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2005 CHAMP Topics
General Health
Birth Characteristics
Weight
Breast Feeding
- Was (CHILD) breastfed for any length of time?
- For how many days, weeks, or months was (CHILD) breastfed?
- Did his/her doctors or health providers give you any help or encouragement for breastfeeding?
Child Care
- In a typical week, how many hours does (CHILD) spend in the care of someone other than a parent or guardian?
- Where Is (CHILD) mostly cared for during working hours?
- About how much money does your household spend weekly or monthly on the cost of daycare or preschool program for (CHILD)?
- Is part of the cost of daycare or preschool for (CHILD) paid for by public funds such as Smart Start or More at Four?
Early Childhood Development
- How concerned are you with how (CHILD) talks and makes speech sounds?
- How concerned are you with how {he/she} understands what you say?
- How concerned are you with how {he/she} uses {his/her}hands and fingers to do things?
- How concerned are you with how {he/she} uses {his/her}arms and legs?
- How concerned are you with how {he/she} behaves?
- How concerned are you with how {he/she} gets along with others?
- How concerned are you with how {he/she} is learning to do things for (himself/herself)?
- How concerned are you with how {he/she} is learning pre-school or school skills, such as learning to read?
Health Care Access and Utilization
- During the past 12 months was there any time when {he/she} was not covered by ANY health insurance?
- What was the MAIN reason that (CHILD) did/does not have health insurance coverage?
- During the time when (CHILD) did not have health insurance was {he/she} eligible or still qualified to re-enroll in Medicaid?
- During the past 12 months, how many times did (CHILD) go to a hospital emergency room for health care, including emergency room visits that resulted in a hospital admission?
- What kind of place does (CHILD) go to most often for sick care:
- When (CHILD) needs a shot or a check-up, where do you usually take {him/her}?
- During the past 12 months did (CHILD) receive all the medical care you felt he or she needed?
- What was the MAIN reason (CHILD) did not get all the medical care that {he/she} needed?
- During the past 12 months, did you delay or not get a medicine that a doctor prescribed for (CHILD) because of cost or lack of insurance?
- Do you have one or more persons you think of as the personal doctor or nurse for (CHILD)?
- Preventive care visits include things like a Well Child check-up, a routine physical exam, immunizations, or health screening tests? During the past 12 months has (CHILD) had a preventive care visit, or Well Child check-up?
- An interpreter is someone who repeats what one person says in a language used by another person. During the past 12 months did you or (CHILD) need an interpreter to help speak with his or her doctors or nurses?
- When you needed an interpreter, how often were you able to get someone other than a family member to help you speak with the doctors or nurses?
- Child currently does not have or at some point in the past 12 months did not have insurance
School Performance
- During the past 12 months, about how many days did (CHILD) miss school because of illness or injury?
- Since starting kindergarten, has {he/she} repeated any grades?
- During the past 12 months, how would you describe the performance of (CHILD) in school?
Asthma
- Has a doctor ever told you that (CHILD) has asthma?
- Does (CHILD) still have asthma?
- During the past 12 months, has (CHILD) had to visit a hospital emergency room or urgent care clinic because of {his/her} asthma?
- Is (CHILD) using a medicine every day, (such as a Beclovent, Azmacort, Pulmicort, Flovent, Advair, Singulair, or Vanceril inhaler) that was prescribed by a doctor to keep {him/her} from having asthma problems?
- Does (CHILD) use a rescue medication SUCH AS Albuterol, Alupent, Ventolin, Proventil, Xopenex or Maxair inhaler?
- During the past 12 months, how many days of daycare or school did (CHILD) miss due to asthma?
- Has a doctor or other health professional ever given you an asthma management plan for (CHILD}?
School Nurse
- Have you ever talked with a school nurse about the health of (CHILD)?
- At school, is (CHILD) allowed to self administer emergency medication for asthma?
Child Health Conditions
- Has a doctor or health professional ever told you that (CHILD) had diabetes or high blood sugar?
- Has a doctor or health professional ever told you that (CHILD) has borderline or pre-diabetes?
- Has a doctor or health professional ever told you that (CHILD) has high blood pressure?
Children with Special Health Care Needs (CSHCN)
- Does (CHILD) currently need or use medicine prescribed by a doctor, other than vitamins?
- Is the need of (CHILD) for prescription medicine because of ANY medical, behavioral, or other health condition?
- Is this a condition that has lasted or is expected to last 12 months or longer?
- Does (CHILD) need or use more medical care (If age 2 yrs or older, INCLUDE phrase: "mental health or educational services") than is usual for most children of the same age?
- Is the need of (CHILD) for medical care (If age 2 yrs or older, INCLUDE phrase: "mental health or educational services") because of ANY medical, behavioral, or other health condition?
- Is this a condition that has lasted or is expected to last for at least 12 months?
- Does (CHILD) receive services from a program called Early Intervention Services?
- Does (CHILD) receive services from a program called Special Educational Services?
Mental Health/Disability
- Has a doctor, other health professional or school representative ever told you that (CHILD) has an emotional or behavioral disorder, or problem with social skills such as depression, anxiety, ADHD, or ADD (Attention Deficit Disorder)?
- Has (child) ever received services or support for this emotional or behavioral problem?
- Where does {he/she}usually receive services for this problem?
- Who pays for most or all of the cost of these services for this problem?
- During the past 12 months, was there any time when {he/she} needed help for this problem, but did not get it?
- Do you think that (CHILD) has an emotional or behavioral disorder or problem with social skills that has not been diagnosed?
- Has a doctor, other health professional or school representative ever told you that (CHILD) has a learning disability such as dyslexia, problems with speech, reading and language, or communication problems, such as understanding what people say?
- Has (CHILD) ever received services or support for this learning disability?
- Do you think that (CHILD) has a learning disability that has not been diagnosed?
- Has a doctor, other health professional or school representative ever told you that (CHILD) has a developmental disability such as autism, mental retardation, or problems with {his/her} ability to learn?
- Has (CHILD) ever received services or support for this developmental disability?
- Do you think that (CHILD) has a developmental disability that has not been diagnosed?
- Has a doctor, other health professional or school representative ever told you that (CHILD) has any type of physical disability such as a congenital heart problem or Muscular dystrophy?
- Has (CHILD) ever received services or support for this disability?
- Do you think that (CHILD) has any physical disability that has not been diagnosed?
- Has a doctor, other health professional or school representative ever told you that (CHILD) has a chronic condition or illness?
- Has (CHILD) ever received services or support for this chronic condition?
- Do you think that (CHILD) has a chronic condition that has not been diagnosed?
- Does the medical, behavioral, or other health condition affect {his/her} ability to do things a great deal, some, or very little?
- Where do you usually go for more information regarding concerns you may have about (CHILD)?
Oral Health
- Has a doctor or nurse ever advised you about how to take care of the dental health of (CHILD) during a medical office or clinic visit?
- How would you rate the condition of the teeth of (CHILD)?
- Does (CHILD) have a dentist or dental clinic where {he/she} goes to regularly?
- Does (CHILD) have dental insurance that helps pay for any routine dental care including cleanings, x-rays and examinations?
- About how long has it been since (CHILD) last saw a dentist?
- During the past 12 months, was there any time (CHILD) needed dental care but could not get it?
- Within the past 12 months when seeking dental care for your child, do you feel the experiences of your child were worse than, the same as, or better than for people of other races?
Sun Safety
- On a sunny summer day, when (CHILD) is outside for more than 15 minutes between 11 am and 3 pm, how often does {he/she} use sunscreen with a Sun Protection Factor or SPF of 15 or more?
- On a sunny summer day, when (CHILD) is outside for more than 15 minutes between 11 am and 3 pm, how often does {he/she} stay in the shade?
- On a sunny summer day, when (CHILD) is outside for more than 15 minutes between 11 am and 3 pm, how often does he/she wear clothes covering most of his/her arms and legs?
Nutrition
- On a typical day, how many servings of fruit does (CHILD) consume?
- On a typical day, how many servings of 100% fruit juice does (CHILD) consume?
- On a typical day, how many servings of vegetables does (CHILD) eat, not including french fries?
- On a typical day, how many servings of french fries or chips does (CHILD) eat?
- On a typical day, how many glasses of milk does (CHILD) drink?
- How often does (CHILD) eat fast food?
- On a typical day, how many times does (CHILD) drink sweetened beverages such as soda pop, sweet tea, fruit punch, Kool-aid, sports drinks or fruit drinks?
Physical Activity
- On a typical day how much total time does your child spend in physically active play?
- In an average week how many days does your child participate in physically active play that is led, taught or coached?
- How far does (he/she) live from school?
- On how many days per week does your child actually walk or ride a bicycle to school?
- On a typical day how much total time does (CHILD) spend watching television?
Parent Reaction to Weight
- How would you describe the weight of your child?
- Are you trying to decrease the amount of food and/or beverages you give (CHILD)?
- Are you trying to reduce the amount of sugar or fat (CHILD) consumes?
- Are you trying to encourage more physical activity or limit TV/video/computer game time?
Food Insecurity
- Is {he/she} currently enrolled in the WIC program?
- Is your household currently enrolled in the Food Stamp Program?
- In the last 12 months, how often did you rely on only a few kinds of low-cost food to feed (CHILD) because you were running out of money to buy food?
- In the last 12 months did you ever cut the size of (CHILD) meals because there was not enough money for food?
- In the last 12 months did (CHILD) ever skip a meal because there was not enough money for food?
- In the last 12 months did (CHILD) ever not eat for a whole day because there was not enough money for food?
Family Involvement
- During the past week, how many times did you or any family member take (CHILD) on any kind of outing, such as to the park, library, zoo, shopping, church, restaurants, or family gatherings?
- How many times does your household eat dinner together in a typical week?
- How many times do you read to (CHILD) in a typical week?
- Do you usually prepare a school lunch for (CHILD)?
Parent Opinion
- How important do you think it is for North Carolina to take additional actions to prevent and reduce tobacco use among our youth?
- To what degree do you support a tobacco free policy in the school of your child so that no one, not students, nor teachers, staff or visitors, could smoke or use other tobacco products on the school grounds at any time?
- To what degree do you support a tobacco free policy in indoor recreational areas?
- To what degree would you support increasing the tax on cigarettes in NC to reduce youth access to tobacco in our state?
- To what extent do you believe overweight in children is a serious problem in your community?
- Do you believe schools should require only healthy options in all food service settings, such as the cafeteria, snack bars, vending machines, concession stands?
- To what degree do you support changing the contents of school vending machines to replace sodas and high calorie/high fat snacks with healthier foods?
- Do you believe it is important for schools to have physical activity policies that provide daily physical education for students in: Elementary School (Kindergarten to 5th Grade)?
- Do you believe it is important for schools to have physical activity policies that provide daily physical education for students in: Middle School (6th through 8th)?
- Do you believe it is important for schools to have physical activity policies that provide daily physical education for students in: High School (9th through 12th)?
- Do you believe it is important for schools to provide routine physical activity opportunities, in addition to physical education, throughout the school day for students of all abilities?
- Do you feel well prepared to talk with a child about reducing the chances of smoking?
Tobacco Indicators
- How often have you discussed the dangers of tobacco use with (CHILD) in the last 12 months?
- To your knowledge, has (CHILD) ever smoked cigarettes?
- To your knowledge, does (CHILD) currently smoke cigarettes?
- How frequently in the last year have you heard about or seen (on TV, from your children, or in other media) the NC Tobacco Reality Unfiltered (TRU) media campaign directed to preventing tobacco use among youth?
Sexual Behavior
- Have you or other members of your family ever talked with your child about what you expect them to do or not do when it comes to sex?
- Do you believe (CHILD) is sexually active?
- Have you discussed with (CHILD) about reducing {his/her} chances of getting HIV/STDs (Sexually Transmitted Diseases)?
- Do you feel well prepared to talk with (CHILD) about reducing {his/her} chances of getting HIV/STDs?
Child Safety and Injury
- How many times in the past month has (CHILD) been left alone for more than one hour without any adult supervision?
- How many times in the past month did (CHILD) get hurt because no adult was watching (him/her) carefully enough?
- How many times in the past month was (CHILD) injured so that he/she could not participate in his/her usual activities for at least one day?
- How many times in the past month has ANYONE in your household taken away privileges, forbade something (like not allowed to watch TV), or grounded him/her [not allowed to leave house]?
- How many times in the past month has ANYONE in your household explained why something (like the behavior) was wrong?
- How many times in the past month has ANYONE in your household shouted, yelled at or screamed at him/her?
- How many times in the past month has ANYONE in your household insulted, by calling (CHILD) dumb, lazy or another name like that?
- How many times in the past month has ANYONE in your household spanked him/her on the bottom with a bare hand?
- How many times in the past month has ANYONE in your household told or showed (child) you loved him/her?
Page Last Updated June 17, 2009
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