Awareness and Concern of Exposure to
Toxic Chemicals in Childhood
USER-FRIENDLY QUESTIONNAIRE HISTORY:
Date Created:
06/08/2014
Date Revised:
Date Retired From Use:
MODULE QUESTIONS:
int_toxchem [if age0_12 lt <1> goto exit_toxchem]
Now we'd like to ask you a few questions about your views on your
children's home environment. By environment we mean in and around your
home.
tox_chem1
[if dc2 eq <1>]
Over the course of a typical week, how often is your child
[else]
Over the course of a typical week, how often are your children
exposed to chemicals or other harmful substances in their home such as
fumes, vapors, liquids or tobacco smoke? Would you say this never happens,
happens about once a week, 2 to 3 times a week, 4 to 6 times a week, or
every day?
Interviewer: If asked, these are some examples of harmful substances in
the home: Air fresheners, paint fumes, fumes from dry cleaned clothes,
household cleaners, dust from renovations, exposure to gas from car
exhaust or gas stoves/ovens, etc.
1
2
3
4
5
8
9
Never
Once a week
2 to 3 times a week
4 to 6 times a week
Every day
don't know
refused
tox_chem2
[if dc2 eq <1>]
The next few questions ask about fish or fish products your child may eat.
First, how often does your child eat fish?
[else]
The next few questions ask about fish or fish products your children may
eat.
First, how often do your children eat fish?
Date of last user friendly questionnaire update: 06/08/2014
Awareness and Concern of Exposure to
Toxic Chemicals in Childhood
Would you say they eat fish several times a week, about once a week, about
once every two weeks, about once a month, less often than once a month, or
never?
1
2
3
4
5
6
8
9
Several times a week
About once a week
About once every two weeks
About once a month
Less often than once a month
Never
don't know
refused
<6,8,9> [goto tox_chem3]
tox_chem2a
[if dc2 eq <1>]
In the past two weeks, has your child eaten any of the following fish:
[else]
In the past two weeks, have your children eaten any of the following fish:
fresh or frozen tuna, shark, swordfish, escolar, marlin or orange roughy?
Interviewer: If R says "yes" to at least one of the fish on the list,
code as 1 (yes).
1
2
5
8
9
Yes
No
My child hasn't eaten fish in the last two weeks
don't know
refused
<5> [goto tox_chem3]
tox_chem2b
What about fish such as salmon, herring, sardines, char, Atlantic mackerel
or rainbow trout.
[if dc2 eq <1>]
In the past two weeks, has your child eaten any of these types of fish?
[else]
In the past two weeks, have your children eaten any of these types of
fish?
Interviewer: If R says "yes" to at least one of the fish on the list,
code as 1 (yes).
1
2
8
9
Yes
No
don't know
refused
Date of last user friendly questionnaire update: 06/08/2014
Awareness and Concern of Exposure to
Toxic Chemicals in Childhood
tox_chem3
Some people are concerned that mercury in fish may mean that eating fish
is not good for you. Have you ever looked for information on mercury
levels in fish?
1
2
5
8
9
Yes
No
I don't do the shopping / I don't shop for food
don't know
refused
tox_chem5
[if dc2 eq <1>]
In a typical day, how often is your child served food or
[else]
In a typical day, how often are your children served food or
beverages that are microwaved in plastic containers, margarine containers,
in a bowl or plate covered in saran wrap, or in Tupperware containers that
are not labelled as being microwavable safe. Would you say once per day,
twice per day, three times per day, four times per day, five or more times
per day, one to a few times per week, less often than once a week, or
never?
1
2
3
4
5
6
7
8
9
98
99
Once per day
Twice per day
Three times per day
Four times per day
Five or more times per day
One to a few times per week
Less often than once a week
Never
Do not have a microwave/don't have access to a microwave
don't know
refused
tox_chem4
[if dc2 eq <1>]
How often does your child play with soft flexible plastic toys?
[else]
How often do your children play with soft flexible plastic toys?
Never, once a week, 2 to 3 times a week, 4 to 6 times a week, every day?
Interviewer: If asked, soft flexible toys similar to that of a rubber
ducky, Sophie the Giraffe, or Barbie's head and not body, head of a
cabbage patch baby.
1
2
3
4
5
8
9
never
once a week
2 to 3 times a week
4 to 6 times a week
every day
don't know
refused
Date of last user friendly questionnaire update: 06/08/2014
Awareness and Concern of Exposure to
Toxic Chemicals in Childhood
tox_chem6
What about harmful chemicals in plastics used for toys, water bottles,
food containers and lining in food cans? How often do you look at the
label to check if the product is free of those chemicals? Would you say
you check the label all the time, most of the time, sometimes, or never?
Interviewer: If asked, Bisphenol A (BPA), is a chemical used primarily in
the production of polycarbonate plastic and epoxy resins. Polycarbonate is
used in beverage bottles, infant feeding bottles, food containers,
processing equipment and other articles. Epoxy resins are used in
protective linings for a variety of canned foods and beverages, including
infant formula. Health Canada recommends that the general principle of "as
low as reasonably achievable" be applied to limit BPA exposure to infants
and newborns (e.g. pre-packaged infant formula products).
Plastics may contain heavy metals such as mercury, arsenic, manganese and
cadmium, as well as other chemicals including: PBDEs (polybrominated
diphenyl ethers), which are added to products to make them less likely to
catch fire; PCBs (polychlorinated biphenyls), formerly used as an
ingredient in many industrial materials; and perfluorinated compounds,
which are used in the manufacture of grease and water repellents used on
products.
1
2
3
4
5
8
9
All the time
Most of the time
Sometimes
Never
I don't do the shopping
don't know
refused
<5> [goto exit_toxchem]
tox_chem4a
Have you ever looked for information on chemicals or metals in plastics
used for toys, water bottles, food containers and lining in food cans?
Interviewer: If asked, Bisphenol A (BPA), is a chemical used primarily in
the production of polycarbonate plastic and epoxy resins. Polycarbonate is
used in beverage bottles, infant feeding bottles, food containers,
processing equipment and other articles. Epoxy resins are used in
protective linings for a variety of canned foods and beverages, including
infant formula. Health Canada recommends that the general principle of "as
low as reasonably achievable" be applied to limit BPA exposure to infants
and newborns (e.g. pre-packaged infant formula products). Plastics may
contain heavy metals such as mercury, arsenic, manganese and cadmium, as
well as other chemicals including: PBDEs (polybrominated diphenyl ethers),
which are added to products to make them less likely to catch fire; PCBs
(polychlorinated biphenyls), formerly used as an ingredient in many
industrial materials; and perfluorinated compounds, which are used in the
manufacture of grease and water repellents used on products.
Date of last user friendly questionnaire update: 06/08/2014
Awareness and Concern of Exposure to
Toxic Chemicals in Childhood
1
2
Yes
No
5
8
9
I don't do the shopping
don't know
refused
Date of last user friendly questionnaire update: 06/08/2014