15 Month Survey - Females

APPENDIX D
15-MONTH FOLLOW-UP SURVEY

Contract No.:
233-02-0056
MPR Reference No.: 8935-141

Building Strong Families:
First Follow-Up Survey
April 2006

Welmoet van Kammen
Rob Wood
Sheena McConnell
Robert Whitaker
Shawn Marsh

Submitted to:
U.S. Department of Health and Human Services
Administration for Children and Families
Office of Planning, Research , and Evaluation
7th Fl., West, Aerospace Center Bldg.
370 L’ Enfant Promenade, SW
Washington, DC 20447
Project Officer:
Nancye Campbell

Submitted by:
Mathematica Policy Research, Inc.
P.O. Box 2393
Princeton, NJ 08543-2393
Telephone: (609) 799-3535
Facsimile: (609) 799-0005

Project Director:
Alan Hershey
Survey Director:
Welmoet van Kammen

OMB No.: xxxx-xxxx
Expiration Date: xx/xx/xxxx

7KH%XLOGLQJ6WURQJ)DPLOLHV(YDOXDWLRQ

)LIWHHQ0RQWK)ROORZ8S6XUYH\

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection will be entered after clearance.
The time required to complete this information collection is estimated to average 45 minutes per respondent, including the time to
review instructions, gather the data needed, and complete and review the information collected.

Prepared by Mathematica Policy Research, Inc.

CONTENTS

Section

Page

IN:

INTRODUCTION.............................................................................................. 1

FS:

FAMILY STRUCTURE ..................................................................................... 4

CO:

INVOLVEMENT WITH CHILD........................................................................ 30

RR:

RELATIONSHIP............................................................................................. 36

WB:

PARENTAL WELL BEING (I) ......................................................................... 50

SE:

RECEIPT OF SERVICES .............................................................................. 54

PA:

PATERNITY AND CHILD SUPPORT ............................................................ 61

WW:

FAMILY SELF-SUFFICIENCY ....................................................................... 67

WB:

PARENTAL WELL BEING (II) ........................................................................ 83

BP:

CITIZENSHIP AND LIVING WITH BIOLOGICAL PARENTS......................... 88

LO:

LOCATING INFORMATION........................................................................... 93

i
Prepared by Mathematica Policy Research, Inc.

QUESTIONNAIRE FORMAT EXPLANATION
The purpose of this page is to illustrate the layout of questions in this instrument and
help the reader to interpret the formatting and instructions, so they can follow the flow of
the questions. This format was designed for ease of use by those who will be
programming the computer-aided telephone interviewing (CATI) survey instrument. If
this questionnaire was administered in a paper and pencil version, the formatting would
be changed; however, the skip logic would remain the same.

Line 2: This box indicates if a previously answered question affects whether this question is asked or which part of the
question is asked, and if so, the specific responses to the earlier question that trigger this question or a specific part of it.
Question number is displayed in
the shaded area.

FS42.2
IF FS42=most of the time (2), some of the time (3), OR none of the time (4)
he if CMALE; she if CFEMALE
Indicates that the question stem should only be
asked if question FS42 was answered 2 or 3.

(IF FS42 =2 or 3) When [he/she] is not living with you,
Question
Text

This code tells the programmer or interviewer
to insert the name of the focal child.

(W/w)ho does [CHILD] live with?
FATHER/MOTHER
GRANDPARENT(S)
OTHER RELATIVES(S)
ADOPTIVE PARENTS
Answer
Categories FOSTER PARENTS
FRIEND(S)
SOMEONE ELSE
DK
REF

1
2
3
4
5
6
7
d
r

Line 3: Indicates wording changes, pronouns to be used, or variations
in the question, based on a known variable about the respondent, such
as gender or relationship status.

ii
Prepared by Mathematica Policy Research, Inc.

FS42.3
OR FS43

FS42.2.1
FS42.3
OR FS43

These are skip
instructions to the next
question asked. You
should follow the
lowest number skip to
the next question, to
see if that question is
appropriate.
Instructions at those
questions will tell you
how to proceed.

SECTION IN: INTRODUCTION
IN1
ALL

May I please speak with [SAMPLE MEMBER]? My name is [NAME] and
I’m calling from Mathematica Policy Research, Inc., a research company in
Princeton, New Jersey.
SAMPLE MEMBER AVAILABLE
SAMPLE MEMBER NOT AVAILABLE

1
2

IN3
IN2

IN2
IN1=2

When would be a good time to reach [SAMPLE MEMBER]?
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
CALL BACK INFO

STRING OF 20

1
Prepared by Mathematica Policy Research, Inc.

END

(REV—4/25/06)

IN3
IN1=1
FATHER NAME IF FEMALE; MOTHER NAME IF MALE

(My name is [NAME] and I’m calling from Mathematica Policy Research,
Inc., a research company in Princeton, New Jersey.) I’m calling you about
the Building Strong Families study you joined a year and a half ago.
You may have a received a letter recently to let you know that we would be
calling you?
When you joined the study, you and [FATHER NAME/MOTHER NAME]
each completed a short questionnaire. At that time, we told you that we
would be contacting each of you again to learn how you are doing.
The interview will take about 45 minutes and you will receive $25 for
completing the interview. Everything that you tell me is completely
confidential. Because we want to get your opinion, it is important that you
answer the questions independently without participation from others. Of
course, you can share with others your experiences answering the
questions after we have completed the interview.
This interview may be taped so my supervisor can monitor the interview
and make sure that the questions are asked correctly.
Is now a good time to start?
OK TO CONTINUE
NOT A GOOD TIME

1
2

IN5
IN4

IN4
IN3=2

When would be a good time to do the interview?
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
CALL BACK INFO

STRING OF 20

2
Prepared by Mathematica Policy Research, Inc.

END

(REV—4/25/06)

IN5
IN3=1

I just need to verify that I am speaking with the correct person. What is
your date of birth?
RESP. BIRTHDAY
DK
REF

MM/DD/YYYY
d
r

FS1
IN6
IN6

IN6
IN5=BIRTHDATE INCORRECT, d OR r

And what are the last 4-digits of your Social Security Number?
RESP. 4-DIGIT SSN
DK
REF

FF
d
r

FS1
IN7
IN7

IN7
IN6=SSN INCORRECT, d OR r

I’m sorry. I need to check my records before I can interview you. Is this
the best time to reach you in the future?
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
YES
NO, CALL BACK INFO

1
STRING OF 20

3
Prepared by Mathematica Policy Research, Inc.

END
END

(REV—4/25/06)

SECTION FS: FAMILY STRUCTURE
FS1
ALL

Before we get started I would like to make sure we have your name
recorded correctly?
What is your first name?
PROBE: Can you spell that for me please?
FIRST NAME OF
RESPONDENT

STRING OF 20

FS2

FS2
ALL

And what is your middle name?
PROBE: Can you spell that for me please?
INSTRUCTION: IF NO MIDDLE NAME, ENTER ZERO.
MIDDLE NAME OF
RESPONDENT

STRING OF 20

FS3

FS3
ALL

And your last name please?
PROBE: Can you spell that for me please?
LAST NAME OF
RESPONDENT

STRING OF 20

4
Prepared by Mathematica Policy Research, Inc.

FS4

(REV—4/25/06)

FS4
ALL

Are you usually called [RESP FIRST NAME] or do you go by another
name?
INSTRUCTION:

IF DIFFERENT NAME, CHANGE TO USUAL NAME WHICH WILL
BE USED AS FILL IN THE REMAINDER OF SURVEY.

PROBE: Can you spell that for me please?
FATHER/MOTHER
USUAL FIRST NAME

STRING OF 20

FS5 OR
FS7

FS5
If not pregnant at baseline (NOTPREG)
FATHER NAME IF FEMALE/MOTHER NAME IF MALE

Our records indicate that you and [FATHER NAME/MOTHER NAME] had a
baby on [BASELINE CHILD BDATE]. Is that correct?
INSTRUCTION:

IF RESPONDENT REPORTS MULTIPLE BIRTHS, ENTER “YES.”
YES
NO, OTHER DATE
NO, BABY DIED

1
2
3

FS6.1
FS6
BOX 1

FS6
IF NOTPREG AND FS5=NO, OTHER DATE

When did you and [FATHER NAME/MOTHER NAME] have the baby?
CHILD BIRTHDAY

MM/DD/YYYY

5
Prepared by Mathematica Policy Research, Inc.

FS6.1

(REV—4/25/06)

FS6.1
IF NOTPREG AND FS5=YES
FATHER NAME IF MALE/MOTHER NAME IF FEMALE
INSTRUCTION:

ENTER WITHOUT ASKING IF ALREADY KNOWN.

And you and [FATHER NAME/MOTHER NAME] had just one baby on
[CHILD BDATE]?
INSTRUCTION:
INSTRUCTION:

IF “NO” PROBE FOR NUMBER OF BABIES.
IF “YES” ENTER ONE.
NUMBER OF BABIES
DK
REF

FF
d
r

FS10

FS7
If pregnant at baseline (PREG)
FATHER NAME IF FEMALE/MOTHER NAME IF MALE

Our records indicate that you and [FATHER NAME/MOTHER NAME] were
expecting a baby around [BASELINE CHILD EXPECTED DELIVERY
DATE].
Did you have a baby around that time?
INSTRUCTION:

IF RESPONDENT REPORTS DATE OF BIRTH, ANSWER “YES”
AND ENTER DATE OF BIRTH ON NEXT SCREEN.

INSTRUCTION:

IF RESPONDENT REPORTS MULTIPLE BIRTHS, ENTER “YES.”
YOU WILL ENTER NUMBER OF BABIES ON ANOTHER SCREEN.

IF RESPONDENT ANSWERS NO, PROBE: I’m sorry. What happened?
YES
NO, MISCARRIAGE
NO, ABORTION
NO, BABY DIED
DK
REF

1
2
3
4
d
r

6
Prepared by Mathematica Policy Research, Inc.

FS8
BOX 1

(REV—4/25/06)

BOX 1: IF FS5=3 OR FS7=2,3,4
DO NOT ASK IF NOT ALREADY INDICATED
FS8 to FS17.6 AND FS42 TO FS46.1
CO1 TO CO4
WB0 (IF NO OTHER CHILDREN)
PA1 TO PA13

FS8
IF PREG AND FS7=YES
FATHER NAME IF MALE/MOTHER NAME IF FEMALE

So, on what date was the baby born?
INSTRUCTION:

ENTER RESPONSE WITHOUT ASKING IF KNOWN.
BIRTHDAY

MM/DD/YYYY

FS9

FS9
IF PREG AND FS7=YES
FATHER NAME IF FEMALE/MOTHER NAME IF MALE
INSTRUCTION:

ENTER WITHOUT ASKING IF ALREADY KNOWN.

And you and [FATHER NAME/MOTHER NAME] had just one baby on
[CHILD BDATE]?
INSTRUCTION:
INSTRUCTION:

IF “NO” PROBE FOR NUMBER OF BABIES.
IF “YES” ENTER ONE.
NUMBER OF BABIES
DK
REF

FF
d
r

7
Prepared by Mathematica Policy Research, Inc.

FS10

(REV—4/25/06)

FS10
ALL
oldest or first born IF FS9>1 or FS6.1>1
(IF FS9>1 or FS6.1>1) For the rest of the interview, we will ask questions only

about the first born or oldest baby that you had on [CHILD BDATE].
What is the first name of this baby?
FIRST NAME OF
CHILD

STRING OF 20

FS12

FS12
ALL

What is [CHILD]’s middle name?
INSTRUCTION:

IF NO MIDDLE NAME ENTER ZERO.
MIDDLE NAME OF
CHILD

STRING OF 20

FS13

STRING OF 20

FS17

FS13
ALL

And [CHILD]’s last name is?
LAST NAME OF CHILD

FS17
ALL

Is [CHILD] male or female?
INSTRUCTION:

DO NOT ASK IF ALREADY KNOWN.
MALE
FEMALE

1
2

8
Prepared by Mathematica Policy Research, Inc.

FS17.1

(REV—4/25/06)

FS17.1
ALL
him IF FS17=CMALE; her IF FS17=CFEMALE DON’T KNOW THIS YET

I want to make sure that we use [CHILD]’s correct first name. Do you call
[him/her] [CHILD] or do you usually call [him/her] by a different name?
INSTRUCTION:

IF DIFFERENT NAME, CHANGE TO USUAL NAME WHICH WILL
BE USED AS FILL IN THE REMAINDER OF SURVEY.
USUAL FIRST NAME
OF [CHILD]

STRING OF 20

FS17.3

FS17.3
IF FEMALE
he if CMALE; she if CFEMALE

At the time [he/she] was born, how much did [CHILD] weigh?
PROBE: You can tell me in pounds and ounces or in kilograms.
INSTRUCTION:

FIRST ENTER IF ANSWER IS IN POUNDS AND OUNCES OR
KILOGRAMS. YOU WILL ENTER THE WEIGHT ON THE NEXT
SCREEN.
POUNDS AND
OUNCES
KILOGRAMS
DK
REF

1

FS17.4

2
d
r

FS17.6
FS19

FS17.4
IF FS17.3=1 (pounds and ounces)
INSTRUCTION:

ENTER NUMBER OF POUNDS.
POUNDS

FF

9
Prepared by Mathematica Policy Research, Inc.

FS17.5

(REV—4/25/06)

FS17.5
IF FS17.3=1 (pounds and ounces)
INSTRUCTION:

ENTER NUMBER OF OUNCES.
OUNCES

FF

FS19

FS17.6
IF FS17.3=2 (kilograms)
INSTRUCTION:

ENTER NUMBER OF KILOGRAMS.
KILOGRAMS

FF.FF

FS19

FS19
ALL
he IF FEMALE; she IF MALE
father’s IF FEMALE; mother’s IF MALE

I want to make sure that I use [FIRST NAME OF FATHER
NAME/MOTHER NAME] correct first name? Is [he/she] usually called
[FIRST NAME OF FATHER NAME/MOTHER NAME] or does [he/she] go
by a different first name?
INSTRUCTION:

IF DIFFERENT NAME, CHANGE TO USUAL NAME WHICH WILL
BE USED AS FILL IN THE REMAINDER OF SURVEY.

INSTRUCTION:

IF RESPONDENT REPORTS THAT FATHER DIED CODE ‘98’
USUAL FIRST NAME
OF [FATHER/MOTHER]

STRING OF 20

10
Prepared by Mathematica Policy Research, Inc.

FS25
(IF ‘98’
BOX2)

(REV—4/25/06)

FS25
ALL
FATHER IF FEMALE; MOTHER IF MALE

The next questions are about you and [FATHER/MOTHER].
Are you and [FATHER/MOTHER]…
Married,
Divorced,
Separated, or
Have you never been married to each other?
MARRIAGE ANNULLED
WIDOWED
PARTNER DIED
DK
REF

1
2
3
4
5
6
7
d
r

FS33
FS26
FS26
FS26
FS26
BOX 2
FS26

BOX 2: IF FS19=‘98’ OR FS25=6 OR FS26=7 (FATHER/MOTHER died)
DO NOT ASK IF NOT ALREADY INDICATED
FS25 TO FS33.2.3
FS43.1 TO FS46.1
RR1 TO RR11
PA11.1 TO PA13
WW25.1 TO WW30

11
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

FS26
if FS25<>1
FATHER IF FEMALE; MOTHER IF MALE

Which of the following statements best describes your current relationship
with [FATHER/MOTHER]?
FS27

We are romantically involved on a steady
basis,
We are involved in an on-again and off-again
relationship, or
We are not in a romantic relationship.

1

3

FS26.1

DK
REF

d
r

FS27

2

FS26.1
IF FS26=3 (no relationship)
FATHER IF MALE/MOTHER IF FEMALE

When did your romantic relationship with [FATHER/MOTHER] end?
PROBE: Just the month and year is fine.
INTERVIEWER:

CODE 99/9999 IF RESPONDENT ANSWERS THAT THEY WERE
NEVER IN A RELATIONSHIP.
DATE END
RELATIONSHIP

MM/YYYY

12
Prepared by Mathematica Policy Research, Inc.

FS26.2

(REV—4/25/06)

FS26.2
IF FS26=3 (no relationship)
him IF FEMALE; her IF MALE

I am going to read you a list of reasons that people give for why their
relationships ended. For each reason, tell me if this is why your
relationship with [FATHER/MOTHER] ended.
(For a thru f) Was it because you, [FATHER/MOTHER], or both of you…
(For g through i) Was it because…
(IF YES FOR A THRU F)

Was that you,
[FATHER/MOTHER] or
both of you?
a

Cheated or were unfaithful?

YES

1

YOU

b

Went to jail or prison?

NO
YES

0
1

YOU

c

Were abusive or violent?

NO
YES

0
1

YOU

d

Used drugs or alcohol?

NO
YES

0
1

YOU

NO
YES

0
1

YOU

NO
YES

0
1

YOU

NO

0

e

f

Could not keep a job or
contribute enough
financially to the family?
Were not a good parent or
role model?

13
Prepared by Mathematica Policy Research, Inc.

1
[FATHER/MOTHER] 2
BOTH
3
1
[FATHER/MOTHER] 2
BOTH
3
1
[FATHER/MOTHER] 2
BOTH
3
1
[FATHER/MOTHER] 2
BOTH
3
1
[FATHER/MOTHER] 2
BOTH
3
1
[FATHER/MOTHER] 2
BOTH
3

(REV—4/25/06)

g

The two of you were not
communicating well or were
arguing too much?

h

Of lack of support from
family members?

i

You and
[FATHER/MOTHER] were
living too far apart?

j

Were there any other
reasons why your romantic
relationship ended?

YES

1

NO
YES

0
1

NO
YES

0
1

NO
YES

0
1

FS26.3

NO

0

FS27 OR FS33

FS26.3
IF FS26.2J=YES

What were those other reasons?
INSTRUCTION: RECORD RESPONSE VERBATIM
REASONS RELATIONSHIP
ENDED

STRING OF 100

FS27 OR FS33

FS27
IF FS25=4 (never been married to each other)
FATHER IF FEMALE; MOTHER IF MALE

What do you think the chances are you will marry [FATHER/MOTHER] in
the future…
No chance,
A little chance,
A 50-50 chance,
A pretty good chance, or
An almost certain chance?
DK
REF

0
1
2
3
4
d
r

14
Prepared by Mathematica Policy Research, Inc.

FS33
FS28

(REV—4/25/06)

FS28
IF FS27<>0, DK
FATHER IF FEMALE; MOTHER IF MALE

Are you and [FATHER/MOTHER] engaged to be married?
YES
NO
DK
REF

1
0
d
r

FS29
FS33

FS29
IF FS28=YES

When are you planning to get married?
DATE OF PLANNED
WEDDING
DK/NO DATE YET
REF

MM/YYYY

FS33

d
r

FS33
ALL
FATHER IF FEMALE; MOTHER IF MALE

Do you currently live with [FATHER/MOTHER] in the same household…
All of the time,
Most of the time,
Some of the time, or
None of the time?
DK
REF

1
2
3
4
d
r

15
Prepared by Mathematica Policy Research, Inc.

FS42
FS33.2

(REV—4/25/06)

FS33.2
IF FS33>2
FATHER IF FEMALE; MOTHER IF MALE

How often do you and [FATHER/MOTHER] see or talk to each other? Is
it…
Every day or almost every day,
A few times a week,
A few times a month,
Only a few times in the past year, or
Hardly ever or never?
DK
REF

FS42 OR
FS37

1
2
3
4
5
d
r

FS33.2.1

FS33.2.1
OPTION1: FS33<>1,2,3 (not living together at all) AND FS25 =1 (married)
OPTION 2: IF FS26=1,2 (romantically involved) AND FS33.2<>1,2,3 (seeing each a
less than a few times)
FATHER IF FEMALE; MOTHER IF MALE

IF OPTION 1: Are you and [FATHER/MOTHER] not living together
because you are not getting along or is there another reason?
IF OPTION 2: Are you and [FATHER/MOTHER] not seeing each other
very much because you are not getting along or is there another reason?
NOT GETTING ALONG
ANOTHER REASON
DK
REF

1
2
d
r

16
Prepared by Mathematica Policy Research, Inc.

FS42
FS33.2.2
FS42

(REV—4/25/06)

FS33.2.2
FS33.2.1=2 AND
OPTION1: FS33<>1,2,3 (not living together at all) AND FS25 =1 (married)
OPTION 2: IF FS26=1,2 (romantically involved) AND FS33.2<>1,2,3 (seeing each a
less than a few times)
FATHER IF FEMALE; MOTHER IF MALE

IF OPTION 1: Why are you and [FATHER/MOTHER] not living together
now?
IF OPTION 2: Why are you and [FATHER/MOTHER] not seeing each
other very much?
INSTRUCTION: PROBE FOR MORE THAN ONE ANSWER.
a
b
c
d
e
f
g

PARTNER IS INCARCERATED
RESPONDENT
INCARCERATED
PARTNER IN MILITARY
RESPONDENT IN MILITARY
PARTNER’S WORK
RESPONDENT’S WORK
OTHER REASON
DK
REF

YES NO
YES NO
YES
YES
YES
YES
YES
d
r

NO
NO
NO
NO
NO

FS42

FS33.2.3
FS42

FS33.2.3
IF FS33.2.2=g
INSTRUCTION:

SPECIFY OTHER
REASON

17
Prepared by Mathematica Policy Research, Inc.

FS42

(REV—4/25/06)

FS37
IF FS25<>(1) (not married) and FS26<>(1,2) (not romantically involved) OR ASK
IF FS33.2.1=1
FATHER IF FEMALE; MOTHER IF MALE

Are you currently involved in a romantic relationship with someone other
than [FATHER/MOTHER]?
YES
NO
DK
REF

1
0
d
r

FS38
FS42

FS38
IF FS37=YES

What is your current partner’s first name?
INSTRUCTION:

IF RESPONDENT INDICATES MORE THAN ONE CURRENT
PARTNER, PROBE FOR NAME OF MAIN OR PRIMARY CURRENT
PARTNER.
FIRST NAME OF
PARTNER

STRING OF 20

FS38.1

FS38.1
IF FS37=YES AND FS25<>1,3 (if not married or not separated)

Are you currently married to [CURRENT PARTNER]?
YES
NO
DK
REF

1
0
d
r

18
Prepared by Mathematica Policy Research, Inc.

FS40

(REV—4/25/06)

FS40
IF FS37=YES

Do you currently live with [CURRENT PARTNER] in the same household…
All of the time,
Most of the time,
Some of the time, or
None of the time?
DK
REF

1
2
3
4
d
r

FS42

FS42
ALL

Next, I have some questions about [CHILD].
Do you currently live with [CHILD] in the same household…
All of the time,
Most of the time,
Some of the time, or
None of the time?
DK
REF

1
2
3
4
d
r

FS43
FS42.2

FS42.2
IF FS42=most of the time (2), some of the time (3), OR none of the time (4)
he if CMALE; she if CFEMALE
(IF FS42 =2 or 3) When [he/she] is not living with you,

(W/w)ho does [CHILD] live with?
FATHER/MOTHER
GRANDPARENT(S)
OTHER RELATIVES(S)
ADOPTIVE PARENTS
FOSTER PARENTS
FRIEND(S)
SOMEONE ELSE
DK
REF

1
2
3
4
5
6
7
d
r

19
Prepared by Mathematica Policy Research, Inc.

FS42.3
OR FS43

FS42.2.1
FS42.3
OR FS43

(REV—4/25/06)

FS42.2.1
IF FS42.2=7
INSTRUCTION:

PROBE FOR RELATIONSHIP OF THIS PERSON TO CHILD.
DESCRIBE OTHER
PERSON

STRING OF 501

FS42.3
OR
FS43

FS42.3
FS42=None of the time (4)

Did you and [CHILD] ever live together in the same household?
YES
NO
DK
REF

1
0
d
r

FS43
FS45

FS43
If FS42=all, most, some of the time (1,2,3) OR IF FS42.3=YES
him IF FS17=MALE; her if FS17=FEMALE

Since [CHILD] was born, how many months have you lived with [him/her] in
the same household?
INSTRUCTION:

IF LESS THAN 1 MONTH, ENTER 1 MONTH.

INSTRUCTION:

IF RESPONDENT ANSWERS “ALL THE TIME,” ENTER [NUMBER
OF MONTHS SINCE CHILD BDATE].
NUMBER OF
MONTHS
DK
REF

FF
d
r

20
Prepared by Mathematica Policy Research, Inc.

FS43.1

(REV—4/25/06)

FS43.1
If FS42=all, most, some of the time (1,2,3) OR IF FS42.3=YES
him IF FS17=MALE; her if FS17=FEMALE

Since [CHILD] was born, how many months have you lived in the same
household with both [him/her] and [FATHER/MOTHER]?
INSTRUCTION:

IF LESS THAN 1 MONTH, ENTER 1 MONTH.

INSTRUCTION:

IF RESPONDENT ANSWERS “ALL THE TIME,” ENTER
[CALCULATED NUMBER OF MONTHS SINCE CHILD BDATE].
NUMBER OF
MONTHS
DK
REF

FF
d
r

FS45 OR
FS46.1
OR FS50

FS45
IFS42=3, 4 ( living with child some or none of the time)

Have you seen [CHILD] in the past month?
YES
NO
DK
REF

1
0
d
r

FS46.1 OR
FS50

FS46.1
FS42.2<>1 or NOT (FS33=1 AND FS42=1) (skip if respondent lives with mother/father
and also child)

Has [FATHER/MOTHER] seen [CHILD] in past month?
YES
NO
DK
REF

1
0
d
r

21
Prepared by Mathematica Policy Research, Inc.

FS50

(REV—4/25/06)

FS50
ALL
had IF FEMALE; fathered IF MALE
(IF FS5=3 OR FS7=4) Since your baby died, have you [had/fathered] another

baby or are you expecting a baby now?
(IF FS7=3) Since the abortion, have you [had/fathered] another baby or are

you expecting a baby now?
(IF FS7=2) Since the miscarriage, have you [had/fathered] another baby or

are you expecting a baby now?
(ELSE) Since [CHILD] was born, have you [had/fathered] another baby or

are you expecting a baby now?
INSTRUCTION:

PROBE FOR ENOUGH DETAIL TO CODE CORRECT ANSWER.

(IF FS6.1>1 OR FS9>1) DON’T COUNT THE OTHER BABIES BORN AT THE SAME
TIME AS [CHILD].
YES, HAD ANOTHER BABY
YES, EXPECTING A BABY NOW
YES, HAD ANOTHER BABY AND IS
EXPECTING A BABY
NO
MISCARRIAGE/STILL BIRTH/ABORTION/
VOLUNTEERED
DK
REF

1
2
3

FS51
FS51.1
FS51

4
5

FS53

d
r

FS51
IF FS50=YES (1,3)
have IF FEMALE; father IF MALE

How many babies did [you/FATHER] have?
NUMBER OF BABIES
DK
REF

FF
d
r

22
Prepared by Mathematica Policy Research, Inc.

FS52 OR
FS51.1

(REV—4/25/06)

FS51.1
IF FS50=YES (2,3)

Are you expecting just one baby now?
YES
NO
DK
REF

1
0
d
r

FS51.1
FS52

FF
d
r

FS52

FS51.2
IF FS51=YES

How many babies are you expecting?
NUMBER OF BABIES
DK
REF

FS52
IF FS50=1, 2, or 3
this baby IF FS51=1 OR FS51.1=YES AND FS50<>3;
of these babies baby IF FS51>1 OR FS51.1=NO OR FS50<>3
FATHER IF FEMALE; MOTHER IF MALE
father IF MALE; mother IF FEMALE

Is [FATHER/MOTHER] the [father/mother] of [this baby/of these babies]?
YES
YES, BUT NOT OF ALL
BABIES
NO
DK
REF

1
2
0
d
r

23
Prepared by Mathematica Policy Research, Inc.

FS53

(REV—4/25/06)

FS53
ALL

Now I have some questions about people in your household.
Altogether, how many children under 18 live with you all or most of the
time? Include all children, even if they are not your own.
(IF FS42>1,2 AND FS5<>3 OR FS 7=1) Please include [CHILD] in your answer.
NUMBER OF CHILDREN
DK
REF

FF
d
r

FS54
FS55
FS55

FS54
IF FS53>0
(or [FATHER/MOTHER/CURRENT PARTNER]) IF FS33=1,2 OR FS 40=1,2
FATHER IF FEMALE; MOTHER IF MALE
(IF FS53>1) How many of these [ANSWER IN FS53] children are you [or

[FATHER/MOTHER/CURRENT PARTNER] primarily responsible for?
(IF FS53=1) Are you [or [FATHER/MOTHER/CURRENT PARTNER] the

adult(s) who are primarily responsible for this child?
INSTRUCTION:

IF ‘YES’ ENTER 1.

NUMBER OF CHILDREN
DK
REF

FF
d
r

24
Prepared by Mathematica Policy Research, Inc.

FS54.15

(REV—4/25/06)

FS54.1
IF FS42=1 or 2 (respondent living with child all or most of the time)
([FATHER/MOTHER/CURRENT PARTNER]) IF FS33=1,2 OR FS 40=1,2

Besides [FATHER/MOTHER/CURRENT PARTNER], are there other adults
living with you who are related to [CHILD]?
YES
NO
DK
REF

1
0
d
r

FS54.2
FS55

1
0
d
r

FS55

FS54.2
IF FS54.1=YES

Are any of these other adults employed?
YES
NO
DK
REF

FS55
ALL

Next, I have some questions about marriage.
CONTINUE

FS56 OR FS66

25
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

FS56
IF FS25= 1,2,3,5,6 (married, separated, divorced, annulled, widowed)
are IF FS25=1 (married); were IF FS25=3,2,5,6 (separated, divorced, annulled,
widowed)
FATHER IF FEMALE; MOTHER IF MALE

You previously told me that you [are/were] married to
[FATHER/MOTHER]?
When did you get married to [FATHER/MOTHER]?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR.
DATE OF MARRIAGE
DK
REF

MM//YYYY
d
r

FS59,
FS56.1OR
FS66

FS56.1
IF FS25=3 (separated)
FATHER IF FEMALE; MOTHER IF MALE

And when did you get separated from [FATHER/MOTHER]?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR.
DATE OF
SEPARATION
DK
REF

MM//YYYY
d
r

26
Prepared by Mathematica Policy Research, Inc.

FS59
OR
FS66

(REV—4/25/06)

FS59
IF FS25=divorced (2) OR FS25=annulled (5) OR FS25=6 (widowed) OR FS25=7
(partner died)
FATHER IF FEMALE; MOTHER IF MALE
(IF FS25=2) When did the divorce become final?
(IF FS25=5) When did the annulment take place?
(IF FS25=6) When did [FATHER/MOTHER] pass away?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR.
DATE OF END OF
MARRIAGE
DK
REF

MM/YYYY
d
r

FS66
OR
FS60

FS60
IF FS38.1=YES

You previously told me that you are married to [CURRENT PARTNER].
When did you get married to [CURRENT PARTNER]?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR.
DATE OF MARRIAGE
DK
REF

MM//YYYY
d
r

27
Prepared by Mathematica Policy Research, Inc.

FS66

(REV—4/25/06)

FS66
ALL
to someone else besides [FATHER/MOTHER] IF FS25=1,2,3,5,6 or FS38.1=YES
FATHER IF FEMALE
MOTHER IF MALE
and IF FS25=1,2,3 AND FS38.1=YES
Your current your partner, [CURRENT PARTNER] IF FS38.1=YES

Have you ever been married [to someone else besides
[FATHER/MOTHER] [and] [your current your partner, [CURRENT
PARTNER]?
YES
NO
DK
REF

1
0
d
r

FS67
NEXT
SECTION

FS67
IF FS66=YES
to someone else besides [FATHER/MOTHER] IF FS25=1,2,3,5,6 or FS38.1=YES
FATHER IF FEMALE
MOTHER IF MALE
and IF FS25=1,2,3 AND FS38.1=YES
your current partner, [CURRENT PARTNER] IF FS38.1=YES

How many times have you been married [to someone else besides
[FATHER/MOTHER] [and] [your current partner, [CURRENT PARTNER]?
NUMBER OF
MARRIAGES
DK
REF

FF
d
r

28
Prepared by Mathematica Policy Research, Inc.

FS68

(REV—4/25/06)

LOOP FOR EACH MARRIAGE IN FS67
FS68
IF FS66=YES
(to someone else) IF FS25=1,2,3,5,6 OR FS38.1=YES
COUNTER=NUMBER IN LOOP (first, second, third, etc.) IF FS67>1
Thinking about the [COUNTER] marriage IF FS67>1
a

Thinking about
the [COUNTER]
marriage (to
someone else),
when did you get
married?

DATE OF MARRIAGE

MM/YYYY

DK

d

REF

r

b

(IF FS25<>1 OR YES
1
FS38.1=NO**)
Are you still
married to this
person?
NO
0
c Did this marriage DIVORCE
1
end through
ANNULMENT
2
divorce or
SPOUSE DIED
3
annulment, or did DK
d
your spouse
REF
r
pass way?
d (IF FS68c=1)
DATE MARRIAGE ENDED
MM/YYYY
When did the
divorce become
final?
(IF FS68c=2)
When did the
annulment take
place?
(IF FS68c=3)
When did your
spouse pass
away?
**Questions should also be skipped if previous answer in b=yes

FS68-b
OR
FS68-c

NEXT IN
LOOP
OR NEXT
SECTION
FS68-c
FS68-d

NEXT IN
LOOP
OR NEXT
SECTION

END LOOP FOR EACH MARRIAGE

29
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

SECTION CO: INVOLVEMENT WITH CHILD
CO1
IF FS<>19=’98’ OR FS25<>6,7 (father alive)
FATHER IF FEMALE; MOTHER IF MALE
father IF FEMALE; mother IF MALE
he if CMALE; she IF CFEMALE

The following statements are about [FATHER/MOTHER]’s and your
involvement in the care of [CHILD].
For each statement, please answer if you strongly agree, agree, are not
sure, disagree, or strongly disagree.
[STATEMENT a to o] Do you strongly agree, agree, are not sure, disagree, or

strongly disagree with this statement?
STRONGLY
NOT
STRONGLY
AGREE
AGREE SURE DISAGREE DISAGREE DK REF
a

b

c

d

e

f

g

I believe
[FATHER/MOTHER]
is a good parent.
[FATHER/MOTHER]
and I communicate
well about [CHILD].
I feel good about
[FATHER/MOTHER]’s
judgment about what
is right for [CHILD].
[FATHER/MOTHER]
makes my job of
being a parent easier.
[FATHER/MOTHER]
and I are a good
team.
[FATHER/MOTHER]
knows how to handle
children well.
When there is a
problem with [CHILD],
we work out a good
solution together.

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

30
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

STRONGLY
NOT
STRONGLY
AGREE
AGREE SURE DISAGREE DISAGREE DK REF
h

[FATHER/MOTHER]
is willing to make
personal sacrifices to
help take care of
[CHILD].
i
Talking to
[FATHER/MOTHER]
about [CHILD] is
something I look
forward to.
j
[FATHER/MOTHER]
pays a great deal of
attention to [CHILD].
k I am satisfied with the
responsibility
[FATHER/MOTHER]
takes for raising
[CHILD].
l
[FATHER/MOTHER]
is committed to being
there for [CHILD].
m [CHILD] needs
[FATHER/MOTHER]
just as much as
[he/she] needs me.
n No matter what might
happen between
[FATHER/MOTHER]
and me, when I think
of [CHILD]’s future, it
includes
[FATHER/MOTHER].
o [FATHER/MOTHER]
is the type of
[father/mother] I want
for [CHILD].

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

5

4

3

2

1

d

r

31
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LOOP FOR CO2
y RESPONDENT ABOUT THEMSELVES IF FS45<>NO (contact with child in past
month).
y FEMALE RESPONDENT ABOUT FATHER IF FS45<> NO AND IF FS46.1 <> NO
(contact of father with child in past month) AND IF FS<>19=’98’ OR FS25<>6,7
(father alive).
you IF RESPONDENT; FATHER FEMALE ABOUT MALE;
have IF RESPONDENT; has IF FEMALE ABOUT MALE
(IF COUNTER=1) The next question is about time [you/FATHER] spend[s]

with [CHILD].
In the past month, how often [have/has] [you/FATHER] spent one or more
hours a day with [CHILD]? Was it…
Everyday or almost every day,
A few times a week,
A few times in the past month,
Once or twice, or
Never?
DK
REF

1
2
3
4
5
d
r

32
Prepared by Mathematica Policy Research, Inc.

CO3

(REV—4/25/06)

END LOOP CO2
CO3
FS45<> NO (no contact with child in past month)
IF FEMALE ONLY, ASK a THRU e.
him If CMALE; her IF CFEMALE

The next questions are about things you may have done with [CHILD] in
the past month.
In the past month, how often have you [STATEMENT a to h]? Was it more
than once a day, about once a day, a few times a week, a few times a
month, rarely, or not at all?
MORE
THAN ABOUT A FEW
A FEW
ONCE A ONCE A TIMES A TIMES A
NOT
DAY
DAY
WEEK MONTH RARELY AT ALL DK REF
a

b
c

d
e

f

Played
games like
“peek-a-boo”
or “gotcha”
with [CHILD].
Sung songs
with [CHILD].
Read or
looked at
books with
[CHILD].
Told stories
to [CHILD].
Played with
games or
toys with
[CHILD].
Helped
[CHILD] to
get dressed.

1

2

3

4

5

6

d

r

1

2

3

4

5

6

d

r

1

2

3

4

5

6

d

r

1

2

3

4

5

6

d

r

1

2

3

4

5

6

d

r

1

2

3

4

5

6

d

r

33
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

MORE
THAN ABOUT A FEW
A FEW
ONCE A ONCE A TIMES A TIMES A
NOT
DAY
DAY
WEEK MONTH RARELY AT ALL DK REF
g

h

Changed
[CHILD]’s
diapers or
helped
[him/her] use
the toilet.
Given
[CHILD] a
bottle or
something to
eat.

1

2

3

4

5

6

d

r

1

2

3

4

5

6

d

r

CO4

34
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LOOP FOR CO4
ASK QUESTION OF
y RESPONDENT: IF FS45<>NO (no contact with child in past month)
y RESPONDENT: ABOUT FATHER/MOTHER IF FS46.1 <> NO
(father/mother had no contact with child in past month)
y RESPONDENT: ABOUT CURRENT PARTNER: IF FS45<>NO AND IF FS37 = 1
(has current partner)

CO4
you IF COUNTER=1; IF COUNTER>1 AND FATHER IF FEMALE ABOUT FATHER;
MOTHER IF MALE ABOUT MOTHER; CURRENT PARTNER IF RESPONDENT
ABOUT CURRENT PARTNER
FILL1: she if MALE; he IF FEMALE
FILL 2: he if CMALE; she IF CFEMALE
have IF RESPONDENT ABOUT THEMSELVES; has IF RESPONDENT ABOUT
[FATHER/MOTHER/CURRENT PARTNER]
(IF COUNTER=1) Sometimes children behave pretty well and sometimes

they don’t. In the past month, how often have you spanked [CHILD]
because [he/she] was misbehaving or acting up?
(IF COUNTER>1) And what about [FATHER/MOTHER/CURRENT

PARTNER]? How often has [he/she] spanked [CHILD] in the past month
because [he/she] was misbehaving or acting up?
Did [you/FATHER/MOTHER/CURRENT PARTNER] do this…
Everyday or nearly every
day,
A few times a week,
A few times in the past
month,
Only once or twice in the
past month, or
Never?
DK
REF

1

END OF
SECTION

2
3
4
5
d
r

END LOOP CO4

35
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

SECTION RR: RELATIONSHIP
RR0
R=ALL

Next, I would like to have your opinion on a few statements about marriage.
Tell me if you strongly agree, agree, disagree, or strongly disagree with the
following statements…
STRONGLY
AGREE
AGREE
A

B

C

D

E

A single parent can
bring up a child just
as well as a
married couple.
It is better for a
couple to get
married than to just
live together.
There are very few
people who have
good and happy
marriages.
When a couple is
committed to each
other, it makes no
difference whether
they are married or
living together.
It is better for
children if their
parents are
married.

DISAGREE

STRONGLY
DISAGREE DK REF

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

RR0.1

36
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

RR0.1
ALL

Now I would like to ask you about your friends.
Do you strongly agree, agree, disagree, or strongly disagree with the
following statement:
Most of my friends are not ready to settle down.
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
DK
REF

1
2
3
4
d
r

RR1 or RR8

RR1
IF FS25=married (1) OR FS26=romantically involved (1) or on-again-off-again
relationship (2)
FATHER IF FEMALE; MOTHER IF MALE

Now I would like to ask about your relationship with [FATHER/MOTHER].
Taking all things together, on a scale from 0 to 10, where 0 is not at all
happy and 10 is completely happy, how happy would you say your
relationship with [FATHER/MOTHER] is?
PROBE: You can pick any number from 0 to 10.
COMPLETELY HAPPY

10
9
8
7
6
5
4
3
2
1
0
d
r

NOT AT ALL HAPPY
DK
REF

37
Prepared by Mathematica Policy Research, Inc.

RR1.1

(REV—4/25/06)

RR1.1
IF FS25=married (1) OR FS26=romantically involved (1) or on-again-off-again
relationship (2)
FATHER IF FEMALE; MOTHER IF MALE

In the past month, about how often did you and [FATHER/MOTHER] spend
time alone together—just the two of you—talking or sharing an activity?
Was it…
Everyday or almost every day,
A few times a week,
A few times in the past month,
Once or twice, or
Never?
DK
REF

1
2
3
4
5
d
r

38
Prepared by Mathematica Policy Research, Inc.

RR1.2

(REV—4/25/06)

RR2
IF FS25=1 (married) OR FS26=1 (romantically involved) OR 2 (on-again-off-again
relationship) OR FS33.2=1,2,3 (see each other at least a few times a month)
FATHER IF FEMALE; MOTHER IF MALE

Now, I am going to read you some statements about things couples may
experience when they are together. Tell me if this often happens,
sometimes happens, or rarely or never happens.
[STATEMENT a-dd] Does this often happen, sometimes happen, or rarely
or never happen?

a

b

e
j
x

m

n
q

v

When I have problems
[FATHER/MOTHER],
really understands
what I’m going through.
[FATHER/MOTHER]
blames me for things
that go wrong.
I feel appreciated by
[FATHER/MOTHER].
I feel respected even
when we disagree.
Even when arguing we
can keep a sense of
humor.
When we discuss
something,
[FATHER/MOTHER]
acts as if I am totally
wrong.
We are good at solving
our differences.
When we argue, one of
us is going to say
something we will
regret.
When we argue, I feel
personally attacked by
[FATHER/MOTHER].

OFTEN

SOMETIMES

RARELY
OR
NEVER

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

39
Prepared by Mathematica Policy Research, Inc.

DK

REF

(REV—4/25/06)

OFTEN

SOMETIMES

RARELY
OR
NEVER

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

1

2

3

d

r

3

2

1

d

r

3

2

1

d

r

3

2

1

d

r

3

2

1

d

r

DK

REF

w

During arguments, we
are good at taking
breaks when we need
them.
s
When we argue, I get
very upset.
y
We are pretty good
listeners, even when
we have different
positions on things.
z
[FATHER/MOTHER] is
good at calming me
when I get upset.
aa Little arguments turn
into ugly fights with
accusations, criticisms,
name calling or
bringing up past hurts.
bb [FATHER/MOTHER]
puts down my opinions,
feelings or desires.
cc [FATHER/MOTHER]
seems to view my
words or actions more
negatively than I mean
them to be.
dd When we argue, one of
us withdraws and
refuses to talk about it.

RR4

40
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

RR4
IF FS25=1 (married) OR FS26=1 (romantically involved) OR 2 (on-again-off-again
relationship) ASK: ALL ITEMS
FOR EVERYONE ELSE ONLY ASK: RRi, RRn, RRr, RRt, RRj RRq .
FATHER IF FEMALE; MOTHER IF MALE
him IF FEMALE; her IF MALE
FATHER IF FEMALE; MOTHER IF MALE

Tell me whether you strongly agree, agree, disagree, or strongly disagree
with the following statements.
[STATEMENT b-z] Do you strongly agree, agree, disagree, or strongly
disagree?

B

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

DK

REF

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

[FATHER/MOTHER]
and I often talk about

things that happen to
each of us during the
day.
C

I

J

N

o

[FATHER/MOTHER]
and I enjoy doing

even ordinary, dayto-day things
together.
[FATHER/MOTHER]
is honest and truthful
with me.
I can trust
[FATHER/MOTHER]
completely.
[FATHER/MOTHER]
can be counted on to
help me.
I may not want to be
with
[FATHER/MOTHER]
a few years from
now.

41
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

p

q

r

t
v

w

x

y

z

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

DK

REF

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

My relationship with
[FATHER/MOTHER]
is more important to
me than almost
anything else in my
life.
[FATHER/MOTHER]
knows and
understands me.
[FATHER/MOTHER]
listens to me when I
need someone to
talk to.
[FATHER/MOTHER]
respects me.
I want this
relationship to stay
strong no matter
what rough times we
may have.
[FATHER/MOTHER]
encourages or helps
me to do things that
are important to me.
[FATHER/MOTHER]
shows love and
affection for me.
I am satisfied with
my sexual
relationship with
[FATHER/MOTHER].
My friends and
relatives support my
relationship with
[FATHER/MOTHER]

RR8

42
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

RR8
ALL
FATHER IF FEMALE; MOTHER IF MALE
man IF FEMALE; woman IF MALE
before you became just friends IF FS26=3; your relationship ended IF FS26=4

Sometimes couples are not always faithful to each other. Since
[RA DATE], has [FATHER/MOTHER] cheated on you with someone else?
(IF FS26 <> TO 1 OR 2) Please think only about the time after RA DATE and

before your romantic relationship with MOTHER/FATHER ended.
Is that…
INSTRUCTION: IF RESPONDENT ANSWERS ‘DK’ DO NOT PROBE.
Definitely yes,
Probably yes,
Probably no, or
Definitely no?
DK
REF

1
2
3
4
d
r

RR9

RR9
ALL
FATHER IF FEMALE; MOTHER IF MALE
man IF FEMALE; woman IF MALE
before you became just friends IF FS26=3; your relationship ended IF FS26=4

Since [RA DATE], have you cheated on [FATHER/MOTHER] with someone
else?
(IF FS26 NOT EQUAL TO 1 OR 2) Please think only about the time after RA

DATE and before your relationship with [FATHER/MOTHER] ended.
YES
NO
DK
REF

1
0
d
r

RR10

43
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

RR10
IF FS25=1 (married) OR FS26=1 (romantically involved) OR 2 (on-again-off-again
relationship)
FATHER IF FEMALE; MOTHER IF MALE

Do you think [FATHER/MOTHER] will cheat on you in the future? Is that…
Definitely yes,
Probably yes,
Probably no, or
Definitely no?
DK
REF

1
2
3
4
d
r

RR11

RR11
IF FS25=1 (married) OR FS26=1 (romantically involved) OR 2 (on-again-off-again
relationship)
FATHER IF FEMALE; MOTHER IF MALE

Do you think you will cheat on [FATHER/MOTHER] in the future? Would
you say…
Definitely yes,
Probably yes,
Probably no, or
Definitely no?
DK
REF

1
2
3
4
d
r

44
Prepared by Mathematica Policy Research, Inc.

RR14

(REV—4/25/06)

Push or
shove you?

c

1

1

YES
1

0

0

NO
0

YES
YES

CURRENT PARTNER
Other partner

YES

Other partner(s)

YES

YES

CURRENT PARTNER
[FATHER/MOTHER]

YES

YES

Other partner(s)
[FATHER/MOTHER]

YES

[CURRENT PARTNER],

Prepared by Mathematica Policy Research, Inc.

b

Throw
something at
you that
could hurt?
Twist your
arm or hair?

a

46

1
1

NO
NO

1

1

NO
NO

1

NO

1

1

NO
NO

1

NO

(IF YES) Was it [FATHER/MOTHER],
[CURRENT PARTNER], or another
partner who did that to you?
[FATHER/MOTHER],
YES
NO

2

2

2

2

2

2

2

2

3

3

3

3

3

3

3

3

4

4

4

4

4

4

4

4

5

5

5

5

5

5

5

5

6

6

6

6

6

6

6

6

(IF YES) How often did [FATHER/MOTHER],
]CURRENT PARTNER], [this other partner] do this
in the past year? Was it…
More
than
20
3-5
6-10
11-20
times
times
times
times
Once
twice
1
2
3
4
5
6

r

r

r

r

r

r

r

r

REF
r

(REV—4/25/06)

d

d

d

d

d

d

d

d

DK
d

In the past year, did [FATHER/MOTHER], [CURRENT PARTNER] or another partner you were involved
with…

Next I’m going to read a list of things that might have happened to you in the past year. If any of these
things happened, please also tell me how often this happened in the past year.

RR14
ALL
FATHER IF FEMALE IF FS<>19=’98’ OR FS25<>6,7/MOTHER IF MALE AND IF FS<>19=’98’ OR FS25<>6,7
CURRENT PARTNER IF FS37=YES (respondent has current partner)
FATHER IF FEMALE; MOTHER IF MALE

Slap you?

Use
a knife or
gun on you?

Punch or hit
you with
something
that could
hurt?
Choke you?

Slam you
against the
wall?

Kick you?

e

f

g

i

j

1

1

1

1

1

1

YES
1

0

0

0

0

0

0

NO
0

YES

Other partner

47

YES

CURRENT PARTNER

YES

Other partner

YES

YES

CURRENT PARTNER

[FATHER/MOTHER]

YES

YES

Some other partner
[FATHER/MOTHER]

YES

CURRENT PARTNER

YES

Other partner

YES

YES

CURRENT PARTNER

[FATHER/MOTHER]

YES

YES

Other partner
[FATHER/MOTHER]

YES

CURRENT PARTNER

YES

Other partner
YES

YES

CURRENT PARTNER
[FATHER/MOTHER]

YES

YES

Other partner
[FATHER/MOTHER]

YES

CURRENT PARTNER

Prepared by Mathematica Policy Research, Inc.

h

Grab you?

d

NO

NO

1

1

1

1

NO
NO

1

NO

1

1

NO
NO

1

NO

1

1

NO

NO

1

NO

1

1

NO
NO

1

NO

1

1

NO
NO

1

NO

1

1

NO
NO

1

NO

(IF YES) Was it [FATHER/MOTHER],
[CURRENT PARTNER], or another
partner who did that to you?
[FATHER/MOTHER]
YES
NO

3

3

3

3

3

3

3

3

3

3

3

3

3

3

3

3

3

3

3

3

(REV—4/25/06)

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

4

5

5

5

5

5

5

5

5

5

5

5

5

5

5

5

5

5

5

5

5

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

(IF YES) How often did [FATHER/MOTHER],
]CURRENT PARTNER], [this other partner] do this
in the past year? Was it…
More
than
20
3-5
6-10
11-20
times
times
times
times
Once
twice
1
2
3
4
5
6

d

d

d

d

d

d

d

d

d

d

d

d

d

d

d

d

d

d

d

d

DK
d

r

r

r

r

r

r

r

r

r

r

r

r

r

r

r

r

r

r

r

r

REF
r

Burn or scald
you on
purpose?

Use threats
or force to
make you
have sex or
do sexual
things you
didn’t want to
do?

l

m

1

1

YES
1

0

0

NO
0

YES

Other partner

48

YES

CURRENT PARTNER

YES

Other partner
YES

YES

CURRENT PARTNER
[FATHER/MOTHER]

YES

YES

Other partner
[FATHER/MOTHER]

YES

CURRENT PARTNER

Prepared by Mathematica Policy Research, Inc.

Beat you up?

k

1
1

NO
NO

1

1

NO
NO

1

NO

1

1

NO
NO

1

NO

(IF YES) Was it [FATHER/MOTHER],
[CURRENT PARTNER], or another
partner who did that to you?
[FATHER/MOTHER]
YES
NO

3

3

3

3

3

3

3

3

RR15

(REV—4/25/06)

2

2

2

2

2

2

2

2

4

4

4

4

4

4

4

4

5

5

5

5

5

5

5

5

6

6

6

6

6

6

6

6

(IF YES) How often did [FATHER/MOTHER],
]CURRENT PARTNER], [this other partner] do this
in the past year? Was it…
More
than
20
3-5
6-10
11-20
times
times
times
times
Once
twice
1
2
3
4
5
6

d

d

d

d

d

d

d

d

DK
d

r

r

r

r

r

r

r

r

REF
r

RR15
ALL
FATHER IF FEMALE IF FS<>19=’98’ OR FS25<>6,7; MOTHER IF MALE IF
FS<>19=’98’ OR FS25<>6,7
CURRENT PARTNER IF FS37=YES (respondent has current partner

In the past year, did you need to see a doctor because of a fight with
MOTHER/FATHER, [CURRENT PARTNER] or another partner you were
involved with? Please, include times when you needed to see a doctor,
even if you didn’t go.
YES
NO
DK
REF

RR16

1
0
d
r

RR15.1
IF RR15=YES
FATHER IF FEMALE AND IF FS<>19=’98’ OR FS25<>6,7; MOTHER IF MALE IF
FS<>19=’98’ OR FS25<>6,7
CURRENT PARTNER IF FS37=YES (respondent has current partner)

Was that because of a fight with FATHER/MOTHER, [CURRENT
PARTNER], or another partner?
FATHER/MOTHER
CURRENT PARTNER
OTHER PARTNER(S)
DK
REF

YES
YES
YES

WB0

d
r

49
Prepared by Mathematica Policy Research, Inc.

NO
NO
NO

(REV—4/25/06)

SECTION WB: PARENTAL WELL BEING (I)
WB0
IF BASELINE Q20 PLUS BASELINE Q21 PLUS (FS9 minus 1) PLUS (FS6.1 minus 1)
PLUS 1 (IF FS50=1 OR 3) MINUS 1 (IF FS5=3 OR FS7=2,3,4) >0
children IF BASELINE Q20 PLUS BASELINE Q21 PLUS (FS9 minus 1) PLUS (FS6.1
minus 1) PLUS 1 (IF FS50=1 OR 3) MINUS 1 (IF FS5=3 OR FS7=2,3,4) >1;
child IF BASELINE Q20 PLUS BASELINE Q21 PLUS (FS9 minus 1) PLUS (FS6.1
minus 1) PLUS 1 (IF FS50=1 OR 3) MINUS 1 (IF FS5=3 OR FS7=2,3,4) =1

Now, I am going to read you a list of ways you might have felt in the past
month about being a parent.
During the past month, how often have you…
[STATEMENT a to d] Was it all of the time, most of the time some of the
time, or none of the time?

a

b

c

d

ALL OF
THE
TIME

MOST
OF
THE
TIME

1

Felt your (child/children)
[is/are] much harder to
care for than most?
Felt your (child
does/children do) things
that really bother you?
Felt you are giving up
more of your life to meet
your (child’s/children’s)
needs than you ever
expected?
Felt angry with your
(child/children)?

SOME
OF THE
TIME

NONE
OF
THE
TIME

DK

REF

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

WB1

50
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

WB1
ALL

Now, I am going to read you a list of ways you might have felt or behaved
during the past week. For each item on the list I will ask you how often you
felt this way.
During the past week… [STATEMENT A-T] Would you say that happened
rarely or none of the time; some of the time; a moderate amount of time; or
most or all of the time?
PROBE: Rarely or none of the time” would mean less than 1 day in the
past week; “some of the time” would mean 1 or 2 days in the past
week; “a moderate amount of time” would mean 3 or 4 days in
the past week; and “most of or all of the time” would mean 5 to 7
days in the past week.
STATEMENT

A

I was bothered by things that
usually don’t bother me.

B

I did not feel like eating; my
appetite was poor.
C I felt that I could not shake off
the blues even with help from
my family or friends.
E I had trouble keeping my mind
on what I was doing.
F I felt depressed.
G I felt that everything I did was
an effort.
J I felt fearful.
K My sleep was restless.
M I talked less than usual.
N I felt lonely.
R I felt sad.
T I could not get “going.”

Rarely
or none
of the
time

Some
of the
time

A moderate
amount of time

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1

2

3

4

d

r

1
1
1
1
1
1

2
3
4
d
2
3
4
d
2
3
4
d
2
3
4
d
2
3
4
d
2
3
4
d
IF 2 OR MORE ANSWERS IN A THRU T >1
WB2 ELSE WB4

51
Prepared by Mathematica Policy Research, Inc.

Most
or all
of
the
time DK REF

r
r
r
r
r
r

(REV—4/25/06)

WB2
IF 2 OR MORE ANSWERS IN A THRU T >1 IN WB1

In the past week, how difficult did these feelings or problems make it for
you to do your work or take care of things at home? Has it been…
Not at all difficult,
Somewhat difficult,
Very difficult, or
Extremely difficult?
DK
REF

1
2
3
4
d
r

WB3

WB3
IF 2 OR MORE ANSWERS IN A THRU T >1 IN WB1

And in the past week, how difficult have these feelings or problems made it
for you to get along with other people?
Not at all difficult,
Somewhat difficult,
Very difficult, or
Extremely difficult?
DK
REF

1
2
3
4
d
r

WB4

WB4
ALL
4 = AMOUNT IF FEMALE; 5 = AMOUNT IF MALE

The next question is about drinking alcoholic beverages. By a “drink” we
mean either a bottle of beer, a wine cooler, a glass of wine, a shot of liquor,
or a mixed drink.
In the past year, how many times have you had [AMOUNT] or more drinks
of alcohol in one day?
NUMBER OF TIMES
DK
REF

FF
d
r

52
Prepared by Mathematica Policy Research, Inc.

WB5

(REV—4/25/06)

WB5
ALL

In the past year, did you have any problems keeping a job or getting along
with family or friends because of your alcohol or drug use?
YES
NO
DK
REF

1
0
d
r

WB6 OR NEXT
SECTION

WB6
IF FS<>19=’98’ OR FS25<>6,7
FATHER IF FEMALE; MOTHER IF MALE
his IF FEMALE; her IF MALE

And what about [FATHER/MOTHER]? In the past year, did
[FATHER/MOTHER] have any problems keeping a job or getting along with
family or friends because of [his/her] alcohol or drug use?
YES

1

NO
DK
REF

0
d
r

53
Prepared by Mathematica Policy Research, Inc.

NEXT
SECTION

(REV—4/25/06)

SECTION SE: RECEIPT OF SERVICES
SE1
ALL
FATHER IF FEMALE; MOTHER IF MALE

The next questions are about programs you may have participated in since
[RADATE]; that is about [NUMBER OF MONTHS SINCE RA] ago.
Since [RADATE] have you attended any classes, workshops, or groups to
help you improve your relationship with [FATHER/MOTHER]? Please
include any marriage preparation classes you may have attended.
PROBE: Please only include help with your relationship you may have
received in a group, workshop, or class.
YES
NO
DK
REF

1
0
d
r

SE2
SE8

SE2
IF SE1=YES

About how many classes, workshops, or group sessions did you attend
since [RADATE]?
NUMBER OF SESSIONS
DK
REF

54
Prepared by Mathematica Policy Research, Inc.

FF
d
r

SE3

(REV—4/25/06)

SE3
IF SE1=YES
(IF SE2=1) About how long did the class, workshop or group session last?
(IF S2>1) About how long did each class, workshop or group session usually

last?
PROBE: In other words, how many hours did you meet each time?
NUMBER OF HOURS
DK
REF

FF
d
r

SE5

SE5
IF SE3=YES
(IF SE2=1) Did [FATHER/MOTHER] attend the class, workshop or group

session with you?
(IF SE2>1) Did [FATHER/MOTHER] usually attend the classes, workshops

or group sessions with you?
YES
NO
DK
REF

1
0
d
r

55
Prepared by Mathematica Policy Research, Inc.

SE8

(REV—4/25/06)

SE8
ALL

Since [RADATE], did you meet with a social worker, counselor, or clergy
member to work on your relationship with [FATHER/MOTHER] in sessions
that were not part of a workshop, class, or group?
PROBE: In other words, sessions that did not include other people
besides you and [FATHER/MOTHER].
YES
NO
DK
REF

1
0
d
r

SE8.1
SE10

SE8.1
IF SE8=YES

Since [RADATE], about how many times did you meet with this person to
work on your relationship?
NUMBER OF TIMES
DK
REF

FF
d
r

SE8.2

SE8.2
IF SE8=YES
(IF SE8.1=1) About how long did the session with this person last?
(IF SE8.1>1) About how long did each session with this person usually last?
NUMBER OF HOURS
DK
REF

FF
d
r

56
Prepared by Mathematica Policy Research, Inc.

SE9

(REV—4/25/06)

SE9
IF SE8=YES
(IF SE8.1=1) Did

[FATHER/MOTHER] attend the session with you?

(IF SE8.1>1) Did [FATHER/MOTHER] usually attend the sessions with you?
YES
NO
DK
REF

1
0
d
r

SE10

SE10
ALL

Since [RADATE], did you receive regular visits to your home from
someone working for an agency or program?
YES
NO
DK
REF

1
0
d
r

SE10.1
SE11

SE10.1
ALL

About how many home visits did you receive since [RADATE]?
PROBE: Your best estimate is fine.
PROBE: I can help you add it up if you want to think out loud.
NUMBER OF VISITS
DK
REF

FF
d
r

57
Prepared by Mathematica Policy Research, Inc.

SE11

(REV—4/25/06)

SE11
ALL

Since [RADATE], have you participated in any classes, groups, or
workshops to help you improve your parenting skills?
YES
NO
DK
REF

1
0
d
r

SE12

SE13
ALL

Since [RADATE], have you taken any classes to finish high school, get a
GED, or learn English?
YES
NO
DK
REF

1
0
d
r

SE14

SE14
ALL

Since [RADATE], have you participated in a job training program?
YES
NO
DK
REF

1
0
d
r

58
Prepared by Mathematica Policy Research, Inc.

FS15

(REV—4/25/06)

SE15
ALL

Since [RADATE], have you participated in a program to help you find a job?
YES
NO
DK
REF

1
0
d
r

SE19

SE19
ALL

Since [RADATE], have you received services to help you with anger
management or domestic violence?
YES
NO
DK
REF

1
0
d
r

59
Prepared by Mathematica Policy Research, Inc.

SE20

(REV—4/25/06)

SE20
ALL

Since [RADATE], have you received services to help you deal with a
mental health, alcohol or substance use problem?
YES
NO
DK
REF

1
0
d
r

60
Prepared by Mathematica Policy Research, Inc.

END OF
SECTION

(REV—4/25/06)

SECTION PA: PATERNITY AND CHILD SUPPORT
PA1
NOT MARRIED AT BIRTH
you IF MALE; FATHER IF FEMALE
are IF MALE; is IF FEMALE

My next questions are about the legal arrangements you and
[MOTHER/FATHER] have regarding [CHILD].
Did you and [MOTHER/FATHER] ever sign a birth certificate or document
that identifies [you/FATHER] as the legal father of [CHILD]? This may have
happened in the hospital when [CHILD] was born or later. Or, has a court
ruled that [you/FATHER] [are/is] [CHILD]’s father?
YES
NO

1
0

DK
REF

d
r

PA1.1
PA2 OR PA11.2
OR PA12

PA1.1
IF PA1=YES
you IF MALE; FATHER IF FEMALE

Did you and [MOTHER/FATHER] voluntarily sign a document establishing
[you/FATHER] as [CHILD]’s legal father? Or did this get handled through
the courts?
VOLUNTARILY SIGNED
DOCUMENT
HANDLED THROUGH
THE COURT
DK
REF

1
2
d
r

61
Prepared by Mathematica Policy Research, Inc.

PA2 OR PA11.2
OR PA12

(REV—4/25/06)

PA2
FS42<> 1,2 (not live with child all or most of the time)

Next I have some questions about the financial contribution you might
make to support [CHILD].
Do you have a legal agreement or child support order that requires you to
provide financial support for [CHILD]?
YES
NO
DK
REF

1
0
d
r

PA5
PA9

PA7
IF PA2=YES

In the past month, how much were you supposed to pay in child support for
[CHILD] under this order?
PROBE: If your support order covers more than one child, tell me the total
amount you were supposed to pay last month.
AMOUNT IN DOLLARS
DK
REF

FF
d
r

PA8 OR PA9

PA8
IF PA7<>0

And in the past month, how much of that amount did you actually pay in
child support?
AMOUNT IN DOLLARS
DK
REF

FF
d
r

62
Prepared by Mathematica Policy Research, Inc.

PA9 OR PA12

(REV—4/25/06)

PA9
IF FS42<> 1,2 (not live with child all or most of the time)
extra IF PA8>0
(IF PA8>0) Not counting the child support you already told me about,

[In/in] the past month, did you give [extra] money to help out with the cost
of raising [CHILD]?
YES
NO
DK
REF

1
0
d
r

PA10
PA11

PA10
IF PA9=YES
extra IF PA8>0

How much [extra] money did you provide in the past month to help support
[CHILD]?
AMOUNT IN DOLLARS
DK
REF

FF
d
r

PA11

PA11
IF FS42<>1,2 (not live with child all or most of the time)
his IF CMALE; her IF CFEMALE

In the past month, did you buy things for [CHILD] that [he/she] needed like
clothes, diapers, or medicine?
YES
NO
DK
REF

1
0
d
r

63
Prepared by Mathematica Policy Research, Inc.

PA11.2 OR
PA12

(REV—4/25/06)

PA11.2
IF FS33<>1,2 (not live together all or most of the time) AND FS42=1,2 (live with child all
or most of the time)
FATHER IF FEMALE; MOTHER IF MALE

Do you have a legal agreement or child support order that requires
[FATHER/MOTHER] to provide financial support for [CHILD]?
YES
NO
DK
REF

1
0
d
r

PA11.7
PA11.9

PA11.7
IF PA11.2=YES
FATHER IF FEMALE; MOTHER

In the past month, how much was [FATHER/MOTHER] supposed to pay in
child support for [CHILD] under that order?
PROBE: If the support order covers more than one child, tell me the total
amount [he/she] was supposed to pay last month for all your
children.
AMOUNT IN DOLLARS
DK
REF

FF
d
r

PA11.8 OR
PA11.9

PA11.8
IF PA11.7<>0
FATHER IF FEMALE; MOTHER IF MALE

And in the past month, how much did [FATHER/MOTHER] actually pay in
child support?
AMOUNT IN DOLLARS
DK
REF

FF
d
r

64
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PA11.9

(REV—4/25/06)

PA11.9
IF FS33<>1,2 (not live together of the time) AND FS42=1,2 (live with child all or most of
the time)
FATHER IF FEMALE; MOTHER IF MALE
extra IF PA11.8>0
(IF PA11.8>0) Not counting the child support you already told me about,

In the past month, did [FATHER/MOTHER] give you [extra] money to help
out with the cost of raising [CHILD]?
YES
NO
DK
REF

1
0
d
r

PA11.10
PA11.11

PA11.10
IF PA11.9=YES
FATHER IF FEMALE; MOTHER IF MALE
extra IF PA8>0

How much [extra] money did [FATHER/MOTHER] pay you in the past
month to help support [CHILD]?
AMOUNT IN DOLLARS
DK
REF

FF
d
r

PA11.11

PA11.11
IF FS33<>1,2 (not live with other parent together all or most of the time) AND FS42=1,2
( live with child all or most of the time)
FATHER IF FEMALE; MOTHER IF MALE
he IF CMALE; she IF CFEMALE

In the past month, did [FATHER/MOTHER] buy things for [CHILD] that
[he/she] needed like clothes, diapers, or medicine?
YES
NO
DK
REF

1
0
d
r

65
Prepared by Mathematica Policy Research, Inc.

PA12

(REV—4/25/06)

PA12
IF FEMALE
his IF CMALE; her IF CFEMALE
him IF CMALE; her IF CFEMALE

Parents deal with meeting the expenses of raising a child in different ways.
When answering the next question, I’d like you to think about all the
expenses associated with raising [CHILD] such as [his/her] food, clothing,
medical expenses, diapers, and any other costs of raising [him/her].
How much of the cost of raising [CHILD] does [FATHER] cover? Would
you say its…
All or almost all,
More than half,
About half,
Less than half, or

1
2
3
4

Little or none?

5

DK
REF

d
r

66
Prepared by Mathematica Policy Research, Inc.

END OF
SECTION

(REV—4/25/06)

SECTION WW: FAMILY SELF-SUFFICIENCY
WW1
ALL

The next questions are about your work.
Have you worked for pay at any time during the past 12 months? Please
include odd jobs and temporary jobs.
YES
NO
DK
REF

1
0
d
r

WW2
WW13 OR
WW8

PROBE: You can include odd jobs, temporary jobs, self-employment,
military service, or any other type of paid work.
WW2
IF WW1=YES

How many months did you work for pay in the past 12 months?
INSTRUCTION: IF LESS THAN 1 MONTH, ENTER 1 MONTH.
NUMBER OF
MONTHS
DK
REF

FF (1 TO 12)

WW3

d
r

WW3
IF WW1=YES

Did you work for pay in the past month?
PROBE: You can include odd jobs, temporary jobs, self-employment,
military service, or any other type of paid work.
YES
NO
DK
REF

1
0
d
r

67
Prepared by Mathematica Policy Research, Inc.

WW4
WW7

(REV—4/25/06)

WW4
IF WW3=YES

What were your total earnings in the past month before taxes and other
deductions? Please include tips, commissions, and overtime pay.
PROBE: If you held more than one job, include your total earnings from all
your jobs during the past month.
PROBE: I can help you add it up if you want to think out loud.
AMOUNT
DK
REF

FFF,FFF.FF
d
r

WW5
WW4.1
WW5

WW4.1
IF WW4=DK

I just need to know a range. Can you tell me if it was…
INSTRUCTION:

YOU CAN STOP READING WHEN RESPONDENT PROVIDES
RANGE.

Less than $500,
Between $500 and $750,
Between $750 and $1000,
Between $1000 and $1250,
Between $1250 and $1500,
Between $1500 and $1750,
Between $1750 and $2000,
Between $2000 and $2500,
Between $2500 and $3000,
Between $3000 and $3500,
Between $3500 and $4000,
Between $4000 and $4500,
Between $4500 and $5000,
Between $5500 and $6000,
$6000 or more?
DK
REF

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
d
r

68
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WW5

(REV—4/25/06)

WW6
IF WW3=YES

How many hours per week did you typically work last month?
AMOUNT OF
HOURS
DK
REF

FFF

WW13

d
r

OR WW8

WW7
IF WW3=NO

Thinking about the last month that you did work, what were your total
earnings before taxes and other deductions? Please include tips,
commissions, and overtime pay.
PROBE: If you held more than one job during that month, include your
total earnings from all your jobs you held that month.
PROBE: I can help you add it up if you want to think out loud.
AMOUNT

FFF,FFF.FF

DK
REF

d
r

69
Prepared by Mathematica Policy Research, Inc.

WW13OR
WW8
WW7.1
WW13
OR WW8

(REV—4/25/06)

WW7.1
IF WW4=DK

I just need to know a range. Can you tell me if it was…
INSTRUCTION:

YOU CAN STOP READING WHEN RESPONDENT PROVIDES
RANGE.

Less than $500,
Between $500 and $750,
Between $750 and $1000,
Between $1000 and $1250,
Between $1250 and $1500,
Between $1500 and $1750,
Between $1750 and $2000,
Between $2000 and $2500,
Between $2500 and $3000,
Between $3000 and $3500,
Between $3500 and $4000,
Between $4000 and $4500,
Between $4500 and $5000,
Between $5500 and $6000,
$6000 or more?
DK
REF

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
d
r

70
Prepared by Mathematica Policy Research, Inc.

WW8 or
WW13

(REV—4/25/06)

WW8
IF FS25=1 OR FS33<3 OR FS40<3
he IF FEMALE; she IF MALE
FATHER IF FEMALE;
MOTHER IF MALE; CURRENT PARTNER IF FS40<3
he IF FEMALE; she IF MALE

The next questions are about jobs [FATHER/MOTHER/CURRENT
PARTNER] had in the past month. Has [he/she] worked for pay in the past
month?
PROBE: You can include odd jobs, temporary jobs, self-employment,
military service, or any other type of paid work.
YES
NO
DK
REF

1
0
d
r

WW8.1
WW13

WW8.1
IF WW8=YES
her IF FEMALE; his IF MALE
he IF FEMALE; she IF MALE

What were [his/her] total earnings in the past month before taxes and other
deductions? Please include tips, commissions, and overtime pay.
PROBE: If [he/she] held more than one job, include total earnings from all
[his/her] jobs during the past month.
PROBE: I can help you add it up if you want to think out loud.
AMOUNT
DK
REF

FFF,FFF.FF
d
r

71
Prepared by Mathematica Policy Research, Inc.

WW13
WW8.2
WW13

(REV—4/25/06)

WW8.2
IF WW8.1=DK

I just need to know a range. Can you tell me if it was…
INSTRUCTION:

YOU CAN STOP READING WHEN RESPONDENT PROVIDES
RANGE.

Less than $500,
Between $500 and $750,
Between $750 and $1000,
Between $1000 and $1250,
Between $1250 and $1500,
Between $1500 and $1750,
Between $1750 and $2000,
Between $2000 and $2500,
Between $2500 and $3000,
Between $3000 and $3500,
Between $3500 and $4000,
Between $4000 and $4500,
Between $4500 and $5000,
Between $5500 and $6000,
$6000 or more?
DK
REF

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
d
r

72
Prepared by Mathematica Policy Research, Inc.

WW5

(REV—4/25/06)

WW13
ALL
FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; CURRENT PARTNER IF FS40<3
LOCAL NAME FOR TANF: NEEDS SITE SPECIFIC FILL

Now I’m going to read a list of income sources. For each, tell me whether
you, [FATHER/MOTHER/CURRENT PARTNER], or the children who live
with you received income from this source in the past month:
PROBE: Did you, [FATHER/MOTHER/CURRENT PARTNER], or the
children who live with you receive income from this source in the
past month?
(IF YES) How much did you

receive in [FILL INCOME
SOURCE] in the past month?
Cash welfare which is also
known as TANF, or [LOCAL
NAME OF TANF]?
Food stamp benefits

Disability insurance such
as Supplemental Security
Income (SSI) or Social
Security Disability Insurance
(SSDI)?
Unemployment Insurance
Benefits or UI
Child support?

Money from friends or
relatives?

YES

1

NO
YES

0
1

NO
YES

0
1

NO

0

YES

1

NO
YES

0
1

NO
YES

0
1

NO

0

FF,FFF.FF
DK
REF
FF,FFF.FF
DK
REF
FF,FFF.FF
DK
REF

FF,FFF.FF
DK
REF
FF,FFF.FF
DK
REF
FF,FFF.FF
DK
REF
WW28

73
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

WW28
ALL
or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; or CURRENT PARTNER
IF FS40<3

In the past month did you [or [FATHER/MOTHER/CURRENT PARTNER]
receive money from any other source, such as rent from boarders, other
government benefits, or any other income we have not already talked
about?
YES
NO
DK
REF

1
0
d
r

WW30
WW32

WW30
IF WW28=YES
or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; or CURRENT PARTNER
IF FS40<3

How much money from these other sources did you [or
[FATHER/MOTHER/CURRENT PARTNER] receive in the past month?
AMOUNT
DK
REF

FFF,FFF.FF
d
r

74
Prepared by Mathematica Policy Research, Inc.

WW32

(REV—4/25/06)

WW32
ALL
and FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
and MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; and CURRENT PARTNER IF
FS40<3
or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; or CURRENT PARTNER IF
FS40<3

The next questions are about bank accounts.
Do you [or [FATHER/MOTHER/CURRENT PARTNER] have any bank
accounts?
YES
NO
DK
REF

1
0
d
r

WW33
WW36

WW33
IF WW32=YES AND (IF FS25=1) OR (IF FS33<3) OR (IF FS40<3)
his IF FEMALE; her IF MALE

Are any of these accounts in…
a Both your names?
b [His/Her] name only?
c Your name only?
DK
REF

YES
YES
YES

WW36

d
r

75
Prepared by Mathematica Policy Research, Inc.

NO
NO
NO

(REV—4/25/06)

WW36
(IF FS25=1) OR (IF FS33<3) OR (IF FS40<3)
FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; and CURRENT PARTNER
IF FS40<3

People handle money differently. Which of the following best describes
how you and [FATHER/MOTHER/CURRENT PARTNER] handle your
money?
We put all our money
together.
We put some of our
money together but
keep the rest separate.
We keep all our money
separate.
DK
REF

WW37

1
2

3
d
r

WW37
(IF FS25=1) OR (IF FS33<3) OR (IF FS40<3)
FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; CURRENT PARTNER IF FS40<3

People also make different arrangements for handling household
expenses, such as paying for rent, food, or utilities. Which of the following
best describes how you and [FATHER/MOTHER/CURRENT PARTNER]
pay for household expenses?
We usually both contribute to
household expenses.
I usually cover household expenses.
[FATHER/MOTHER/CURRENT
PARTNER] usually covers household
expenses.
Someone else covers most of our
household expenses.
We have some other kind of
arrangement.
DK
REF

76
Prepared by Mathematica Policy Research, Inc.

1

WW38

2
3

4

WW37.1

5

WW37.2

d
r

WW38

(REV—4/25/06)

WW37.1
IFWW37=4

Who covers these household expenses?
INSTRUCTION: PROBE FOR RELATIONSHIP TO RESPONDENT
DESCRIBE PERSON

STRING OF 50

WW38

WW37.2
IF WW37=5

What kind of arrangement do you have?
DESCRIBE
ARRANGEMENT

STRING OF 50

WW38

WW38
ALL
and/or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
and/or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; and/or CURRENT
PARTNER IF FS40<3

Do you [and/or [FATHER/MOTHER/CURRENT PARTNER] own a car,
truck or van?
YES
NO
DK
REF

1
0
d
r

77
Prepared by Mathematica Policy Research, Inc.

WW40

(REV—4/25/06)

WW40
ALL
FATHER/MOTHER/CURRENT PARTNER
and/or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE;
and/or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; and/or CURRENT
PARTNER IF FS40<3

Do you [and/or [FATHER/MOTHER/CURRENT PARTNER] own the home
you live in?
YES
NO
DK
REF

WW53

1
0
d
r

WW53
ALL

Now, I have some questions about financial difficulties you may have
experienced in the past 12 months.
Please tell me if there has been a time during the past 12 months when…
a

b

c

You could not pay the full
amount of the rent or
mortgage that you were
supposed to pay?
You had service turned off by
the water, gas or electric
company, or the oil company
would not deliver oil because
you could not afford to pay
the bill?
You were evicted from your
home or apartment because
you could not pay the rent or
mortgage?

YES
1

NO
0

DK
d

REF
r

1

0

d

r

1

0

d

r

WW54

78
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

WW54
IF FS5<>3 OR FS7<>2,3,4 (child alive)
NOTE: NEED STATE/LOCAL FILL FOR MEDICAID

The next questions are about health insurance coverage.
Is [CHILD] currently covered by Medicaid, [STATE/LOCAL FILL], or any
other government program that pays for medical care?
YES
NO
DK
REF

1
0
d
r

WW55

WW55.1.1
IF FS5<>3 OR FS7<>2,3,4 (child alive)

Is [CHILD] currently covered by health insurance through your or someone
else’s employer, or insurance purchased directly from a private insurance
company?
YES
NO
DK
REF

1
0
d
r

WW55.2

WW55.2
ALL
NOTE: NEED STATE/LOCAL FILL FOR MEDICAID.

Are you currently covered by Medicaid, [STATE/LOCAL FILL], or any other
government program that pays for medical care?
YES
NO
DK
REF

1
0
d
r

79
Prepared by Mathematica Policy Research, Inc.

WW55.2.1

(REV—4/25/06)

WW55.2.1
ALL

Are you currently covered by health insurance through your or someone
else’s employer, or insurance purchased directly from a private insurance
company?
YES
NO
DK
REF

1
0
d
r

WW55.3

WW55.3
ALL

In general would you say your health is…
Excellent,
Very good,
Good,
Fair, or
Poor?
DK
REF

1
2
3
4
5
d
r

WW55

WW56
ALL
FATHER IF FEMALE; MOTHER IF MALE

Next I have some questions about people who are available to help you in
an emergency.
(IF FS19=’98’ OR FS25=6,7) Is there someone to take care of [CHILD] in an

emergency?
(ELSE) Is there someone, other than [FATHER/MOTHER] you could count

on to take care of [CHILD] in an emergency?
YES
NO
DK
REF

1
0
d
r

80
Prepared by Mathematica Policy Research, Inc.

WW57
WW58

(REV—4/25/06)

WW57
IF WW56=YES

How many people would you be able to count on to take care of [CHILD] in
an emergency?
(IF FS<>19=’98’ OR FS25<>6) Do not include [FATHER/MOTHER] in this total.

PROBE: Your best estimate is fine.
NUMBER OF PEOPLE
DK
REF

FF
d
r

WW58

WW58.1
ALL
(IF FS19=’98’ OR FS25=6,7) Is there someone you could turn to if you

suddenly needed to borrow $100 dollars?
(ELSE) Is there someone other than [FATHER/MOTHER] you could turn to

if you suddenly needed to borrow $100 dollars?
YES
NO
DK
REF

1
0
d
r

WW59
WW60

WW59
IF WW58.1=YES

How many people could you borrow $100 dollars from in an emergency?
(IF FS<>19=’98’ OR FS25<>6) Do not include [FATHER/MOTHER] in this

number.
PROBE: Your best estimate is fine.
NUMBER OF PEOPLE
DK
REF

FF
d
r

81
Prepared by Mathematica Policy Research, Inc.

WW60

(REV—4/25/06)

WW60
ALL
FATHER IF FEMALE; MOTHER IF MALE

Suppose you had a problem, and you were feeling depressed or confused
about what to do.
(IF FS19<>’98’ OR FS25<>6) Besides [FATHER/MOTHER],
(ELSE) [Is/is] there a relative or friend you could turn to for help or advice if

you had a problem and felt like that?
YES
NO
DK
REF

1
0
d
r

WW62
WW63

WW62
IF WW61=YES

How many people would you be able to turn to for help or advice if you had
a problem and felt like that?
(IF FS<>19=’98’ OR FS25<>6) Do not include [FATHER/MOTHER] in this

number.
PROBE: Your best estimate is fine.
NUMBER OF PEOPLE
DK
REF

FF
d
r

82
Prepared by Mathematica Policy Research, Inc.

WW63

(REV—4/25/06)

SECTION WB: PARENTAL WELL BEING (II)
WB9
ALL
INSTRUCTIONS: IS RESPONDENT CURRENTLY IN PRISON OR JAIL?
YES
NO

1
0

WB11.1
WB11

WB11
IF WB9=NO

The next questions are about involvement you may have had with the
police and/or the criminal justice system.
Have you ever been arrested? Please include all arrests whether you were
guilty or not.
YES
NO
DK
REF

1
0
d
r

WB11.1
WB25.1 OR
END OF
SECTION

WB11.1
IF WB11=YES OR IF WB9=YES
(IF WB9=YES) The next questions are about involvement you may have had

with the police and/or the criminal justice system.
(IF WB9=NO) Have you been arrested in the past [MONTHS SINCE RA]

months, that is since [RADATE]?
YES
NO
DK
REF

1
0
d
r

83
Prepared by Mathematica Policy Research, Inc.

WB11.2
WB12

(REV—4/25/06)

WB11.2
IF WB11.1=YES

How many times have you been arrested in the past [MONTHS SINCE RA]
months?
NUMBER OF ARRESTS
DK
REF

FF
d
r

WB15

WB15
ALL

Now, I would like to ask you about the time before [RADATE].
Before [RADATE], were you ever in jail or prison?
YES
NO
DK
REF

1
0
d
r

WB23

WB23
IF WB11<>0

I also would like to ask about any convictions or sentences you may have
received.
Before [RADATE], were you ever convicted and sentenced to go to jail or
prison? Please include any sentence you received, even if you did not
serve any time.
YES
NO
DK
REF

1
0
d
r

84
Prepared by Mathematica Policy Research, Inc.

WB24
WB25.1 OR
END OF
SECTION

(REV—4/25/06)

WB24
If WB23=YES

Please think about the longest sentence you received before [RADATE].
How long was that sentence? Please tell me the total length of the prison
sentence, even if you did not serve all of it.
INSTRUCTION:

IF LESS THAN 1 WEEK, ENTER 1 WEEK.

INSTRUCTION:

FIRST ENTER IF RESPONSE IS WEEKS, MONTHS AND/OR
YEARS. YOU WILL ENTER THE NUMBER OF YEARS AND/OR
MONTH ON NEXT TWO SCREENS.

INSTRUCTION:

ENTER ALL THAT APPLY
a

DAYS

b

WEEKS

c

MONTHS

d

YEARS
DK
REF

YES
NO
YES
NO
YES

WB24.1
OR
WB24.2
OR
WB24.3

NO
YES
NO
d
r

END OF
SECTION

85
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

WB24.1
IF WB23a=YES
INSTRUCTION: ENTER NUMBER OF WEEKS
WEEKS

FF

WB24.2 OR
WB24.3

WB24.2
IF WB23a=YES
INSTRUCTION: ENTER NUMBER OF MONTHS
MONTHS

FF

WB24.3

WB24.3
IF WB23b=YES
INSTRUCTION: ENTER NUMBER OF YEARS
YEARS

FF

WB25.1 OR
SEND OF
SECTION

WB25.1
IF FEMALE RESPONDENT

The next questions are about involvement [FATHER] may have had with
the police or the criminal justice system.
Has [FATHER] ever been arrested? Please include all arrests whether he
was guilty or not.
YES
NO
DK
REF

1
0
d
r

86
Prepared by Mathematica Policy Research, Inc.

WB26
END OF
SECTION

(REV—4/25/06)

WB26
IF WB25.1=YES

Has [FATHER] been arrested in the past [MONTHS SINCE RA] months,
that is since [RADATE]?
YES
NO
DK
REF

1
0
d
r

WB27
WB30

WB27
IF WB26=YES

How many times in the past [MONTHS SINCE RA] months has [FATHER]
been arrested?
FF
d
r

WB30

YES

1

NO
DK
REF

0
d
r

END OF
SECTION

NUMBER OF ARRESTS
DK
REF

WB30
IF WB28=YES

Is [FATHER] currently in prison or jail?

87
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

SECTION BP: CITIZENSHIP AND LIVING WITH
BIOLOGICAL PARENTS
CC1
CC1=ALL

Next, I would like to ask you some questions about where you were born
and about your childhood.
What country were you born in?
UNITED STATES
PUERTO RICO
CANADA
MEXICO
CUBA
DOMINICAN REPUBLIC
EL SALVADOR
HAITI
JAMAICA
GUATEMALA
NICARAGUA
OTHER COUNTRY
DK
REFUSED

1
2
3
4
5
6
7
8
9
10
11
12
d
r

BP1
CC2

CC1.1
CC2

CC1.1
CC1=12
INSTRUCTION:

SPECIFY
OTHER
COUNTRY

88
Prepared by Mathematica Policy Research, Inc.

CC2

(REV—4/25/06)

CC2
IF CC1>2

When did you first come to live in the United States?
INSTRUCTION:

FIRST CODE IF ANSWER IS, ‘SPECIFIC YEAR’ OR ‘NUMBER OF
YEARS AGO’…

INSTRUCTION:

YOU WILL BE ABLE TO ENTER SPECIFIC YEAR OR NUMBER OF
YEARS ON THE NEXT SCREEN.
SPECIFIC YEAR
NUMBER OF YEARS AGO
DK
REF

1
2
d
r

CC2.1
CC2.2
BP1

CC2.1
IF CC2=1
INSTRUCTION:

ENTER
SPECIFIC
YEAR

CC3

INSTRUCTION:

ENTER
NUMBER OF
YEARS AGO

CC3

CI2.2
IF CC2=2

89
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

BP1
ALL

When you were growing up—that is before you turned 18—most of the time
did you live with…
PROBE: In which of these living situations did you spend most of your
time before you turned 18?
Both your biological
mother and your
biological father,
Your biological mother
only,
Your biological father
only, or
Neither of your biological
parents?
DK
REF

1

BP2

2

BP3

3
4
d
r

BP2
If BP1=1

Did you usually live with both your parents at the same time?
YES
NO
DK
REF

1
0
d
r

90
Prepared by Mathematica Policy Research, Inc.

BP3

(REV—4/25/06)

BP3
ALL

Were your biological parents ever married to each other?
YES
NO
DK
REF

1
0
d
r

BP7

BP7
ALL

Before you turned 18, did anyone—a stranger, friend, date, relative, or
someone else you knew—ever do or try to do something sexual to you or
make you do something sexual to them against your wishes?
YES
NO
DK
REF

1
0
d
r

BP8

BP8
ALL

Before you turned 18, were you ever beaten up, burned, assaulted with a
weapon, or had your life threatened by an adult in your family or
household?
YES
NO
DK
REF

1
0
d
r

91
Prepared by Mathematica Policy Research, Inc.

BP9

(REV—4/25/06)

BP9
ALL
man IF FEMALE; woman IF MALE

I have a few more questions about your sexual relationships.
How old were you the first time you had sexual intercourse with a
man/woman?
PROBE: By sexual intercourse I mean that you made love, had sex, or
went all the way with a man/woman.
AGE OF FIRST
INTERCOURSE
DK
REF

FF

BP10

d
r

BP10
ALL
man IF FEMALE; woman IF MALE
male IF FEMALE; female IF MALE

Since [RADATE], how many men/women, have you had sexual intercourse
with? Please count every [male/female] sexual partner since [RADATE],
even if you had sex only once.
NUMBER OF TIMES
DK
REF

FFF
d
r

92
Prepared by Mathematica Policy Research, Inc.

END OF
SECTION

(REV—4/25/06)

SECTION LO: LOCATING INFORMATION
LO1
ALL
HIDE REFERENCE TO MONEY IF CELL PHONE COMP

We are almost done. (We will be sending you a (check/gift card) for $25
within the next four weeks.) We need to make sure we have your correct
address and some information on other people in case you move.
What is your full address?
PROBE: Can you spell the street name for me please?
PROBE: Is there an apartment number?
PROBE: Besides the P.O. Box, do you have a street address?
ADDR LINE 1

STRING OF 20

LO1.1

INSTRUCTION:

ENTER ADDR
LINE 2

LO1.2

INSTRUCTION:

ENTER CITY

LO1.3

INSTRUCTION:

ENTER STATE

LO1.3.1

LO1.1

LO1.2

LO1.3

93
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO1.3.1

INSTRUCTION:

ENTER ZIP CODE

LO2

LO2
ALL

What is your home phone number?
HOME PHONE
NUMBER
DOES NOT HAVE
PHONE
DK
REF

FFF-FFF-FFFF

LO2.1

1

LO3

d
r

LO3

LO2.1
LO2=phone number

Whose name is that phone number listed in?
ENTER NAME
LISTED IN SAMPLE
MEMBER’S NAME
DK
REF

STRING OF 20
0
d
r

94
Prepared by Mathematica Policy Research, Inc.

LO3

(REV—4/25/06)

LO3
ALL

Is there (a/another) phone number where you can be reached?
HOME PHONE
NUMBER
NO OTHER PHONE
DK
REF

FFF-FFF-FFFF

LO3.1

1
d
r

LO4

LO3.1
LO3=phone number

Whose name is that phone number listed in?
ENTER NAME
LISTED IN SAMPLE
MEMBER’S NAME
DK
REF

STRING OF 20
0

LO3.2
LO4

d
r

LO3.2
LO3=NAME

What is their relationship to you?
RELATIONSHIP
DK
REF

STRING OF 20
d
r

95
Prepared by Mathematica Policy Research, Inc.

LO4

(REV—4/25/06)

LO4
ALL

Do you (also) have a cell-phone or pager number?
CELL-PHONE/
PAGER NUMBER
DOES NOT HAVE
PHONE
DK
REF

FFF-FFF-FFFF

LO5

1
d
r

LO5
ALL

As part of the study, we will contact you again in about a year and a half.
In case you move, we would like the name, address and telephone number
of up to three relatives or close friends who would know where you are.
We will only contact them if we have trouble getting in touch with you
directly.
PROBE: Your grandmother or your mother or someone else who would
always know where you are would be the most helpful.
What is their first name of a person who would always know where you
are?
PROBE: Can you spell that for me please?
FIRST NAME OF
CONTACT
NO CONTACT
PERSON
DK
REF

STRING OF 20

LO5.1

0

LO17

d
r

96
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO5.1
LO5=NAME

And what is their middle name?
PROBE: Can you spell that for me please?
INSTRUCTION: IF NO MIDDLE NAME, ENTER ZERO
MIDDLE NAME OF
CONTACT

STRING OF 20

LO5.2

LO5.2
LO5=NAME

And their last name please?
PROBE: Can you spell that for me please?
LAST NAME OF
RESPONDENT

STRING OF 20

LO6

STRING OF 20
d
r

LO6.1

STRING OF 20
0
d
r

LO7

LO6
LO5=NAME

What is their relationship to you?
RELATIONSHIP
DK
REF

LO6.1
LO5=NAME

Does [he/she] have a nickname?
NICKNAME
NO NICKNAME
DK
REF

97
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO7
LO5=NAME

What is their full address?
PROBE: Can you spell the street name for me please?
PROBE: Is there an apartment number?
PROBE: Besides the P.O. Box, do you have a street address?
ADDR LINE 1

STRING OF 20

LO7.1

INSTRUCTION:

ENTER ADDR
LINE 2

LO7.2

INSTRUCTION:

ENTER CITY

LO7.3

INSTRUCTION:

ENTER STATE

LO7.4

INSTRUCTION:

ENTER ZIP CODE

LO8

LO7.1

LO7.2

LO7.3

LO7.4

98
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO8
LO5=NAME

What is their home phone number?
HOME PHONE
NUMBER
DOES NOT HAVE
PHONE
DK
REF

FFF-FFF-FFFF

LO8.1

1

LO9

d
r

LO8.1
LO8=phone number

Whose name is that phone number listed in?
ENTER NAME
DK
REF

STRING OF 20
d
r

LO9

LO9
LO5<>0, d or r

Could you tell me the name, address and telephone number of another
relative or close friend who will know how to contact you a year and a half
from now.
What is their first name?
PROBE: Can you spell that for me please?
FIRST NAME OF
CONTACT
NO CONTACT
PERSON
DK
REF

STRING OF 20

LO9.1

0

LO17

d
r

99
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO9.1
LO9=NAME

And what is their middle name?
PROBE: Can you spell that for me please?
INSTRUCTION: IF NO MIDDLE NAME, ENTER ZERO
MIDDLE NAME OF
CONTACT

STRING OF 20

LO9.2

LO9.2
LO9=NAME

And their last name please?
PROBE: Can you spell that for me please?
LAST NAME OF
RESPONDENT

STRING OF 20

LO10

STRING OF 20
d
r

LO10.1

STRING OF 20
0
d
r

LO11

LO10
LO9=NAME

What is their relationship to you?
RELATIONSHIP
DK
REF

LO10.1
LO9=NAME

Does [he/she] have a nickname?
NICKNAME
NO NICKNAME
DK
REF

100
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO11
LO9=NAME

What is their full address?
PROBE: Can you spell the street name for me please?
PROBE: Is there an apartment number?
PROBE: Besides the P.O. Box, do you have a street address?
ADDR LINE 1

STRING OF 20

LO11.1

INSTRUCTION:

ENTER ADDR
LINE 2

LO11.2

INSTRUCTION:

ENTER CITY

LO11.3

INSTRUCTION:

ENTER STATE

LO11.4

INSTRUCTION:

ENTER ZIP CODE

LO12

LO11.1

LO11.2

LO11.3

LO11.4

101
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO12
LO9=NAME

What is their home phone number?
HOME PHONE
NUMBER
DOES NOT HAVE
PHONE
DK
REF

FFF-FFF-FFFF

LO12.1

1

LO13

d
r

LO12.1
LO12=phone number

Whose name is that phone number listed in?
ENTER NAME
DK
REF

STRING OF 20
d
r

LO13

LO13
LO5<>0, d or r AND LO9<>0, d or r

Could you tell me one more name, address and telephone number of a
relative or close friend who will know how to contact you a year and a half
from now.
What is their first name?
PROBE: Can you spell that for me please?
FIRST NAME OF
CONTACT
NO CONTACT
PERSON
DK
REF

STRING OF 20

LO13.1

0

LO17

d
r

102
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO13.1
LO13=NAME

And what is their middle name?
PROBE: Can you spell that for me please?
INSTRUCTION: IF NO MIDDLE NAME, ENTER ZERO
MIDDLE NAME OF
CONTACT

STRING OF 20

LO13.2

LO13.2
LO13=NAME

And their last name please?
PROBE: Can you spell that for me please?
LAST NAME OF
RESPONDENT

STRING OF 20

LO14

STRING OF 20
d
r

LO14.1

STRING OF 20
0
d
r

LO15

LO14
LO13=NAME

What is their relationship to you?
RELATIONSHIP
DK
REF

LO14.1
LO13=NAME

Does [he/she] have a nickname?
NICKNAME
NO NICKNAME
DK
REF

103
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO15
LO13=NAME

What is their full address?
PROBE: Can you spell the street name for me please?
PROBE: Is there an apartment number?
PROBE: Besides the P.O. Box, do you have a street address?
ADDR LINE 1

STRING OF 20

LO15.1

INSTRUCTION:

ENTER ADDR
LINE 2

LO15.2

INSTRUCTION:

ENTER CITY

LO15.3

INSTRUCTION:

ENTER STATE

LO15.4

INSTRUCTION:

ENTER ZIP CODE

LO16

LO15.1

LO15.2

LO15.3

LO15.4

104
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO16
LO13=NAME

What is their home phone number?
HOME PHONE
NUMBER
DOES NOT HAVE
PHONE
DK
REF

FFF-FFF-FFFF

LO16.1

1

LO17

d
r

LO16.1
LO16=phone number

Whose name is that phone number listed in?
ENTER NAME
DK
REF

STRING OF 20
d
r

LO17

LO17
COMPLETES FROM SOC

Thank you very much for your time. Those are all the questions I have
right now.
Is [FATHER/MOTHER] available? I’d like to interview [him/her] too, if they
are around.

105
Prepared by Mathematica Policy Research, Inc.

(REV—4/25/06)

LO18
COMPLETES WITH FIELD LOCATOR

Thank you very much for your time. Those are all the questions I have
right now.
Is [FATHER/MOTHER] available? I’d like to interview [him/her] too, if
[he/she] is around.
Please hand the phone back to our field locator.
INTERVIEWER:

CONFIRM WITH FIELD LOCATOR THAT SM HAS BEEN PAID.
YES
NO
DK
REF

1
0
d
r

106
Prepared by Mathematica Policy Research, Inc.

END

(REV—4/25/06)