2002 Youth Smoking Survey - Technical Report

Parent's Questionnaire

CHILD 1:
Province
School Board
School
Grade
Student No
First name:
Last name:

CHILD 2:
Province
School Board
School
Grade
Student No
First name:
Last name:

CHILD 3:
Province
School Board
School
Grade
Student No
First name:
Last name:

Parent telephone numbers:
Home
Other
Interviewer number:
Interviewer Name (please print)

FINAL STATUS

1) Completed or partial interview
2) Refused interview
3) No answer
4) Language problem
5) Unusual circumstances (specify)
6) Consent not given
7) Other (specify)

PARENTAL CONSENT FORM(S) RETURNED

Hello, I'm... from Statistics Canada. May I speak to the parent/guardian of (YSS child(s) name). Sometime ago, you received a letter explaining the Youth Smoking Survey and you returned a consent form allowing your child to participate in the survey. I am calling you now to conduct a brief interview. While your participation is voluntary, your answers are important and will be kept confidential under the Statistics Act.

Interviewer: Go to question Q01

PARENTAL CONSENT FORM(S) NOT RETURNED

Hello, I'm... from Statistics Canada. May I speak to the parent/guardian of (YSS child(s) name). Sometime ago, you may have received a letter explaining the Youth Smoking Survey and asking you to sign a consent form allowing your child to participate in the survey. My records show that the consent form hasn't been returned. Did you receive the information letter and the consent form?

1) Yes
Ask for consent and go to Q01.

2) No
Explain the survey by reading the letter sent to the parents. Ask for consent and go to Q01.

Q01. Interviewer: Was consent given?

3) Yes Go to Q02.
4) No End interview and enter the final status.

Q02. Would you prefer to be interviewed in English or in French?

5) English
6) French

Q03. Including yourself, how many people live in your household?

Q04. How many of them are less than 19 years old?

Q05. What is your marital status?

1) Married
2) Common law
3) Separated
4) Divorced
5) Widowed
6) Single, never married
7) Refused

Q06. Interviewer: Enter respondent's sex.

1) Male
2) Female

Q07. Which of the following best describes (name of child)'s...family situation? (Select one answer per child).

	Child's Family Situation	Child 1 Enter First Name	Child 2 Enter First Name	Child 2 Enter First Name
1)	Lives with both parents either natural or adoptive	01	02	03
2)	Lives with one natural or adoptive parent and this parent's spouse or partner	04	05	06
3)	Lives with one parent (natural or adoptive)	07	08	09
4)	Lives in a shared custody arrangement	10	11	12
5)	Other arrangement, specify	13	14	15
6)	Refused	16	17	18

Interviewer: If Q04 = 2 or more, go to Q08, else go to Q09.

Q08. Of the children now living in your household, is (name of child)...

		Child 1 Enter First Name	Child 2 Enter First Name	Child 2 Enter First Name
1)	the oldest child?	01	02	03
2)	the youngest child?	04	05	06
3)	the middle child?	07	08	09
4)	Refused	10	11	12

Q09. The Youth Smoking Survey asks children about health advice given to them by doctors and dentists. Does (child's name) have a regular family...

		Child 1 Enter First Name	Child 2 Enter First Name	Child 2 Enter First Name
a) doctor?
1)	Yes	01	02	03
2)	No	04	05	06
3)	Don't know	07	08	09
4)	Refused	10	11	12
b) dentist?
1)	Yes	13	14	15
2)	No	16	17	18
3)	Don't know	19	20	21
4)	Refused	22	23	24

Q10. Now, I would like to ask about smoking in your household. Including both family members and regular visitors, how many people smoke INSIDE your home every day or almost every day?
(Probe: Please include cigarettes, cigar and pipe)

6) None
7) Refused

Q11. Are there any restrictions against smoking cigarettes in your home?

1) Yes
2) No Go to Q13.
3) Don't know
Go to Q13.
4) Refused
Go to Q13.

Q12. How is smoking restricted in your home? (Mark all that apply)

1) Smokers are asked to refrain from smoking in the house
2) Smoking is allowed in certain rooms only
3) Smoking is restricted in the presence of young children
4) Other restriction
5) Don't know
6) Refused

Interviewer: Refer to Q07. Ask Q13a & Q13b if the child(en) LIVE(S) with both parents (natural or adoptive) or with a parent and step-parent/guardian or with two guardians. Else, if it is a one-parent family, ask Q13a only. The same instructions apply to Q14a & Q14b, Q15a & Q15b and Q16a & Q16b.

Q13a. and Q13b. questions

	Q13a.	Q13b.
Frequency of Smoking	At the present time do you smoke cigarettes every day, occasionally, or not at all?	Frequency of Smoking Does the other parent/ step-parent or guardian in the household smoke cigarettes every day, occasionally, or not at all?
Every day	01	02
Occasionally	03	04
Not at all	05	06
Don't know	07	08
Refused	09	10

Interviewer: Please follow the same instructions as for Q13a & Q13b.

Q14a and Q14b questions

	Q14a.	Q14b.
Education Levels	What is the highest grade or level of education you have ever attained? (Mark one only)	What is the highest grade or level of education ever attained by the other parent/guardian in the household? (Mark one only)
Grade 8 or lower (Québec: Secondary 2 or lower)	01	02
Grade 9-10 (Québec: Secondary 3 or 4)	03	04
Grade 11-13 or lower (Québec: Secondary 5)	05	06
No post-secondary degree, certificate or diploma	07	08
Trade certificate or diploma from vocational school or apprenticeship training	09	10
Non-university certificate or diploma from a community college, CEGEP, School of nursing, etc.	11	12
University certificate below bachelor's level	13	14
Bachelor's degree	15	16
University degree or certificate above bachelor's degree	17	18
Other (please specify)	19	20
Don't know	21	22
Refused	23	24

Q15a and Q15b questions

		Q15a.	Q15b.
	Main Activity	Which of the following best describes your MAIN activity during the last 12 months? Were you... (Mark one only)	What was the MAIN activity of the other parent/guardian in the household... (Mark one only)
1)	working at a job or business?	01	02
2)	looking for work?	03	04
3)	raising a family?	05	06
4)	retired?	07	08
5)	Trade certificate or diploma from vocational school or apprenticeship training	09	10
6)	Other	11	12

Interviewer: If Q15a or Q15b is "working at a job or business" (code 01 or 02) go to Q16a or Q16b, else go to Q17.

Q16a or Q16b questions

		Q16a.	Q165b.
	Occupation	Which of the following best describes your occupation? (Mark one only)	What is the occupation of the other parent/guardian in the household? (Mark one only)
1)	Management	01	02
2)	Professional (including accountants)	03	04
3)	Technologist, technician or technical occupation	05	06
4)	Administrative, financial or clerical	07	08
5)	Sales or service	09	10
6)	Trades, transport or equipment operator	11	12
7)	Occupation in farming, forestry, fishing or mining	13	14
8)	Occupation in processing, manufacturing or utilities	15	16
9)	Other	17	18

Q17. To complete the questions about your household, I would like to ask you about your household income. What is your best estimate of the total household income for the last 12 months before taxes and deductions?

Please include income from all the sources. Was it...

01) less than $15,000
02) $15,000 to under $30,000
03) $30,000 to under $45,000
04) $45,000 to under $60,000
05) $60,000 to under $80,000
06) $80,000 to under $100,000
07) $100,000 or more
08) Don't know
09) Refused

Q18. Thank you for completing this survey. To avoid duplication, Statistics Canada has entered into a data sharing agreement with Health Canada. Your and your child's information, together with information about the school size, type and community size, would be provided to Health Canada.

However, the department would not be given your names, the school's name or other identifiers. The agreement requires that they keep the information confidential and use it only for statistical purposes.

Do you agree to let Statistics Canada share the data with Health Canada?

1) Yes
2) No

Thank you for your participation

Interviewer: enter the final status on the cover page.