Hispanic Stree Inventory English

Master Parent English - HEPI 2

Master Parent English - HEPI 2 (English)

Version DE24884EN

Page 1

09/14/04

Master Parent English - HEPI 2

HISPANIC STRESS INVENTORY

HISPANIC STRESS INVENTORY
Please indicate whether the following situations have occurred to you during the last 3 months. Then if it did occur to
you, indicate how worried or tense the situation made you feel. If the situation did not happen to you, mark "no" and
skip to the next question. Remember there is no right or wrong answer so try and be as honest as you can.
HSI1.

I have seen my son/daughter behave delinquently. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI3

HSI2.

How worried are you about this? (Choose one)

HSI3.

I have questioned the idea that "marriage is forever." Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI5

HSI4.

How worried are you about this? (Choose one)

HSI5.

I have felt unaccepted by others due to my Latino culture. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI7

HSI6.

How worried are you about this? (Choose one)

HSI7.

Because I do not know enough English, it has been difficult for me to interact with others. Has this occurred to you in
the past 3 months?

1
2
3
4
5
8

1
0
8

HSI8.

How worried are you about this? (Choose one)

Version DE24884EN

Yes
No
Refuse to Answer
1
2
3
4
5
8

Page 2

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI9

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI9.

HISPANIC STRESS INVENTORY

My children have been influenced by bad friends. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI11

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI10.

How worried are you about this? (Choose one)

HSI11.

Others have been too worried about the amount and quality of the work I do. Has this occurred to you in the past 3
months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI13

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI12.

How worried are you about this? (Choose one)

HSI13.

I have not been able to forget the last few months in my home country. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI15

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI14.

How worried are you about this? (Choose one)

HSI15.

My spouse has been drinking too much alcohol. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI17

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI16.

How worried are you about this? (Choose one)

HSI17.

I have thought that my children used illegal drugs. Has this occurred to you in the past 3 months?
1
0
8

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Yes
No
Refuse to Answer

Skip to HSI19

09/14/04

Master Parent English - HEPI 2

HISPANIC STRESS INVENTORY

HSI18.

How worried are you about this? (Choose one)

HSI19.

My children have been drinking alcohol. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

Skip to HSI21

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI23

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI20.

How worried are you about this? (Choose one)

HSI21.

I have been discriminated against. Has this occurred to you in the past 3 months?
1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI22.

How worried are you about this? (Choose one)

HSI23.

My spouse has expected me to be more traditional in our relationship. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI25

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI24.

How worried are you about this? (Choose one)

HSI25.

My spouse and I have disagreed on how to bring up our children. Has this occurred to you in the past 3 months?
1
0
8

HSI26.

How worried are you about this? (Choose one)

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Page 4

Yes
No
Refuse to Answer

Skip to HSI27

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI27.

HISPANIC STRESS INVENTORY

My spouse and I have disagreed on the importance of religion within our family. Has this occurred to you in the past 3
months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI29

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI28.

How worried are you about this? (Choose one)

HSI29.

I have been criticized about my work. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI31

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI30.

How worried are you about this? (Choose one)

HSI31.

My spouse and I have had disagreements about who should control the household money. Has this occurred to you in
the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI33

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI32.

How worried are you about this? (Choose one)

HSI33.

I have thought a lot about the fact that my son (daughter) left home to live independently. Has this occurred to you in
the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI35

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI34.

How worried are you about this? (Choose one)

HSI35.

Because of American ideas about children it has been difficult for me to decide how strict to be with my children. Has
this occurred to you in the past 3 months?
1
Yes
0
No
Skip to HSI37
8

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Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HISPANIC STRESS INVENTORY

HSI36.

How worried are you about this? (Choose one)

HSI37.

Because of my poor English people have treated me badly. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI39

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI38.

How worried are you about this? (Choose one)

HSI39.

I have felt that being too close to my family interfered with my own goals. Has this occurred to you in the past 3
months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI41

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI40.

How worried are you about this? (Choose one)

HSI41.

I have thought that my children want their independence before they are ready. Has this occurred to you in the past 3
months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI43

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI42.

How worried are you about this? (Choose one)

HSI43.

I have felt that members of my family are losing their religion. Has this occurred to you in the past 3 months?
1
0
8

HSI44.

How worried are you about this? (Choose one)

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Page 6

Yes
No
Refuse to Answer

Skip to HSI45

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI45.

HISPANIC STRESS INVENTORY

My children have not respected my authority the way they should. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI47

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI46.

How worried are you about this? (Choose one)

HSI47.

Because we have different customs, I have had arguments with other members of my family. Has this occurred to you
in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI49

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI48.

How worried are you about this? (Choose one)

HSI49.

Members of my family have considered divorce as a solution to their marital problems. Has this occurred to you in the
past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI51

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI50.

How worried are you about this? (Choose one)

HSI51.

Because of the lack of family unity, I have felt lonely and isolated. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI53

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI52.

How worried are you about this? (Choose one)

HSI53.

Because I am Latino I have been expected to work harder. Has this occurred to you in the past 3 months?
1
0
8

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Yes
No
Refuse to Answer

Skip to HSI55

09/14/04

Master Parent English - HEPI 2

HISPANIC STRESS INVENTORY

HSI54.

How worried are you about this? (Choose one)

HSI55.

It has been difficult for me to understand why my spouse wishes to be more Americanized. Has this occurred to you in
the past 3 months?

1
2
3
4
5
8

1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI57

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI56.

How worried are you about this? (Choose one)

HSI57.

My spouse and I have disagreed on which language is spoken to our children at home. Has this occurred to you in the
past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI59

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI58.

How worried are you about this? (Choose one)

HSI59.

Due to problems in understanding English, I have had difficulties in school. Has this occurred to you in the past 3
months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI61

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI60.

How worried are you about this? (Choose one)

HSI61.

My spouse has not helped with household chores. Has this occurred to you in the past 3 months?
1
0
8

HSI62.

How worried are you about this? (Choose one)

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Page 8

Yes
No
Refuse to Answer

Skip to HSI63

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI63.

HISPANIC STRESS INVENTORY

My income has not been sufficient to support my family or myself. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI65

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI64.

How worried are you about this? (Choose one)

HSI65.

I feared the consequences of deportation. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI67

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI66.

How worried are you about this? (Choose one)

HSI67.

I have thought that my children were not receiving a good education. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI69

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI68.

How worried are you about this? (Choose one)

HSI69.

My legal status has been a problem in getting a good job. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI71

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI70.

How worried are you about this? (Choose one)

HSI71.

There have been cultural conflicts in my marriage. Has this occurred to you in the past 3 months?
1
0
8

HSI72.

How worried are you about this? (Choose one)

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Page 9

Yes
No
Refuse to Answer

Skip to HSI73

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI73.

HISPANIC STRESS INVENTORY

I have felt that my children's ideas about sexuality are too liberal. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI75

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI74.

How worried are you about this? (Choose one)

HSI75.

There has been physical violence among members of my family. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI77

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI76.

How worried are you about this? (Choose one)

HSI77.

I did not get the job I wanted because I did not have the proper skills. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI79

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI78.

How worried are you about this? (Choose one)

HSI79.

Because I am Latino I have had difficulty finding the type of work I want. Has this occurred to you in the past 3
months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI81

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI80.

How worried are you about this? (Choose one)

HSI81.

My spouse has expected me to be less traditional in our relationship. Has this occurred to you in the past 3 months?
1
0
8

Version DE24884EN

Page 10

Yes
No
Refuse to Answer

Skip to HSI83

09/14/04

Master Parent English - HEPI 2

HISPANIC STRESS INVENTORY

HSI82.

How worried are you about this? (Choose one)

HSI83.

The pressures to achieve economic success have made me stop going to church. Has this occurred to you in the past 3
months?

1
2
3
4
5
8

1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI85

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI84.

How worried are you about this? (Choose one)

HSI85.

My children have talked about leaving home. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI87

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI86.

How worried are you about this? (Choose one)

HSI87.

My legal status has limited my contact with family or friends. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI89

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI88.

How worried are you about this? (Choose one)

HSI89.

I have felt that I would never regain the status and respect that I had in my home country. Has this occurred to you in
the past 3 months?
1
0
8

HSI90.

How worried are you about this? (Choose one)

Version DE24884EN

Page 11

Yes
No
Refuse to Answer

Skip to HSI91

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI91.

HISPANIC STRESS INVENTORY

I have felt that family relations are becoming less important for people that I'm close to. Has this occurred to you in the
past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI93

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI92.

How worried are you about this? (Choose one)

HSI93.

My children have received bad school reports (or bad grades). Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI95

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI94.

How worried are you about this? (Choose one)

HSI95.

It has been difficult for my spouse and I to combine Latino and American culture. Has this occurred to you in the past
3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI97

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI96.

How worried are you about this? (Choose one)

HSI97.

My boss has thought of me as being too passive. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI99

1
2
3
4
5
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

HSI98.

How worried are you about this? (Choose one)

HSI99.

I have had to watch the quality of my work so others do not think I am lazy. Has this occurred to you in the past 3
months?
1
0
8

Version DE24884EN

Page 12

Yes
No
Refuse to Answer

Skip to HSI101

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Master Parent English - HEPI 2

HISPANIC STRESS INVENTORY

HSI100.

How worried are you about this? (Choose one)

HSI101.

Because I am Latino it has been hard to get promotions or salary raises. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI103

HSI102.

How worried are you about this? (Choose one)

HSI103.

Because of money problems, I have to work away from my family. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI105

HSI104.

How worried are you about this? (Choose one)

HSI105.

I had serious arguments with family members. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

HSI106.

How worried are you about this? (Choose one)

HSI107.

I have been around too much violence. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

HSI108.

How worried are you about this? (Choose one)

HSI109.

I have avoided immigration officials. Has this occurred to you in the past 3 months?

1
2
3
4
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8
1
0
8

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Yes
No
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Extremely worried/tense
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Not at all worried/tense
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Skip to HSI109
Not at all worried/tense
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Extremely worried/tense
Refuse to Answer

Skip to HSI111

09/14/04

Master Parent English - HEPI 2

HISPANIC STRESS INVENTORY

HSI110.

How worried are you about this? (Choose one)

HSI111.

I have thought that if I went to a social or government agency I would be deported. Has this occurred to you in the past
3 months?

1
2
3
4
5
8

1
0
8

Yes
No
Refuse to Answer

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI113

HSI112.

How worried are you about this? (Choose one)

HSI113.

My personal goals have been in conflict with family goals. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

HSI114.

How worried are you about this? (Choose one)

HSI115.

Both my spouse and I have had to work. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI115
Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI117

HSI116.

How worried are you about this? (Choose one)

HSI117.

Because I do not know enough English, it has been difficult to deal with day to day situations. Has this occurred to you
in the past 3 months?

1
2
3
4
5
8

1
0
8

HSI118.

How worried are you about this? (Choose one)

Version DE24884EN

Yes
No
Refuse to Answer
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Not at all worried/tense
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Extremely worried/tense
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Skip to HSI119
Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI119.

HISPANIC STRESS INVENTORY

I have not been able to forget about the war related deaths which happened to friends or family members.Has this
occurred to you in the past 3 months?
1
Yes
0
No
Skip to HSI121
8

Refuse to Answer

HSI120.

How worried are you about this? (Choose one)

HSI121.

My spouse and I have had disagreements on the use of contraceptives. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI123

HSI122.

How worried are you about this? (Choose one)

HSI123.

My children have seen too much sex on television or at the movies. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI125

HSI124.

How worried are you about this? (Choose one)

HSI125.

I have noticed that religion is less important to me now than before. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI127

HSI126.

How worried are you about this? (Choose one)

HSI127.

I have felt guilty about leaving family and friends in my home country. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

HSI128.

How worried are you about this? (Choose one)

Version DE24884EN

Yes
No
Refuse to Answer
1
2
3
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Page 15

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A little worried/tense
Moderately worried/tense
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Extremely worried/tense
Refuse to Answer

Skip to HSI129
Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI129.

HISPANIC STRESS INVENTORY

My spouse has not been adapting to American life. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

Skip to HSI131

HSI130.

How worried are you about this? (Choose one)

HSI131.

I have been forced to accept low paying jobs. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI133

HSI132.

How worried are you about this? (Choose one)

HSI133.

There have been conflicts among members of my family. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Yes
No
Refuse to Answer

Skip to HSI135

HSI134.

How worried are you about this? (Choose one)

HSI135.

I have been questioned about my legal status. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

HSI136.

How worried are you about this? (Choose one)

HSI137.

I have had difficulty finding legal services. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

HSI138.

How worried are you about this? (Choose one)

Version DE24884EN

Yes
No
Refuse to Answer
1
2
3
4
5
8

Page 16

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A little worried/tense
Moderately worried/tense
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Extremely worried/tense
Refuse to Answer

Skip to HSI137
Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI139
Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

HSI139.

HISPANIC STRESS INVENTORY

I have felt that I might lose my job to newly arriving immigrants. Has this occurred to you in the past 3 months?
1
0
8

Yes
No
Refuse to Answer

HSI140.

How worried are you about this? (Choose one)

HSI141.

I have felt pressured to learn English. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

Skip to HSI141
Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI143

HSI142.

How worried are you about this? (Choose one)

HSI143.

Some members of my family have become too individualistic. Has this occurred to you in the past 3 months?

1
2
3
4
5
8
1
0
8

Yes
No
Refuse to Answer

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

Skip to HSI145

HSI144.

How worried are you about this? (Choose one)

HSI145.

I have felt that my spouse and I have not been able to communicate. Has this occurred to you in the past 3 months?
1
0
8

HSI146.

1
2
3
4
5
8
Yes
No
Refuse to Answer

How worried are you about this? (Choose one)

Version DE24884EN

Skip to instruction before FAM1
1
2
3
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Page 17

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Extremely worried/tense
Refuse to Answer

Not at all worried/tense
A little worried/tense
Moderately worried/tense
Very worried/tense
Extremely worried/tense
Refuse to Answer

09/14/04

Master Parent English - HEPI 2

Version DE24884EN

Colorado Service Utilization Questionnaire

Page 18

09/14/04