PRAMS Standard State-Specific Questions

Table of Contents

Standard Questions:

1\.
Breastfeeding\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
1

2\. Contraceptive
Use/Information\...\...\...\...\...\...\...\...\...\...\...\.... 2

3\. Prenatal
Care\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
4

4\. Barriers to Well-Baby
Care\...\...\...\...\...\...\...\...\...\...\...\...\...\... 5

5\. Social
Services\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
5

6\.
Safety\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
6

7\. Social
Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
6

8\. Parent/Household
Characteristics\...\...\...\...\...\...\...\...\...\...\... 7

9\. Postpartum
Morbidity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
9

10\. Sick Baby
Care\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
9

11\. Physical Activity and Work During Pregnancy\...\...\...\.... 10

12\.
Income\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
10

13\. Mental
Health\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
10

14\. HIV
Testing\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
11

1\. Breastfeeding

A\) Barriers to Initiation of Breastfeeding:

1\. If you breastfed your new baby, go to Question \_\_ .

What were your reasons for not breastfeeding?

Check all that apply.

\[ \] I didn=t want to breastfeed

\[ \] I had to go to work or school

\[ \] I think it=s better for my baby to be bottle fed

\[ \] It takes too much time to breastfeed

\[ \] I was taking medicine

\[ \] My baby was not with me

\[ \] Other\-\--\>Please tell us:\_\_\_\_\_\_\_\_\_\_\_\_\_\_

B\) Barriers to Continuation of Breastfeeding:

2\. If you did not breastfeed your new baby, go to Question \_\_ .

Do you breastfeed your new baby now?

\[ \] No

\[ \] Yes\-\-\-\-\-\-\--\>Go to Question \_\_

3\. What were your reasons for stopping breastfeeding?

Check all that apply.

\[ \] I didn=t want to keep breastfeeding

\[ \] I had to go to work or school

\[ \] I tried but my baby didn=t breastfeed very well

\[ \] I didn=t have enough milk

\[ \] I felt it was the right time to stop

\[ \] My baby was not with me

\[ \] I was taking medicine

\[ \] Other\-\--\>Please tell us:\_\_\_\_\_\_\_\_\_\_\_\_\_\_

C\) Breastfeeding Information Received:

4\. If your baby was not born in a hospital, go to Question \_\_\_.

This question asks about things that may have happened at the hospital
where your new baby was born. For each thing, circle Y (Yes) if it
happened and circle N (No) if it did not happen.

a\) Hospital staff gave me information about breastfeeding Y N

b\) My baby stayed in the same room with me at the hospital YN

c\) I breastfed my baby at the hospital Y N

d\) Hospital staff helped me learn how to breastfeed Y N

e\) My baby was fed only breastmilk at the hospital Y N

f\) Hospital staff told me to breastfeed whenever my baby wanted Y N

g\) The hospital gave me a gift pack with formula Y N

h\) The hospital gave me a telephone number to call for

help about breastfeeding Y N

D\) Plans to Breastfeed:

5\. During your most recent pregnancy, what did you think about
breastfeeding your new baby?

Check one answer.

\[ \] I knew I would breastfeed

\[ \] I thought I might breastfeed

\[ \] I knew I would not breastfeed

\[ \] I didn=t know what to do about breastfeeding

2\. Contraceptive Use/Information

A\) Current Contraceptive Use:.

6\. Are you or your husband/partner using any kind of birth control now?

Birth control means having your tubes tied, vasectomy, the pill,
condoms, diaphragm, foam, rhythm, Norplant, shots (Depo-Provera) or ANY
other way to keep from getting pregnant.

\[ \] No\-\-\-\-\-\-\-\-\--\>Go to Question \_\_\_

\[ \] Yes

7\. What kind of birth control are you or your husband/partner using
now?

Check all that apply \*\[and then go to Question \_\_ \].

\[ \] Tubes tied (sterilization)

\[ \] Vasectomy (sterilization)

\[ \] Pill

\[ \] Condoms

\[ \] Foam, jelly, cream

\[ \] Norplant

\[ \] Shots (Depo-Provera)

\[ \] Withdrawal

\[ \] Other\-\-\-\--\>Please tell us:\_\_\_\_\_\_\_\_\_\_\_

\* Used if Question 3 follows Question 2.

8\. What are your reasons for not using any birth control now?

Check all that apply.

\[ \] I am not having sex

\[ \] I want to get pregnant

\[ \] I don=t want to use birth control

\[ \] My husband or partner doesn=t want to use birth control

\[ \] I don=t think I can get pregnant

\[ \] I can=t pay for birth control

\[ \] I am pregnant now

\[ \] Other \-\-\-\--\>Please tell us:\_\_\_\_\_\_\_\_\_\_\_

B\) Postpartum Information about Birth Control:

9\. After your new baby was born, did a doctor, nurse or other health
worker talk with you about using birth control?

\[ \] No

\[ \] Yes

3\. Prenatal Care

A\) Satisfaction with PNC:

10\. If you did not go for prenatal care, go to Question \_\_.

We would like to know how you felt about the prenatal care you got
during your most recent pregnancy. If you went to more than one place
for prenatal care, answer for the place where you got most of your care.
For each thing, circle Y (Yes) if you were satisfied and N (No) if you
were not satisfied.

Were you satisfied with. . . Yes No

a\. The amount of time you had to wait

after you arrived for your visits Y N

b\. The amount of time the doctor or

nurse spent with you during your

visits Y N

c\. The advice you got on how to take

care of yourself Y N

d\. The understanding and respect that

the staff showed toward you as a

person Y N

B\) Supplement to Items on Content of Prenatal Care Question:

If you did not go for prenatal care, go to Question \_\_.

11\. At any time during your prenatal care, did a doctor, nurse, or
other health worker talk with you about diseases or birth defects that
could run in your family?

\[ \] No

\[ \] Yes

12\. At any time during your prenatal care, did a doctor, nurse, or
other health worker talk with you about doing tests to see if your baby
had a birth defect or genetic disease?

\[ \] No

\[ \] Yes

13\. At any time during your prenatal care, did a doctor, nurse, or
other health worker talk with you about how much weight you should gain
during your pregnancy?

\[ \] No

\[ \] Yes

14\. At any time during your prenatal care, did a doctor, nurse, or
other health worker ask if you were smoking?\*

\[ \] No

\[ \] Yes

15\. At any time during your prenatal care, did a doctor, nurse, or
other health worker ask if you were drinking alcoholic beverages (beer,
wine, wine cooler, or liquor)?\*

\[ \] No

\[ \] Yes

4\. Barriers to Well Baby Care

16\. Has your baby gone as many times as you wanted for routine well
baby care?

\[ \] No

\[ \] Yes\-\-\--\>Go to Question \_\_

17\. Did any of these things keep your baby from having routine well
baby care?

Check all that apply.

\[ \] I didn=t have enough money or insurance to pay for it

\[ \] I had no way to get my baby to the clinic or office

\[ \] I didn=t have anyone to take care of my other children

\[ \] I couldn=t get an appointment

\[ \] My baby was too sick to go for routine care

\[ \] Other\-\-\--\>Please tell us:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5\. Social Services

A\) Services during pregnancy:

18\. During your most recent pregnancy, did you get any of these
services?

Circle Y (Yes) if you got the service and N (No) if you did not get it.

Yes No

Childbirth classes Y N

Parenting classes Y N

Classes on how to stop smoking Y N

Visits to your home by a nurse or other

health worker Y N

Food Stamps Y N

AFDC (Welfare) Y N

B\) Services After Delivery

19\. Since you delivered your new baby, have you used any of these
services?

Circle Y (Yes) if you used the service and N (No) if you have not used
it.

List of services. . .

C\) WIC after delivery:

20\. Since your new baby was born, have you used WIC services for your
new baby?

\[ \] No

\[ \] Yes

6\. Safety

A\) Home Safety:

21\. Listed below are some things about safety. For each thing, circle Y
(Yes) if it applies to you and N (No) if it doesn=t.

Yes No

a\. My infant was brought home from the hospital in an

infant car seat Y N

b\. My baby always rides in an infant car seat Y N

c\. My home has a working smoke alarm Y N

d\. There are loaded guns, rifles, or other firearms in my home Y N

B\) Co-sleeping:

22\. How often does your new baby sleep in the same bed with you?

\[ \] Always

\[ \] Almost always

\[ \] Sometimes

\[ \] Never

7\. Social Support

A\) Social Support During Pregnancy:

23\. During your most recent pregnancy, who would have helped you if a
problem had come up? For example, who would have helped you if you
needed to borrow \$50 or you got sick and had to be in bed for several
weeks? Check all that apply.

\[ \] My husband or partner

\[ \] My mother, father, or in-laws

\[ \] Other family member or relative

\[ \] A friend

\[ \] Someone else \-\-\-\--\>\_\_\_\_\_\_\_\_\_\_

\[ \] No one would have helped me

24\. During your most recent pregnancy, would you have had the kinds of
help listed below if you had needed them? For each thing, circle Y (Yes)
if you would have had it or N (No) if not.

Yes No

a\. Someone to loan me \$50 Y N

b\. Someone to help me if I were sick

and needed to be in bed Y N

c\. Someone to take me to the clinic or

doctor=s office if I needed a ride Y N

d\. Someone to talk with about my problems Y N

B\) Social Support After Delivery:

25\. Since you delivered your new baby, who would help you if a problem
came up? For example, who would help you if you needed to borrow \$50 or
you got sick and had to be in bed for several weeks? Check all that
apply.

\[ \] My husband or partner

\[ \] My mother, father, or in-laws

\[ \] Other family member or relative

\[ \] A friend

\[ \] Someone else \-\-\-\--\>\_\_\_\_\_\_\_\_\_\_

\[ \] No one would help me

26\. Since you delivered your new baby, would you have the kinds of help
listed below if you needed them? For each thing, circle Y (Yes) if you
would have had it or N (No) if not.

a\. Someone to loan me \$50 Yes No

b\. Someone to help me if I were sick

and needed to be in bed Yes No

c\. Someone to talk with about my problems Yes No

d\. Someone to take care of my baby Yes No

8\. Parent/Household Characteristics

A\) Father=s Age:

27\. When you got pregnant, how old was your new baby=s father?

\_\_\_\_ Years Old

\[ \] I don=t know

B\) Relationship Status at Conception:

28\. When you got pregnant, did your new baby=s father live with you?

\[ \] No

\[ \] Yes

29\. When you got pregnant, what relationship did you have with your
baby=s father?

\[ \] He was my husband (legally married)

\[ \] He was my partner (not legally married)

\[ \] He was my boyfriend

\[ \] He was a friend

\[ \] Other\-\-\--\>Please tell us:\_\_\_\_\_\_\_\_\_\_\_\_\_

C\) Age at Menarche and Conception of First Birth:

30\. How old were you when you had your first menstrual period?

\_\_\_\_ Years Old

31\. How old were you when you got pregnant with your first baby?

\_\_\_ Years Old

D\) Telephone Coverage:

32\. Do you have a telephone in your home that has been working

(in service) for the past month?

\[ \] No\-\-\-\-\--\>Go to Question \_\_

\[ \] Yes

33\. Is your telephone number listed in the most recent telephone book
under

your last name and current address?

\[ \] Yes

\[ \] Telephone unlisted

\[ \] Telephone listed under another name or address

E\) Household Composition:

34\. When you got pregnant, who lived in the same house with you?

Check all that apply.

\[ \] My husband or partner

\[ \] Children age 5 and under\--\>How many?\_\_\_\_

\[ \] Children age 6 and over\-\--\>How many?\_\_\_\_

\[ \] My mother

\[ \] My father

\[ \] My husband=s or partner=s parent(s)

\[ \] Friend or roommate

\[ \] Other relative

\[ \] Other\-\--\>Please tell us:\_\_\_\_\_\_\_\_\_\_\_

\[ \] I lived alone

35\. Who lives in the same house with you now?

Check all that apply.

\[ \] My husband or partner

\[ \] Children age 5 and under\--\>How many?\_\_\_\_

\[ \] Children age 6 and over\-\--\>How many?\_\_\_\_

\[ \] My mother

\[ \] My father

\[ \] My husband=s or partner=s parent(s)

\[ \] Friend or roommate

\[ \] Other relative

\[ \] Other\-\--\>Please tell us:\_\_\_\_\_\_\_\_\_\_\_

\[ \] I live alone

36\. Do you have a husband or partner who lives with you now?

\[ \] No

\[ \] Yes

9\. Postpartum Morbidity

37\. After you delivered your baby and went home from the hospital, did
you have to go back and stay at least one night for any kind of problem?

\[ \] No\-\-\-\-\-\--\>Go to Question \_\_\_

\[ \] Yes

38\. Why did you have to go back into the hospital?

\[ \] Vaginal bleeding

\[ \] Fever or infection

\[ \] Other\-\--\>Please tell us:\_\_\_\_\_\_\_\_

39\. How many weeks old was your baby the first time you had to go back
to the hospital after your delivery and stay at least one night?

\_\_\_\_ Weeks old

10\. Sick Baby Care

40\. How many times has your new baby gone for care when he or she was
sick?

\_\_\_ Times

\[ \]
None\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--\>Go to
Question \_\_

\[ \] My baby has not been sick\-\-\-\-\-\--\>Go to Question \_\_

41\. Where have you taken your new baby when he or she was sick and
needed care?

Check all that apply.

\[ \] Hospital clinic

\[ \] Health department clinic

\[ \] Hospital emergency room

\[ \] Private doctor=s office

\[ \] State-specific

\[ \] State-specific

\[ \] Other\-\--\> Please tell us:\_\_\_\_\_\_\_\_\_\_\_

42\. Has your baby gone for care as many times as you wanted when he or
she was sick?

\[ \] No

\[ \] Yes

\[ \] My baby has not been sick

11\. Physical activity

12\. Income:

B\) Income Follow-up Question:

43\. How many people, including yourself, depended on this income?

\_\_\_\_ People

13\. Mental Health Questions:

1\) During Pregnancy

44\. How would you describe the time during your pregnancy?

Check the best answer.

\[ \] One of the happiest times of my life

\[ \] A happy time with few problems

\[ \] A moderately hard time

\[ \] A very hard time

\[ \] One of the worst times of my life

2\) Postpartum depression

45\. In the months after your delivery, would you say that you were. . .

Check the best answer.

\[ \] Not depressed at all

\[ \] A little depressed

\[ \] Moderately depressed

\[ \] Very depressed

\[ \] Very depressed and had to get help

46\. At any time during your pregnancy or after delivery, did a doctor,
nurse, or other health worker talk with you about Ababy blues@
(postpartum depression)?

\[ \] No

\[ \] Yes

14\. HIV Testing

47\. At any time during your most recent pregnancy or delivery, did you
have a blood test for HIV (the virus that causes AIDS)?

\[ \] No

\[ \] Yes

\[ \] I don=t know

20\. ORAL HEALTH

Q 48 This question is about care of your teeth during your most recent
pregnancy. For each thing, circle Y(Yes) if it is true or N(No) if it is
not true.

No Yes

a\. I needed to see a dentist for a problem N Y

b\. I went to a dentist or dental clinic N Y

c\. A dental or other health care worker talked with me about

how to care for my teeth and gums N Y