CUBS Query Module Configuration Selection
Getting Started
Click on a blue bar to open and close selections to see a list of measures available.- Current childcare arrangements
Current childcare arrangements (question wording)
By childcare we mean any kind of regular arrangement where someone other than the parents or legal guardians takes care of your child. Please include preschool as childcare. Do you now have regular childcare arrangements for your 3-year-old child? - Childcare in center
Childcare in center (question wording)
What types of childcare do you regularly use for your 3-year-old child now? (check all that apply) Childcare center, preschool, Head Start or other center that is not a caregiver's home - Childcare in relative's home
Childcare in relative's home (question wording)
What types of childcare do you regularly use for your 3-year-old child now? (check all that apply) Care in a relative's home - Childcare in non-relative's home
Childcare in non-relative's home (question wording)
What types of childcare do you regularly use for your 3-year-old child now? (check all that apply) Care in a non-relative's home - Childcare in home by relative
Childcare in home by relative (question wording)
What types of childcare do you regularly use for your 3-year-old child now? (check all that apply) Care in your home by a relative (not your child's parent or legal guardian) - Childcare in home by non-relative
Childcare in home by non-relative (question wording)
What types of childcare do you regularly use for your 3-year-old child now? (check all that apply) Care in your home by a non-relative - Other type of childcare
Other type of childcare (question wording)
What types(s) of childcare do you regularly use for your 3-year-old child now? (check all that apply) Other - Hours in childcare
Hours in childcare (question wording)
In a typical week, how many total hours does your child spend in childcare? - Childcare assistance
Childcare assistance (question wording)
Do you now receive childcare assistance to pay for childcare for your child? - Cost of childcare
Cost of childcare (question wording)
What is the average cost that you pay now for childcare for your 3-year-old child? Do not include any assistance or financial support that you receive for childcare. Include only the cost for this child. - Prefers different form of childcare, even if not currently using childcare (2015-current)
- Not using preferred childcare because it isn't available in community (among all mothers)
- Not using preferred childcare because can't afford to stay home (among all mothers)
- Not using preferred childcare because cost is too high (among all mothers)
- Not using preferred childcare for other reason (among all mothers)
- Not using preferred childcare because it doesn't fit schedule (among all mothers)
- Not using preferred childcare because it can't accommodate children with special needs (among all mothers)
- Not using preferred childcare because waiting list is too long (among all mothers)
- Prefers different form of childcare
Prefers different form of childcare (question wording)
Would you prefer to use a form of childcare for your child other than what you are using now? - Barrier - Can't afford to stay home, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.)
Barrier - Can't afford to stay home, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.) (question wording)
Why are you not using your preferred form of childcare for your child now? (Check all that apply) I can't afford to stay home (Among mothers who currently have regular childcare arrangemnts and who would prefer to use another form of childcare.) - Barrier - Cost is too high, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.)
Barrier - Cost is too high, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.) (question wording)
Why are you not using your preferred form of childcare for your child now? (Check all that apply) Cost is too high (Among mothers who currently have regular childcare arrangemnts and who would prefer to use another form of childcare.) - Barrier - Not available to fit schedule, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.)
Barrier - Not available to fit schedule, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.) (question wording)
Why are you not using your preferred form of childcare for your child now? (Check all that apply) Not available to fit my schedule (Among mothers who currently have regular childcare arrangemnts and who would prefer to use another form of childcare.) - Barrier - Waiting list too long, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.)
Barrier - Waiting list too long, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.) (question wording)
Why are you not using your preferred form of childcare for your child now? (Check all that apply) Waiting list is too long (Among mothers who currently have regular childcare arrangemnts and who would prefer to use another form of childcare.) - Barrier - Not available in community, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.)
Barrier - Not available in community, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.) (question wording)
Why are you not using your preferred form of childcare for your child now? (Check all that apply) Not available in my community (Among mothers who currently have regular childcare arrangments and who would prefer to use another form of childcare.) - Barrier - Can't accommodate special needs, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.)
Barrier - Can't accommodate special needs, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.) (question wording)
Why are you not using your preferred form of childcare for your child now? (Check all that apply) Cannot accommodate children with special needs (Among mothers who currently have regular childcare arrangemnts and who would prefer to use another form of childcare.) - Barrier - Other, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.)
Barrier - Other, 2012-2014 (among mothers with current regular childcare and who would prefer to use another form of childcare.) (question wording)
Why are you not using your preferred form of childcare for your child now? (Check all that apply) Other (Among mothers who currently have regular childcare arrangements and who would prefer to use another form of childcare.) - Ever use childcare on a routine or regular basis
- Ability to work compromised by childcare needs
- Childcare- Removed from childcare due to child's difficult behaviors
- Change in household members
Change in household members (question wording)
Indicate Yes or No for whether your child ever experienced a change in household members (including a new sibling). - Conflict between parents
Conflict between parents (question wording)
Indicate Yes or No for whether your child ever experienced conflict between parents. - Being away from parent
Being away from parent (question wording)
Indicate Yes or No for whether your child ever experienced being away from either parent for longer than a one month time period. - Overnight stay in hospital
Overnight stay in hospital (question wording)
Indicate Yes or No for whether your child ever experienced an overnight stay in the hospital (not including right after birth). - Death in the family
Death in the family (question wording)
Indicate Yes or No for whether your child ever experienced the death of a close family member. In 2015, this question was changed to ask whether your child ever experienced the death of a household member. - Alcoholism or mental health disorder in family
Alcoholism or mental health disorder in family (question wording)
Indicate Yes or No for whether your child ever experienced alcoholism or mental health disorder in the family. In 2015, this question was changed to ask whether your child ever experienced alcoholism or mental health disorder among household members. - Seeing violence or physical abuse
Seeing violence or physical abuse (question wording)
Indicate Yes or No for whether your child ever experienced seeing violence or physical abuse in person. In 2015, this question was changed to ask whether your child has ever witnessed violence or physical abuse between household members. - Childhood Stressors- Adult ever physically hurt child (other than spanking)
- Time watching television
Time watching television (question wording)
Yesterday, how many hours or minutes did your child spend watching television shows, videos or movies or playing video games? Include time on a computer or hand held device. - Time reading to child
Time reading to child (question wording)
Yesterday, how much time did you or someone else read aloud to your child one-on-one or in a small group? - Children's books in home
Children's books in home (question wording)
How many children's picture books are in your home now, including library books? Please only include picture books that are for young children. - Reads to child (days in past week)
Reads to child (days in past week) (question wording)
During the past week, how many days did you or someone else in your household read a book or a story to your child. Circle the number of days. - Eats meals with child (days in past week)
Eats meals with child (days in past week) (question wording)
During the past week, how many days did you and your 3-year-old child sit down and eat a meal together. Circle the number of days. - Child has caring relationship
Child has caring relationship (question wording)
Indicate Yes or No for whether the statement applies to your child's situation now: My child has a caring relationship with at least one adult other than parents. - Child has usual bedtime
Child has usual bedtime (question wording)
Indicate Yes or No for whether the statement applies to your child's situation now: My child's bedtime is usually the same everyday. - Child plays outside the family
Child plays outside the family (question wording)
Indicate Yes or No for whether the statement applies to your child's situation now: My child plays with children outside the family on a regular basis. - Build or make things with child (days in past week)
- Play counting or number games with child (days in past week)
- Talk about feelings with child (days in past week)
- Sing song or say rhymes with child (days in past week)
- BMI percentile
- Care with hearing specialist
- Care with speech therapist
- Care with eye specialist
- Care with physical therapist
- Ever enrolled in WIC
- Ever enrolled in Head Start
- Ever enrolled in Early Intervention
- Ever enrolled in School district special education
- Asthma symptoms
- Asthma or asthma-like condition
- Asthma medication
- Overweight
- Child's weight comparison
- Concerns about behavior
- Seek help for behavioral concerns
- Limited in ability to do things most children can do
- Limited ability due to medical or behavioral condition
- Child attend preschool now
- Child needs or uses more medical, mental, or education services
- Child uses more services due to medical or behavioral condition
- Provider talk with mother about physical activity or exercise for child
- Provider talk with mother about ways to parent and discipline child
- Provider talk with mother about nutrition or feeding child
- Provider talk with mother about reading with child
- Provider talk with mother about how secondhand smoke could affect child
- Provider talk with mother about how much time child watches tv or videos
- Usual place of medical care
Usual place of medical care (question wording)
When your child is sick, where do you usually take him or her for medical care? (check one answer) - Provider knows child and health history
Provider knows child and health history (question wording)
2012-2014: Is there a doctor, nurse, or other health care worker at the place you usually take your child for medical care when he or she is sick who knows your child well and is familiar with your child's health history? 2015-: question did not specify 'at the place you usually take your child when sick'. - Well-child check-up previous 12 months
Well-child check-up previous 12 months (question wording)
During the past 12 months, has your child seen a health care worker for routine medical care such as a well-child check-up or physical exam? - Health care barrier - Couldn't get appointment
Health care barrier - Couldn't get appointment (question wording)
During the past 12 months, did you have problems getting health care for you child when he or she was sick because you couldn't get an appointment when you wanted one? - Health care barrier - Not enough money
Health care barrier - Not enough money (question wording)
During the past 12 months, did you have problems getting health care for you child when he or she was sick because you didn't have enough money or insurance to pay for it? - Health care barrier - Service not available
Health care barrier - Service not available (question wording)
During the past 12 months, did you have problems getting health care for you child when he or she was sick because the service your child needed was not available in your community? - Health care barrier - Not satisfied with provider
Health care barrier - Not satisfied with provider (question wording)
During the past 12 months, did you have problems getting health care for you child when he or she was sick because you weren't satisfied with the only available health care provider? - Health care barrier - Couldn't miss work
Health care barrier - Couldn't miss work (question wording)
During the past 12 months, did you have problems getting health care for you child when he or she was sick because you couldn't take time off from work? - Health care barrier - Other problems
Health care barrier - Other problems (question wording)
During the past 12 months, did you have problems getting health care for you child when he or she was sick because you had other problems getting health care? - Completed child development checklist in past 12 months
- No health coverage now
No health coverage now (question wording)
Is your child covered by any of these types of health plans now? (Check all that apply) My child is not covered by any health plan now. - Health insurance from job
Health insurance from job (question wording)
Is your child covered by any of these types of health plans now? (Check all that apply) Private health insurance from your job or the job of your husband or partner - Medicaid or Denali KidCare
Medicaid or Denali KidCare (question wording)
Is your child covered by any of these types of health plans now? (Check all that apply) Medicaid or Denali KidCare - Tribal health coverage
Tribal health coverage (question wording)
Is your child covered by any of these types of health plans now? (Check all that apply) Alaska Native Health Service (ANS), Native regional health corporation, IHS, or other tribal health coverage - Military facility
Military facility (question wording)
Is your child covered by any of these types of health plans now? (Check all that apply) TRICARE or other military health care - Purchased insurance
Purchased insurance (question wording)
Is your child covered by any of these types of health plans now? (Check all that apply) Private health insurance purchased directly from an insurance company by you or someone else - Other health coverage
Other health coverage (question wording)
Is your child covered by any of these types of health plans now? (Check all that apply) Other - Health care coverage gap
Health care coverage gap (question wording)
Was there ever a time since your child was born when he or she was not covered by any type of health plan? - Private insurance purchased on the health insurance marketplace
- Immunizations - Ever delayed or did not get vaccine (4 level)
- Immunizations- Provider advised against it (among those who delayed)
- Immunizations- Vaccine not available (among those who delayed)
- Immunizations- Personal choice or belief (among those who delayed)
- Immunizations- Cost of the vaccine (among those who delayed)
- Immunizations- Problem getting to a provider (among those who delayed)
- Delay reason - Couldn't get appointment (among those who delayed)
Delay reason - Couldn't get appointment (question wording)
What were the resasons you delayed or did not get vaccine shots or immunizations for your child? (Check all that apply) I couldn't get an appointment when I wanted one - Delayed or did not get vaccine, 2012-2014
Delayed or did not get vaccine, 2012-2014 (question wording)
Have you ever delayed or decided not to get vaccine shots or immunizations for your child? - Delay reason - Too many shots given at once, 2012-2014 (among those who delayed)
Delay reason - Too many shots given at once, 2012-2014 (question wording)
What were the resasons you delayed or did not get vaccine shots or immunizations for your child? (Check all that apply) I think too many shots are given at once - Delay reason - Some shots given too early, 2012-2014 (among those who delayed)
Delay reason - Some shots given too early, 2012-2014 (question wording)
What were the resasons you delayed or did not get vaccine shots or immunizations for your child? (Check all that apply) I think some shots are given too early - Delay reason - Some shots do more harm, 2012-2014 (among those who delayed)
Delay reason - Some shots do more harm, 2012-2014 (question wording)
What were the resasons you delayed or did not get vaccine shots or immunizations for your child? (Check all that apply) I think some shots do more harm than good - Delay reason - Religious beliefs or concerns, 2012-2014 (among those who delayed)
Delay reason - Religious beliefs or concerns, 2012-2014 (question wording)
What were the resasons you delayed or did not get vaccine shots or immunizations for your child? (Check all that apply) I have religious beliefs or concerns about some or all shots - Delay reason - Some diseases won't affect child, 2012-2014 (among those who delayed)
Delay reason - Some diseases won't affect child, 2012-2014 (question wording)
What were the resasons you delayed or did not get vaccine shots or immunizations for your child? (Check all that apply) I do not think some of the diseases will affect my child - Delay reason - Didn't know when due, 2012-2014 (among those who delayed)
Delay reason - Didn't know when due, 2012-2014 (question wording)
What were the resasons you delayed or did not get vaccine shots or immunizations for your child? (Check all that apply) I didn't know when the shots were due - Delay reason - Other, 2012-2014 (among those who delayed)
Delay reason - Other, 2012-2014 (question wording)
What were the resasons you delayed or did not get vaccine shots or immunizations for your child? (Check all that apply) Other - Delay specific vaccine shot or immunization, 2012-2014
Delay specific vaccine shot or immunization, 2012-2014 (question wording)
Did you delay or decide not to get a specific vaccine shot or immunization for your child?
- Injury- Animal bite or insect sting
- Injury- Choking or other type of blocked airway
- Injury- Fall
- Injury- Finger smash
- Injury- Motor vehicle accident
- Injury- Other
- Injury- seek medical help advice
- Contact with harmful or toxic substances around home
- Call poison control or seek medical help because child had contact with toxic substances
- Experience depressive symptoms
Experience depressive symptoms (question wording)
Below is a list of feelings and experiences that women sometimes have. Write on the line the number of the choice that best describes how often you have felt this way during the past 3 months. Use the scale when answering. (1=Never 2=Rarely 3=Sometimes 4=Often 5=Always) I felt down, depressed, or sad I felt hopeless I felt slowed down - Provider talked about depression
Provider talked about depression (question wording)
During the past 12 months, did a doctor, nurse or other health care or mental health care worker talk to you about depression orhow you are feeling emotionally? - Physical abuse by partner
Physical abuse by partner (question wording)
During the past 12 months, did your husband or partner push, hit, slap, kick, choke or physically hurt you in any other way? - Controlling partner (emotional abuse)
Controlling partner (emotional abuse) (question wording)
During the past 12 months, did your husband or partner threaten you, limit your activities against your will or make you feel unsafe in any other way? - Moved to new address
Moved to new address (question wording)
Indicate Yes or No for whether you moved to a new address since your 3-year-old child was born. - Someone very close died
Someone very close died (question wording)
Indicate Yes or No for whether someone very close to you died since your 3-year-old child was born. - Couldn't pay bills
Couldn't pay bills (question wording)
Indicate Yes or No for whether you had a lot of bills you couldn't pay since your 3-year-old child was born. - Marital status changed
Marital status changed (question wording)
Indicate Yes or No for whether your marital status changed (you got married, divorced, separated, or became a widow) since your 3-year-old child was born. - Someone close had drinking or drug problem
Someone close had drinking or drug problem (question wording)
Indicate Yes or No for whether someone very close you had a problem with drinking or drugs since your 3-year-old child was born. - Someone close was mentally ill
Someone close was mentally ill (question wording)
Indicate Yes or No for whether someone very close to you was depressed, mentally ill, or suicidal since your 3-year-old child was born. - Lost my job
Lost my job (question wording)
Indicate Yes or No for whether you lost your job since your 3-year-old child was born. - Husband or partner lost job
Husband or partner lost job (question wording)
Indicate Yes or No for whether your husband or partner lost his job since your 3-year-old child was born. - Diagnosed with depression
Diagnosed with depression (question wording)
Indicate Yes or No for whether you were diagnosed with depression since your 3-year-old child was born. - Husband or partner or mom in jail
Husband or partner or mom in jail (question wording)
Indicate Yes or No for whether your husband or partner or you went to jail since your 3-year-old child was born. - Homeless
Homeless (question wording)
Indicate Yes or No for whether you were homeless since your 3-year-old child was born. - Someone will listen to me
Someone will listen to me (question wording)
Indicate Yes or No for whether the statement applies to you now: I know someone who would listen to me if I needed to talk. - Someone will take me to clinic
Someone will take me to clinic (question wording)
Indicate Yes or No for whether the statement applies to you now: I know someone who would take me to the clinic or doctor's office if I needed a ride. - Someone will help me when sick
Someone will help me when sick (question wording)
Indicate Yes or No for whether the statement applies to you now: I know someone who would help me if I was sick and needed to be in bed. - Someone will loan me money
Someone will loan me money (question wording)
Indicate Yes or No for whether the statement applies to you now: I know someone who would loan me money for bills if I needed it. - Confident in ability to raise child
Confident in ability to raise child (question wording)
Indicate Yes or No for whether the statement applies to you now: I am confident in my ability to raise and take care of my child. - Knows where to go for parenting information
Knows where to go for parenting information (question wording)
Indicate Yes or No for whether the statement applies to you now: I know where to go for parenting information or if I have questions or concerns about my child's development. - Has steps to manage stress
Has steps to manage stress (question wording)
Indicate Yes or No for whether the statement applies to you now: I have steps I can take to manage stress. - Feels comfortable asking for help
Feels comfortable asking for help (question wording)
Indicate Yes or No for whether the statement applies to you now: I feel comfortable asking for help when I need it. - Care for an ailing or sick family member
- Husband or partner or mom lost job
- Cut in work hours or pay
- Breastfeeding duration
Breastfeeding duration (question wording)
The following statements are about breastfeeding or feeding pumped breast milk. Please select the statement that best describes how you fed your child? (check one answer). I never fed any breast milk to my child. I fed breast milk to my child for less than 1 month. I fed breast milk to my child for 1 month or more. How many months? - Breastfeeding at 6 months
Breastfeeding at 6 months (question wording)
I fed breast milk to my child for 1 month or more, Less than 6 months or never, OR 6 months or more - Breastfeeding at 12 months
Breastfeeding at 12 months (question wording)
I fed breast milk to my child for 1 month or more, Less than 12 months or never, OR 12 months or more - Type of milk child usually drinks
Type of milk child usually drinks (question wording)
What type of milk does your child usually drink now? (check one answer) - Drank PLAIN WATER yesterday
Drank PLAIN WATER yesterday (question wording)
Yesterday, about how many cups of plain water did your child drink? - Drank MILK yesterday
Drank MILK yesterday (question wording)
Yesterday, about how many cups of milk did your child drink? - Drank 100% FRUIT JUICE yesterday
Drank 100% FRUIT JUICE yesterday (question wording)
Yesterday, about how many cups of 100% fruit juice did your child drink? - Drank SODA yesterday
Drank SODA yesterday (question wording)
Yesterday, about how many cups of soda (such as Coke or Sprite) did your child drink? - Drank SWEETENED OR FRUIT DRINKS yesterday
Drank SWEETENED OR FRUIT DRINKS yesterday (question wording)
Yesterday, about how many cups of sweetened or fruit drinks (such as Kool-Aid, Tang, or Capri Sun) did your child drink? - Ate FRUIT yesterday
Ate FRUIT yesterday (question wording)
Yesterday, how many times (including meals and snacks) did your child eat fruit (fresh, canned, frozen or dried)? - Ate FRIED POTATOES yesterday
Ate FRIED POTATOES yesterday (question wording)
Yesterday, how many times (including meals and snacks) did your child eat french fries, tater tots or potato chips? - Ate VEGETABLES yesterday
Ate VEGETABLES yesterday (question wording)
Yesterday, how many times (including meals and snacks) did your child eat other vegetables or salad? - Ate SWEETS yesterday
Ate SWEETS yesterday (question wording)
Yesterday, how many times (including meals and snacks) did your child eat candy, cookies, or other sweets? - Drank DIET DRINKS yesterday
- Tooth decay or cavities
Tooth decay or cavities (question wording)
Has a health care worker ever told you your child has tooth decay or cavities? - Child ever seen by dentist
Child ever seen by dentist (question wording)
Has your child ever been to see a dentist or dental care provider? - Age at first dental visit
Age at first dental visit (question wording)
When was your child first seen by a dentist or dental care provider? - Dental check-up or cleaning
Dental check-up or cleaning (question wording)
What dental care has your child received? (Check all that apply) Dental check-up or teeth cleaning - Tooth pulled
Tooth pulled (question wording)
What dental care has your child received? (Check all that apply) Tooth pulled - Other dental care
Other dental care (question wording)
What dental care has your child received? (Check all that apply) Other dental care
- Child wears life jacket IN BOAT
Child wears life jacket IN BOAT (question wording)
When your child rides in a boat, how often does he or she wear a life jacket? - Child wears life jacket NEAR OPEN WATER
Child wears life jacket NEAR OPEN WATER (question wording)
When you child is outside near open water, such as a lake, river, or ocean, how often does he or she wear a life jacket? - No one else shares responsibility
No one else shares responsibility (question wording)
Besides yourself, who else shares responsibility for raising your child? Do not include paid childcare providers. (Check all that apply) No one else - Child's father helps raise child
Child's father helps raise child (question wording)
Besides yourself, who else shares responsibility for raising your child? Do not include paid childcare providers. (Check all that apply) My husband/partner (child's father) - Child's grandparent(s) help raise child
Child's grandparent(s) help raise child (question wording)
Besides yourself, who else shares responsibility for raising your child? Do not include paid childcare providers. (Check all that apply) My child's grandparent(s) - Other relative(s) help raise child
Other relative(s) help raise child (question wording)
Besides yourself, who else shares responsibility for raising your child? Do not include paid childcare providers. (Check all that apply) Other relative(s) - Husband/partner (not child's father) helps raise child
Husband/partner (not child's father) helps raise child (question wording)
Besides yourself, who else shares responsibility for raising your child? Do not include paid childcare providers. (Check all that apply) My husband/partner (not child's father) - Other person helps raise child
Other person helps raise child (question wording)
Besides yourself, who else shares responsibility for raising your child? Do not include paid childcare providers. (Check all that apply) Other - Time with father in past week
Time with father in past week (question wording)
During a typical week, how many days is your child with his or her father (or one other adult male such as a family member or friend) for more than 1 hour? This could include doing things like reading, playing, or spending time together. Do not include paid childcare workers. - Supervision - Indoors
Supervision - Indoors (question wording)
When you are taking care of your child, how often do you watch or stay with your child while he or she is indoors? - Supervision - Bathtub
Supervision - Bathtub (question wording)
When you are taking care of your child, how often do you watch or stay with your child while he or she is in the bathtub? - Supervision - Open water
Supervision - Open water (question wording)
When you are taking care of your child, how often do you watch or stay with your child while he or she is outside near open water? - Supervision - Car
Supervision - Car (question wording)
When you are taking care of your child, how often do you watch or stay with your child while he or she is in the car? - Supervision- Outdoors
- Not enough food in past 3 months
Not enough food in past 3 months (question wording)
During the past 3 months, did you, your 3-year-old child, or other household members ever have to cut the size of meals or skip meals because there wasn't enough food in your home? - Use food bank in past 3 months
Use food bank in past 3 months (question wording)
Indicate Yes or No for whether you used a Food Bank or Food Pantry to feed you, your 3-year-old child, or other household members during the past 3 months. - Use Food Stamps in past 3 months
Use Food Stamps in past 3 months (question wording)
Indicate Yes or No for whether you used a Food Stamps to feed you, your 3-year-old child, or other household members during the past 3 months. - Use school lunch program in past 3 months
Use school lunch program in past 3 months (question wording)
Indicate Yes or No for whether you used a Free or reduced price school lunch program to feed you, your 3-year-old child, or other household members during the past 3 months. - Use WIC in past 3 months
Use WIC in past 3 months (question wording)
Indicate Yes or No for whether you used WIC to feed you, your 3-year-old child, or other household members during the past 3 months. - Household income in past 12 months
Household income in past 12 months (question wording)
During the past 12 months, what was your yearly total household income before taxes? Include your income, your husband's or partner's income, and any other income you may have received. (All information will be kept private and will not affect any services you are now getting) - Access to the internet at home
- Smoke cigarettes in past 2 years
Smoke cigarettes in past 2 years (question wording)
Have you smoked any cigarettes in the past 2 years? - Average number of cigarettes per day
Average number of cigarettes per day (question wording)
How many cigarettes do you smoke on an average day now? (A pack has 20 cigarettes). - Alcohol - average number of days per week
Alcohol - average number of days per week (question wording)
During the past 30 days, how many days per week on average did you have any alcoholic drinks? Circle the number of days per week. Include wine, wine coolers, beer, liquor, and mixed drinks. - Alcohol - average number of drinks per day
Alcohol - average number of drinks per day (question wording)
During the past 30 days, on the days when you drank, about how many drinks did you drink on average? A drink is 1 glass of wine, wine cooler, can or bottle of beer, shot of liquor, or mixed drink. - Alcohol - binges in past 30 days
Alcohol - binges in past 30 days (question wording)
During the past 30 days, how many times did you drink 4 alcoholic drinks or more in a two hour time span? - Any marijuana or hash use in the past two years
- Average number days per week used marijuana or hash in past 30 days
- Number of smokers in home now