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.

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Table of Contents

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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