The Infant Feeding Practices Survey II followed women continuously from early pregnancy throughout their infant's first year of life. During the pregnancy, each woman received a Prenatal Questionnaire, and a subsample of 1,500 of these women received the Diet History Questionnaire in the mail. These questionnaires were followed by a telephone Birth Screener interview around the expected date of delivery to determine whether the baby had been born.
Each mother and baby was followed with a Neonatal Questionnaire mailed two to four weeks after the baby's birth. Then came a series of nine Postnatal Questionnaires mailed approximately monthly throughout the infant's first year of life, each consisting of several modules sent in various combinations according to a specified timeline [PDF-47k]. When the infant was about 4 months old, another Diet History Questionnaire was sent to a subsample of 1,500 to assess the mother's diet. To the extent possible, the postnatal Diet History Questionnaire was sent to the same women who completed it prenatally.
The Consumer Opinion Panel members who participated in the Infant Feeding Practices Study were given a name for their subpanel, "Project FIRST (Feeding Infants Research STudy)." This name was used on all questionnaires sent to IFPS respondents so that they would recognize the materials as being part of the study.
With the exception of the Diet History Questionnaire and the Birth Screener, all questionnaires asked families about their participation in the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
A Demographic Questionnaire was routinely sent to consumer opinion panel members. This questionnaire asked for basic demographic data including age and sex of all household members, household size, race and Hispanic ethnicity, marital status, education, employment status, occupation, household income, and home ownership.
The Prenatal Questionnaire was sent when the woman was in the third trimester of pregnancy. It focused on factors associated with infant feeding choices, the baby's family medical history, and the mother's employment and social support system.
The Prenatal and Postpartum Diet History Questionnaires collected information from a subsample of mothers about their food consumption and intake of nutrients from foods and dietary supplements. Using identical questionnaires mailed near the end of pregnancy and about four months postpartum, this part of the study provided information on the mother's consumption of certain fortified foods, foods of concern during pregnancy and lactation, alcohol intake, prenatal vitamin supplements, and herbal and botanical preparations sometimes used for conditions of pregnancy or breastfeeding. Until the IFPS II, little was known about the use of herbal products among pregnant and lactating women.
The Birth Screener consisted of a very short telephone interview with any adult household member to determine whether the infant had been born and to determine whether the family qualified to continue their participation in the study. If the family could not be reached by telephone, they were mailed a postcard asking them to dial into an Interactive Voice Response questionnaire. If they did not respond to the post card, they were mailed a copy of the Birth Screener questions along with the Neonatal Questionnaire around the time they would have received this questionnaire if the baby had been born on the due date. To qualify, women and their infants had to meet these criteria:
- Healthy infant and mother
- Full-term or near-term birth
- Birth weight of at least 5 pounds
- A single birth (no twins or multiple births)
The Neonatal Questionnaire was sent to the mother when her infant is approximately three weeks old. This questionnaire examined factors that commonly occur near the time of the birth and that affect infant feeding choices. It also asked about early feeding practices (including herbal intake by the infant), sources of information, sources of support, and any feeding-related treatment for jaundice.
The Postnatal Questionnaires consist of various combinations of eight modules that were mailed to the mother approximately monthly from the time her infant is 2 months through 7 months of age, then three times (about every 7 weeks) until 12 months of age. Many of the modules include questions that are asked in some months but not others. View the timetable timetable [PDF-43k] for the administration of each topic.
Module A: Infant Feeding and Health
Module A was sent with each Postnatal Questionnaire. This module contained one of the major measures of the study, the infant's food frequency checklist. It also asked about dietary supplement and herbal intake by infants, details about breastfeeding and infant formula feeding, infant health and use of medicines, infant weight and length, stool characteristics, and feeding of commercial baby foods. In month 2 only, it included a measure of postpartum depression.
The food frequency checklist in Module A enabled analysts to examine these types of questions:
- Infant's age when introduced to solid food and the age when introduced to specific food groups
- The infant's feeding schedule
- Feeding of allergenic foods
- Once supplemental foods are introduced, the frequency of feeding each food group at each month of infancy
- Any changes in eating patterns from month to month
- The number of feedings per day of infant formula and breast milk
In addition, the checklist enabled researchers to analyze patterns of breastfeeding exclusivity, in particular whether mothers occasionally gave formula to an infant who is otherwise exclusively breastfed. Patterns of feeding foods other than breast milk and formula indicated the extent to which mothers followed current infant feeding guidelines, such as those published by national professional organizations. Information on whether foods fed to infants are baby foods or not provided information about exposure of infants to foods marketed for older children and adults, including foods fortified at levels only appropriate for older age groups.
Module B: Breastfeeding Cessation
Questions regarding breastfeeding cessation were included on each Postnatal Questionnaire, but they were answered only once, just after the mother had completely stopped breastfeeding. This module established the infant age when breastfeeding ceased and asked reasons for breastfeeding cessation and attitudes toward breastfeeding.
Module C: Food Allergy
The food allergy segment asked whether the mother believed that the infant had a food allergy, details of the implicated food, and details of the infant's symptoms, diagnosis, and treatment. Module C was sent at infant ages 4 months, 9 months, and 12 months.
Module D: Breastfeeding
Module D asked for details about breastfeeding, the mother's sources of information, any maternal dietary change due to breastfeeding, her reasons for supplementing with formula or other foods, and details of her experience expressing breast milk manually or with a breast pump. Module D also included a measure of the mother's embarrassment about breastfeeding and how she managed breastfeeding and work. This module was sent three times, at months 2, 5, and 7.
Module E: Infant Formula
Module E asked for details about formula feeding, formula label use and understanding, sources of information, brand choice, brand changing, and food safety practices. It asked for type of formula fed to the infant but not specific formula brand. Understanding current practices will contribute to more relevant and targeted consumer education. Information about a mother's use of infant formula labels and her evaluation of labels indicated how well the different parts of the label communicate to mothers. Module E was sent four times, at months 2, 5, 7, and 9.
Module F: Information Sources
Module F had questions that were not asked together, but rather were inserted among questions in the other modules as appropriate. A question about sources of information on herbal products was sent at months 3 and 10. Questions about information sources for breastfeeding were sent in month 2, and questions about information sources for general infant feeding were sent in months 4 and 10.
Module G: Breastfeeding Awareness Campaign Evaluation
Module G included the direct measures of the mother's awareness of the National Breastfeeding Awareness Campaign messages and whether she agreed with those messages. Like those questions presented in Module F, questions from Module G were not asked as a separate module but rather as questions incorporated at appropriate places in other modules. Questions from Module G were sent in months 3 and 7.
Module H: Sleeping Arrangements, Child Care, Employment, and Health
Module H asked about all topics other than feeding. These included sleeping arrangements and position; child care and child care support for breastfeeding; details of the mother's employment and employer support for breastfeeding; how mothers managed to combine breastfeeding and work for pay; and the mother's overall health, weight status, and tobacco use. Module H was sent in months 3, 6, 9, and 12. A question about exposure to sunlight was administered at infant age 9 months.
Questions about WIC participation and any severe health problems the infants may have encountered were placed at the end of each Postnatal Questionnaire. The presence of severe health conditions disqualified infants from participating in the rest of the study. Certain questions from other modules that did not fit elsewhere were also included in Module J in the months those modules were administered.
The Non-pregnant/Non-postpartum Diet History Questionnaire was identical to the prenatal and postpartum versions. It was sent to a sample of 1,400 non-pregnant/non-postpartum women of child-bearing age for comparison purposes.
List of questionnaires used in the IFPS II, in sequential order:
- Demographic Questionnaire for COP members – Front [PDF-1.6Mb]
- Demographic Questionnaire for COP members – Back [PDF-1.2Mb]
- Demographic Questionnaire for non-COP members [PDF-451k]
- Diet History Questionnaire: Prenatal Cover Letter [PDF-94k]
- Diet History Questionnaire: Postpartum Cover Letter [PDF-102k]
- Diet History Questionnaire: Non-pregnant, Non-postpartum Screener and Food Safety Awareness Assessment [PDF-72k]
- Diet History Questionnaire: Non-pregnant, non-postpartum cover letter [PDF-64k]
- Diet History Questionnaire [PDF-438k]
- Project FIRST Invitation: Trifold recruitment brochure [PDF-3.3Mb]
- Prenatal Questionnaire cover letter and screener [PDF-102k]
- Prenatal Questionnaire [PDF-766k]
- National Breastfeeding Awareness Campaign Ad Insert [PDF-221k]
- Birth Screener: Mailer accompanying the Neonatal Questionnaire [PDF-107k]
- Birth Screener: Postcard [PDF-431k]
- Neonatal Questionnaire: Cover Letter [PDF-127k]
- Neonatal Questionnaire [PDF-708k]
- Neonatal: Formula Products Insert [PDF-109k]
- Neonatal Questionnaire: Follow-up Reminder Postcard [PDF-389k]
- Month 2 Questionnaire: Cover Letter [PDF-127k]
- Infant Month 2 Questionnaire [PDF-1.2Mb]
- Infant Month 2: Formula Products Insert [PDF-158k]
- Month 3 Questionnaire: Cover Letter [PDF-132k]
- Month 3 Questionnaire [PDF-1.2Mbk]
- Month 3: Formula Products Insert [PDF-135k]
- Directors letter [PDF-106k]
- Month 4 Questionnaire: Cover Letter [PDF-129k]
- Month 4 Questionnaire [PDF-512k]
- Month 4: Formula Products Insert [PDF-140k]
- Month 5 Questionnaire: Cover Letter [PDF-118k]
- Month 5 Questionnaire [PDF-1.5Mb]
- Month 5: Formula Products Insert [PDF-144k]
- Month 6 Questionnaire: Cover Letter [PDF-123k]
- Month 6 Questionnaire [PDF-841k]
- Month 6: Formula Products Insert [PDF-142k]
- Month 7 Questionnaire: Cover Letter [PDF-132k]
- Month 7 Questionnaire [PDF-1.4Mb]
- Month 7: Formula Products Insert [PDF-135k]
- National Breastfeeding Awareness Campaign Ad Insert [PDF-224k]
Note: There was no Month 8 Questionnaire.
- Month 9 Questionnaire: Cover Letter [PDF-128k]
- Month 9 Questionnaire [PDF-1.4Mb]
- Month 9: Formula Products Insert [PDF-139k]
- Month 9 Questionnaire: Follow-up Reminder Post Card [PDF-921k]
- Month 10.5 Questionnaire: Cover Letter [PDF-128k]
- Month 10.5 Questionnaire [PDF-630k]
- Month 10.5: Formula Products Insert [PDF-135k]
- Month 12 Questionnaire: Cover Letter [PDF-128k]
- Month 12 Questionnaire [PDF-992k]
- Month 12: Formula Products Insert [PDF-136k]