Dental Health

VERSION 6 – 3/15/11

DENTAL HEALTH STUDY

UCLA Patient

Psychosocial Assessment

English

Date

Time: __________________ a.m./p.m.

Day of Week M T W Th F Sa Su

Client ID #

Interviewer #

Site __________________

Compiled: Version 2- March 19, 2010 (Shetty, Fintzy)

Revision 1: March 23 ( Shetty)

Revision 2: March 24 (Fintzy)

Version 3: March 30 (Fintzy)

Revision 1: May 6 (Fintzy, Shetty)

Revision 2: May 20 (Fintzy)

Revision 3: June 28, 2010 (Fintzy)

Version 4: September 7, 2010 (Fintzy)

Revision 1: October 6, 2010 (Fintzy)

Revision 2: October 13, 2010 (Fintzy)

Version 5: January 26, 2011 (Fintzy)

Version 6: March 15, 2011 (Fintzy)


Dental Health Assessments

A. Dental Health Introduction 4

B. Sociodemographic Information 5

C. Dental Health 9

D. Substance Use 15

E. General Health 23

F. Medications 24

G. Brief Symptom Inventory 26

H. Dietary Recall/Food Frequency Questionnaire 29

J. Urine Drug Screen (Methamphetamine/Amphetamine) 35


A. Dental Health Study Introduction

Thank you for agreeing to participate in this very important study about methamphetamine use and dental health.

To learn as much as possible about you, you will be asked to answer questions about yourself. Some of the questions may seem very personal. However, we want to remind you that all of your answers are confidential--that is, your name will never be attached to any of the information.

Even for the most difficult questions, it is important that you answer as honestly as possible, because your answers will help us understand better how use of meth affects dental health.

As we go through these questions, there will be three different ways that you will be asked to answer, depending on the type of question I ask.

For example, for very brief or short questions, I’ll ask a question and just wait for you to give an answer.

Other times, I’ll ask a question and then say a short list of answers, and you’ll pick the answer you think describes you or your situation best.

Finally, sometimes I’ll ask you a question and then I’ll show you a card with a list of answers – I’ll always read the card to you – and then you’ll choose the best answer for you.

As we go along through the interview, you’ll see how each of these works and get used to the different ways to answer, and I’ll help you through them.

O.K., good. Let's get started.


B. Sociodemographic Information

(adapted from NHANES 2009, demographic information, and Adolescent Trials Network)

Now I’d like to ask some questions about you and your background.

B1. How old are you? _______

B2. What is your date of birth? _______

B3. Code gender:

Male 1

Female 2

B4. Are you now married, widowed, divorced, separated, never married or living with a partner?

Married 1

Widowed 2 Divorced 3 Separated 4 Never married 5

Living with partner 6 Refused -7777

Don’t know -9999

B5. In what country were you born?

United States 1 Other country 2 Refused -7777

Don’t know -9999


B5a. Select country of birth (if “other country” to B5)

Argentina 1

Belize 2

Bolivia 3

Brazil 4

Chile 5

Colombia 6

Costa Rica 7

Cuba 8

Dominican Republic 9

Ecuador 10

El Salvador 11

Guatemala 12

Honduras 13

Mexico 14

Nicaragua 15

Panama 16

Paraguay 17

Peru 18

Philippines 19

Puerto Rico 20

Spain 21

Uruguay 22

Venezuela 23

Other country (CAPI INSTRUCTION:

DO NOT SPECIFY) 40

B6. In what month and year did you come to the United States to stay?

|___|___| Enter month number

Refused -7777

Don’t know -9999

|___|___|___|___| Enter 4-digit year

Refused -7777

Don’t know -9999

B7. Do you consider yourself to be Hispanic or Latino?

Yes 1

No 0

Refused -7777

Don’t know -9999


B8. What race do you consider yourself to be?

HAND CARD

[categories from Inclusion Enrollment Report]

American Indian/Alaska native 1

Asia 2

Native Hawaiian or other Pacific Islander 3

Black or African American 4

White 5

More than one race 6

Refused -7777

Don’t know -9999

B9. What is the highest grade or level of school you have completed or the highest degree you have received?

HAND CARD

READ HAND CARD CATEGORIES IF NECESSARY.

ENTER HIGHEST LEVEL OF SCHOOL COMPLETED.

(PROBE: Did you complete that year?)

Never attended/Kindergarten only 0

1st grade 1

2nd grade 2

3rd grade 3

4th grade 4

5th grade 5

6th grade 6

7th grade 7

8th grade 8

9th grade 9

10th grade 10

11th grade 11

12th grade, no diploma 12

High school graduate 13

GED or equivalent 14

Some college, no degree 15

Associate degree: occupational,
technical, or vocational program 16

Associate degree: academic program 17

Bachelor’s degree (EXAMPLE: BA,
AB, BS, BBA) 18

Master’s degree (EXAMPLE: MA, MS,
MEng, MEd, MBA) 19

Professional school degree
(EXAMPLE: MD, DDS, DVM, JD) 20

Doctoral degree (EXAMPLE:
PhD, EdD) 21

Refused -7777

Don’t know -9999


,

B10. When you were in school, were you given medication (such as Ritalin) to help you sit still or pay attention?

Yes 1

No 0

B11. In general, what language(s) do you read and speak? [Brief Acculturation Scale (NHANES 2009)]

Only Spanish 1

Spanish better than English 2

Both equally 3

English better than Spanish 4

Only English 5

B12. What language(s) do you usually speak at home?

Only Spanish 1

Spanish better than English 2

Both equally 3

English better than Spanish 4

Only English 5

B13. In which language(s) do you usually think?

Only Spanish 1

Spanish better than English 2

Both equally 3

English better than Spanish 4

Only English 5

B14. What language(s) do you usually speak with your friends?

Only Spanish 1

Spanish better than English 2

Both equally 3

English better than Spanish 4

Only English 5


C. Dental Health

Instructions: Now I would like to ask you some questions about your dental care.

(DO NOT READ RESPONSE CATEGORIES)

C1. Do you go to the dentist regularly to get your teeth checked?
(PROBE: Please answer as best you can based on what you consider to be regular.)
(PROBE: I just need a Yes or No response/answer)

YES 1

NO 0

C2. (READ RESPONSE CATEGORIES)
How often do you usually go to the dentist to have your teeth checked?

More than once a year 1
Once a year 2
Once every two years 3
Less than once every two years 4

C3. About how long has it been since you last visited a dentist? Include all types of dentists, such as, orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists. (NHANES 99+).

6 months or less 1
More than 6 months, but not more than 1 year ago 2
More than 1 year, but not more than 2 years ago 3
More than 2 years, but not more than 3 years ago 4
More than 3 years, but not more than 5 years ago 5
More than 5 years ago 6
Never have been 7
Refused -7777
DK -9999

C4. What are the reasons that you have never gone to the dentist in past 12 months? (Multiple items can be checked) (NHIS 1999/09)

Afraid 1
Nervous 2
Needles 3
Cost/no insurance 4
Don’t know a dentist 5
Dentist too far 6
Can't get there 7
No problems 8
No teeth 9

Afraid dentist might be aware I use MA 10

“Tweaking”/using MA 11
Not important 12
Didn't think of it 13
Other 14

Refused -7777
DK -9999

C5. What was the main reason you last visited the dentist? (NHANES 99+)

Went in on own for check-up, examination or cleaning 1
Was called in by the dentist for check-up, examination or cleaning 2
Something was wrong, bothering or hurting me 3
Went for treatment of a condition that dentist discovered at earlier check-up or examination 4
Other 5
Refused -7777
DK -9999

C5a. Prior to this study, is this facility where you have typically received dental services?

Yes 1

No 0

C5b. If no, what is the zip code of the facility at which you have typically received dental services prior to being enrolled in this study? _________________

C6. (READ RESPONSE CATEGORIES)

How often do you usually brush your teeth?

Don’t brush 1

Less than once a day 2

Between 1 and 3 times a day 3

Other 4

___________________________

Specify

C7. (DO NOT READ RESPONSE CATEGORIES)

Have you had a tooth or teeth pulled in the past year?

Yes 1

No 0

a. (If yes) Why?

Gum disease 1

Cavities 2

Gum disease and cavities 4

Other 3

___________________________

Specify

C8. Now I have some questions about the condition of your teeth and gums.
How would you describe the condition of your teeth? Would you say . . . (NHANES 1999+)

Excellent 1
Very good 2
Good 3
Fair 4
Poor 5
Refused -7777
Don’t know -9999

C9. What specific problems do you have with your teeth? (Multiple items can be checked)

Toothache 1

Sensitivity 2

Cavities / Caries 3

Broken / Missing fillings or restorations 4

Broken / Fracture teeth 5

Staining / Discoloration of teeth 6

Crooked teeth / Need braces 7

Teeth needing extractions 8

Missing teeth 9

Gum / periodontal related problems 10

Denture problem 11

Unsatisfactory prior dental experience 12

None / No specific problem 13

Other 14

Refused -7777

Don’t know -9999

(NHANES 1999-2002)

C10. During the past 30 days have you experienced a toothache or painful tooth (including pain with biting or chewing, or sensations to hot, cold , or sweets)? (NHANES 1999-2002)

Yes 1

No 0

Refused -7777
Don’t know -9999

C11. For how many days in the past 30 days did you have these sensations? (If yes to above)

_________Enter the number of days (1-30)

C12. During the past 30 days, for about how many days did these sensations keep you from doing your usual activities?

_________Enter the number of days (1-30)

C13. During the past 30 days have you experienced any sores or irritations around the lips, tongue, cheeks, gums, or roof of mouth?

Yes 1

No 0

Refused -7777
Don’t know -9999

C14. For how many days in the past 30 days did you have these sensations? (If yes to above)

_________Enter the number of days (1-30)

C15. During the past 30 days, for about how many days did these sensations keep you from doing your usual activities?

_________Enter the number of days (1-30)

C16. (DO NOT READ RESPONSE CATEGORIES)
Does your mouth feel dry when eating a meal?
(PROBE: In general, (REPEAT 1)...)
(PROBE: I just need a Yes or No response/answer)
(PROBE: Please answer as best you can, based on your own definition of a dry mouth.)

Yes 1

No 0

C17. (DO NOT READ RESPONSE CATEGORIES)
Do you need to sip liquids to aid in swallowing dry foods?
(PROBE: In general, (REPEAT 2)...)
(PROBE: I just need a Yes or No response).

Yes 1

No 0

C18. (DO NOT READ RESPONSE CATEGORIES)
Does the amount of saliva in your mouth seem to be too little, too much, or you don't notice it?
(PROBE: In general, (REPEAT 3)...)
(PROBE: Please give me your best estimate).

Too little 1

Too much 2

Don’t notice 3

C19. How often during the last year have you had painful aching anywhere in your mouth? Would you say . . . [OHIP-7]

HAND CARD C18

Very often, 1

Fairly often, 2

Occasionally, 3

Hardly ever, or 4

Never? 5

Refused -7777

Don't Know -9999

C20. How often during the last year have you felt that life in general was less satisfying because of problems with your teeth, mouth or dentures? Would you say . . .

HAND CARD

Very often, 1

Fairly often, 2

Occasionally, 3

Hardly ever, or 4

Never? 5

Refused -7777

Don't Know -9999

C21. How often during the past year have you had difficulty doing your usual jobs or going to school because of problems with your teeth, mouth or dentures? Would you say…

HAND CARD

Very often, 1

Fairly often, 2

Occasionally, 3

Hardly ever, or 4

Never? 5

Refused -7777

Don't Know -9999

C22. How often during the last year has your sense of taste been affected by problems with your teeth, mouth or dentures? Would you say . . .

HAND CARD

Very often, 1

Fairly often, 2

Occasionally, 3

Hardly ever, or 4

Never? 5

Refused -7777

Don't Know -9999

C23. How often during the last year have you avoided particular foods because of problems with your teeth, mouth or dentures? Would you say . . .

HAND CARD

Very often, 1

Fairly often, 2

Occasionally, 3

Hardly ever, or 4

Never? 5

Refused -7777

Don't Know -9999

C24. How often during the last year have you found it uncomfortable to eat any food because of problems with your teeth, mouth or dentures? Would you say . . .

HAND CARD

Very often, 1

Fairly often, 2

Occasionally, 3

Hardly ever, or 4

Never? 5

Refused -7777

Don't Know -9999

C25. How often during the last year have you been self-conscious or embarrassed because of your teeth, mouth or dentures? Would you say . . .

HAND CARD

Very often, 1

Fairly often, 2

Occasionally, 3

Hardly ever, or 4

Never? 5

Refused -7777

Don't Know -9999


D. Substance Use

(for use with the paper timeline reminder)

Now we will be asking you questions about each year that you have used meth, so that we can get a complete picture of your life in terms of meth use. To help you remember, together we will create a timeline of your life, where we will write down significant events, such as beginning or ending school, getting married, moving, or other events that may help jog your memory about starting, stopping, or changing your meth use.

The timeline contains a space for the events we will be asking about. We will indicate in the space for the appropriate month and year when any of the activities/events listed below (Items 1-11) occurred. You may or may not have experienced some of these activities or events:

(Interviewer uses timeline and handcard.)

1. Graduating from, or returning to, school or a training program

2. Change in your employment (i.e., new job, loss of a job, promotion)

3. Changes in your residence (from one house to another, another town or state)

4. Births, marriages, or divorce (your own, your children, or others in your family)

5. Children moving out of the house or others moving into your house

6. Deaths of family members or friends

7. Criminal activities, arrests, jail or prison time

8. Probation or parole status

9. Drug treatment (outpatient, residential, detox, AA, etc.)

10. Hospitalizations, for either medical or psychiatric problems, or onset of illness

11. Other events that would help you remember when your meth use changed

(If subject cannot recall what month of the year an event occurred, PROBE: Was it around Christmas… the 4th of July? Do you remember if it was hot or cold outside?)