v e r s i o n ; 18.1.93; Epi stem file; IDniOx.OES; VSFILE; INFQESIO Version: 18.1.93; Epi stem file.: IDMOx.OES; WSFILE; INFQESIO
Homerton Hospital Ward and Laboratory Studies Breast Feeding Information
Page
Baby's Study No
0
Interviewer:
I would now like to ask you some questions about bow you have been feeding your baby.
Tick the appropriate answer
1. Hava you breastfed your baby since s/he was born?
If no. go to next page If yes. continue
No [ Yes i
2. Have you breastfed her/him in the last 24 hours? No (
If yes, go to question 4 If no. continue
3. How old was s/he when you stopped?
If less than 1 week, number of days
Yes [
weeks days 4. How old was your baby when you first gave her/him
anything other than breastmilk i.e. any other milks or any solids?
[ 1
Coding summary for breastfeeding
Breastfeeding status
Never started breastfeeding 98 Not yet given up breastfeeding 99 Breastfed for n weeks n
If now stopped and fed for < 1 week, code as 01 weeks
Duration exclusive breastfeeding
Still exclusively breastfed 99 Exclusively breastfed for n weeks n If given formula feed when < 1 week code as 01
Homerton Hospital Ward and Laboratory Studies Family History and Socioeconomic Information
Page
Baby's Study No
B
Interviewer:
I would now like to ask you some questions about your
family's health. By _ this, I mean tbe bealtb of you. the baby's father.,brothers or sisters.
Has any member of your family ever had wheezing or whistling in the chest? Yes(2) No(l) If any, specify who -
Has a doctor ever said family has asthma? If any, specify who -
that any member of your Yes{2) N o d )
Has any member of your family ever had hayfever? If any, specify who - Yes(2) No(I)
Has any member of your family ever had eczema? If any, specify who - Yes(2) No(l)
Apart from the illnesses I have mentioned above, have you or.(baby's) father aver suffered from any chest trouble? Yes(2) No(l) If yes who
Has your baby ever had eczema? Yes(2) No (1)
Interviewer;
I would now like to ask you some questions about tbe work you and (baby's) father do and about your borne. It is surprising but baby's breathing may be effected
by the work their parents do. These questions won't take long to answer and will be treated in strict confidence.
What is/was (baby's) father's most recent job?
] ] ] ] ] ] Ask Mother: .
What is your job or what was your most recent job *1
before you had (baby)? I
to be coded later
How old were you when you left full-time education? (age last birthday before leaving)
m
Appendix A.3.
(cont’d)V e r s io n ; 18.1.93; Epi stem file: IDAlOx.OES; VSFILE: INFQESIO Version: 18.1.93: Epi stem file: IDMOx.QES; VSFILE: INFQESIO
Homerton Hospital Ward and Laboratory Studies
Smoking History
Page
Baby's Study No
0
Interviewer:
I would now like to ask some questions about smoking.
Did you smoke at any time while you were pregnant with (baby's name)? •Yes(2) No(1)
•If yes, ask and record details as below.
] In pregnancy mother smoked cigarettes/day from month % to month
Are you still smoking/have you smoked at all since (baby's name) was born? *Yes(2) No(l)
Are there any members of your household who have smoked since (baby's name) was born? *Yes(2) No(l)
Does (baby's name) have contact with any friends, family or childminders who smoke? *Yes(2) No(l)
•If yes, ask and record details as below. Postnatal smoking exposure
from X to V weeks ever smokes/d in Person smoked n cigarettes/day of baby's life baby's presence? (give relationship to baby) x y yes(2) No(lJ
Homerton Hospital Ward and Laboratory Studies
Infant Status
Page Baby's Study No
0
Code 1» No; 2» Yes where appropriate
Respiratory Disease If yes, give details of respiratory disease here
Other Disease If yes, give details of other disease here
Previous Wheeze or Lower Respiratory Illness
Recent Upper Respiratory Illness in last 3 weeks)
Symptomatic at time of test If yes, give details here
Is your baby currently recevlng any medicines? (2- yes; 1» no;)
If yes, specify drug and time in hours since last dose Drug 1 Codes: 1» beta-agonists; 2» ip.bromide; 3» steroids;
tbeopbylllnes; 5* Intal; 6> surfactant; 7» other; (specify ...) Time 1 Drug 2 (specify: ... ) Time 2 Drug 3 (specify: ... ) Time 3 ] ] ] ] ] ] ] ] ] ]
Appendix
A .3 . (cont’d)Version; 18.1.93: Epi stem file; IDAlOx.QES: WSFILE; INFQESIO H o m e r t o n H o s p i t a l W a r d a n d L a b o r a t o r y S t u d i e s T e s t D e t a i l s P a g e B a b y ' s S t u d y No
0
Code: l^no; 2 » y e s w h e re appropriateS e d a t e d
P o s t u r e (!• supine: 2= prone: 3 * lateral: 4* semi-recumbent)
O p e r a t o r (initials)