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22. Please share whether you use or plan to use prenatal nutrition supplements: (Select one for each)


Yes


Prior to conceiving During pregnancy


Postpartum/after baby’s birth


23. Before or between pregnancies, or after you’ve completed your family, do you plan to use any of the following birth control methods: (Select all that apply)  Pills


 Patch  Vaginal ring  IUD  Diaphragm  Condom  I prefer to not use birth control  Other: ..................................


24. After pregnancy, what are your health & fitness concerns: (Please rate each) Greatest


Concern Proper recovery for my body


Losing the weight gained in pregnancy Becoming more active/f it Eating healthfully


Getting adequate sleep


Managing my moods/emotions Managing stress


Breastfeeding baby Feeding baby


Transitioning baby to solid foods


Avoiding another pregnancy right away Resuming sexual relations with my partner Balancing family while resuming my job


Other:................................................................................................ PERSONAL CARE


25. Do/did you switch brands on any of the following beauty or skincare products during pregnancy? (Select all that apply)  Cleansers


26. How important are natural/organic products to you? (Select one)  Very important


 Somewhat important INFANT CARE


27. Did you or do you plan to breastfeed your baby? (Select one)  Yes, I did: For <3 months | 3-6 months | 6-9 months | 9-12 months | 12 months+  Yes, I plan to start breastfeeding post birth  No, I have health complications preventing breastfeeding  No, I plan to feed baby artif icial infant nutrition (formula)  Unsure/Undecided


28. Do you plan to vaccinate your infant? (Select one)  Yes, we do/will vaccinate according to current schedules  Yes, we do/will vaccinate but on a modif ied schedule  No; please explain: Don’t believe in vaccinations’ protective effects Think vaccinations could cause problems Other: ..........................................................................................


29. Did you or do you plan to bank your baby’s cord blood or placenta? (Select one)  Yes; please select how: Private cord blood bank


Public cord blood bank


 No; please select why: Too expensive


Ongoing maintenance costs


Don’t believe cord blood products can be used as therapies Don’t know enough about cord blood banking


30. Where did/will baby primarily sleep after birth? (Select one)  In a crib/bassinet in my room  In a crib/bassinet in baby’s room  In my bed (co-sleeping)


Concern


Somewhat Concerned


Least Unsure  Not important  Body/hand lotion  Cosmetics/makeup  Moisturizers  Hair products  Sun care/sunscreen  Other:..........................................


Somewhat Concerned


Least Concern Not Concerned


Very Likely Somewhat Likely Not Likely Doesn’t apply No Over-the-counter medicines:


Pain relief Teething Colic/gas Baby clothing:


Onesies, sleepers Sleep sacks Swaddling wraps Baby gear:


Crib Bassinet


Changing table Mattress/bedding


Diaper disposal system Humidifier


Baby monitor Car seat/booster seat


More than one car/booster seat Car seat/stroller system Stroller


Sling/wrap carrier Backpack carrier Front-facing carrier Activity center/mat Bouncy chair/seat Swing


Play yard High chair


Safety gates/child-proofing items Books/music


Toys/electronics Videos/DVDs


ABOUT YOU 33. Are you: (Select one)


 Female  Male


34. Into which group does your age fall?  <18  18-24  25-34  35-39  40+


35. How many children ages 18 or younger live with you now? (Select one)  1  2  3  4  5+  None


36. Of the children who live with you now, into which groups do their ages fall? (Check all that apply)  Newborn to 6 months  7-11 months  1-2 years  6-12 years


 3-5 years  13+ years


37. What types of media/devices do you use/prefer for gaining health information? (Select and rate all that apply) Most prefer


Somewhat prefer


 Print magazines  Websites


 Printed books  eBooks  Tablet


 Laptop/Computer  SmartPhone/iPhone  Text message  Apps


 Other: .............................................................................................


38. What social media sites do you use/prefer? (Select and rate all that apply) Most prefer


Somewhat prefer


 Other:..................................................  Facebook  Twitter


31. Please rate your concerns as a parent from greatest to least regarding the following infant care practices: (Please rate each) Greatest


Not Concern


Bathing baby properly Caring for baby’s skin


Dressing baby appropriately Treating skin issues like diaper rash or cradle cap Sun protection for baby


Caring for baby’s gums and teeth Feeding baby


Playing with baby Day-to-day infant care


GO SHOPPING 32. How likely you are to buy/register for the following products: (Please rate each)


Very Likely Baby care:


Diaper rash creams/ointments Diapers Wipes


Cleansers Shampoos


Feeding baby:


Breast pump/nursing supplies Nursing cover/wrap


Breastmilk storage supplies Breastmilk warmer Bottles/sippy cups Bottle sterilizer Infant formula


Age-related baby foods Organic baby foods


60 health4mom.org


ENTER OUR DRAWING: Complete this section to enter our drawing. All completed surveys that include the following completed information and that are received by 12/31/13 will be entered into our drawing. Winners will be notified on or about 1/15/2014; prizes will be shipped to winners by the donor. (See sweepstakes rules p. 58).


Name:........................................................................................ Address:..................................................................................... City:........................................... State:............. Zip:.................... Email:......................................................................................... Telephone:..................................................................................


Somewhat Likely Not Likely Doesn’t apply Concerned


 Google+  Pinterest


 Other: .............................................................................................


39. What is the highest level of education you have completed to date? (Select one)  Some high school  High school  Some college  College  Post-grad


40. What is your employment status? (Select one)  Employed


 On maternity leave  Not employed


41. What is your current annual household income before taxes? (Select one)  Less than $35,000  $35,001-$49,999  $50,000-$74,999  $75,000-$99,999  $100,000-$149,999  $150,000-$199,999  $200,000+


42. What is your ethnicity? (Select one)  White/Caucasian  Black/African American  Hispanic/Spanish  Asian  Native American  Prefer not to answer


 Other: .............................. Don’t prefer Doesn’t Apply/Don’t know Don’t prefer Doesn’t Apply/Don’t know


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