26.12.2013 Views

Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Exposure to Sunlight:<br />

During the summer do you like to spend time outside? Yes No<br />

Do you enjoy being out in the sun? Yes No<br />

If no, explain: ____________________________________________________________________<br />

Where do you spend your outside activities? Shade Sunshine Both No Difference<br />

In a given week during summer (mid-April to mid-October) how much time would you normally<br />

spend outside? Everyday Most days A few days Once or twice <strong>on</strong>ly Never<br />

When you are outside during the summer how l<strong>on</strong>g are you outdoors?<br />

Less than 15 minutes > 15 minutes but < 1 hour<br />

1 hour to 4 hours More than 4 hours<br />

What time <str<strong>on</strong>g>of</str<strong>on</strong>g> day would best reflect the times you normally would spend time outside?<br />

Early morning (sunrise to 10:00am) Late morning (10:00am to no<strong>on</strong>)<br />

Early afterno<strong>on</strong> (no<strong>on</strong> to 3:00pm) Late afterno<strong>on</strong> (3:00pm to 5:00pm)<br />

Evening (after 5:00pm)<br />

Do you feel healthier/better when you spend time outside? Yes No No difference<br />

Would you think you’d spend more or less time outside if you were pregnant during the summer<br />

m<strong>on</strong>ths? More Less No difference<br />

When outside do you:<br />

Let the sun reach your skin by wearing<br />

short sleeve tops or shorts? Usually Now and then Never<br />

Wear a hat? Usually Now and then Never<br />

Use sunscreen? Usually Now and then Never<br />

Use insect repellant (bug spray)? Usually Now and then Never<br />

Family & Financial Pr<str<strong>on</strong>g>of</str<strong>on</strong>g>ile:<br />

Which <str<strong>on</strong>g>of</str<strong>on</strong>g> the following would best describe you?<br />

Single Married Divorced Comm<strong>on</strong>-law relati<strong>on</strong>ship<br />

Number <str<strong>on</strong>g>of</str<strong>on</strong>g> people in your household (including yourself): _____________________<br />

What is the highest level <str<strong>on</strong>g>of</str<strong>on</strong>g> schooling you have finished? _________________________________<br />

Which source <str<strong>on</strong>g>of</str<strong>on</strong>g> household income listed below would describe you and your family?<br />

Full-time job Part-time job(s) Government Assistance Other: _______________<br />

Do you receive financial help from any relatives or friends? Yes No<br />

Which <str<strong>on</strong>g>of</str<strong>on</strong>g> the following best describes your yearly income?<br />

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!