Birth Defects Risk Factor Survey

NOTIFICATION: With few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. See http://www.dshs.state.tx.us/ for more information.

Question Title

* 1. Which risk factor report(s) did you access?

47,XXX

47,XYY

Achondroplasia

Anal Atresia

Atrial Septal Defect (ASD)

Conotruncal Heart Defects

Craniosynostosis

Diaphragmatic Hernia

Down Syndrome

Ear Defects

Esophageal Atresia

Gastroschisis

Holoprosencephaly

Hydrocephaly

Hypolastic Left Heart Syndrome

Intestinal Atresia/Stenosis

Klinefelter Syndrome

Neural Tube Defects

None

Omphalocele

Oral Clefts

Patent Ductus Arteriosus

Pyloric Stenosis

Renal Agenesis

Talipes Equinovarus (Clubfoot)

Triploidy

Trisomy 13

Trisomy 18

Turner Syndrome

Other (please specify)

Question Title

* 2. Are there other birth defects that you would like to see a risk factor report for? If so, which?

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* 3. Please rate the risk factor series:

	Disagree	Somewhat Agree	Strongly Agree.
It helped me understand what might cause this birth defect.	It helped me understand what might cause this birth defect. Disagree	It helped me understand what might cause this birth defect. Somewhat Agree	It helped me understand what might cause this birth defect. Strongly Agree.
I will probably look up some of the references cited in this report.	I will probably look up some of the references cited in this report. Disagree	I will probably look up some of the references cited in this report. Somewhat Agree	I will probably look up some of the references cited in this report. Strongly Agree.
It was at the appropriate reading level for me.	It was at the appropriate reading level for me. Disagree	It was at the appropriate reading level for me. Somewhat Agree	It was at the appropriate reading level for me. Strongly Agree.
It helped me understand what a risk factor is.	It helped me understand what a risk factor is. Disagree	It helped me understand what a risk factor is. Somewhat Agree	It helped me understand what a risk factor is. Strongly Agree.

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* 4. Do you have any comments or suggestions for improvement?

Question Title

* 5. Which is your main reason for reading these risk factor reports?

Someone I know (other than my child) has this defect.

I am the parent of a child with a birth defect.

I am doing research for a class.

I am doing research as a professional.

I am pregnant or thinking of becoming pregnant.

Other (please specify)

Thank you for your time. This information will be used to make the Birth Defects Risk Factor Survey more useful. Please contact Amy Case at birthdefects@dshs.state.tx.us for more information.