Join research study

Join MSU study on pregnancy health

Please answer all the questions to join this research study. Your answers are kept confidential and will not be shared with anyone except the research team.
Please verify that you are human*
1. Age:*
Your age in years
2. Which week of pregnancy are you currently in?*
Enter number of weeks
3. Do you live in the United States and plan to give birth here?*

YesNo
4. How would you rate your overall health right now?*

Very PoorPoorFairGoodVery Good
5. Where do you get most of your health information?*

Friends/relativesMy doctor /nurse/other health providerInternet searchSocial mediaTVRadioBooks / magazinesOther source not listed here
6. How would you rate the safety of your residential neighborhood?*

Very unsafeUnsafeFairSafeVery Safe
7. Which of the following best describes the condition of the public sidewalks in front of your home?*

No sidewalksUnpaved sidewalksPaved sidewalk, poorly maintainedPaved sidewalk, moderately maintainedPaved sidewalk, well maintainedOther condition not mentioned here
8. Which of the following best describes the average amount of vehicle traffic in front of your home?*

Very low trafficLow trafficModerate trafficHeavy trafficVery Heavy traffic
9. How many traffic lanes are present in front of your home? Please include all lanes, both directions.*

1 lane2 lane3 lane4 lane5 lane
10. How many drinks does it take to make you feel high?*

Less than or equal to 2 drinksMore than 2 drinks
Q10 score
11. Have people annoyed you by criticizing your drinking?*

YesNo
Q11 score
12. Have you felt you ought to cut down on your drinking?*

YesNo
Q12 score
13. Have you ever had a drink ﬁrst thing in the morning to steady your nerves or to get rid of a hangover?*

YesNo
Q13 score
14. In the past month, how often did you usually have any kind of drink containing alcohol?*

Every day5 to 6 times a week3 to 4 times a weekTwice a weekOnce a week2 to 3 timesOnceI did not drink any alcohol in the past month
Q14 score
15. During the 12 months before you became pregnant, how often did you have 4 or more drinks containing any kind of alcohol within a two-hour period?*

Every day5 to 6 times a week3 to 4 times a weekTwo days a weekOne day a week2 to 3 days a monthOne day a month3 to 11 days in the year before I became pregnant1 or 2 days in the year before I became pregnantNever
Q15 score
X score
T score
Result*
source
area
Should be Empty:

Join MSU study on pregnancy health