Red - names of the variables. Yellow Variables coded after

Red - names of the variables. Yellow – Variables coded after cessation of the survey

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Ministry of Health

Department of Health Education and Promotion The Israel Center for Disease Control The Department of Mother, Child and Adolescent Health The Nutrition Department The Public Health Nursing Department

Child Nutrition Survey – MABAT INFANT Questionnaire 5 - For age 2 years

Questionnaire number ______ mnidgam MKR: 1= Jews 2= Arabs Date: ____________________ Edate

Interviewer, read: Hello, my name is _______ and I am calling on behalf of the Ministry of Health. Is it possible to speak to __________?

Two years ago, while you were in the maternity ward, after birth, you agreed to participate in a survey regarding child nutrition. About 1 year ago, the last interview took place. Your child is now two years old. I wanted to ask you a few questions. I want to remind you that your answers are confidential, and on no account will personal details such as your name or your telephone number be publicized. Is it possible for you to answer a few questions in the next 15 minutes?

1. Yes. (If yes, begin the survey) 2. No (If no, ask: When will you be available? to fix another time) If the answer is “I’m not interested” then ask, “May I ask why?” _______________________________________________ After she gives her answer, say, “Thank you and have a good day” (now, end the

interview). How are you? Interviewer: record here the name of the child from the file, and read: In the interview, I will relate to (name of the child), unless stated otherwise. Is the child a boy or girl? Interviewer: circle sex Interviewer: read " Could you please bring (name of the child)'s “Tipat Halav” (Well Baby Center) booklet?”

1. Toddler’s Nutrition Interviewer read: “Now I am going to ask some questions about feeding your child” 1. Until what age did (name of toddler) breastfeed or receive expressed breast milk? E1

1. Less than half a year or did not breastfeed at all (go to question 4) 2. Six months or more (go to question 1.1) 3. He/she is still breastfeeding (go to question 2) 4. I don’t remember

1.1. How many months in total? __________ months (go to question 3) E2months 2. Until when do you intend to breastfeed? E2

1. Until two years 8. Until five and a half years 2. Until two and a half years 9. Until six years 3. Until three years 10. Until six and a half years 4. Until three and a half years 11. Until seven years 5. Until four years 12. Until seven and a half years 6. Until four and a half years 13. Refuses to answer 7. Until five years 14. Other, specify: ________ E2other - (go to question 4)


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3. What were the reasons for cessation of breastfeeding? __________ EstopBF 4. Does (name of toddler) regularly receive infant formula? E4

1. Yes 2. No – (go to question 8)

5. What type of formula do you generally feed (name of toddler) now? Eform1_1new

1 Dairy formula

2 Lactose-free formula

3 Non-dairy formula

4 “Mehadrin” formula (strictly kosher)

7 Other 7. Why does (name of toddler) receive formula now? E7 _____________________________________________________________________________ 8. Has (name of toddler) received the following foods in the past month?

Refuses to answer

Don’t know/don’t remember

Does not

receive

Less than once/week

1-2 times a week

3-6 times a week

Once a day

More than

once a day

Food item Food

group

8 7 6 5 4 3 2 1 E8_1 Porridge

Cereals and

starches

8 7 6 5 4 3 2 1 E8_2 Unsweetened breakfast cereal

8 7 6 5 4 3 2 1 E8_3 Sweetened breakfast cereal

8 7 6 5 4 3 2 1 E8_4 Rice/pasta/wheat/couscous/sweet potato/potato

8 7 6 5 4 3 2 1 E8_5 Bread/pita/crackers/breadsticks

8 7 6 5 4 3 2 1 E8_6 Butter/margarine/other fatty spreads

Fats

8 7 6 5 4 3 2 1 E8_7 Avocado

8 7 6 5 4 3 2 1 E8_8 Humus spread/tehini

8 7 6 5 4 3 2 1 E8_43 Chocolate bar

8 7 6 5 4 3 2 1 E8_9 Chocolate spread/halvah/honey

8 7 6 5 4 3 2 1 E8_10 Beef

Protein

rich foods

8 7 6 5 4 3 2 1 E8_11 Chicken

8 7 6 5 4 3 2 1 E8_12 Fish (including tuna)

8 7 6 5 4 3 2 1 E8_13 Eggs

8 7 6 5 4 3 2 1 E8_14

Legumes (white beans, chickpeas, lentils, peas)

8 7 6 5 4 3 2 1 E8_15 Soy and soy products

8 7 6 5 4 3 2 1 E8_44 Meat sausage


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Refuses to answer

Don’t know/don’t remember

Does not

receive

Less than once/week

1-2 times a week

3-6 times a week

Once a day

More than

once a day

Food item Food group

8 7 6 5 4 3 2 1 E8_16 Fresh vegetables

Fruits

and vegetables

8 7 6 5 4 3 2 1 E8_17 Cooked vegetables

8 7 6 5 4 3 2 1 E8_18 Fresh fruits

8 7 6 5 4 3 2 1 E8_19 Cooked fruits

8 7 6 5 4 3 2 1 E8_20 Preserved fruits (eg: Gerber)

8 7 6 5 4 3 2 1 E8_21 Chocolate milk or flavored milk

Dairy products

8 7 6 5 4 3 2 1 E8_22 Cow’s milk (3%)

8 7 6 5 4 3 2 1 E8_23 Cow’s milk (1%)

8 7 6 5 4 3 2 1 E8_24 White or cottage cheese

8 7 6 5 4 3 2 1 E8_25 Unsweetened yogurt or sour cream

8 7 6 5 4 3 2 1 E8_26

Sweetened milk desserts or cheese desserts or yogurt with sugar

8 7 6 5 4 3 2 1 E8_27 Soy-based desserts

8 7 6 5 4 3 2 1 E8_28 Yellow or processed cheese

8 7 6 5 4 3 2 1 E8_29 Infant formula Infant

foods

8 7 6 5 4 3 2 1 E8_30 Breast milk Breast

Milk

8 7 6 5 4 3 2 1 E8_31 Peanut snack (“Bamba”) or other salted snacks

Other

8 7 6 5 4 3 2 1 E8_40 Pizza

Fast food 8 7 6 5 4 3 2 1 E8_41 Hamburger

8 7 6 5 4 3 2 1 E8_42 Falafel

9. How many cups or bottles of the following drinks does the toddler have a day or a week? 9.1. Unfiltered tap water: Edrink1

1. Never 2. Number of cups or bottles a day __________Edrink1cups_day (number) 3. Number of cups or bottles a week _________Edrink1cups_week (number)

4. Don’t know/don’t remember

9.2. Mineral water: Edrink2 1. Never 2. Number of cups or bottles a day __________ Edrink2cups_day (number) 3. Number of cups or bottles a week _________Edrink2cups_week (number) 4. Don’t know/don’t remember

9.3. Filtered water: Edrink3 1. Never 2. Number of cups or bottles a day __________ Edrink3cups_day (number) 3. Number of cups or bottles a week _________Edrink3cups_week (number) 4. Don’t know/don’t remember


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9.4. Infant tea: Edrink4 1. Never 2. Number of cups or bottles a day __________ Edrink4cups_day (number) 3. Number of cups or bottles a week_________ Edrink4cups_week (number) 4. Don’t know/don’t remember 9.5. Herbal tea: Edrink5

1. Never 2. Number of cups or bottles a day __________ Edrink5cups_day (number) 3. Number of cups or bottles a week _________ Edrink5cups_week (number) 4. Don’t know/don’t remember

9.6. Regular tea: Edrink6


9.7. Juice (fruit or vegetable): Edrink7


9.8. Soft drinks or drinks made of sweetened syrup Edrink8

1. Never 2. Number of cups or bottles a day __________ Edrink8cups_day (number) 3. Number of cups or bottles a week _________Edrink8cups_week (number) 4. Don’t know/don’t remember

10. Do you usually allow the toddler to feed himself foods such as fruit, meat patties, bread (finger foods)? E10

1. Yes 2. No. Why not? ____________ E10why

11. Do you usually allow the toddler to feed himself foods such as yogurt, cheese, soup, puree - foods which are eaten with a teaspoon? E11

1. Yes 2. No. Why not? ____________ E11why

12. Where does (name of toddler) eat the following meals? 12.1. Where does (name of toddler) eat breakfast? E12_1

1. At home 2. In family day care

3. At the day care center 4. At the caregiver's home

5. Refuses to answer 6. Other: _________________ E12_1other

12.2. Where does (name of toddler) eat lunch? E12_2

1. At home 2. In family day care




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12.3. Where does (name of toddler) eat dinner? E12_3 1. At home 2. In family day care



13. The meals that (name of toddler) eats at home (not with the caregiver or at the day care center) take place:

Not relevant

Never Sometimes Often Always Place

5 4 3 2 1 E13_1 At the table .1

5 4 3 2 1 E13_2 In front of the television .2

5 4 3 2 1 E13_3 While playing .3

5 4 3 2 1 E13_4 In the playground or in the garden

.4

14. How many times a week do you or another parent eat a family meal together with (name of toddler)? E14

1. Every day or almost every day 2. 2-4 times during the week (on weekdays) 3. Mainly on weekends or on “Shabbat” 4. Almost never 5. There is no fixed routine 6. Refuses to answer

15. Does the toddler eat sausages? E15

1. Yes 2. No go to question 17

16. How do you usually prepare the sausages before serving them? E16

1. I cut them lengthwise and into small pieces 2. I cut them into rings 3. I give a whole sausage 4. Other 5. Refuses to answer

17. Does the toddler eat grapes? E17

1. Yes 2. No go to question 19

18. How do you usually prepare the grapes before serving them? E18

1. I cut them 2. I give them whole 3. Refuses to answer

19. Does the toddler eat sweets (lollies)? E19 1. Yes 2. No 3. Refuses to answer

20. Does the toddler eat popcorn? E20 1. Yes 2. No 3. Refuses to answer


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21. Does (name of toddler) receive nutrition supplements (such as vitamins, minerals, herbal supplements, Polycose)? Enutsupp

1. Yes 2. No (go to the next section) 3. Refuses to answer

22. Who recommended taking the supplement? ____________ Enutsupp_who 23. What is the name of the supplement that (name of toddler) receives? ENutsuppname _______________________________________ 24. What is the amount of the supplement that (name of toddler) receives? Enutsuppamt_________________________________________ 25. Does (name of toddler) receive other nutrition supplements (such as vitamins, minerals, herbal supplements, Polycose)? Enutsupp2

1. Yes 2. No (go to the next section)

26. Who recommended taking the supplement?____________ Enutsupp2_who 27. What is the name of the supplement that (name of toddler) receives? Enutsuppname2 _________________________________ 28. What is the amount of the supplement that (name of toddler) receives? Enutsuppamt2 ______________________________________ 28.1. Does (name of toddler) receive other nutrition supplements (such as vitamins, minerals, herbal supplements, Polycose)? Enutsupp3

1. Yes 2. No (go to the next section)

28.2. Who recommended taking the supplement?____________ Enutsupp3_who 28.3 What is the name of the supplement that (name of toddler) receives? Enutsuppname3 _________________________________ 28.4 What is the amount of the supplement that (name of toddler) receives? Enutsuppamt3 ______________________________________

3. The Toddler’s Health Interviewer read: Could you please bring your toddler’s “Well Baby Center” (“Tipat Halav”) booklet with information on weight and length?

1. Yes 2. No 3. Do not remember / the booklet is not available

Note: it important the weight and height measurement will be from the same date

29. How old was (name of toddler) the last time his/her length and weight were measured?____________ months Ewthtage 30 What was (name of toddler)’s most recent weight in kilograms?_____Ewt______ kg

31. What was (name of toddler)’s most recent length in centimeters?_____Eht_____ cm


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32. Is the toddler allergic to a specific food or drink? E32 1. Yes 2. No )go to question 38 on medical problems) 3. Refuses to answer (go to question 38 on medical problems)

33. Is (name of toddler) allergic to one or more of the following? 33.1. Is (name of toddler) allergic to peanuts? E33_1

1. Yes 2. No 3. Refuses to answer

34.1. Did the toddler ever have peanuts (including a peanut snack "Bamba")? E34_1


If the answer to question 33.1 is "no" or "refuses to answer" go to question 33.2 35.1. Who told you that (name of toddler) is allergic or sensitive to peanuts?__________________________ E35who_1 33.2. Is (name of toddler) allergic to cow's milk? E33_2

1. Yes 2. No 3. Refuse to answer

34.2. Did the toddler ever have cow's milk (including dairy products)? E34_2


If the answer to question 33.2 is "no" or "refuses to answer" go to question 33.3 35.2. Who told you that (name of toddler) is allergic or sensitive to cow's milk?__________________________ E35who_2 33.3. Is (name of toddler) allergic to sesame? E33_3


34.3. Did the toddler ever have sesame (including Tehini and Halva)? E34_3


If the answer to question 33.3 is "no" or "refuses to answer" go to question 33.4 35.3. Who told you that (name of toddler) is allergic or sensitive to sesame?__________________________ E35who_3 33.4. Is (name of toddler) allergic to fish? E33_4



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34.4. Did the toddler ever have fish? E34_4


If the answer to question 33.4 is "no" or "refuses to answer" go to question 33.5 35.4. Who told you that (name of toddler) is allergic or sensitive to fish?_______________________ E35who_4 33.5. Is (name of toddler) allergic to egg white? E33_5


34.5. Did the toddler ever have egg white? E34_5


If the answer to question 33.5 is "no" or "refuses to answer" go to question 33.6 35.5. Who told you that (name of toddler) is allergic or sensitive to egg white?__________________________ E35who_5 33.6. Is (name of toddler) allergic to soy? E33_6


34.6. Did the toddler ever have soy? E34_6


If the answer to question 33.6 is "no" or "refuses to answer" go to question 33.7 35.6. Who told you that (name of toddler) is allergic or sensitive to soy? __________________________ E35who_6 33.7. Is the toddler allergic to another food not mentioned? E33_7

1. Yes 2. No go to question 36 3. Refuses to answer go to question 36

33.77. To what other food is the toddler allergic? ____________________E33_7name 34.7. Did the toddler ever have the other food mentioned? E34_7


35.7. Who told you that the toddler is allergic or sensitive to the other food mentioned? ________________________________ E35who_7


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36. Did (name of toddler) have an allergy that passed? E36 1. Yes 2. No (go to question 38)

37. To what food was the allergy that passed? _______________ E37 38. Is (name of toddler) undergoing some sort of medical inquiry or has he/she been diagnosed with specific medical problems in the past year? Emedprob1yesno

1. Yes 2. No (go to question 41) 3. Refuses to answer

39. What illnesses or health problems was (name of toddler) diagnosed with, or being inquired for in the last year? ____________________________ Emedprob1 40. Was he/she referred to another person for follow-up or treatment? Emedprob1Rx


39.1. Was he/she diagnosed with another illnesses or health problem? Emedprob2yesno


39.11. What illnesses or health problems was (name of toddler) diagnosed with, or being inquired for in the last year? ____________________________ Emedprob2 40.1. Was he/she referred to another person for follow-up or treatment? Emedprob2Rx


39.12. Was he/she diagnosed with another illnesses or health problem? Emedprob3yesno


39.112. What illnesses or health problems was (name of toddler) diagnosed with, or being inquired for in the last year? ____________________________ (No answers) 40.12. Was he/she referred to another person for follow-up or treatment? (No answers)


41. Was (name of toddler) hospitalized in the past year? Ebabyhosp

1. Yes 2. No (Go to the question 44) 3. Refuses to answer

42. For how long was (name of toddler) hospitalized? __________ days Ehospdays 43. What was the reason for the hospitalization? ______________ Ehosp1why


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43.1. Was there another reason for hospitalization? Ehosp2 1. Yes 2. No (Go to the question 44) 3. Refuses to answer

43.2. What was the additional reason? ________________________________ Ehosp2why 44. Does (name of toddler) brush his/her teeth? Ebrush

1. Yes 2. No (Go to the section 4 "vaccinations”) 3. Refuses to answer

45. How frequently does (name of toddler) brush his/her teeth? Ebrush_freq

1. Every day, twice a day, morning and evening 2. Every day, once a day in the evening 3. Every day, once a day in the morning 4. 4-6 times a week 5. 1-3 times a week 6. Other, ____________________ Ebrush_freq_other 7. Refuses to answer

46. Who usually brushes (name of toddler) teeth? Ebrush_who

1. The toddler him/herself 2. An adult brushes the toddler's teeth 3. Combination of the toddler and help from an adult 4. Other ____________________ Ebrush_who_other 5. Refuses to answer

47. How old was (name of toddler) when he/she started to brush his/her teeth? Ebrush_age

______________months

4. Vaccinations To the interviewer, read: Now I’m going to ask you about all of the vaccinations your child received. You can refer to your child’s vaccination booklet for help. 48. Could you please bring your child’s “Well Baby Center” (“Tipat halav”) booklet with information on vaccinations?

1. Yes 2. No (go to the question 53)

48.1. Did (name of toddler) receive the DTaP-IPV-HiB 4th dose at age 1 year vaccination at age 1 year? E48_1

1. Yes (go to the question 48.2) 2. No 3. Refuses to answer

49.1. Why not? ________________________ E49_1 48.2. Did (name of toddler) receive the vaccination for measles, mumps, rubella, chicken pox at age 1 year? E48_2

1. Yes (go to question 48-3) 2. No 3. Refuses to answer

49.2. Why not? ________________________ E49_2


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48.3. Did (name of toddler) receive Hepatitis A vaccination at age 18 months? E48_3

1. Yes (go to question 50) 2. No 3. Refuses to answer

49.3. Why not? ________________________ E49_3 50. Did (name of toddler) receive any other vaccinations in the past year that were not mentioned? E50

1. Yes 2. No (go to question 53) 3. Refuses to answer (go to question 53)

51. What other vaccinations did (name of toddler) receive in the last year? ________________E50_1name 52. Was it given privately? E52_1

1. Yes 2. No 3. Refuses to answer 4. Other____________________ E52_1other

51.1. Did (name of toddler) receive any other vaccinations in the past year? E51_1


51.12. What other vaccinations did (name of toddler) receive in the past year? _________________ E50_2name 52.2. Was it given privately? E52_2

1. Yes 2. No 3. Refuses to answer 4. Other ____________ (no answers)

51.2. Did (name of toddler) receive any another vaccinations in the past year? E51_2


52.12. What other vaccinations did (name of toddler) receive in the past year? _________________ E50_3name 52.3. Was it given privately? E52_3

1. Yes 2. No 3. Refuses to answer 4. Other ____________ (no answers)

5. Smoking Habits 53. Do you currently smoke? Esmokenow



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54. How many cigarettes do you smoke? E54

1. _______ a day Ecigsnow_day (number) 2. _______ a week

55. Does your spouse currently smoke? Esmoke_spouse

1. Yes 2. No 3. Not relevant (no spouse) 4. Refuses to answer

6. Knowledge and Attitudes 56. What are your sources of information on child nutrition? (mark all the possibilities) Einfosource1- Einfosource15

1. Physician 2. "Well Baby Center" ("Tipat halav") nurse 3. Lactation counselor 4. Dietitian 5. Television 6. Radio 7. Newspapers 8. Publications of the Ministry of Health 9. Publications from HMO's, hospitals 10. Courses and books 11. Internet 12. Family 13. Friends 14. Companies, such as food companies 15. Other: specify ____________________ Einfosource15_other 18. Self-knowledge or previous experience Einfosource18

57. Are you familiar with the Ministry of Health's recommendations for preventing choking for infants and toddlers? E57


58. Are you familiar with the Ministry of Health's recommendations for brushing toddlers’ teeth? E58


59. Is (name of toddler) under follow-up at “Tipat Halav” (“Well Baby Center”)? E59

1. Yes – go to question 61 2. No – go to question 60 3. Refuses to answer – go to question 61

60. Why not? ____________________________ E60 go to question 62 61. Is (name of toddler) under supervision at “Well Baby Center” (“Tipat Halav”): E61

1. On a regular basis for follow-up including vaccinations 2. Only for vaccinations 3. Refuses to answer 4. Other, specify: _________________________ E61other


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62. I’m going to read to you a number of statements. Please tell me if you agree or disagree, on a scale of 1-4 with 1 being “I strongly agree” and 4 “I don't agree at all”.

6 Refuses

to answer (Don’t read)

5 I have

no opinion (Don’t read)

4 Don't

agree at all

3 2 1 Strongly

agree

Statement

6 5 4 3 2 1 It is a woman’s right to breastfeed in a public place

Eknow1

6 5 4 3 2 1 Going back to work necessitates cessation of breastfeeding

Eknow3

6 5 4 3 2 1 Breastfeeding is an enjoyable experience Eknow5

6 5 4 3 2 1 Advertisements of infant formula companies are a reliable source of information on child nutrition

Eknow6

6 5 4 3 2 1 Vaccines prevent dangerous diseases Eknow7

6 5 4 3 2 1 Breastfeeding mothers will have less absenteeism from work Eknow11

6 5 4 3 2 1 Vaccines are more dangerous than the diseases they prevent Eknow12

6 5 4 3 2 1 A breastfed child has more ear infections Eknow13

6 5 4 3 2 1 A child not breastfed has more diarrhea Eknow19

6 5 4 3 2 1 A breastfeeding woman needs to avoid certain foods

Eknow20

6 5 4 3 2 1 Leaving the house is difficult when you are breastfeeding

Eknow23

6 5 4 3 2 1 Breastfeeding helps the mother return to her previous figure

Eknow24

6 5 4 3 2 1

Infant formula is as good for the baby as breast milk (to the Interviewer: formula is powder, mixed with water in order to prepare a bottle feed).

Eknow26

6 5 4 3 2 1

I feel comfortable when a woman breastfeeds near me, in a public place, such as a shopping center, a coffee shop, public park, etc.

Eknow27

6 5 4 3 2 1 The workplace needs to provide breastfeeding mothers with an appropriate place to express milk

Eknow28

6 5 4 3 2 1 There is no connection between vaccines and development problems (including Autism)

Eknow29

6 5 4 3 2 1 It is very important that the toddler finishes all the food offered to him

Eknow30

6 5 4 3 2 1 A portion of formula is a substitute for a meal

Eknow31

6 5 4 3 2 1 It is important to allow the toddler to feed him/herself

Eknow32

6 5 4 3 2 1 Vaccinations are safe to use Eknow33

6 5 4 3 2 1 Family meals contribute to the prevention of obesity

Eknow35


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7. Demography

Interviewer read: With your permission, a few questions about you and your family. 63. Which of the following situations best describes your employment today? E63

1. I work away from home 2. I work from home 3. I don’t work (go to question 66) 4. Other ____________________________________ E63other 5. Refuses to answer

64. How old was (name of toddler) when you returned to work? E64age ________________ months – interviewer, fill in number of months

65. What is your field of work? ________________________________ E65 66. What is your profession? _________________________________ E66 67. Have you given birth to another child since (name of toddler) was born? E67_1


68. What is the date of birth of the child born after (name of toddler)? E68_1 ____(dd)____(mm)____(yy) 67.1. Have you given birth to another child? E67_2


68.1. What is the date of birth? E68_2 ____(dd)____(mm)____(yy) 69. What is your marital status? Estatus

1. Married or living with a spouse 2. Single 3. Divorced/separated 4. Widow 5. Refuses to answer 6. Other: specify____________________________ Estatus_other

70. What is the average monthly net income (after taxes), from all sources, from all household members? Eincome

1. Up to 3,400 NIS 2. 3,401-5,500 NIS 3. 5,501-8,200 NIS 4. 8,201-10,500 NIS 5. 10,501-14,100 NIS 6. 14,101-16,700 NIS 7. 16,701-24,700 NIS 8. 24,701 NIS and over 9. I don’t know 10. Refuses to answer 11. Not relevant (kibbutz member, a student who doesn’t work, a member of a communal

moshav) Interviewer read: Thank you for your cooperation. Your answers will assist the Ministry of Health in giving recommendations for toddler nutrition.

Time: _______

Documents

Red - names of the variables. Yellow Variables coded after