National Health and Nutrition Examination Survey PHONE FOLLOW-UP DIETARY INTERVIEWER PROCEDURES MANUAL January 2002 TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY ..................................................... 1-1 1.1 History of the National Health and Nutrition Examination Programs 1-1 1.2 Overview of the Current NHANES .................................................... 1-3 1.2.1 Data Collection.................................................................... 1-4 1.3 Sample Selection................................................................................. 1-6 1.4 Field Organization for NHANES ....................................................... 1-7 1.5 Exams and Interviews in the Mobile Examination Center (MEC) ..... 1-10 1.5.1 Exam Sessions..................................................................... 1-12 1.5.2 Exam Team Responsibilities............................................... 1-13 1.5.3 Examination Components. .................................................. 1-14 1.5.4 Second Exams ..................................................................... 1-18 1.5.5 Sample Person Remuneration. ............................................ 1-19 1.5.6 Report of Exam Findings. ................................................... 1-19 1.5.7 Dry Run Day. ...................................................................... 1-20 1.6 Integrated Survey Information System (ISIS) .................................... 1-21 1.7 Confidentiality and Professional Ethics.............................................. 1-21 2 INTRODUCTION TO THE DIETARY INTERVIEW................................... 2-1 2.1 Dietary Interview Component in the National Health and Nutrition Examination Survey (NHANES) ................................. 2-1 2.2 The Role of the PFU Dietary Interviewer........................................... 2-3 2.3 Observers and Visitors........................................................................ 2-4 3 GENERAL INTERVIEWING TECHNIQUES............................................... 3-1 3.1 Before Beginning the Interview.......................................................... 3-1 3.2 Beginning the Interview...................................................................... 3-1 3.3 Administering the Interview ............................................................... 3-2 3.3.1 Asking the Questions .......................................................... 3-2 3.3.2 Maintaining Rapport ........................................................... 3-4 3.3.3 Difficult Situations .............................................................. 3-5 3.3.4 Incomplete Information....................................................... 3-5 iii TABLE OF CONTENTS (continued) Chapter Page 3.4 Probing................................................................................................ 3-5 3.4.1 What is Probing and Why is it Necessary ........................... 3-6 3.4.2 Probing Inappropriate Responses........................................ 3-7 3.4.3 Probing Methods Should be Neutral ................................... 3-8 3.4.4 Kinds of Probes ................................................................... 3-8 3.4.5 The Don’t Know (DK) Response........................................ 3-10 3.4.6 Additional Guidelines for Probing ...................................... 3-10 3.4.7 When to Stop Probing ......................................................... 3-11 3.5 General Rules for Recording Answers ............................................... 3-11 3.6 Ending the Interview........................................................................... 3-12 4 DIETARY INTERVIEW APPLICATION FEATURES ................................ 4-1 4.1 General Overview of Computer.......................................................... 4-1 4.1.1 Keyboard ............................................................................. 4-1 4.2 PFU Dietary Interview Related Systems ............................................ 4-4 4.2.1 Key Features of The Wrapper Program .............................. 4-5 4.2.2 Key Features of The AMPM Program ................................ 4-7 5 PHONE FOLLOW-UP CONTACT PROCEDURES ..................................... 5-1 5.1 Check Daily Schedule......................................................................... 5-1 5.2 Document Call Attempts .................................................................... 5-6 5.3 Retry Broken Appointments ............................................................... 5-11 5.4 Reschedule Appointments .................................................................. 5-11 5.5 Reminder Calls ................................................................................... 5-16 6 CONDUCTING THE 24-HOUR RECALL INTERVIEW ............................. 6-1 6.1 Introduction of the PFU Dietary Interview using the USDA Automated Multiple Pass Method (AMPM) Instrument .................... 6-1 6.1.1 Key Features of the 24-Hour Dietary Recall....................... 6-2 6.2 Accessing the Program ....................................................................... 6-4 6.3 Introduction to Respondent................................................................. 6-5 6.4 Step 1: The Quick List Pass (QL) ....................................................... 6-10 iv TABLE OF CONTENTS (continued) Chapter Page 6.4.1 The Main Food List (MFL)................................................. 6-16 6.4.2 Leaving the Quick List (QL) Pass....................................... 6-26 6.5 Step 2: The Forgotten Foods List (FFL) ............................................. 6-27 6.6 Step 3: The Time and Occasion Pass (T/O)........................................ 6-34 6.7 Step 4: The Detail and Review Cycle (DRC) ..................................... 6-44 6.7.1 Measuring Guide Instructions Screen ................................. 6-46 6.7.2 Midnight to First Occasion Probe ....................................... 6-47 6.7.3 Collecting Details and Amounts ......................................... 6-49 6.7.4 Food Source Question ......................................................... 6-93 6.7.5 Review of Occasion ............................................................ 6-101 6.7.6 Occasion Location Question ............................................... 6-103 6.7.7 Between Interval Probe ....................................................... 6-105 6.7.8 Last Occasion to Midnight Probe........................................ 6-106 6.7.9 Collection of Remainder Foods........................................... 6-107 6.8 Step 5: The Final Review Probe (FR)................................................. 6-108 6.9 Intake Health-Related Questions ........................................................ 6-109 6.9.1 Usual Intake ........................................................................ 6-109 6.9.2 Water Questions .................................................................. 6-110 6.10 Dietary Recall Section Status ............................................................. 6-132 6.11 The Post-Recall Section...................................................................... 6-134 6.11.1 Observations Screen............................................................ 6-134 6.11.2 Post-Recall Section Status Screen....................................... 6-137 7 ADDITIONAL INTAKE PROCEDURES...................................................... 7-1 7.1 Proxy and Assisted Interviews............................................................ 7-1 7.1.1 Proxy Interviews with Child SPs Under 9 Years of Age .... 7-2 7.1.2 Assisted Interviews with Child SPs 9 to 11 Years Old ....... 7-3 7.1.3 Proxy or Assisted Interviews with Adults Unable to Report for Themselves ........................................................ 7-3 7.2 Interviewing Children ......................................................................... 7-3 7.3 Data Retrieval Procedures .................................................................. 7-4 7.3.1 Data Retrieval Criteria ........................................................ 7-5 7.3.2 Flagging Eating Occasions for Data Retrieval .................... 7-5 v TABLE OF CONTENTS (continued) Chapter Page 7.3.3 Documenting Data Retrieval Source Information............... 7-10 7.3.4 Data Retrieval Collection Procedures ................................. 7-17 7.4 Documenting Missing Meals (if Data Retrieval is Not Required)...... 7-18 7.5 Documenting Skipped Meals.............................................................. 7-18 7.6 Documenting Fasts on the Recall Day................................................ 7-18 7.7 Documenting Breast-fed Infants ......................................................... 7-19 7.8 “Same As” (Foods Previously Reported by the SP or Household Member) ........................................................................... 7-21 7.9 Procedures for Misreporting Foods .................................................... 7-21 7.10 Adding Remembered Additions ......................................................... 7-22 7.11 RFL IS FULL (Documenting 41 or more Reported Foods) ............... 7-23 7.11.1 RFL IS FULL – Recording Primary Foods During the Dietary Recall...................................................................... 7-24 7.11.2 RFL IS FULL – Recording Primary Linked Foods During the Dietary Recall ................................................... 7-25 7.11.3 RFL IS FULL – Recording Primary Foods While