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 Draft Study Survey Instruments

The National Children's Study will collect information about participants through self or care-giver reported questionnaires, biological specimens, environmental samples, physical assessments, and participant, household, and community observations.  The study will gather information about both health and disease.  One conceptual approach used is identification and measurement of characteristics of healthy individuals at different ages and developmental stages. 

The Study is proposing 23 data collection points (some in person and some remote) from pregnancy through 21 years of age.  The proposed schedule is shown below.

Pregnancy and Infancy Preschool Youth
Pregnancy before 20 weeks* 18 months 7 years*
Pregnancy after 20 weeks* 24 months* 9 years*
Birth* 30 months 11 years*
3 months 36 months* 13 years*
6 months* 42 months 15 years*
9 months 48 months* 17 years*
12 months* 54 months 19 years*
  60 months* 21 years*

* In person visits

Below are draft sample data collection instruments including:

  1. Draft of the first pregnancy interview (PDF 366 KB)
  2. Draft of the second pregnancy interview (PDF 208 KB)
  3. A draft of the interview conducted around the time of birth (PDF 240 KB)
  4. A draft of a sample interview for a 21 year old (PDF 321 KB)
  5. Draft Dietary history questionnaire for the pregnant woman (PDF 718 KB)
  6. Draft biospecimen collection forms
    1. Maternal Blood (PDF 509 KB)
    2. Infant Blood (PDF 236 KB)
    3. Maternal Urine (PDF 546 KB)
    4. Cord Blood (PDF 570 KB)
    5. Placental Tissue (PDF 935 KB)
  7. Draft forms for collection of dust
    1. Vacuum Sample (PDF 315 KB)
    2. Wipe Sample (PDF 620 KB)
  8. Draft of the child anthropometry exam form (PDF 1.48 MB)

Of note, these are included as examples of data collections, not as final forms.  Comments on these draft data collection instruments can be submitted to