Document ID: EPA-HQ-ORD-2004-0023-0008
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2008-10-07T04:00Z

BEACH INTERVIEW

								OMB Control No.: 2080-0068

								Expiration Date:   xx/xx/xxxx

Site ID ______

Friday _______ Saturday _______	Sunday______ Monday _________			

Date:__-__-____

Time: _________

Have you been interviewed by the National Beaches Survey in the last 28
days?

Would you be willing to participate in a study on illnesses associated
with recreation at  

the beach?  

Yes (give brochure with consent form, inform about 2 follow-up calls)	

No (Terminate Interview).

  

2a.	Our survey is primarily for households of one or more persons that
live together at the same address; Do you all live at the same address?

How many members in your party are at the beach today including
yourself?   

What time did you and your household arrive at the beach today?

We are interested in asking about the health of your household during
the few weeks 

following your beach visit.  Could you please give me your telephone
number so we can get in touch with you in 10-12 days from now?

5a.	If “NO” Is it for one of the following reasons?  Too busy, no
longer interested, will not be available, specify, other reason?

5b.	10-12 days from now which phone number(s) should we call?

5c.	Is this your home, vacation, or cell phone number?

5d.	Additional phone numbers?

6.  	What are the best times to reach you during week days?

6a.	Can I please have your mailing address so that we can send you your
$25 Thank you check?  We will destroy your identifying information after
we mail the check.

7. 	Please tell me the first name of the members of your household at
the beach today, their birth dates, gender race ethnicity, and whether
they are in diapers.

8.  	Will (you/all these people with you at the beach today) be living
(with you) at the same 

	address(es) during the next two weeks?

9.  		Have any of these household members at the beach today been ill in
the past 3 days with:

	Diarrhea or loose bowels

	Urinary tract infection or burning sensation

	Throwing-up or vomiting

	Sore throat or cough

	Earache, ear infection or runny ears

	Eye infection

	Rash or itchy skin

	Sunburn

Are there any household members NOT present at the beach today?

10a. 	Have any household members NOT present at the beach today been ill
in the past 3 days with:

Diarrhea or loose bowels

Urinary tract infection or burning sensation

Throwing-up or vomiting

Sore throat or cough

Earache, ear infection or runny ears

Eye infection

Rash or itchy skin

Sunburn

11. 	Do you or any household members at the beach today, not including
anyone who stayed at home, suffer from any of the following chronic
long-term conditions:

Gastrointestinal problems such as Crohn’s disease or irritable bowel
syndrome

Chronic respiratory diseases such as asthma or emphysema

Allergies, other than drug allergies

Skin problems such as psoriasis or eczema

12. 		How many times do you usually come to this beach each summer
(Memorial Day to Labor Day)?

13. 		How many miles did you travel to the beach today?

14. 		During the past two weeks, did you (anyone in your household at
the beach today) go bathing or swimming anywhere - at this or some other
beach, pool or lake?

14a.		Did you go bathing or swimming anywhere in the past one week
(Monday through Friday) at this or some other beach, pool or lake?

14b.		Did you actually get your head or face wet?

14c.		During the past 2 weeks, did you get a sunburn that lasted more
that 12 hours?

PART B– Exit Beach Interview

15. 	Were you the person that we interview on the beach or earlier
today?

16a. 	Did you or anyone in your household wade, swim, or play in the
water today?

16a1.	Did you immerse your body, not necessarily you head, in the water
today?

16a2.	Did you put your face in the water or submerge head in the water
today?

16a3.	Did you get water in the mouth today?

16a4.	Did you swallow the water?

16b.		Were you in the water at the following times today?  {time charts
given} 

16b1.	If “YES” what part of the beach did you swim in? {include all
beach areas}

16b2.	If “YES” what part of the beach did you swim in most of the
time?

16c.		What total time did you stay in the water?  We are only interested
in time actually in the water, not the total time at the beach?

16d.		Did you engage in any of the following water-related activities
while at the beach today?

	{Dropdown list of water activities}

17.		What would you estimate your total time in direct sunlight was? 
This does not include being indoors or under umbrellas, etc.?

18.  	Did you engage in any of the following activities while at the
beach today?

a.	Collecting sea shells, rocks, feathers, etc?

b.	Digging in sand or building sand castles?

c.	Had their body buried in the sand?

18c1.	Did person get sand in their mouth

After digging in sand, or building sand castles…did person eat or
drink anywhere (not necessarily at the beach)?

After digging in sand, or building sand castles…did person wash their
hands before eating? Washing of hands may include the use of personal
water-free hand sanitizer?

18c1b.		Was the sand the person dug in or played with dry or wet?

18d.	Did you engage in any of the following activities while at the
beach today?

	Playing with algae or seaweed

	

18d1.	Did you get any seaweed in their mouth?

18d1a.	After playing with algae or seaweed…did you eat or drink
anywhere (not necessarily at the beach)?

18d1b.	After playing with algae or seaweed… did person wash their
hands before eating? Washing of hands may include the use of personal
water free hand sanitizer?

19.	Did you cut yourself today or have an open cut when you came to
beach today?

20. 	Did you wear sunscreen/sunblock today?

21.		What was the SPF rating of the sunscreen/sunblock you used most
often today?

21a.		When you used sunscreen/sunblock today, how did you apply it? 
Only to certain areas of my body?  All exposed skin?

Did you reapply at least once today?

23.	Did you wear a hat today?

23a.		Did the hat have a wide brim or another way to shade face, ears,
and back of the neck from the sun?

23a1.	Did you use protective equipment such as a canopy, umbrella or
other type of sunshade today?

23b.		Did you wear protective clothing, such as a long-sleeved shirt or
cover-up?

During the summer, if you go out in the sun repeatedly without sunscreen
or protective 

clothing, which one of these things most usually happens to your skin?

A dark tan

Some tanning

No tan, maybe some freckles

Repeated sunburns

Other (specify)

Never go out in the sun

Did you wear insect repellant today?

Did your or any member of your household consume food while at the beach
today?

26a.	Was the food brought from home?

26b.	Was the food purchased from vending machines or a vendor at the
beach?

26c.	Was the food purchased from a vendor outside the beach?

Did your or any member of your household consume drinks while at the
beach today?

27a.	Were the drinks brought from home?

27b.	Were the drinks purchased from vending machines or a vendor at the
beach?

27c.	Were the drinks purchased from a vendor outside the beach?

28.	In the past 48 hours has anyone who is at the beach today done the
following…

Have you come in contact with any unknown animals?

Come in contact with someone who has complained of diarrhea, vomiting,
or stomach illness?

Consumed raw shellfish?

Consumed rare/raw meat?

Consumed runny or raw eggs?Telephone Interview - follow-up (10-12 days)

Is this person (primary respondent from beach interview)?

Yes (continue)

No (reschedule or continue) 

Were you at the beach on (give date) with (primary respondent)?  

Yes - Continue

I’m going to ask questions about any swimming you’ve done and
illnesses you’ve experienced in the last week for the following
people:

A1.		May I have your first name please?

During your beach visit where you enrolled in this study on __________

A2. 		Did you wear ear plugs while in the water?  Ask for all household
members at the beach.

A3. 		Did you wear nose plugs while in the water?  Ask for all household
members at the beach.

A4. 		Did you wear eye goggles while in the water?  Ask for all
household members at the beach.

A5. 		During the beach interview, did you have contact with an animal? 
Ask for all household members at the beach.

A6. 		Between your beach visit on ______ date and today were you
menstruating or pregnant?  Ask for all household members at the beach.

We are now going to switch and ask you questions about activities that
have occurred since the Beach Interview.

B1.		Have you, or any of the people I just mentioned, gone bathing or
swimming anywhere since we talked to you at the beach interview on
______?  Please include any bathing or swimming such as at a beach,
waterpark, public pool, private pool, or wading pool.

B2.		Who was it that went bathing or swimming?   Ask for all household
members at the beach.

B3a. 	Did you go bathing or swimming at the beach (where the interview
was taken) since the beach interview on this date {BEACH INTERVIEW
DATE}.

B3b. 	Did you go bathing or swimming at any other beach since the beach
interview on this date {BEACH INTERVIEW DATE}.

B3c. 	Was this beach at a:

Lake

River

Ocean

Other, specify

B3d. 	Did you go bathing or swimming at a waterpark?

B3e. 	Did you go bathing or swimming at a public pool?

B3f. 	Did you go bathing or swimming at a private pool?

B3g. 	Did you go bathing or swimming in a wading pool?

B3h. 	Did you go bathing or swimming any other place?

B3i. 	Swim location of any other place?

B4. 		Did you actually get your face wet while bathing or swimming?  Ask
for all household members at the beach.

B5. 		On which days did you go bathing or swimming?  Ask for all
household members at the beach.

B6. 		Have you or anyone else had a stomachache or abdominal cramping
since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for
all household members at the beach.

B6a.	Who had a stomachache or abdominal cramping since the interview at
{STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members
at the beach.

B7. 		Have you or anyone else had diarrhea or loose bowels since the
interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all
household members at the beach.

B7a.	Who had diarrhea or loose bowels since the interview at {STUDY
BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members at the
beach.

B8. 		Have you or anyone else had nausea since the interview at {STUDY
BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members at the
beach.

B8a.	Who had nausea since the interview at {STUDY BEACH} ON {BEACH
INTERVIEW DATE}?  Ask for all household members at the beach.

B9. 		Have you or anyone else had throwing-up or vomiting since the
interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all
household members at the beach.

B9a.	Who had throwing-up or vomiting since the interview at {STUDY
BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members at the
beach.

B10.	Have you or anyone else had urinary tract infection or burning
sensation when urinating since the interview at {STUDY BEACH} ON {BEACH
INTERVIEW DATE}?  Ask for all household members at the beach.

B10a.	Who had urinary tract infection or burning sensation when
urinating since the interview at {STUDY BEACH} ON {BEACH INTERVIEW
DATE}?  Ask for all household members at the beach.

B11. 	Have you or anyone else had fever since the interview at {STUDY
BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members at the
beach.

B11a.	Who had fever since the interview at {STUDY BEACH} ON {BEACH
INTERVIEW DATE}?  Ask for all household members at the beach.

B12. 	Have you or anyone else had headache lasting more than a few hours
since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for
all household members at the beach.

B12a.	Who had headache lasting more than a few hours since the interview
at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household
members at the beach.

B13. 	Have you or anyone else had sore throat since the interview at
{STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members
at the beach.

B13a.	Who had sore throat since the interview at {STUDY BEACH} ON {BEACH
INTERVIEW DATE}?  Ask for all household members at the beach.

B14. 	Have you or anyone else had a bad cough since the interview at
{STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members
at the beach.

B14a.	Who had a bad cough since the interview at {STUDY BEACH} ON {BEACH
INTERVIEW DATE}?  Ask for all household members at the beach.

B15. 	Have you or anyone else had a cold since the interview at {STUDY
BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members at the
beach.

B15a.	Who had a cold since the interview at {STUDY BEACH} ON {BEACH
INTERVIEW DATE}?  Ask for all household members at the beach.

B16. 	Have you or anyone else had a runny or stuffy nose since the
interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all
household members at the beach.

B16a.	Who had a runny or stuffy nose since the interview at {STUDY
BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members at the
beach.

B17. 	Have you or anyone else had an earache, ear infection, or runny
ears  since the interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}? 
Ask for all household members at the beach.

B17a.	Who had an earache, ear infection, or runny ears since the
interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all
household members at the beach.

B18. 	Have you or anyone else had watery eyes since the interview at
{STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members
at the beach.

B18a.	Who had watery eyes since the interview at {STUDY BEACH} ON {BEACH
INTERVIEW DATE}?  Ask for all household members at the beach.

B19. 	Have you or anyone else had an eye infection since the interview
at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household
members at the beach.

B19a.	Who had an eye infection since the interview at {STUDY BEACH} ON
{BEACH INTERVIEW DATE}?  Ask for all household members at the beach.

B20. 	Have you or anyone else had an infected cut since the interview at
{STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members
at the beach.

B20a.	Who had an infected cut since the interview at {STUDY BEACH} ON
{BEACH INTERVIEW DATE}?  Ask for all household members at the beach.

B21. 	Have you or anyone else had a rash or itchy skin since the
interview at {STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all
household members at the beach.

B21a.	Who had a rash or itchy skin since the interview at {STUDY BEACH}
ON {BEACH INTERVIEW DATE}?  Ask for all household members at the beach.

B22. 	Have you or anyone else had a sunburn since the interview at
{STUDY BEACH} ON {BEACH INTERVIEW DATE}?  Ask for all household members
at the beach.

B22a.	Who had a sunburn since the interview at {STUDY BEACH} ON {BEACH
INTERVIEW DATE}?  Ask for all household members at the beach.

We will now ask about some activities people may have done since the day
of the beach interview on the {BEACH INTERVIEW DATE}

B23a. 	Since the day of the beach interview, have you or anyone else
come in contact with any animals?  Ask for all household members at the
beach.

B23b.	Who came into contact with animals since {BEACH INTERVIEW DATE}? 
Ask for all household members at the beach.

B23c.	Was this animal or any of these animals unfamiliar to you?

B23d.	What kind of animals were they?

B24a.	Since the day of the beach interview has anyone come into contact
with someone who has complained of diarrhea, vomiting, or stomach
illness?

B24b.	Who had contact with someone complaining of diarrhea, vomiting, or
stomach illness since {BEACH INTERVIEW DATE}?

B25a.	Since the day of the beach interview has anyone eaten raw shell
fish, such as oysters, clams, mussels, crabs?

B25b.	Who has eaten raw shell fish, such as oysters, clams, mussels,
crabs since {BEACH INTERVIEW DATE}?

B26a.	Since the day of the beach interview has anyone rare or raw meat? 

B26b.	Who has eaten rare or raw meat since {BEACH INTERVIEW DATE}? 

B27a.	Since the day of the beach interview has anyone eaten raw or runny
eggs?

B27b.	Who has eaten raw or runny eggs since {BEACH INTERVIEW DATE}?

SECTION C

This section is for all persons that experience symptoms.

C1.		On what day did your stomachache or abdominal cramping start?

C1a.	Do you still have a stomachache or abdominal cramping?

C1b.	(For persons that still have symptom) For how many days did you
have a stomachache or abdominal cramping?

C2.		On what day did your diarrhea or loose bowels start?

C2a.	Do you still have a diarrhea or loose bowels cramping?

C2b.	For how many days did you have a diarrhea or loose bowels cramping?

C2c.	What was the maximum number of bouts or episodes of diarrhea
experienced in a 24-hour period?  Ask for each person with symptom.

C3.		On what day did your nausea start?

C3a.	Do you still have nausea?

C3b.	For how many days did you have nausea?

C4.		On what day did your throwing-up or vomiting start?

C4a.	Do you still have throwing-up or vomiting?

C4b.	For how many days did you have throwing-up or vomiting?

C4c.	What was the maximum number of bouts or episodes of throwing-up or
vomiting experienced in a 24-hour period?  Ask for each person with
symptom.

C5.		On what day did your urinary tract infection or burning sensation
start?

C5a.	Do you still have a urinary tract infection or burning sensation?

C5b.	For how many days did you have urinary tract infection or burning
sensation?

C6.		On what day did your fever start?

C6a.	Do you still have a fever?

C6b.	For how many days did you have a fever?

C6c.	Was your temperature taken using a thermometer?  

C6d.	What is the highest temperature that you had since your beach
interview on {BEACH INTERVIEW DATE}?

C7.		On what day did your headache start?

C7a.	Do you still have a headache?

C7b.	For how many days did you have headache?

C8.		On what day did your sore throat start?

C8a.	Do you still have a sore throat?

C8b.	(For persons that still have symptom) For how many days did you
have sore throat?

C8c.	(For persons that still have symptom) Was this sore throat related
to allergies?

C9.		On what day did your bad cough start?

C9a.	Do you still have a bad cough?

C9b.	For how many days did you have a bad cough?

C9c.	Was this bad cough related to allergies?

C10.	On what day did your cold start?

C10a.	Do you still have a cold?

C10b.	For how many days did you have a cold?

C10c.	Was this cold related to allergies?

C11.	On what day did your runny or stuffy nose start?

C11a.	Do you still have a runny or stuffy nose?

C11b.	For how many days did you have a runny or stuffy nose?

C11c.	Was this runny or stuffy nose related to allergies?

C12.	On what day did your earache, ear infection or runny ears start?

C12a.	Do you still have an earache, ear infection or runny ears?

C12b.	For how many days did you have an earache, ear infection or runny
ears?

C12c.	Was this earache, ear infection or runny ears related to
allergies?

C13.	On what day did your watery eyes start?

C13a.	Do you still have watery eyes?

C13b.	For how many days did you have watery eyes?

C13c.	Was this watery eyes related to allergies?

C14.	On what day did your eye infection start?

C14a.	Do you still have eye infection?

C14b.	For how many days did you have eye infection?

C15.	On what day did your cut first get infected?

C15a.	Do you still have an infected cut?

C15b.	For how many days did you have an infected cut?

C15c.	Where were you cut?  Mark all that apply

C16.	On what day did your rash, itchy skin, or skin infection start?

C16a.	Do you still have a rash, itchy skin, or skin infection?

C16b.	For how many days did you have a rash, itchy skin, or skin
infection?

C16c.	Where did you have a rash, itchy skin, or skin infection?  Mark
all that apply

C17.	On which parts of the body were you sunburned?  Mark all that apply

Drop down list

SECTION D

Ask only once for each person reporting symptoms

D1.		When your condition began, were you working for pay either inside
or outside the home?  Please include jobs for which you were
self-employed.

D2.		During your illness, did you miss any time from work, for example
because you called in sick or took time off to see a doctor?

D3.		How many days?

D4.		Did this illness prevent you from performing daily activities such
as school, recreation, or vacation activities, or work around the home?

D5.		How many days?

D6.		Did this illness cause other household members to lose time at
work?

D7.		How many days?

D8a.	Did you consult a healthcare provider over the phone about this
illness/condition?

D8b.	Did you visit a healthcare provider?	

D8c.	How many times?	

D8d.	What illness did the healthcare provider say you had?	

D8e.	Did you visit an emergency room?

D8f		How many times?	

D8g.	Were you admitted to a hospital?

D8h.	How many days were you hospitalized?

D8i.		Were you given intravenous fluids?

D9a.	Did you receive a prescription for an antibiotic or other drug for
this illness/condition?

D9b.	About how much of your own or your household’s money was spent
altogether for these prescription medicines?  Amount to nearest dollar.

D10a.	Did you use any over-the-counter medications, including things
like special drinks, only because of this illness/condition?

D10b.	About how much of your own or your household’s money was spent
altogether for these over-the-counter medications?  Amount to nearest
dollar.

SECTION E

E1.		Before today, were you aware that people could become ill by
swimming at the beach?

E2.		After today, will you change the way you use the water at the
beach?

SECTION Q

These are questions from beach interview to ensure data collection for
important exposures.  Ask for all households.

 

Q1.		Did you or anyone in your household wade, swim, or play in the
water on {BEACH INTERVIEW DATE}?

Q1a.1.	Did you immerse your body, not necessarily your head in the water
{BEACH INTERVIEW DATE}?

Q1a.2.	Did you put your face in the water or submerge head in the water
on {BEACH INTERVIEW DATE}?

Q1a.3.	Did you get water in your mouth on {BEACH INTERVIEW DATE}?

Q1a.4.	Did you gag or cough after getting water in your mouth on {BEACH
INTERVIEW DATE}?

Q1a.5.	Did you swallow the water on {BEACH INTERVIEW DATE}?

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