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pdfOMB Approved No. 2900-0727
Estimated Burden Avg. 20 min.
VA Form 10-21089
Survey of Post-Deployment Adjustment Among Operation
Enduring Freedom & Operation Iraqi Freedom (OEF/OIF) Veterans
This survey asks questions about your deployment and your post-deployment experiences,
health, attitudes and emotions. Please read the instructions and questions carefully.
First, we need to ask you a few questions:
Will you participate in this survey?
1
YES, I will participate (IF YES, PLEASE GO TO QUESTION 1 BELOW)
2
NO, I do not wish to participate
IF NO, PLEASE MAIL THE BLANK SURVEY BACK TO STOP FUTURE REQUESTS
TO COMPLETE THE SURVEY.
If YES:
1. How many years total have you served in the military including Active, Reserve or
National Guard? _____ years
2. Are you currently serving in either:
1
Regular Active Duty
2
National Guard
3
Reserves
3. How many times have you been deployed to OEF/OIF (please put 0 if you were
never deployed to OEF/OIF)? _____ times
If you HAVE NOT been deployed to OEF or OIF, you may END THE SURVEY NOW.
Please return it in the enclosed envelope and we will not re-contact you.
If you HAVE been deployed to OEF, OIF or both, please CONTINUE.
Thank you for your participation!
The Paperwork Reduction Act of 1995 requires us to notify you that this information collected is in accordance with the clearance
requirements of section 3507 of this Act. The public reporting burden for this collection of information is estimated to average 20
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. No person will be penalized for failing to furnish this
information if it does not display a currently valid OMB control number. This collection of information is intended to fulfill the need
identified by the Department of Veterans Affairs in their call for the development, improvement, and/or validation of measures for
screening, detection, and diagnosis. Response to this survey is voluntary and failure to furnish this information will have no effect on
any of your benefits.
Privacy Act: The execution of this form does not authorize the release of information other than that specifically described below.
The information requested on this form is solicited under Title 38, U.S.C., Part I, Chapter 5, Section 527. Information from the data
collection will become part of a system of records that complies with the Privacy Act of 1974. This system is identified as “Veteran,
Patient, Employee and Volunteer Research and Development Project Records-VA (34VA11)” as set forth in the Compilation of
Privacy Act Issuances via online GPO access at http://www.gpoaccess.gov/privacyact/index.html.
INSTRUCTIONS
Choose only one answer for each question unless the instructions say otherwise.
• Read each question carefully. Different questions ask about different timeframes.
• Mark your responses clearly. Some questions ask you to put an X in the appropriate box. Others ask you to
circle your answer.
1. What was your branch of the military during your
deployments to OEF/OIF?
1 Marines
2 Army
3 Other __________________________
10. During what time period was your second deployment?
(Example: FROM: 12/05 TO: 03/06)
FROM: ___/___ TO: ___/___
mo yr
mo yr
Please answer the following questions about each of
your individual deployments to OEF/OIF. With regard to
your first deployment:
2. Were you deployed to:
1 OEF or
2 OIF
11. During your second deployment, were you:
1 Regular active duty
2 National Guard
3 Reserves
12. What was your military rank at the beginning of your
second deployment (e.g., E-5, O-6)?
__________________________
3. Were you located in:
1 Iraq
2 Afghanistan
3 Other
13. What was your primary military occupation during your
second deployment?
1 Combat
2 Combat Support
4. During what time period was your first deployment?
(Example: FROM: 12/05 TO: 03/06)
With regard to your third deployment:
14. Were you deployed to:
1 OEF or
2 OIF
FROM: ___/___ TO: ___/___
mo yr
mo yr
5. During your first deployment, were you:
1 Regular active duty
2 National Guard
3 Reserves
6. What was your military rank at the beginning of your first
deployment (e.g., E-5, O-6)?
___________________
7. What was your primary military occupation during your
first deployment?
1 Combat
2 Combat Support
15. Were you located in:
1 Iraq
2 Afghanistan
3 Other
Please skip to
page 2, question
20 if you have
only been
deployed to OEF
or OIF twice.
16. During what time period was your third deployment?
(Example: FROM: 12/05 TO: 03/06)
FROM: ___/___ TO: ___/___
mo yr
mo yr
With regard to your second deployment:
17. During your third deployment, were you:
1 Regular active duty
2 National Guard
3 Reserves
8. Were you deployed to:
1 OEF or
2 OIF
18. What was your military rank at the beginning of your third
deployment (e.g., E-5, O-6)?
_________________________
9. Were you located in:
1 Iraq
2 Afghanistan
3 Other
Please skip to
page 2, question
20 if you have
only been
deployed to OEF
or OIF once.
19. What was your primary military occupation during your
third deployment?
1 Combat
2 Combat Support
Page 1
20. During the past 4 weeks, how much have you been bothered by any of the following problems?
Not bothered
at all
1
Bothered a
little
2
Bothered a
lot
3
b. Back pain
1
2
3
c. Pain in your arms, legs, or joints (knees, hips, etc.)
1
2
3
d. Menstrual cramps or other problems with your periods (Women only)
1
2
3
e. Headaches
1
2
3
f. Chest pain
1
2
3
g. Dizziness
1
2
3
h. Fainting spells
1
2
3
i. Feeling your heart pound or race
1
2
3
j. Shortness of breath
1
2
3
k. Pain or problems during sexual intercourse
1
2
3
l. Constipation, loose bowels, or diarrhea
1
2
3
m. Nausea, gas, or indigestion
1
2
3
n. Feeling tired or having low energy
1
2
3
o. Trouble sleeping
1
2
3
a. Stomach pain
21. Either based on your own experiences or what you have heard from others, please rate your opinion of the
following aspects of Department of Veterans Affairs (VA) care:
Extremely
negative
1
Somewhat
negative
2
3
Somewhat
positive
4
Extremely
positive
5
b. Privacy and confidentiality of medical records
1
2
3
4
5
c. Ease of using VA care
1
2
3
4
5
d. Healthcare staff’s skill and expertise
1
2
3
4
5
e. Staff’s courtesy and respect toward patients
1
2
3
4
5
a. Availability of needed services
Neutral
22. Please answer the following questions about the time since you returned from your most recent deployment
to OEF/OIF:
a. Have you had a physical health problem that required healthcare?
b. Have you had an emotional problem that required healthcare?
c. Have you gotten any medical care for yourself? For example, hospital stays, doctor’s visits,
urgent care, routine exams, medical tests or shots?
c1. If yes to 22c: Did you go to a Department of Veterans Affairs (VA) healthcare facility
for any of this care?
d. Have you seen a professional for help with an emotional problem? These professionals
could be psychologists, therapists, counselors or psychiatrists and could include groups led
by professional counselors and visits for medication for emotional problems.
d1. If yes to 22d: Did you go to a Department of Veterans Affairs (VA) healthcare facility
for any of this care?
Page 2
Yes
No
1
2
1
2
1
2
1
2
1
2
1
2
23. Please answer the following questions about your life after your return from your most recent deployment to OEF/OIF.
Strongly
disagree
Somewhat
disagree
Neither
agree nor
disagree
Somewhat
agree
Strongly
agree
a. The transition from my deployment back to my regular life
was extremely difficult.
1
2
3
4
5
b. Following my deployment, it was hard to reconnect with my
family and friends.
1
2
3
4
5
c. In general, I was less satisfied with my life after my
deployment than I had been before my deployment.
1
2
3
4
5
Not
applicable
d. Following my deployment, returning to work was a challenge.
0
1
2
3
4
5
e. I had difficulty resuming my relationship with my
spouse/significant other following my deployment.
0
1
2
3
4
5
24. Below is a list of problems and complaints that military personnel have in response to stressful deployment
experiences. Please read each one carefully, then circle one of the numbers to the right to indicate how much
you have been bothered by that problem in the past month.
Not at all
A little bit
Moderately
Quite a bit
Extremely
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
j. Feeling distant or cut off from other people?
1
2
3
4
5
k. Feeling emotionally numb or being unable to have loving feelings
for those close to you?
l. Feeling as if your future somehow will be cut short?
1
2
3
4
5
1
2
3
4
5
m. Trouble falling or staying asleep?
1
2
3
4
5
n. Feeling irritable or having angry outbursts?
1
2
3
4
5
o. Having difficulty concentrating?
1
2
3
4
5
p. Being “superalert” or watchful or on guard?
1
2
3
4
5
q. Feeling jumpy or easily startled?
1
2
3
4
5
a. Repeated, disturbing memories, thoughts or images of a stressful
deployment experience?
b. Repeated, disturbing dreams of a stressful deployment
experience?
c. Suddenly acting or feeling as if a stressful deployment experience
were happening again (as if you were reliving it)?
d. Feeling very upset when something reminded you of a stressful
deployment experience?
e. Having physical reactions (e.g., heart pounding, trouble breathing,
sweating) when something reminded you of a stressful
deployment experience?
f. Avoiding thinking about or talking about a stressful deployment
experience or avoiding having feelings related to it?
g. Avoiding activities or situations because they reminded you of a
stressful deployment experience?
h. Trouble remembering important parts of a stressful deployment
experience?
i. Loss of interest in activities that you used to enjoy?
Page 3
25. Please read each statement and circle the number that best indicates how much the statement applied to
you over the past week. There are no right or wrong answers.
Did not
apply to me
at all
Applied to
me to some
degree, or
some of the
time
a. I was aware of the dryness of my mouth.
1
2
Applied to
me to a
considerable
degree, or a
good part of
the time
3
b. I experienced breathing difficulty (e.g., excessively rapid breathing,
breathlessness in the absence of physical exertion).
c. I had a feeling of shakiness (e.g., legs going to give way).
1
2
3
4
1
2
3
4
d. I found myself in situations that made me so anxious I was most
relieved when they ended.
e. I had a feeling of faintness.
1
2
3
4
1
2
3
4
f. I perspired noticeably (e.g., hands sweaty) in the absence of high
temperatures or physical exertion.
g. I felt scared without any good reason.
1
2
3
4
1
2
3
4
h. I had difficulty swallowing.
1
2
3
4
i. I was aware of the action of my heart in the absence of physical
exertion (e.g., sense of heart rate increase, heart missing a beat).
j. I felt I was close to panic.
1
2
3
4
1
2
3
4
k. I feared that I would be “thrown” by some trivial but unfamiliar task.
1
2
3
4
l. I felt terrified.
1
2
3
4
m. I was worried about situations in which I might panic and make a
fool of myself.
1
2
3
4
n. I experienced trembling (e.g., in the hands).
1
2
3
4
Applied to
me very
much, or
most of the
time
4
26. Below is a list of some of the ways you may feel or behave. Please indicate how often you have felt this way
during the past week by circling the number in the column that best fits your answer.
None of the
time or less
than one day
1
a. I felt depressed.
1 – 2 days
3 – 4 days
5 – 7 days
2
3
4
b. I felt that everything I did was an effort.
1
2
3
4
c. My sleep was restless.
1
2
3
4
d. I was happy.
1
2
3
4
e. I felt lonely.
1
2
3
4
f. People were unfriendly.
1
2
3
4
g. I enjoyed life.
1
2
3
4
h. I felt sad.
1
2
3
4
i. I felt that people disliked me.
1
2
3
4
j. I could not get “going.”
1
2
3
4
Page 4
27. Since your most recent deployment to OEF/OIF, have
you thought about or attempted to kill yourself?
1 No
2 It was just a passing thought.
3 I briefly considered it, but not seriously.
4 I thought about it and was somewhat serious.
5 I had a plan for killing myself which I thought
would work and seriously considered it.
6 I attempted to kill myself, but I do not think I
really meant to die.
7 I attempted to kill myself, and I think I really
hoped to die.
33. The statements below are about your combat
experiences during your most recent deployment
to OEF/OIF. Please circle “Yes” if the statement is
true or “No” if the statement is false.
28. Since your most recent deployment to OEF/OIF, how
often have you thought about killing yourself?
1 Not at all
2 Rarely
3 Sometimes
4 Often
5 Very often
29. Since your most recent deployment to OEF/OIF, have
you ever told someone that you were going to commit
suicide, or that you might do it?
1 No
2 Yes, during one short period of time
3 Yes, during more than one period of time
30. How likely is it that you will attempt suicide someday?
1 No chance at all
2
3
Some chance
4
5
Very likely
31. Since your most recent deployment to OEF/OIF, have
you used alcohol?
1 No (IF NO, GO TO QUESTION 33)
2 Yes (IF YES, GO TO QUESTION 32)
32. If YES to Question 31, please answer the following
questions about the time since your most recent
deployment to OEF/OIF:
a. Have you felt you ought to cut
down on your drinking?
b. Have people annoyed you by
criticizing your drinking?
c. Have you felt bad or guilty about
your drinking?
d. Have you had a drink first thing in
the morning to steady your nerves
or to get rid of a hangover?
Yes
No
1
2
1
2
1
2
1
2
Page 5
Yes
No
1
2
1
2
1
2
1
2
a. I went on combat patrols or
missions.
b. I or members of my unit
encountered land or water mines
and/or booby traps.
c. I or members of my unit received
hostile incoming fire from small
arms, artillery, rockets, mortars, or
bombs.
d. I or members of my unit received
“friendly” incoming fire from small
arms, artillery, rockets, mortars, or
bombs.
e. I was in a vehicle (for example, a
truck, tank, APC, helicopter, plane,
or boat) that was under fire.
f. I or members of my unit were
attacked by terrorists or civilians.
g. I was part of a land or naval artillery
unit that fired on the enemy.
h. I was part of an assault on
entrenched or fortified positions.
i. I took part in an invasion that
involved naval and/or land forces.
j. My unit engaged in battle in which it
suffered casualties.
k. I personally witnessed someone
from my unit or an ally unit being
seriously wounded or killed.
l. I personally witnessed soldiers from
enemy troops being seriously
wounded or killed.
m. I was wounded or injured in combat.
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
n. I fired my weapon at the enemy.
1
2
o. I killed or think I killed someone in
combat.
1
2
34. The statements below are about your experiences. Please indicate if you ever experienced the following
events anytime during your most recent deployment to OEF/OIF by circling either “Yes” or “No.”
a. I observed homes or villages that had been destroyed.
b. I saw refugees who had lost their homes and belongings as a result of battle.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
I saw people begging for food.
I or my unit took prisoners of war.
I interacted with enemy soldiers who were taken as prisoners of war.
I was exposed to the sight, sound, or smell of animals that had been wounded or killed
from war-related causes.
I took care of injured or dying people.
I was involved in removing dead bodies after battle.
I was exposed to the sight, sound, or smell of dying men and women.
I saw enemy soldiers after they had been severely wounded or disfigured in combat.
I saw the bodies of dead enemy soldiers.
I saw civilians after they had been severely wounded or disfigured.
I saw the bodies of dead civilians.
I saw Americans or allies after they had been severely wounded or disfigured in combat.
I saw the bodies of dead Americans or allies.
Yes
1
1
1
1
1
No
2
2
2
2
2
1
2
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
35. The statements below are about the amount of danger you felt you were exposed to during your most recent
deployment to OEF/OIF. Please read each statement and describe how much you agree or disagree with each
statement by circling the number in the column that best fits your answer.
a. I thought I would never survive.
b. I felt safe.
c. I was extremely concerned that the enemy would use nuclear,
biological, chemical agents (NBCs) against me.
d. I felt that I was in great danger of being killed or wounded.
e. I was concerned that my unit would be attacked by the enemy.
f. I worried about the possibility of accidents (for example,
friendly fire or training injuries in my unit).
g. I was afraid I would encounter a mine or booby trap.
h. I felt secure that I would be coming home after the war.
i. I thought that vaccinations I received would actually cause me
to be sick.
j. I was concerned that the tablets I took to protect me would
make me sick.
k. I felt that I would become sick from the pesticides or other
routinely used chemicals.
l. I was concerned about the health effects of breathing bad air.
m. I thought that exposure to depleted uranium would negatively
affect my health.
n. I was afraid that the equipment I was given to protect me from
nuclear, biological, chemical agents (NBCs) would not work.
o. I worried about getting an infectious disease.
Page 6
Strongly
disagree
Somewhat
disagree
1
1
2
2
Neither
agree nor
disagree
3
3
1
2
1
1
Somewhat
agree
Strongly
agree
4
4
5
5
3
4
5
2
2
3
3
4
4
5
5
1
2
3
4
5
1
1
2
2
3
3
4
4
5
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
37. Were you affected by a blast or explosion?
1 No (IF NO, GO TO QUESTION 38)
2 Yes (IF YES, GO TO QUESTION 37a)
36. During your most recent deployment to OEF or OIF did
you ever hit your head?
1 No (IF NO, GO TO QUESTION 37)
2 Yes (IF YES, ANSWER QUESTIONS 36a – c)
37a. If Yes, how? (CHECK ALL THAT APPLY)
1 Thrown off your feet
2 Knocked to the ground
3 Stunned or confused
4 Ringing in the ears or problems
hearing
5 Trouble breathing
6 Hit by flying debris
7 Other: _________________________
36a. If Yes, how? (CHECK ALL THAT APPLY)
1 Blast or explosion
2 Motor vehicle accident
3 Fall
4 Hit on the head by a person
5 Hit on the head by a moving object (bullet,
shrapnel, etc.)
6 Other: ________________________
36b. When you hit your head, did you black out,
pass out, or lose consciousness?
1 Yes
2 No
36c. After you hit your head, were you dazed or
confused?
1 Yes
2 No
(GO TO QUESTION 37)
38. These statements are about your relationships with other military personnel during your most recent
deployment to OEF/OIF. Read each statement and describe how much you agree or disagree by circling the
number that best fits your answer.
a. My unit was like family to me.
b. I felt a sense of camaraderie between myself and other
soldiers in my unit.
c. Members of my unit understood me.
d. Most people in my unit were trustworthy.
e. I could go to most people in my unit for help when I had a
personal problem.
f. My commanding officer(s) were interested in what I
thought and how I felt about things.
g. I was impressed by the quality of leadership in my unit.
h. My superiors made a real attempt to treat me as a
person.
i. The commanding officer(s) in my unit were supportive of
my efforts.
j. I felt like my efforts really counted to the military.
k. The military appreciated my service.
l. I was supported by the military.
Page 7
Strongly
disagree
Somewhat
disagree
1
2
Neither
agree nor
disagree
3
1
2
1
1
Somewhat
agree
Strongly
agree
4
5
3
4
5
2
2
3
3
4
4
5
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
39. The following set of statements refers to concerns you may have had related to your life and family back home
during your most recent deployment to OEF/OIF. These questions do not ask if these events actually occurred,
but only how concerned you were that they might happen while you were deployed. Please describe how
concerned you were for each item by circling the number that best fits your answer.
WHILE I WAS DEPLOYED, I WAS CONCERNED ABOUT:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
Not
applicable
Not at all
A little
Moderately
A great
deal
0
0
0
0
0
0
0
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
0
1
1
2
2
3
3
4
4
Missing out on a promotion at my job back home.
Missing out on opportunities to start a career while I was away.
Damaging my career because I was overseas for a long time.
Losing touch with my co-workers or supervisors back home.
Being unable to financially support my family while I was away.
Harming my relationship with my spouse/significant other.
Being left by my spouse/significant other.
Missing out on my children’s growth and development while I
was away.
Losing touch with my friends.
Missing important events at home such as birthdays, weddings,
funerals, graduations, etc.
The well-being of my family or friends while I was away.
My inability to help my family or friends if they had some type of
problem.
My inability to directly manage or control family affairs.
The care that my children were receiving while I was away.
40. The set of questions below is about difficulties you may have had with other military personnel during your
most recent deployment to OEF/OIF. Please describe how often you experienced each circumstance by circling
the number that best fits your answer.
Never
Once or
twice
Sometimes
Many times
a. Treated me in an overly critical way.
1
2
3
4
b. Behaved in a way that was uncooperative when working with me.
1
2
3
4
c. Treated me as if I had to work harder than others to prove myself.
1
2
3
4
d. Questioned my abilities or commitment to perform my job effectively.
1
2
3
4
e. Acted as though my mistakes were worse than others.
1
2
3
4
f. Tried to make my job more difficult to do.
1
2
3
4
g. “Put me down” or treated me in a condescending way.
1
2
3
4
WHILE I WAS DEPLOYED, UNIT LEADERS OR OTHER UNIT MEMBERS:
42. During your most recent deployment to OEF/OIF, did
someone ever use force or threat of force to have sex
with you against your will?
1 No
2 Yes
41. During your most recent deployment to OEF/OIF, did
you receive uninvited and unwanted sexual attention,
such as touching, cornering, pressure for sexual
favors, or verbal remarks?
1 No
2 Yes
Page 8
43. The set of questions below is about any sexual issues you may have had with other military personnel during
your most recent deployment to OEF/OIF. Please describe how often you experienced each circumstance by
circling the number that best fits your answer.
1
Once or
twice
2
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
1
2
2
3
3
4
4
Never
WHILE I WAS DEPLOYED, UNIT LEADERS OR OTHER UNIT MEMBERS:
a. Gossiped about my sex life or spread rumors about my sexual activities.
b. Made crude and offensive sexual remarks directed at me, either
publicly or privately.
c. Offered me some sort of reward or special treatment to take part in
sexual behavior.
d. Threatened me with some sort of retaliation for not being sexually
cooperative (for example, the threat of a negative review, physical
violence, or to ruin my reputation).
e. Made unwanted attempts to stroke or fondle me (for example, stroking
my leg or neck).
f. Made unwanted attempts to have sex with me.
g. Forced me to have sex.
Sometimes
Many times
3
4
IF YOU CIRCLED “1” (NEVER) FOR ALL QUESTIONS 43a-g, SKIP TO QUESTION 50 ON NEXT PAGE.
IF YOU CIRCLED 2, 3, OR 4 FOR ANY QUESTION, PLEASE ANSWER QUESTIONS 44 to 49 BELOW.
44. If you experienced any of the situations asked about in question 43, think of the specific situation that
had the greatest effect on you and answer the following questions about that situation.
HOW MUCH DID YOU FIND THIS SITUATION TO BE:
a.
b.
c.
d.
Annoying?
Offensive?
Disturbing?
Threatening?
Not at all
Slightly
Moderately
Very
Extremely
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
45. Did the situation occur during duty hours or while you
were off-duty?
1 All of it occurred during duty hours
2 Most of it occurred during duty hours; some offduty
3 Some of it during duty hours; most off-duty
4 None of it occurred during duty hours; all off-duty
47. Was the person or people who did this to you
(CHECK ALL THAT APPLY):
1 Male
2 Female
48. How long did this situation last?
1 A single event
2 Less than one week
3 One week to less than one month
4 One month to six months
5 More than six months
46. Was the person or people who did this to you (CHECK
ALL THAT APPLY):
1 Your military supervisor(s) or military personnel
of a higher rank/grade than you
2 Your military co-worker(s)
3 Your military subordinate(s)
4 Other military person(s)
5 Civilian(s) employed by the military
6 Other civilian person(s)
7 Other or unknown person(s)
49. Do you consider this situation to have been sexual
harassment?
1 Definitely was not sexual harassment
2 Probably was not sexual harassment
3 Uncertain
4 Probably was sexual harassment
5 Definitely was sexual harassment
Page 9
Please answer the following questions to complete
the survey.
55. Which best describes your current employment
status?
1 Worker for pay
2 Homemaker
3 Unemployed
4 Student
5 Retired
6 Disabled
50. What is your gender?
1 Male
2 Female
51. What is your age?
_________________________
52. Are you of Hispanic or Latino origin or descent?
1 Yes, Hispanic or Latino
2 No, not Hispanic or Latino
56. Which of the following categories best describes your
annual household income before taxes?
1 $25,000 or less
2 $25,001 to $50,000
3 $50,001 to $75,000
4 Over $75,001
53. In which of the following categories do you feel that
you belong? (PLEASE SELECT ONE OR MORE.)
1 Pacific Islander or Native Hawaiian
2 American Indian or Alaska Native
3 Asian
4 Black or African American
5 White
57. Are you currently involved in a romantic relationship?
1 No (IF NO, GO TO QUESTION 61 ON NEXT PAGE)
2 Yes (IF YES, GO TO QUESTION 58)
54. What is the highest level of education you have
attained?
1 High school graduate/GED
2 Vocational or technical training
3 Some college
4 Four-year college graduate
5 Some graduate or professional school
6 Graduate or professional degree
58. Please circle the number that best describes how much you and your partner agree or disagree with each other
about aspects of your life together in the past month.
a. Philosophy of life
b. Aims, goals, and things believed important
c. Amount of time spent together
Always
disagree
Almost always
disagree
Frequently
disagree
Occasionally
disagree
Almost always
agree
Always agree
1
1
1
2
2
2
3
3
3
3
3
3
4
4
4
5
5
5
59. Please circle the number that indicates how often you and your partner did the following activities together
in the past month.
a. Had a stimulating exchange of ideas
b. Calmly discussed something
c. Worked together on a project
Never
Less than
once a month
Once or twice
a month
Once or twice
a week
Once a day
More than
once a day
1
1
1
2
2
2
3
3
3
4
3
3
4
4
4
5
5
5
Page 10
60. Now consider your relationship with your partner
generally. On the scale below, please check the box
that best indicates the degree of happiness, all things
considered, of your relationship.
1 Extremely unhappy
2 Fairly unhappy
3 A little unhappy
3 Happy
4 Very happy
5 Extremely happy
6 Perfect
62. Do you have any children?
1 No (IF NO, THE SURVEY IS COMPLETE, THANK
YOU FOR PARTICIPATING!)
2 Yes (IF YES, PLEASE ANSWER THE FOLLOWING
FINAL QUESTIONS 62a – c, 63)
62a. If Yes to Q62: How many children do you
have? __________
62b. Please list the ages of your children.
_____ _____ _____ _____
61. What is your current relationship status?
1 Married IF Yes, how many years_____________
2 Living as a couple
3 Never married
4 Separated
5 Divorced
6 Widowed
62c. How many of your children live with you?
____________
63. If Yes to Question 62, please answer these questions about being a parent. Listed below are a number of
statements. Please respond to each item, indicating your agreement or disagreement with each statement.
a. The problems of taking care of a child are easy to solve
once you know how your actions affect your child, an
understanding I have acquired.
b. I would make a fine model for a new parent to follow in
order to learn what he/she would need to know in
order to be a good parent.
c. Being a parent is manageable, and any problems are
easily solved.
d. I meet my own personal expectations for expertise in
caring for my child.
e. If anyone can find the answer to what is troubling my
child, I am the one.
f. Considering how long I’ve been a parent, I feel
thoroughly familiar with this role.
g. I honestly believe I have all the skills necessary to be a
good parent to my child.
Strongly
disagree
Disagree
Mildly
disagree
Mildly
agree
Agree
Strongly
agree
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
THANK YOU FOR YOUR PARTICIPATION IN THE OEF/OIF POST-DEPLOYMENT SURVEY
Page 11
| File Type | application/pdf |
| File Modified | 2012-02-24 |
| File Created | 2008-08-13 |