98: RF
- 99: DK
Relationship without Confirmation (RNC) - Question identifier:RNC_Q2A
What is the relationship...
of: RESPONDENT_NAME1 (AGE, [Male/Female])
to: RESPONDENT_NAME2 (AGE, [Male/Female])
Is that a(n)... ?
- 1: Birth [father/mother]
- 2: Step[father/mother]
- 3: Adoptive [father/mother]
- 8: RF
- 9: DK
Relationship without Confirmation (RNC) - Question identifier:RNC_Q2B
What is the relationship...
of: RESPONDENT_NAME1 (AGE, [Male/Female])
to: RESPONDENT_NAME2 (AGE, [Male/Female])
Is that a(n)... ?
- 1: Birth [son/daughter]
- 2: Step[son/daughter]
- 3: Adopted [son/daughter]
- 8: RF
- 9: DK
Relationship without Confirmation (RNC) - Question identifier:RNC_Q2C
What is the relationship...
of: RESPONDENT_NAME1 (AGE, [Male/Female])
to: RESPONDENT_NAME2 (AGE, [Male/Female])
Is that a(n)... ?
- 1: Full [brother/sister]
- 2: Half [brother/sister]
- 3: Step[brother/sister]
- 4: Adopted [brother/sister]
- 5: Foster [brother/sister]
- 8: RF
- 9: DK
Relationship without Confirmation (RNC) - Question identifier:RNC_Q2D
What is the relationship...
of: RESPONDENT_NAME1 (AGE, [Male/Female])
to: RESPONDENT_NAME2 (AGE, [Male/Female])
Is that a(n)... ?
- 1: [Father/Mother]-in-law
- 2: [Son/Daughter]-in-law
- 3: [Brother/Sister]-in-law
- 4: Other in-law
- 8: RF
- 9: DK
Relationship without Confirmation (RNC) - Question identifier:RNC_Q2E
What is the relationship...
of: RESPONDENT_NAME1 (AGE, [Male/Female])
to: RESPONDENT_NAME2 (AGE, [Male/Female])
Is that a(n)... ?
- 1: [Uncle/Aunt]
- 2: Cousin
- 3: [Nephew/Niece]
- 4: Other relative
- 8: RF
- 9: DK
Relationship without Confirmation (RNC) - Question identifier:RNC_Q2F
What is the relationship...
of: RESPONDENT_NAME1 (AGE, [Male/Female])
to: RESPONDENT_NAME2 (AGE, [Male/Female])
Is that a(n)... ?
- 1: [Boyfriend/Girlfriend]
- 2: Roommate/lodger/boarder
- 3: Other - Specify
- 8: RF
- 9: DK
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