MEC In-Person Dietary Interviewers Procedures Manual January 2006 TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY ............................................................................ 1-1 1.1 History ................................................................................................ 1-1 1.2 Goals of the Survey............................................................................. 1-4 1.3 NHANES Data Accomplishments...................................................... 1-4 1.4 National Center for Health Statistics .................................................. 1-6 1.5 Sample Selection................................................................................. 1-6 1.6 Field Organization for NHANES ....................................................... 1-7 1.7 Exams and Interviews in the Mobile Examination Center (MEC) ..... 1-10 1.7.1 Exam Sessions..................................................................... 1-11 1.7.2 Exam Team Responsibilities............................................... 1-12 1.7.3 Examination Components ................................................... 1-13 1.7.4 Sample Person Remuneration ............................................. 1-20 1.7.5 Report of Exam Findings .................................................... 1-20 1.7.6 Dry Run Day ....................................................................... 1-21 1.8 Integrated Survey Information System (ISIS) .................................... 1-22 1.9 Confidentiality and Professional Ethics.............................................. 1-22 2 INTRODUCTION TO THE DIETARY INTERVIEW................................... 2-1 2.1 Dietary Interview Component in the National Health and Nutrition Examination Survey ............................................................ 2-1 2.2 The Role of the Dietary Interviewer ................................................... 2-3 2.3 Other Duties of the Dietary Interviewer ............................................. 2-4 2.4 Observers and MEC Visitors .............................................................. 2-5 3 EQUIPMENT, SUPPLIES, AND MATERIALS............................................ 3-1 3.1 Description of the MEC Interview Room and Equipment.................. 3-1 3.2 MEC Interview Supplies and Other Equipment ................................. 3-1 3.2.1 Measuring Guides ............................................................... 3-1 3.2.2 Tape Recorder ..................................................................... 3-3 3.3 MEC Dietary Interviewer Materials ................................................... 3-3 3.3.1 Handcards............................................................................ 3-4 3.3.2 Reminder Cards................................................................... 3-4 3.3.3 Measuring Guide Package................................................... 3-4 iii TABLE OF CONTENTS (continued) Chapter Page 3.3.4 Audiotape Consent Forms................................................... 3-5 3.4 Equipment Setup and Teardown Procedures ...................................... 3-5 3.4.1 MEC Dietary Interview Room Setup Procedures ............... 3-5 3.4.2 MEC Dietary Interview Room Teardown Procedures ........ 3-10 4 GENERAL INTERVIEWING TECHNIQUES............................................... 4-1 4.1 Before Beginning the Interview.......................................................... 4-1 4.2 Activities and Resources Helpful to Your Interview.......................... 4-1 4.2.1 Getting Oriented to a New Community .............................. 4-1 4.2.2 Helpful Contacts.................................................................. 4-2 4.2.3 Beginning the Interview...................................................... 4-3 4.3 Administering the Interview ............................................................... 4-4 4.3.1 Asking the Questions .......................................................... 4-5 4.3.2 Maintaining Rapport ........................................................... 4-7 4.3.3 Difficult Situations.............................................................. 4-8 4.3.4 Incomplete Information....................................................... 4-8 4.4 Probing................................................................................................ 4-9 4.4.1 What is Probing and Why is it Necessary ........................... 4-9 4.4.2 Probing Inappropriate Responses........................................ 4-10 4.4.3 Probing Methods Should be Neutral ................................... 4-11 4.4.4 Kinds of Probes................................................................... 4-11 4.4.5 The Don’t Know (DK) Response........................................ 4-13 4.4.6 Additional Guidelines for Probing ...................................... 4-13 4.4.7 When to Stop Probing ......................................................... 4-14 4.5 General Rules for Recording Answers ............................................... 4-14 4.6 Ending the Interview........................................................................... 4-15 5 DIETARY INTERVIEW APPLICATION FEATURES ................................ 5-1 5.1 General Overview of Computer.......................................................... 5-1 5.1.1 Keyboard............................................................................. 5-1 5.1.2 Dietary Interview Application Features .............................. 5-4 5.1.3 Turning Computer On and Accessing the Program ............ 5-15 iv TABLE OF CONTENTS (continued) Chapter Page 6 CONDUCTING THE 24-HOUR DIETARY RECALL INTERVIEW........... 6-1 6.1 Introduction of the MEC 24-Hour Dietary Recall using the USDA Automated Multiple Pass (AMPM) instrument.................................. 6-1 6.2 Key Features of the 24-Hour Dietary Recall....................... 6-2 6.3 Introduction to Respondent................................................................. 6-4 6.4 Step 1: The Quick List Pass (QL)....................................................... 6-4 6.4.1 The Main Food List (MFL)................................................. 6-10 6.4.2 Leaving the Quick List (QL) Pass....................................... 6-20 6.5 Step 2: The Forgotten Foods List (FFL)............................................. 6-21 6.6 Step 3: The Time and Occasion Pass (T/O)........................................ 6-27 6.7 Step 4: The Detail and Review Cycle (DRC) ..................................... 6-34 6.7.1 Measuring Guide Instructions Screen ................................. 6-36 6.7.2 Midnight to First Occasion Probe ....................................... 6-37 6.7.3 Collecting Details and Amounts ......................................... 6-38 6.7.4 Food Source Question ......................................................... 6-84 6.7.5 Review of Occasion ............................................................ 6-92 6.7.6 Occasion Location Question ............................................... 6-94 6.7.7 Between Interval Probe....................................................... 6-96 6.7.8 Last Occasion to Midnight Probe........................................ 6-97 6.7.9 Collection of Remainder Foods........................................... 6-98 6.8 Step 5: The Final Review Probe (FR)................................................. 6-99 6.9 Intake Health-Related Questions ........................................................ 6-100 6.9.1 Usual Intake ........................................................................ 6-101 6.9.2 Source of Plain Drinking Water.......................................... 6-102 6.9.3 Salt Use Questions .............................................................. 6-103 6.9.4 Following a Special Diet..................................................... 6-106 6.10 Dietary Recall Section Status ............................................................. 6-112 7 CONDUCTING THE POST-RECALL QUESTIONS.................................... 7-1 7.1 General Overview of the Post-Recall Section .................................... 7-1 7.2 Fish and Shellfish Questions............................................................... 7-2 7.3 Food Security Questions..................................................................... 7-4 7.4 Child Recent Health Questions........................................................... 7-7 v TABLE OF CONTENTS (continued) Chapter Page 7.5 Child Pesticide Use Questions............................................................ 7-8 7.6 Scheduling a Phone Follow-up Interview........................................... 7-9 7.7 Observations Questions ...................................................................... 7-18 7.8 Post-Recall Section Status .................................................................. 7-20 8 ADDITIONAL INTAKE PROCEDURES...................................................... 8-1 8.1 Proxy and Assisted Interviews............................................................ 8-1 8.1.1 Proxy Interviews with Child SPs Under 9 Years of Age .... 8-2 8.1.2 Assisted Interviews with Child SPs 9 to 11 Years Old ....... 8-3 8.1.3 Proxy or Assisted Interviews with Adults Unable to Report for Themselves ........................................................ 8-3 8.2 Interviewing Children......................................................................... 8-3 8.3 Data Retrieval Procedures .................................................................. 8-4 8.3.1