English

Youth Selfreport Follow Up Form

1 forms  
  1. StudyEvent: The CoRonavIruS Health Impact Survey (CRISIS) V0.3
    1. Youth Selfreport Follow Up Form
Background
Description

Background

Alias
UMLS CUI [1,1]
C1706907
UMLS CUI [2,1]
C0010447
Identification Number:
Description

Record ID

Data type

text

Alias
UMLS CUI [1,1]
C2348585
Country:
Description

Country

Data type

text

Alias
UMLS CUI [1,1]
C1562954
State/ Province/ Region:
Description

State/ Province/ Region of residence

Data type

text

Alias
UMLS CUI [1,1]
C1830433
Your age (years):
Description

age

Data type

integer

Alias
UMLS CUI [1,1]
C0001779
Exposure status During the PAST TWO WEEKS...
Description

Exposure status During the PAST TWO WEEKS...

Alias
UMLS CUI [1,1]
C0332157
UMLS CUI [1,2]
C5203676
UMLS CUI [1,3]
C4288440
...have you been exposed to someone with positive SARS CoV 2 test?
Description

exposed___1

Data type

boolean

Alias
UMLS CUI [1,1]
C0332157
UMLS CUI [1,2]
C0027361
UMLS CUI [1,3]
C5244023
UMLS CUI [1,4]
C4288440
...have you been exposed to someone medical diagnosed with a SARS CoV 2 infection without positive test result?
Description

exposed___2

Data type

boolean

Alias
UMLS CUI [1,1]
C0332157
UMLS CUI [1,2]
C0027361
UMLS CUI [1,3]
C0011900
UMLS CUI [1,4]
C5203670
UMLS CUI [1,5]
C4288440
...have you been exposed to someone with possible COVID-19 symptoms during the past two weeks?
Description

exposed___3

Data type

boolean

Alias
UMLS CUI [1,1]
C0332157
UMLS CUI [1,2]
C0027361
UMLS CUI [1,3]
C1457887
UMLS CUI [1,4]
C0332281
UMLS CUI [1,5]
C5203670
UMLS CUI [1,6]
C4288440
...have you had a fever?
Description

symptoms___1

Data type

boolean

Alias
UMLS CUI [1,1]
C0015967
UMLS CUI [1,2]
C4288440
...have you had a cough?
Description

symptoms___2

Data type

boolean

Alias
UMLS CUI [1,1]
C0010200
UMLS CUI [1,2]
C4288440
...have you had shortness of breath?
Description

symptoms___3

Data type

boolean

Alias
UMLS CUI [1,1]
C0013404
UMLS CUI [1,2]
C4288440
...have you had a sore throat?
Description

symptoms___4

Data type

boolean

Alias
UMLS CUI [1,1]
C0242429
UMLS CUI [1,2]
C4288440
...have you had fatigue?
Description

symptoms___5

Data type

boolean

Alias
UMLS CUI [1,1]
C0015672
UMLS CUI [1,2]
C4288440
...have you had loss of taste or smell?
Description

symptoms___6

Data type

boolean

Alias
UMLS CUI [1,1]
C5382033
UMLS CUI [1,2]
C4288440
...have you had an eye infection?
Description

symptoms___7

Data type

boolean

Alias
UMLS CUI [1,1]
C0015403
UMLS CUI [1,2]
C4288440
...have you had other symptoms?
Description

symptoms___8

Data type

boolean

Alias
UMLS CUI [1,1]
C3257980
UMLS CUI [1,2]
C4288440
... has a family member living in the same household have COVID-19 diagnosis?
Description

diagnosedfamily___1

Data type

boolean

Alias
UMLS CUI [1,1]
C4330269
UMLS CUI [1,2]
C0086282
UMLS CUI [1,3]
C0011900
UMLS CUI [1,4]
C5203670
UMLS CUI [1,5]
C4288440
... has a family member not living in the same household have COVID-19 diagnosis?
Description

diagnosedfamily___2

Data type

boolean

Alias
UMLS CUI [1,1]
C0086282
UMLS CUI [1,2]
C0011900
UMLS CUI [1,3]
C5203670
UMLS CUI [1,4]
C4288440
...has any of your family members fallen ill physically due to COVID-19?
Description

impact___1

Data type

boolean

Alias
UMLS CUI [1,1]
C0086282
UMLS CUI [1,2]
C0221423
UMLS CUI [1,3]
C5203676
UMLS CUI [1,4]
C4288440
...has any of your family members been hospitalized due to COVID-19?
Description

impact___2

Data type

boolean

Alias
UMLS CUI [1,1]
C0086282
UMLS CUI [1,2]
C0019993
UMLS CUI [1,3]
C0678226
UMLS CUI [1,4]
C5203670
UMLS CUI [1,5]
C4288440
...has any of your family members been put into self-quarantine with symptoms due to COVID-19?
Description

impact___3

Data type

boolean

Alias
UMLS CUI [1,1]
C0086282
UMLS CUI [1,2]
C5392942
UMLS CUI [1,3]
C5203670
UMLS CUI [1,4]
C4288440
...has any of your family members been put into self-quarantine without symptoms due to COVID-19?
Description

impact___4

Data type

boolean

Alias
UMLS CUI [1,1]
C0086282
UMLS CUI [1,2]
C5392942
UMLS CUI [1,3]
C5203676
UMLS CUI [1,4]
C0231221
UMLS CUI [1,5]
C4288440
...has any of your family members lost or been laid off from their job due to COVID-19?
Description

impact___5

Data type

boolean

Alias
UMLS CUI [1,1]
C0086282
UMLS CUI [1,2]
C0425083
UMLS CUI [1,3]
C0678226
UMLS CUI [1,4]
C5203676
UMLS CUI [1,5]
C4288440
...has any of your family members have a reduced ability to earn money due to COVID-19?
Description

impact___6

Data type

boolean

Alias
UMLS CUI [1,1]
C0086282
UMLS CUI [1,2]
C0392756
UMLS CUI [1,3]
C0021162
UMLS CUI [1,4]
C0678226
UMLS CUI [1,5]
C5203676
UMLS CUI [1,6]
C4288440
...has any of your family members passed away due to COVID-19?
Description

impact___7

Data type

boolean

Alias
UMLS CUI [1,1]
C0086282
UMLS CUI [1,2]
C1306577
UMLS CUI [1,3]
C0678226
UMLS CUI [1,4]
C5203670
UMLS CUI [1,5]
C4288440
How much are you reading or talking about Coronavirus/ COVID-19?
Description

reading/ talking about Coronavirus/ COVID-19 past two weeks

Data type

text

Alias
UMLS CUI [1,1]
C0034754
UMLS CUI [1,2]
C3874886
UMLS CUI [1,3]
C5203676
UMLS CUI [1,4]
C4288440
UMLS CUI [2,1]
C0234856
UMLS CUI [2,2]
C3874886
UMLS CUI [2,3]
C5203676
UMLS CUI [2,4]
C4288440
Has the Coronavirus/ COIVD-19 crisis in your area led to any positive change in your life?
Description

positive change in life due to Coronavirus/ COVID-19 crisis past two weeks

Data type

text

Alias
UMLS CUI [1,1]
C0376558
UMLS CUI [1,2]
C1446409
UMLS CUI [1,3]
C0392747
UMLS CUI [1,4]
C5392141
UMLS CUI [1,5]
C4288440
...have you been suspected of having a COVID-19 infection?
Description

I.10

Data type

text

Alias
UMLS CUI [1,1]
C5203676
UMLS CUI [1,2]
C3714514
UMLS CUI [1,3]
C0750491
Other Symptoms:
Description

I.1

Data type

text

Alias
UMLS CUI [1,1]
C3257980
UMLS CUI [1,2]
C4288440
...how worried have you been about being infected?
Description

I.2

Data type

text

Alias
UMLS CUI [1,1]
C5203676
UMLS CUI [1,2]
C3714514
UMLS CUI [1,3]
C0233481
...how worried have you been about friends or family being infected?
Description

I.4

Data type

text

Alias
UMLS CUI [1,1]
C0079382
UMLS CUI [1,2]
C5203676
UMLS CUI [1,3]
C3714514
UMLS CUI [1,4]
C0233481
UMLS CUI [2,1]
C0086282
UMLS CUI [2,2]
C5203676
UMLS CUI [2,3]
C3714514
UMLS CUI [2,4]
C0233481
...how worried have you been about your physical health being influenced by COVID-19?
Description

I.5

Data type

text

Alias
UMLS CUI [1,1]
C0233481
UMLS CUI [1,2]
C5203670
UMLS CUI [1,3]
C0392760
UMLS CUI [1,4]
C0517226
...how worried have you been about your mental/emotional health being influenced by COVID-19?
Description

I.6

Data type

text

Alias
UMLS CUI [1,1]
C0233481
UMLS CUI [1,2]
C5203670
UMLS CUI [1,3]
C0392760
UMLS CUI [1,4]
C0025353
Please specify:
Description

I.7

Data type

text

Alias
UMLS CUI [1,1]
C0376558
UMLS CUI [1,2]
C1446409
UMLS CUI [1,3]
C0392747
UMLS CUI [1,4]
C5392141
UMLS CUI [1,5]
C4288440
Life changes During the PAST TWO WEEKS...
Description

Life changes During the PAST TWO WEEKS...

Alias
UMLS CUI [1,1]
C0376558
UMLS CUI [1,2]
C0392747
UMLS CUI [1,3]
C4288440
...has your school building been closed?
Description

school closing within previous two weeks

Data type

text

Alias
UMLS CUI [1,1]
C0036375
UMLS CUI [1,2]
C0587267
UMLS CUI [1,3]
C0678226
UMLS CUI [1,4]
C5392141
UMLS CUI [1,5]
C4288440
Are classes in session?
Description

classes in session

Data type

boolean

Alias
UMLS CUI [1,1]
C0036375
UMLS CUI [1,2]
C0038492
UMLS CUI [1,3]
C0441833
UMLS CUI [1,4]
C1553514
UMLS CUI [1,5]
C4288440
Are you attending classes in-person?
Description

attended classes in person within previous two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0036375
UMLS CUI [1,2]
C1999232
UMLS CUI [1,3]
C1553514
UMLS CUI [1,4]
C4288440
Have classes resumed online?
Description

classes resumed online within previous two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0036375
UMLS CUI [1,2]
C4505477
UMLS CUI [1,3]
C4288440
Do you have easy access to the internet and a computer?
Description

internet and computer access within previous two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C4704731
UMLS CUI [1,2]
C0444454
UMLS CUI [1,3]
C0009622
UMLS CUI [1,4]
C4288440
Are there assignments for you to complete?
Description

assignments within the previous two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0683853
UMLS CUI [1,2]
C4288440
Are you able to receive meals from the school?
Description

meals from school

Data type

boolean

Alias
UMLS CUI [1,1]
C1998602
UMLS CUI [1,2]
C1517320
UMLS CUI [1,3]
C0036375
UMLS CUI [1,4]
C4288440
...how many people, from outside of your household, have you had an in-person conversation with?
Description

in-person conversation count within previous two weeks

Data type

integer

Alias
UMLS CUI [1,1]
C0750480
UMLS CUI [1,2]
C0871703
UMLS CUI [1,3]
C1553514
UMLS CUI [1,4]
C4288440
...how much time have you spent going outside of the home (e.g., going to stores, parks, etc.)?
Description

time outside within previous two weeks

Data type

text

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C1709359
UMLS CUI [1,3]
C4288440
...how stressful have the restrictions on leaving home been for you?
Description

stress due to restrictions

Data type

text

Alias
UMLS CUI [1,1]
C0038435
UMLS CUI [1,2]
C0678226
UMLS CUI [1,3]
C4534363
UMLS CUI [1,4]
C4288440
...have your contacts with people outside of your home changed relative to before the Coronavirus/COVID-19 crisis in your area?
Description

social contact change due to COVID-19 pandemic

Data type

text

Alias
UMLS CUI [1,1]
C0392747
UMLS CUI [1,2]
C0237101
UMLS CUI [1,3]
C1711239
UMLS CUI [1,4]
C5392141
UMLS CUI [1,5]
C4288440
...how much difficulty have you had following the recommendations for keeping away from close contact with people?
Description

difficulty distancing

Data type

text

Alias
UMLS CUI [1,1]
C0332218
UMLS CUI [1,2]
C5440893
UMLS CUI [1,3]
C4288440
...has the quality of the relationships between you and members of your family changed?
Description

change of family relationships

Data type

text

Alias
UMLS CUI [1,1]
C0392747
UMLS CUI [1,2]
C0439849
UMLS CUI [1,3]
C0086282
UMLS CUI [1,4]
C4288440
...how stressful have these changes in family contacts been for you?
Description

stress due to changes in family relationships

Data type

text

Alias
UMLS CUI [1,1]
C0038435
UMLS CUI [1,2]
C0678226
UMLS CUI [1,3]
C0392747
UMLS CUI [1,4]
C0439849
UMLS CUI [1,5]
C0086282
UMLS CUI [1,6]
C4288440
...has the quality of your relationships with your friends changed?
Description

change of relationships to friends

Data type

text

Alias
UMLS CUI [1,1]
C0392747
UMLS CUI [1,2]
C0439849
UMLS CUI [1,3]
C0079382
UMLS CUI [1,4]
C4288440
...how stressful have these changes in social contacts been for you?
Description

stress due to changes to relationships to friends

Data type

text

Alias
UMLS CUI [1,1]
C0038435
UMLS CUI [1,2]
C0678226
UMLS CUI [1,3]
C0392747
UMLS CUI [1,4]
C0439849
UMLS CUI [1,5]
C0079382
UMLS CUI [1,6]
C4288440
...how much has cancellation of important events (such as graduation, prom, vacation, etc.) in your life been difficult for you?
Description

difficulty due to event cancellations

Data type

text

Alias
UMLS CUI [1,1]
C0332218
UMLS CUI [1,2]
C0441471
UMLS CUI [1,3]
C1553388
UMLS CUI [1,4]
C4288440
...to what degree have changes related to the Coronavirus/COVID-19 crisis in your area created financial problems for your family?
Description

financial difficulties due to COVID-19 pandemic

Data type

text

Alias
UMLS CUI [1,1]
C0015576
UMLS CUI [1,2]
C0549106
UMLS CUI [1,3]
C0678226
UMLS CUI [1,4]
C5392141
UMLS CUI [1,5]
C4288440
...to what degree are you concerned about the stability of your living situation?
Description

concerned about living stability

Data type

text

Alias
UMLS CUI [1,1]
C2107029
UMLS CUI [1,2]
C2184149
UMLS CUI [1,3]
C4288440
...did you worry whether your food would run out because of a lack of money?
Description

worried about food shortage due to financial problems

Data type

boolean

Alias
UMLS CUI [1,1]
C0233481
UMLS CUI [1,2]
C0598456
UMLS CUI [1,3]
C0678226
UMLS CUI [1,4]
C0549106
UMLS CUI [1,5]
C4288440
How hopeful are you that the Coronavirus/COVID-19 crisis in your area will end soon?
Description

hopeful about end of COVID-19 pandemic

Data type

text

Alias
UMLS CUI [1,1]
C5224035
UMLS CUI [1,2]
C0444930
UMLS CUI [1,3]
C5392141
UMLS CUI [1,4]
C4288440
Daily behaviors During the PAST TWO WEEKS...
Description

Daily behaviors During the PAST TWO WEEKS...

Alias
UMLS CUI [1,1]
C0871707
UMLS CUI [1,2]
C4288440
...on average, what time did you go to bed on WEEKDAYS?
Description

bedtime weekdays two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0521112
UMLS CUI [1,2]
C0680189
UMLS CUI [1,3]
C4288440
...on average, what time did you go to bed on WEEKENDS?
Description

bedtime weekends two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0521112
UMLS CUI [1,2]
C0680190
UMLS CUI [1,3]
C4288440
...on average, how many hours per night did you sleep on WEEKDAYS?
Description

hours of sleep weekdays two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C2937255
UMLS CUI [1,2]
C0680189
UMLS CUI [1,3]
C4288440
...on average, how many hours per night did you sleep on WEEKENDS?
Description

hours of sleep weekends two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C2937255
UMLS CUI [1,2]
C0680190
UMLS CUI [1,3]
C4288440
...how many days per week did you exercise (e.g., increased heart rate, breathing) for at least 30 minutes?
Description

exercise frequency weekly two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C2230062
UMLS CUI [1,2]
C4288440
...how many days per week did you spend time outdoors?
Description

days/week with time spent outdoors two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0677547
UMLS CUI [1,2]
C4534420
UMLS CUI [1,3]
C4288440
Emotions/ Worries During the PAST TWO WEEKS...
Description

Emotions/ Worries During the PAST TWO WEEKS...

Alias
UMLS CUI [1,1]
C0013987
UMLS CUI [1,2]
C4288440
UMLS CUI [2,1]
C0233481
UMLS CUI [2,2]
C4288440
...how worried were you generally?
Description

worried

Data type

text

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0233481
UMLS CUI [1,3]
C4288440
...how happy versus sad were you?
Description

happiness/ sadness two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C1821411
UMLS CUI [1,2]
C4288440
UMLS CUI [2,1]
C0681889
UMLS CUI [2,2]
C3536794
UMLS CUI [2,3]
C4288440
...how much were you able to enjoy your usual activities?
Description

joy of usual activities two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C4316940
UMLS CUI [1,3]
C0871707
UMLS CUI [1,4]
C4288440
...how relaxed versus anxious were you?
Description

relaxation/ anxiety two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0035028
UMLS CUI [1,3]
C4288440
UMLS CUI [2,1]
C0681889
UMLS CUI [2,2]
C0003467
UMLS CUI [2,3]
C4288440
...how fidgety or restless were you?
Description

fidgety/ restlessness two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0424235
UMLS CUI [1,3]
C4288440
UMLS CUI [2,1]
C0681889
UMLS CUI [2,2]
C3887611
UMLS CUI [2,3]
C4288440
...how fatigued or tired were you?
Description

fatigue two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0015672
UMLS CUI [1,3]
C4288440
...how well were you able to concentrate or focus?
Description

focus/ concentration two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0086045
UMLS CUI [1,3]
C4288440
...how irritable or easily angered were you?
Description

irritable/ angered two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0022107
UMLS CUI [1,3]
C4288440
UMLS CUI [2,1]
C0681889
UMLS CUI [2,2]
C2227997
UMLS CUI [2,3]
C4288440
...how lonely were you?
Description

loneliness two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C0681889
UMLS CUI [1,2]
C0023974
UMLS CUI [1,3]
C4288440
...to what extent did you have negative thoughts, thoughts about unpleasant experiences or things that make you feel bad?
Description

negative thoughts two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C4321352
UMLS CUI [1,2]
C1142075
UMLS CUI [1,3]
C4288440
Media use During the PAST TWO WEEKS, how much time per day did you spend...
Description

Media use During the PAST TWO WEEKS, how much time per day did you spend...

Alias
UMLS CUI [1,1]
C5392110
UMLS CUI [1,2]
C0556974
UMLS CUI [1,3]
C4288440
UMLS CUI [2,1]
C0042649
UMLS CUI [2,2]
C0556974
UMLS CUI [2,3]
C4288440
...watching TV or digital media (e.g., Netflix, YouTube, web surfing)?
Description

digital media consumtion two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C3827501
UMLS CUI [1,2]
C0556974
UMLS CUI [1,3]
C4288440
...using social media (e.g., Facetime, Facebook, Instagram, Snapchat, Twitter, TikTok)?
Description

social media consumtion two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C3179065
UMLS CUI [1,2]
C0556974
UMLS CUI [1,3]
C4288440
...playing video games?
Description

hours/day playing video games two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C2047133
UMLS CUI [1,2]
C4288440
Substance use During the PAST TWO WEEKS, how frequently did you use...
Description

Substance use During the PAST TWO WEEKS, how frequently did you use...

Alias
UMLS CUI [1,1]
C0237123
UMLS CUI [1,2]
C4288440
...alcohol?
Description

alcohol consumpiton frequency two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C4321352
UMLS CUI [1,2]
C0001948
UMLS CUI [1,3]
C4288440
...vaping products?
Description

vaping frequency two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C4321352
UMLS CUI [1,2]
C4083280
UMLS CUI [1,3]
C4288440
...cigarettes or other tobacco products?
Description

tobacco use frequency two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C4321352
UMLS CUI [1,2]
C0543414
UMLS CUI [1,3]
C4288440
...marijuana/cannabis (e.g., joint, blunt, pipe, bong)?
Description

marijuana/ cannabis use frequency two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C4321352
UMLS CUI [1,2]
C4316909
UMLS CUI [1,3]
C4288440
...opiates, heroin, or narcotics?
Description

opiate/ heroin/ narcotic abuse frequency two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C4321352
UMLS CUI [1,2]
C4551628
UMLS CUI [1,3]
C4288440
UMLS CUI [2,1]
C4321352
UMLS CUI [2,2]
C0600241
UMLS CUI [2,3]
C4288440
UMLS CUI [3,1]
C4321352
UMLS CUI [3,2]
C0524661
UMLS CUI [3,3]
C4288440
...other drugs including cocaine, crack, amphetamine, methamphetamine, hallucinogens, or ecstasy?
Description

frequency of other drug abuse two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C4321352
UMLS CUI [1,2]
C0848734
UMLS CUI [1,3]
C4288440
...sleeping medications or sedatives/hypnotics?
Description

sleeping pill/ sedative/ hypnotic abuse frequency two weeks prior to CRISIS

Data type

text

Alias
UMLS CUI [1,1]
C4321352
UMLS CUI [1,2]
C0599396
UMLS CUI [1,3]
C0013146
UMLS CUI [1,4]
C4288440
UMLS CUI [2,1]
C4321352
UMLS CUI [2,2]
C1456771
UMLS CUI [2,3]
C4288440
UMLS CUI [3,1]
C4321352
UMLS CUI [3,2]
C0338699
UMLS CUI [3,3]
C4288440
Which of the following supports were in place for you before the Coronavirus/COVID-19 crisis in your area and have been disrupted over the PAST TWO WEEKS? (check all that apply)
Description

Which of the following supports were in place for you before the Coronavirus/COVID-19 crisis in your area and have been disrupted over the PAST TWO WEEKS? (check all that apply)

Alias
UMLS CUI [1,1]
C0748877
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C0678226
UMLS CUI [1,4]
C5392141
Resource room
Description

resource room disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C3846158
Tutoring
Description

tutoring disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0872010
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Mentoring programs
Description

mentoring program disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C4255266
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
After school activity programs
Description

after school activity programs disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0681383
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Volunteer programs
Description

volunteer program disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C2367294
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Psychotherapy
Description

psychotherapy disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0033968
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Psychiatric care
Description

psychiatric care disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0597312
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Occupational therapy
Description

occupational therapy disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C1318464
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Physical therapy
Description

physical therapy disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0949766
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Speech/language therapy
Description

speech/language therapy disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0589155
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Sporting activities
Description

sporting activities disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0038039
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Medical care for chronic illnesses
Description

medical care for chronic illnesses disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C1555457
UMLS CUI [1,2]
C0332454
UMLS CUI [1,3]
C4288440
Other
Description

other supports disrupted past two weeks

Data type

boolean

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0748877
UMLS CUI [1,3]
C0332454
UMLS CUI [1,4]
C4288440
Other: Specify
Description

specify other supports disrupted within the past two weeks

Data type

text

Alias
UMLS CUI [1,1]
C3845569
UMLS CUI [1,2]
C0748877
UMLS CUI [1,3]
C0332454
UMLS CUI [1,4]
C4288440
Additional concerns and comments
Description

Additional concerns and comments

Alias
UMLS CUI [1,1]
C3482667
UMLS CUI [1,2]
C1830770
Please describe anything else that concerns you about the impact of Coronavirus/COVID-19 on you, your friends, or your family.
Description

anything_else

Data type

text

Alias
UMLS CUI [1,1]
C5392141
UMLS CUI [1,2]
C4049986
UMLS CUI [1,3]
C0205394
Comment section - Youth Selfreport Follow Up Form
Description

Comment section - Youth Selfreport Follow Up Form

Alias
UMLS CUI [1,1]
C4321425
Please provide any comments that you would like to share about this survey and/or related topics.
Description

survey comments

Data type

text

Alias
UMLS CUI [1,1]
C1830770
UMLS CUI [1,2]
C0332281
UMLS CUI [1,3]
C0034394
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Similar models

Youth Selfreport Follow Up Form

1 forms
  1. StudyEvent: The CoRonavIruS Health Impact Survey (CRISIS) V0.3
    1. Youth Selfreport Follow Up Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Background
C1706907 (UMLS CUI [1,1])
C0010447 (UMLS CUI [2,1])
Record ID
Item
Identification Number:
text
C2348585 (UMLS CUI [1,1])
Item
Country:
text
C1562954 (UMLS CUI [1,1])
country
Code List
Country:
CL Item
Afghanistan (1)
CL Item
Albania (2)
CL Item
Algeria (3)
CL Item
Andorra (4)
CL Item
Angola (5)
CL Item
Antigua and Barbuda (6)
CL Item
Argentina (7)
CL Item
Armenia (8)
CL Item
Australia (9)
CL Item
Austria (10)
CL Item
Azerbaijan (11)
CL Item
Bahamas (12)
CL Item
Bahrain (13)
CL Item
Bangladesh (14)
CL Item
Barbados (15)
CL Item
Belarus (16)
CL Item
Belgium (17)
CL Item
Belize (18)
CL Item
Benin (19)
CL Item
Bhutan (20)
CL Item
Bolivia (21)
CL Item
Bosnia and Herzegovina (22)
CL Item
Botswana (23)
CL Item
Brazil (24)
CL Item
Brunei (25)
CL Item
Bulgaria (26)
CL Item
Burkina Faso (27)
CL Item
Burundi (28)
CL Item
Côte d'Ivoire (29)
CL Item
Cabo Verde (30)
CL Item
Cambodia (31)
CL Item
Cameroon (32)
CL Item
Canada (33)
CL Item
Central African Republic (34)
CL Item
Chad (35)
CL Item
Chile (36)
CL Item
China (37)
CL Item
Colombia (38)
CL Item
Comoros (39)
CL Item
Congo (Congo-Brazzaville) (40)
CL Item
Costa Rica (41)
CL Item
Croatia (42)
CL Item
Cuba (43)
CL Item
Cyprus (44)
CL Item
Czechia (Czech Republic) (45)
CL Item
Democratic Republic of the Congo (46)
CL Item
Denmark (47)
CL Item
Djibouti (48)
CL Item
Dominica (49)
CL Item
Dominican Republic (50)
CL Item
Ecuador (51)
CL Item
Egypt (52)
CL Item
El Salvador (53)
CL Item
Equatorial Guinea (54)
CL Item
Eritrea (55)
CL Item
Estonia (56)
CL Item
Eswatini (fmr. "Swaziland") (57)
CL Item
Ethiopia (58)
CL Item
Fiji (59)
CL Item
Finland (60)
CL Item
France (61)
CL Item
Gabon (62)
CL Item
Gambia (63)
CL Item
Georgia (64)
CL Item
Germany (65)
CL Item
Ghana (66)
CL Item
Greece (67)
CL Item
Grenada (68)
CL Item
Guatemala (69)
CL Item
Guinea (70)
CL Item
Guinea-Bissau (71)
CL Item
Guyana (72)
CL Item
Haiti (73)
CL Item
Holy See (74)
CL Item
Honduras (75)
CL Item
Hungary (76)
CL Item
Iceland (77)
CL Item
India (78)
CL Item
Indonesia (79)
CL Item
Iran (80)
CL Item
Iraq (81)
CL Item
Ireland (82)
CL Item
Israel (83)
CL Item
Italy (84)
CL Item
Jamaica (85)
CL Item
Japan (86)
CL Item
Jordan (87)
CL Item
Kazakhstan (88)
CL Item
Kenya (89)
CL Item
Kiribati (90)
CL Item
Kuwait (91)
CL Item
Kyrgyzstan (92)
CL Item
Laos (93)
CL Item
Latvia (94)
CL Item
Lebanon (95)
CL Item
Lesotho (96)
CL Item
Liberia (97)
CL Item
Libya (98)
CL Item
Liechtenstein (99)
CL Item
Lithuania (100)
CL Item
Luxembourg (101)
CL Item
Madagascar (102)
CL Item
Malawi (103)
CL Item
Malaysia (104)
CL Item
Maldives (105)
CL Item
Mali (106)
CL Item
Malta (107)
CL Item
Marshall Islands (108)
CL Item
Mauritania (109)
CL Item
Mauritius (110)
CL Item
Mexico (111)
CL Item
Micronesia (112)
CL Item
Moldova (113)
CL Item
Monaco (114)
CL Item
Mongolia (115)
CL Item
Montenegro (116)
CL Item
Morocco (117)
CL Item
Mozambique (118)
CL Item
Myanmar (formerly Burma) (119)
CL Item
Namibia (120)
CL Item
Nauru (121)
CL Item
Nepal (122)
CL Item
Netherlands (123)
CL Item
New Zealand (124)
CL Item
Nicaragua (125)
CL Item
Niger (126)
CL Item
Nigeria (127)
CL Item
North Korea (128)
CL Item
North Macedonia (129)
CL Item
Norway (130)
CL Item
Oman (131)
CL Item
Pakistan (132)
CL Item
Palau (133)
CL Item
Palestine State (134)
CL Item
Panama (135)
CL Item
Papua New Guinea (136)
CL Item
Paraguay (137)
CL Item
Peru (138)
CL Item
Philippines (139)
CL Item
Poland (140)
CL Item
Portugal (141)
CL Item
Qatar (142)
CL Item
Romania (143)
CL Item
Russia (144)
CL Item
Rwanda (145)
CL Item
Saint Kitts and Nevis (146)
CL Item
Saint Lucia (147)
CL Item
Saint Vincent and the Grenadines (148)
CL Item
Samoa (149)
CL Item
San Marino (150)
CL Item
Sao Tome and Principe (151)
CL Item
Saudi Arabia (152)
CL Item
Senegal (153)
CL Item
Serbia (154)
CL Item
Seychelles (155)
CL Item
Sierra Leone (156)
CL Item
Singapore (157)
CL Item
Slovakia (158)
CL Item
Slovenia (159)
CL Item
Solomon Islands (160)
CL Item
Somalia (161)
CL Item
South Africa (162)
CL Item
South Korea (163)
CL Item
South Sudan (164)
CL Item
Spain (165)
CL Item
Sri Lanka (166)
CL Item
Sudan (167)
CL Item
Suriname (168)
CL Item
Sweden (169)
CL Item
Switzerland (170)
CL Item
Syria (171)
CL Item
Tajikistan (172)
CL Item
Tanzania (173)
CL Item
Thailand (174)
CL Item
Timor-Leste (175)
CL Item
Togo (176)
CL Item
Tonga (177)
CL Item
Trinidad and Tobago (178)
CL Item
Tunisia (179)
CL Item
Turkey (180)
CL Item
Turkmenistan (181)
CL Item
Tuvalu (182)
CL Item
Uganda (183)
CL Item
Ukraine (184)
CL Item
United Arab Emirates (185)
CL Item
United Kingdom (186)
CL Item
United States of America (187)
CL Item
Uruguay (188)
CL Item
Uzbekistan (189)
CL Item
Vanuatu (190)
CL Item
Venezuela (191)
CL Item
Vietnam (192)
CL Item
Yemen (193)
CL Item
Zambia (194)
CL Item
Zimbabwe (195)
State/ Province/ Region of residence
Item
State/ Province/ Region:
text
C1830433 (UMLS CUI [1,1])
age
Item
Your age (years):
integer
C0001779 (UMLS CUI [1,1])
Item Group
Exposure status During the PAST TWO WEEKS...
C0332157 (UMLS CUI [1,1])
C5203676 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
exposed___1
Item
...have you been exposed to someone with positive SARS CoV 2 test?
boolean
C0332157 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C5244023 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
exposed___2
Item
...have you been exposed to someone medical diagnosed with a SARS CoV 2 infection without positive test result?
boolean
C0332157 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C0011900 (UMLS CUI [1,3])
C5203670 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
exposed___3
Item
...have you been exposed to someone with possible COVID-19 symptoms during the past two weeks?
boolean
C0332157 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,3])
C0332281 (UMLS CUI [1,4])
C5203670 (UMLS CUI [1,5])
C4288440 (UMLS CUI [1,6])
symptoms___1
Item
...have you had a fever?
boolean
C0015967 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
symptoms___2
Item
...have you had a cough?
boolean
C0010200 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
symptoms___3
Item
...have you had shortness of breath?
boolean
C0013404 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
symptoms___4
Item
...have you had a sore throat?
boolean
C0242429 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
symptoms___5
Item
...have you had fatigue?
boolean
C0015672 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
symptoms___6
Item
...have you had loss of taste or smell?
boolean
C5382033 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
symptoms___7
Item
...have you had an eye infection?
boolean
C0015403 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
symptoms___8
Item
...have you had other symptoms?
boolean
C3257980 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
diagnosedfamily___1
Item
... has a family member living in the same household have COVID-19 diagnosis?
boolean
C4330269 (UMLS CUI [1,1])
C0086282 (UMLS CUI [1,2])
C0011900 (UMLS CUI [1,3])
C5203670 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
diagnosedfamily___2
Item
... has a family member not living in the same household have COVID-19 diagnosis?
boolean
C0086282 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
C5203670 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
impact___1
Item
...has any of your family members fallen ill physically due to COVID-19?
boolean
C0086282 (UMLS CUI [1,1])
C0221423 (UMLS CUI [1,2])
C5203676 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
impact___2
Item
...has any of your family members been hospitalized due to COVID-19?
boolean
C0086282 (UMLS CUI [1,1])
C0019993 (UMLS CUI [1,2])
C0678226 (UMLS CUI [1,3])
C5203670 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
impact___3
Item
...has any of your family members been put into self-quarantine with symptoms due to COVID-19?
boolean
C0086282 (UMLS CUI [1,1])
C5392942 (UMLS CUI [1,2])
C5203670 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
impact___4
Item
...has any of your family members been put into self-quarantine without symptoms due to COVID-19?
boolean
C0086282 (UMLS CUI [1,1])
C5392942 (UMLS CUI [1,2])
C5203676 (UMLS CUI [1,3])
C0231221 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
impact___5
Item
...has any of your family members lost or been laid off from their job due to COVID-19?
boolean
C0086282 (UMLS CUI [1,1])
C0425083 (UMLS CUI [1,2])
C0678226 (UMLS CUI [1,3])
C5203676 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
impact___6
Item
...has any of your family members have a reduced ability to earn money due to COVID-19?
boolean
C0086282 (UMLS CUI [1,1])
C0392756 (UMLS CUI [1,2])
C0021162 (UMLS CUI [1,3])
C0678226 (UMLS CUI [1,4])
C5203676 (UMLS CUI [1,5])
C4288440 (UMLS CUI [1,6])
impact___7
Item
...has any of your family members passed away due to COVID-19?
boolean
C0086282 (UMLS CUI [1,1])
C1306577 (UMLS CUI [1,2])
C0678226 (UMLS CUI [1,3])
C5203670 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
Item
How much are you reading or talking about Coronavirus/ COVID-19?
text
C0034754 (UMLS CUI [1,1])
C3874886 (UMLS CUI [1,2])
C5203676 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
C0234856 (UMLS CUI [2,1])
C3874886 (UMLS CUI [2,2])
C5203676 (UMLS CUI [2,3])
C4288440 (UMLS CUI [2,4])
CL.1
Code List
How much are you reading or talking about Coronavirus/ COVID-19?
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Occasionally (3)
CL Item
Often (4)
CL Item
Most of the time (5)
Item
Has the Coronavirus/ COIVD-19 crisis in your area led to any positive change in your life?
text
C0376558 (UMLS CUI [1,1])
C1446409 (UMLS CUI [1,2])
C0392747 (UMLS CUI [1,3])
C5392141 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
CL.1
Code List
Has the Coronavirus/ COIVD-19 crisis in your area led to any positive change in your life?
CL Item
None (1)
CL Item
Only a few (2)
CL Item
Some (3)
Item
...have you been suspected of having a COVID-19 infection?
text
C5203676 (UMLS CUI [1,1])
C3714514 (UMLS CUI [1,2])
C0750491 (UMLS CUI [1,3])
CL.3
Code List
...have you been suspected of having a COVID-19 infection?
CL Item
Yes, has positive test (1)
C5244023 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
CL Item
Yes, medical diagnosis, but no test (2)
C5203676 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
C3841003 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
CL Item
Yes, have had some possible symptoms, but no diagnosis by doctor (3)
C1457887 (UMLS CUI [1,1])
C5203676 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
C0011900 (UMLS CUI [1,4])
C0549184 (UMLS CUI [1,5])
CL Item
No symptoms or signs (4)
C5203676 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
C0549184 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
I.1
Item
Other Symptoms:
text
C3257980 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
Item
...how worried have you been about being infected?
text
C5203676 (UMLS CUI [1,1])
C3714514 (UMLS CUI [1,2])
C0233481 (UMLS CUI [1,3])
CL.4
Code List
...how worried have you been about being infected?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
...how worried have you been about friends or family being infected?
text
C0079382 (UMLS CUI [1,1])
C5203676 (UMLS CUI [1,2])
C3714514 (UMLS CUI [1,3])
C0233481 (UMLS CUI [1,4])
C0086282 (UMLS CUI [2,1])
C5203676 (UMLS CUI [2,2])
C3714514 (UMLS CUI [2,3])
C0233481 (UMLS CUI [2,4])
CL.4
Code List
...how worried have you been about friends or family being infected?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
...how worried have you been about your physical health being influenced by COVID-19?
text
C0233481 (UMLS CUI [1,1])
C5203670 (UMLS CUI [1,2])
C0392760 (UMLS CUI [1,3])
C0517226 (UMLS CUI [1,4])
CL.4
Code List
...how worried have you been about your physical health being influenced by COVID-19?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
...how worried have you been about your mental/emotional health being influenced by COVID-19?
text
C0233481 (UMLS CUI [1,1])
C5203670 (UMLS CUI [1,2])
C0392760 (UMLS CUI [1,3])
C0025353 (UMLS CUI [1,4])
CL.4
Code List
...how worried have you been about your mental/emotional health being influenced by COVID-19?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
I.7
Item
Please specify:
text
C0376558 (UMLS CUI [1,1])
C1446409 (UMLS CUI [1,2])
C0392747 (UMLS CUI [1,3])
C5392141 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
Item Group
Life changes During the PAST TWO WEEKS...
C0376558 (UMLS CUI [1,1])
C0392747 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
Item
...has your school building been closed?
text
C0036375 (UMLS CUI [1,1])
C0587267 (UMLS CUI [1,2])
C0678226 (UMLS CUI [1,3])
C5392141 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
schoolclosed
Code List
...has your school building been closed?
CL Item
Yes (1)
CL Item
No (0)
CL Item
Not Applicable (2)
classes in session
Item
Are classes in session?
boolean
C0036375 (UMLS CUI [1,1])
C0038492 (UMLS CUI [1,2])
C0441833 (UMLS CUI [1,3])
C1553514 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
attended classes in person within previous two weeks
Item
Are you attending classes in-person?
boolean
C0036375 (UMLS CUI [1,1])
C1999232 (UMLS CUI [1,2])
C1553514 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
classes resumed online within previous two weeks
Item
Have classes resumed online?
boolean
C0036375 (UMLS CUI [1,1])
C4505477 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
internet and computer access within previous two weeks
Item
Do you have easy access to the internet and a computer?
boolean
C4704731 (UMLS CUI [1,1])
C0444454 (UMLS CUI [1,2])
C0009622 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
assignments within the previous two weeks
Item
Are there assignments for you to complete?
boolean
C0683853 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
meals from school
Item
Are you able to receive meals from the school?
boolean
C1998602 (UMLS CUI [1,1])
C1517320 (UMLS CUI [1,2])
C0036375 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
in-person conversation count within previous two weeks
Item
...how many people, from outside of your household, have you had an in-person conversation with?
integer
C0750480 (UMLS CUI [1,1])
C0871703 (UMLS CUI [1,2])
C1553514 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
Item
...how much time have you spent going outside of the home (e.g., going to stores, parks, etc.)?
text
C0040223 (UMLS CUI [1,1])
C1709359 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
timeoutside
Code List
...how much time have you spent going outside of the home (e.g., going to stores, parks, etc.)?
CL Item
Not at all (1)
CL Item
1-2 days per week (2)
CL Item
A few days per week (3)
CL Item
Several days per week (4)
CL Item
Every day (5)
Item
...how stressful have the restrictions on leaving home been for you?
text
C0038435 (UMLS CUI [1,1])
C0678226 (UMLS CUI [1,2])
C4534363 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
restrictionsstress
Code List
...how stressful have the restrictions on leaving home been for you?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
...have your contacts with people outside of your home changed relative to before the Coronavirus/COVID-19 crisis in your area?
text
C0392747 (UMLS CUI [1,1])
C0237101 (UMLS CUI [1,2])
C1711239 (UMLS CUI [1,3])
C5392141 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
contactschanged
Code List
...have your contacts with people outside of your home changed relative to before the Coronavirus/COVID-19 crisis in your area?
CL Item
A lot less (1)
CL Item
A little less (2)
CL Item
About the same (3)
CL Item
A little more (4)
CL Item
A lot more (5)
Item
...how much difficulty have you had following the recommendations for keeping away from close contact with people?
text
C0332218 (UMLS CUI [1,1])
C5440893 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
difficultydistancing
Code List
...how much difficulty have you had following the recommendations for keeping away from close contact with people?
CL Item
None (1)
CL Item
A little (2)
CL Item
Moderate (3)
CL Item
A lot (4)
CL Item
A great amount (5)
Item
...has the quality of the relationships between you and members of your family changed?
text
C0392747 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
C0086282 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
familychange
Code List
...has the quality of the relationships between you and members of your family changed?
CL Item
A lot worse (1)
CL Item
A little worse (2)
CL Item
About the same (3)
CL Item
A little better (4)
CL Item
A lot better (5)
Item
...how stressful have these changes in family contacts been for you?
text
C0038435 (UMLS CUI [1,1])
C0678226 (UMLS CUI [1,2])
C0392747 (UMLS CUI [1,3])
C0439849 (UMLS CUI [1,4])
C0086282 (UMLS CUI [1,5])
C4288440 (UMLS CUI [1,6])
familychangestress
Code List
...how stressful have these changes in family contacts been for you?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
...has the quality of your relationships with your friends changed?
text
C0392747 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
C0079382 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
friendschange
Code List
...has the quality of your relationships with your friends changed?
CL Item
A lot worse (1)
CL Item
A little worse (2)
CL Item
About the same (3)
CL Item
A little better (4)
CL Item
A lot better (5)
Item
...how stressful have these changes in social contacts been for you?
text
C0038435 (UMLS CUI [1,1])
C0678226 (UMLS CUI [1,2])
C0392747 (UMLS CUI [1,3])
C0439849 (UMLS CUI [1,4])
C0079382 (UMLS CUI [1,5])
C4288440 (UMLS CUI [1,6])
friendchangestress
Code List
...how stressful have these changes in social contacts been for you?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
...how much has cancellation of important events (such as graduation, prom, vacation, etc.) in your life been difficult for you?
text
C0332218 (UMLS CUI [1,1])
C0441471 (UMLS CUI [1,2])
C1553388 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
difficultycancellations
Code List
...how much has cancellation of important events (such as graduation, prom, vacation, etc.) in your life been difficult for you?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
...to what degree have changes related to the Coronavirus/COVID-19 crisis in your area created financial problems for your family?
text
C0015576 (UMLS CUI [1,1])
C0549106 (UMLS CUI [1,2])
C0678226 (UMLS CUI [1,3])
C5392141 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
financedifficulty
Code List
...to what degree have changes related to the Coronavirus/COVID-19 crisis in your area created financial problems for your family?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
...to what degree are you concerned about the stability of your living situation?
text
C2107029 (UMLS CUI [1,1])
C2184149 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
livingdifficulty
Code List
...to what degree are you concerned about the stability of your living situation?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
worried about food shortage due to financial problems
Item
...did you worry whether your food would run out because of a lack of money?
boolean
C0233481 (UMLS CUI [1,1])
C0598456 (UMLS CUI [1,2])
C0678226 (UMLS CUI [1,3])
C0549106 (UMLS CUI [1,4])
C4288440 (UMLS CUI [1,5])
Item
How hopeful are you that the Coronavirus/COVID-19 crisis in your area will end soon?
text
C5224035 (UMLS CUI [1,1])
C0444930 (UMLS CUI [1,2])
C5392141 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
hopefullyend
Code List
How hopeful are you that the Coronavirus/COVID-19 crisis in your area will end soon?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item Group
Daily behaviors During the PAST TWO WEEKS...
C0871707 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
Item
...on average, what time did you go to bed on WEEKDAYS?
text
C0521112 (UMLS CUI [1,1])
C0680189 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
bedtimeweekdays_2_fd7e26
Code List
...on average, what time did you go to bed on WEEKDAYS?
CL Item
Before 9 pm (1)
CL Item
9 pm - 11 pm (2)
CL Item
11 pm - 1 am (3)
CL Item
After 1 am (4)
Item
...on average, what time did you go to bed on WEEKENDS?
text
C0521112 (UMLS CUI [1,1])
C0680190 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
bedtimeweekends_2_ba9e58
Code List
...on average, what time did you go to bed on WEEKENDS?
CL Item
Before 9 pm (1)
CL Item
9 pm - 11 pm (2)
CL Item
11 pm - 1 am (3)
CL Item
After 1 am (4)
Item
...on average, how many hours per night did you sleep on WEEKDAYS?
text
C2937255 (UMLS CUI [1,1])
C0680189 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
hoursofsleepweekdays_2_500a2e
Code List
...on average, how many hours per night did you sleep on WEEKDAYS?
CL Item
<6 hours (1)
CL Item
6-8 hours (2)
CL Item
8-10 hours (3)
CL Item
>10 hours (4)
Item
...on average, how many hours per night did you sleep on WEEKENDS?
text
C2937255 (UMLS CUI [1,1])
C0680190 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
hoursofsleepweekends_2_c9f657
Code List
...on average, how many hours per night did you sleep on WEEKENDS?
CL Item
<6 hours (1)
CL Item
6-8 hours (2)
CL Item
8-10 hours (3)
CL Item
>10 hours (4)
Item
...how many days per week did you exercise (e.g., increased heart rate, breathing) for at least 30 minutes?
text
C2230062 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
exerciseprior_2
Code List
...how many days per week did you exercise (e.g., increased heart rate, breathing) for at least 30 minutes?
CL Item
None (1)
CL Item
1-2 days (2)
CL Item
3-4 days (3)
CL Item
5-6 days (4)
CL Item
Daily (5)
Item
...how many days per week did you spend time outdoors?
text
C0677547 (UMLS CUI [1,1])
C4534420 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
outdoorsprior_2
Code List
...how many days per week did you spend time outdoors?
CL Item
None (1)
CL Item
1-2 days (2)
CL Item
3-4 days (3)
CL Item
5-6 days (4)
CL Item
Daily (5)
Item Group
Emotions/ Worries During the PAST TWO WEEKS...
C0013987 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
C0233481 (UMLS CUI [2,1])
C4288440 (UMLS CUI [2,2])
Item
...how worried were you generally?
text
C0681889 (UMLS CUI [1,1])
C0233481 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
priorworry_2
Code List
...how worried were you generally?
CL Item
Not worried at all (1)
CL Item
Slightly worried (2)
CL Item
Moderately worried (3)
CL Item
Very worried (4)
CL Item
Extremely worried (5)
Item
...how happy versus sad were you?
text
C1821411 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
C0681889 (UMLS CUI [2,1])
C3536794 (UMLS CUI [2,2])
C4288440 (UMLS CUI [2,3])
priorhappyvssad_2
Code List
...how happy versus sad were you?
CL Item
Very sad/depressed/unhappy (1)
CL Item
Moderately sad/depressed/unhappy (2)
CL Item
Neutral (3)
CL Item
Moderately happy/cheerful (4)
CL Item
Very happy/cheerful (5)
Item
...how much were you able to enjoy your usual activities?
text
C0681889 (UMLS CUI [1,1])
C4316940 (UMLS CUI [1,2])
C0871707 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
priorenjoyactivities_2_4212c2
Code List
...how much were you able to enjoy your usual activities?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Very much (4)
CL Item
A lot (5)
Item
...how relaxed versus anxious were you?
text
C0681889 (UMLS CUI [1,1])
C0035028 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
C0681889 (UMLS CUI [2,1])
C0003467 (UMLS CUI [2,2])
C4288440 (UMLS CUI [2,3])
priorrelaxedvsanxious_2
Code List
...how relaxed versus anxious were you?
CL Item
Very relaxed/calm (1)
CL Item
Moderately relaxed/calm (2)
CL Item
Neutral (3)
CL Item
Moderately nervous/anxious (4)
CL Item
Very nervous/anxious (5)
Item
...how fidgety or restless were you?
text
C0681889 (UMLS CUI [1,1])
C0424235 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
C0681889 (UMLS CUI [2,1])
C3887611 (UMLS CUI [2,2])
C4288440 (UMLS CUI [2,3])
priorfidget_2
Code List
...how fidgety or restless were you?
CL Item
Not fidgety/restless at all (1)
CL Item
Slightly fidgety/restless (2)
CL Item
Moderately fidgety/restless (3)
CL Item
Very fidgety/restless (4)
CL Item
Extremely fidgety/restless (5)
Item
...how fatigued or tired were you?
text
C0681889 (UMLS CUI [1,1])
C0015672 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
priorfatigue_2
Code List
...how fatigued or tired were you?
CL Item
Not fatigued or tired at all (1)
CL Item
Slightly fatigued or tired (2)
CL Item
Moderately fatigued or tired (3)
CL Item
Very fatigued or tired (4)
CL Item
Extremely fatigued or tired (5)
Item
...how well were you able to concentrate or focus?
text
C0681889 (UMLS CUI [1,1])
C0086045 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
priorfocus_2
Code List
...how well were you able to concentrate or focus?
CL Item
Very focused/attentive (1)
CL Item
Moderately focused/attentive (2)
CL Item
Neutral (3)
CL Item
Moderately unfocused/distracted (4)
CL Item
Very unfocused/distracted (5)
Item
...how irritable or easily angered were you?
text
C0681889 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
C0681889 (UMLS CUI [2,1])
C2227997 (UMLS CUI [2,2])
C4288440 (UMLS CUI [2,3])
priorirritable_2
Code List
...how irritable or easily angered were you?
CL Item
Not irritable or easily angered at all (1)
CL Item
Slightly irritable or easily angered (2)
CL Item
Moderately irritable or easily angered (3)
CL Item
Very irritable or easily angered (4)
CL Item
Extremely irritable or easily angered (5)
Item
...how lonely were you?
text
C0681889 (UMLS CUI [1,1])
C0023974 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
priorlonely_2
Code List
...how lonely were you?
CL Item
Not lonely at all (1)
CL Item
Slightly lonely (2)
CL Item
Moderately lonely (3)
CL Item
Very lonely (4)
CL Item
Extremely lonely (5)
Item
...to what extent did you have negative thoughts, thoughts about unpleasant experiences or things that make you feel bad?
text
C4321352 (UMLS CUI [1,1])
C1142075 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
priornegthoughts_2_aff3aa
Code List
...to what extent did you have negative thoughts, thoughts about unpleasant experiences or things that make you feel bad?
CL Item
Not at all (1)
CL Item
Rarely (2)
CL Item
Occasionally (3)
CL Item
Often (4)
CL Item
A lot of the time (5)
Item Group
Media use During the PAST TWO WEEKS, how much time per day did you spend...
C5392110 (UMLS CUI [1,1])
C0556974 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
C0042649 (UMLS CUI [2,1])
C0556974 (UMLS CUI [2,2])
C4288440 (UMLS CUI [2,3])
Item
...watching TV or digital media (e.g., Netflix, YouTube, web surfing)?
text
C3827501 (UMLS CUI [1,1])
C0556974 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
priortvmedia_2
Code List
...watching TV or digital media (e.g., Netflix, YouTube, web surfing)?
CL Item
No TV or digital media (1)
CL Item
Under 1 hour (2)
CL Item
1-3 hours (3)
CL Item
4-6 hours (4)
CL Item
More than 6 hours (5)
Item
...using social media (e.g., Facetime, Facebook, Instagram, Snapchat, Twitter, TikTok)?
text
C3179065 (UMLS CUI [1,1])
C0556974 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
priorsocialmedia_2
Code List
...using social media (e.g., Facetime, Facebook, Instagram, Snapchat, Twitter, TikTok)?
CL Item
No social media (1)
CL Item
Under 1 hour (2)
CL Item
1-3 hours (3)
CL Item
4-6 hours (4)
CL Item
More than 6 hours (5)
Item
...playing video games?
text
C2047133 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
priorvideogames_2
Code List
...playing video games?
CL Item
No video games (1)
CL Item
Under 1 hour (2)
CL Item
1-3 hours (3)
CL Item
4-6 hours (4)
CL Item
More than 6 hours (5)
Item Group
Substance use During the PAST TWO WEEKS, how frequently did you use...
C0237123 (UMLS CUI [1,1])
C4288440 (UMLS CUI [1,2])
Item
...alcohol?
text
C4321352 (UMLS CUI [1,1])
C0001948 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
twoweeksalcohol
Code List
...alcohol?
CL Item
Not at all (1)
CL Item
Rarely (2)
CL Item
Once a month (3)
CL Item
Several times a month (4)
CL Item
Once a week (5)
CL Item
Several times a week (6)
CL Item
Once a day (7)
CL Item
More than once a day (8)
Item
...vaping products?
text
C4321352 (UMLS CUI [1,1])
C4083280 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
twoweeksvaping
Code List
...vaping products?
CL Item
Not at all (1)
CL Item
Rarely (2)
CL Item
Once a month (3)
CL Item
Several times a month (4)
CL Item
Once a week (5)
CL Item
Several times a week (6)
CL Item
Once a day (7)
CL Item
More than once a day (8)
Item
...cigarettes or other tobacco products?
text
C4321352 (UMLS CUI [1,1])
C0543414 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
twoweekstobacco
Code List
...cigarettes or other tobacco products?
CL Item
Not at all (1)
CL Item
Rarely (2)
CL Item
Once a month (3)
CL Item
Several times a month (4)
CL Item
Once a week (5)
CL Item
Several times a week (6)
CL Item
Once a day (7)
CL Item
More than once a day (8)
Item
...marijuana/cannabis (e.g., joint, blunt, pipe, bong)?
text
C4321352 (UMLS CUI [1,1])
C4316909 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
twoweeksmarijuana
Code List
...marijuana/cannabis (e.g., joint, blunt, pipe, bong)?
CL Item
Not at all (1)
CL Item
Rarely (2)
CL Item
Once a month (3)
CL Item
Several times a month (4)
CL Item
Once a week (5)
CL Item
Several times a week (6)
CL Item
Once a day (7)
CL Item
More than once a day (8)
Item
...opiates, heroin, or narcotics?
text
C4321352 (UMLS CUI [1,1])
C4551628 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
C4321352 (UMLS CUI [2,1])
C0600241 (UMLS CUI [2,2])
C4288440 (UMLS CUI [2,3])
C4321352 (UMLS CUI [3,1])
C0524661 (UMLS CUI [3,2])
C4288440 (UMLS CUI [3,3])
twoweeksopiates_a2078c
Code List
...opiates, heroin, or narcotics?
CL Item
Not at all (1)
CL Item
Rarely (2)
CL Item
Once a month (3)
CL Item
Several times a month (4)
CL Item
Once a week (5)
CL Item
Several times a week (6)
CL Item
Once a day (7)
CL Item
More than once a day (8)
Item
...other drugs including cocaine, crack, amphetamine, methamphetamine, hallucinogens, or ecstasy?
text
C4321352 (UMLS CUI [1,1])
C0848734 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
twoweeksother
Code List
...other drugs including cocaine, crack, amphetamine, methamphetamine, hallucinogens, or ecstasy?
CL Item
Not at all (1)
CL Item
Rarely (2)
CL Item
Once a month (3)
CL Item
Several times a month (4)
CL Item
Once a week (5)
CL Item
Several times a week (6)
CL Item
Once a day (7)
CL Item
More than once a day (8)
Item
...sleeping medications or sedatives/hypnotics?
text
C4321352 (UMLS CUI [1,1])
C0599396 (UMLS CUI [1,2])
C0013146 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
C4321352 (UMLS CUI [2,1])
C1456771 (UMLS CUI [2,2])
C4288440 (UMLS CUI [2,3])
C4321352 (UMLS CUI [3,1])
C0338699 (UMLS CUI [3,2])
C4288440 (UMLS CUI [3,3])
twoweeksleeping_5290cb
Code List
...sleeping medications or sedatives/hypnotics?
CL Item
Not at all (1)
CL Item
Rarely (2)
CL Item
Once a month (3)
CL Item
Several times a month (4)
CL Item
Once a week (5)
CL Item
Several times a week (6)
CL Item
Once a day (7)
CL Item
More than once a day (8)
Item Group
Which of the following supports were in place for you before the Coronavirus/COVID-19 crisis in your area and have been disrupted over the PAST TWO WEEKS? (check all that apply)
C0748877 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C0678226 (UMLS CUI [1,3])
C5392141 (UMLS CUI [1,4])
resource room disrupted past two weeks
Item
Resource room
boolean
C3846158 (UMLS CUI [1,1])
tutoring disrupted past two weeks
Item
Tutoring
boolean
C0872010 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
mentoring program disrupted past two weeks
Item
Mentoring programs
boolean
C4255266 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
after school activity programs disrupted past two weeks
Item
After school activity programs
boolean
C0681383 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
volunteer program disrupted past two weeks
Item
Volunteer programs
boolean
C2367294 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
psychotherapy disrupted past two weeks
Item
Psychotherapy
boolean
C0033968 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
psychiatric care disrupted past two weeks
Item
Psychiatric care
boolean
C0597312 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
occupational therapy disrupted past two weeks
Item
Occupational therapy
boolean
C1318464 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
physical therapy disrupted past two weeks
Item
Physical therapy
boolean
C0949766 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
speech/language therapy disrupted past two weeks
Item
Speech/language therapy
boolean
C0589155 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
sporting activities disrupted past two weeks
Item
Sporting activities
boolean
C0038039 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
medical care for chronic illnesses disrupted past two weeks
Item
Medical care for chronic illnesses
boolean
C1555457 (UMLS CUI [1,1])
C0332454 (UMLS CUI [1,2])
C4288440 (UMLS CUI [1,3])
other supports disrupted past two weeks
Item
Other
boolean
C0205394 (UMLS CUI [1,1])
C0748877 (UMLS CUI [1,2])
C0332454 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
specify other supports disrupted within the past two weeks
Item
Other: Specify
text
C3845569 (UMLS CUI [1,1])
C0748877 (UMLS CUI [1,2])
C0332454 (UMLS CUI [1,3])
C4288440 (UMLS CUI [1,4])
Item Group
Additional concerns and comments
C3482667 (UMLS CUI [1,1])
C1830770 (UMLS CUI [1,2])
anything_else
Item
Please describe anything else that concerns you about the impact of Coronavirus/COVID-19 on you, your friends, or your family.
text
C5392141 (UMLS CUI [1,1])
C4049986 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Item Group
Comment section - Youth Selfreport Follow Up Form
C4321425 (UMLS CUI [1,1])
survey comments
Item
Please provide any comments that you would like to share about this survey and/or related topics.
text
C1830770 (UMLS CUI [1,1])
C0332281 (UMLS CUI [1,2])
C0034394 (UMLS CUI [1,3])
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