Violence Against Children Survey
NCHS Questionnaire Design Research Laboratory
QDRL VACS Attach 1 - Qnne final 0710 2012
Violence Against Children Survey Evaluation Study - Philippines
OMB: 0920-0222
Attachment 1 VIOLENCE AGAINST CHILDREN SURVEY - Philippines: Age13-24Years
The Public Health Service Act provides us with the authority to do this research (42 United States Code 242k). All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).
Public reporting burden for this collection of information is estimated to average 2 hours 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0222).
OMB #0920-0222; Expiration Date: 06/30/2015
F1 |
RECORD THE TIME THE INTERVIEW BEGAN (00:00):
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F2 |
The first questions are about yourself:
How old were you on your last birthday? |
don’T know/declined................................................. |
99 |
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F3
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EDUCATION:
Have you ever attended school? |
NO...................................................................................... DON’T KNOW/DECLINED……………………………. |
1 2 99 |
F10 |
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F4
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Are you currently attending school? |
YES.................................................................................... NO..................................................................................... DON’T KNOW/DECLINED……………………………. |
2 99 |
F7 |
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F5
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How would you describe your grades in school? Excellent, very good, good, fair, or poor?
How is R determining this? |
EXCELLENT................................................................... VERY GOOD.................................................................. GOOD.............................................................................. FAIR................................................................................. POOR............................................................................... DON’T KNOW/DECLINED……………………………. |
1 2 3 4 5 99 |
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F6
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How do you travel to school on most days? (Interviewer, respondent should provide only one answer)
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SCHOOL BUS.................................................................. CAR.................................................................................. PUBLIC TRANSPORTATION........................................ WALKING ALONE......................................................... WALKING WITH siblings/friends........................ BICYCLE.......................................................................... I BOARD AT SCHOOL................................................... OTHER (SPECIFY) : ___________________________ DON’T KNOW/DECLINED……………………………. |
1 2 3 4 5 6 7 88 99 |
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F7
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What is the highest level of schooling you have completed?
How many years was R in school? |
less than primary................................................... pRIMARY......................................................................... elementary…………………………………………. sECONDARY................................................................... hIGHER THAN SECONDARY……………….……….. DON’T KNOW/DECLINED……………………………. |
1 2 3 4 5 99 |
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F8
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How close do you feel to other students at your school? Very close, somewhat close, not too close, not close at all?
How is R determining this? |
Very close........................................................ Somewhat Close....................................................... Not Too close............................................................. Not cloes at all................................................. DON’T KNOW/DECLINED……………………………. |
1 2 3 4 99 |
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F9
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How much do you feel that your teachers care about you? A lot, A little, Not very much, Not at all?
How is R determining this? (Interviewer prompt if necessary: Do you strongly agree, agree, disagree or strongly disagree?) |
A Lot........................................................ A LITTLE....................................................... Not very much.......................................................... Not at all................................................. DON’T KNOW/DECLINED……………………………. |
1 2 3 4 99 |
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F10
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WORK:
Have you ever worked for money or any other form of payment? |
YES................................................................................... NO..................................................................................... don’t know / DECLINED…………………………. |
1
99 |
F15 |
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F12 |
What was this type of work? |
MINING…………………................................................. QUARRYING..................................................................... PYROTECHNICS PRODUCTION................................... FISHING………................................................................ DOMESTIC WORK……………...................................... CONSTRUCTION.............................................................. OTHER (SPECIFY) : ___________________________ DON’T KNOW/DECLINED……………………………. |
1 2 3 4 5 6 88 99 |
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F15 |
GENDER ATTITUDES: Sometimes a husband is annoyed or angered by things his wife does. Do you believe that it is acceptable for a man to hit or beat his wife: (Read categories below)
INTERVIEWER: PLEASE CIRCLE THE APPROPRIATE RESPONSE FOR QUESTION A THROUGH E |
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F16 |
Sometimes men and women have different ideas about having sex. Do you agree or disagree with the following statements: (Read categories below)
INTERVIEWER: PLEASE CIRCLE THE APPROPRIATE RESPONSE FOR QUESTION A THROUGH E |
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F231 |
PV4: WITNESSING PHYSICAL VIOLENCE
The following questions are about physical violence by strangers or people you know well in the home or the community. |
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F232 |
WITNESSING AT HOME
Have you seen any adults in your home hit, kick, slap, punch, or hurt each other intentionally: never, once, a few times, many times?
(Determine if these specific acts are being considered or if other acts are also included) |
A)
Never... Once..... few....... many.... Dk/dta. |
2 3 4
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F233
F233 |
B) How old were you when this first happened: 0-5, 6-11, 12-17, 18 or older?
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C) How old were you the most recent time this happened?
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D) Did this happen in the last 12 months?
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0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older....... Don’t know/ DECLINED …….. |
1 2 3 4
99 |
0 to 5 years......... 6 to 11 years....... 12 to 17 years..... 18 or older.......... DON’t KNOW/ DECLINED.............. |
1 2 3 4
99 |
YES.............. NO................ DK/DTA...... |
1 2 99 |
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1
2
1
PHYSICAL VIOLENCE
F153 |
pv2: PARENTS AND OTHER RELATIVES (Ask highlighted questions in this section, and then probe for accuracy of answers)
Now let us discuss parents and other relatives.
PV2A: Has a parent or other relative punched, kicked, whipped, or beat you with an object: never, once, a few times, many times?
(Determine if these specific acts are being considered or if other acts are also included: Punched, kicked, whipped, choked, smothered, drowned, weapon)
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Never.......................................................... Once............................................................ few............................................................... many........................................................... DON’T KNOW/DECLINED…................... |
3 4
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F166 F160
F166 |
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F154 |
PV2A: MOST RECENT TIME
How old were you the most recent time this happened? |
0 to 5 years............................................. 6 to 11 years........................................... 12 to 17 years......................................... 18 or older............................................. DON’T KNOW/DECLINED…................... |
1 2 3 4 99 |
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F155 |
What was your relationship to the relative who did this to you this most recent time?
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F156 |
Was this relative older than you, younger than you, or about the same age? |
older........................................................ younger.................................................. about same age.................................. don’t know/DECLINED...................... |
1
3 99 |
f158
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F157 |
Would you say this relative was more than 10 years older than you, 5-10 years older or less than 5 years older? |
more than 10 years older…........... 5-10 YEARS OLDER……………………… less than 5 years older…............... don’t know/DECLINED........................ |
1 2 3 99 |
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2
F158 |
Did this happen in the last 12 months? |
YES…....................….....….....…................. NO................................................................. DON’t KNOW/DECLINED……..……….. |
1 2 99 |
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F159 |
As a result of this most recent time when a relative punched, kicked, whipped, or beat you with an object, did you experience?
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F160 |
PV2A: FIRST TIME
How old were you the first time this happened? |
0 to 5 years.............................................. 6 to 11 years............................................ 12 to 17 years…...................................... 18 or older.............................................. DON’T KNOW/DECLINED….................... |
1 2 3 4 99 |
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F161 |
What was your relationship to the relative who did this to you the first time?
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F162 |
Was the relative than older you, younger than you, or about the same age? |
older........................................................ younger.................................................. about same age.................................. don’t know/DECLINED...................... |
1
3 99 |
f164
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F163 |
Would you say this relative more than 10 years older than you, 5-10 years older, or less than 5 years older? |
more than 10 years older............. 5-10 YEARS OLDER………………..……... less than 5 years older.................. don’t know/DECLINED........................ |
1 2 3 99 |
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F164 |
Did this happen in the last 12 months? |
YES............................................................... NO................................................................. DON’t KNOW/DECLINED……..……….. |
1 2 99 |
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F165 |
As a result of this first time when a relative punched, kicked, whipped, or beat you with an object, did you experience?
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F166 |
PV2B:
Has a parent or any other relative choked, smothered, tried to drown, burned or scalded you intentionally: never, once, a few times, many times? |
Never......................................................... Once............................................................ few.............................................................. many.......................................................... DON’T KNOW/DECLINED......................... |
3 4
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f179 f173
f179 |
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F179 |
PV2C:
Has a parent or other relative used or threatened to use a knife or other weapon against you: never, once, a few times, many times?
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Never......................................................... Once........................................................... few.............................................................. many......................................................... DON’T KNOW/DECLINED…................... |
3 4
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f192 f186
f192 |
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F300 |
EMOTIONAL VIOLENCE
EV1
Has/did a parent or primary caregiver ever say that you were not loved, or did not deserve to be loved, or that they wished you had never been born or were dead, or has a parent or primary caregiver ever ridiculed you or put you down (for example say that you were stupid or useless): never, once, a few times, or many times? |
Never............................................................ Once.............................................................. few................................................................. many............................................................. DON’T KNOW/DECLINED…...................... |
3 4
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F400 F306
F400 |
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F1021 |
PERPETRATION (Ask highlighted questions in this section, and then probe for accuracy of answers)
Have you slapped or pushed a current or previous partner/husband: never, once, a few times, many times? By partner I mean a boyfriend, romantic partner, fiancé, live-in partner, or husband. |
Never................................................................................. Once................................................................................... few...................................................................................... many.................................................................................. DON’T KNOW/DECLINED.............................................. |
1 2 3 4 99 |
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F1022 |
Have you punched, kicked, whipped, or beat with an object a current or previous partner/husband: never, once, a few times, many times? |
Never................................................................................. Once................................................................................... few...................................................................................... many.................................................................................. DON’T KNOW/DECLINED.............................................. |
1 2 3 4 99 |
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F1023 |
Have you choked, smothered, tried to drown, or intentionally burned or scalded a current or previous partner/husband: never, once, a few times, many times? |
Never................................................................................. Once................................................................................... few...................................................................................... many.................................................................................. DON’T KNOW/DECLINED.............................................. |
1 2 3 4 99 |
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F1024 |
Have you used or threatened to use a knife or other weapon against a current or previous partner/husband: never, once, a few times, many times? |
Never................................................................................. Once................................................................................... few...................................................................................... many.................................................................................. DON’T KNOW/DECLINED.............................................. |
1 2 3 4 99 |
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F1025 |
Have you forced a current or previous partner/husband to have sexual intercourse or perform any other sex acts with you when they did not want to: never, once, a few times, many times? |
Never................................................................................. Once................................................................................... few...................................................................................... many.................................................................................. DON’T KNOW/DECLINED.............................................. |
1 2 3 4 99 |
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F1026 |
Have you forced someone who was not your husband or partner at the time to have sexual intercourse or perform any other sex acts with you when they did not want to: never, once, a few times, many times? |
Never................................................................................. Once................................................................................... few...................................................................................... many.................................................................................. DON’T KNOW/DECLINED.............................................. |
1 2 3 4 99 |
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F400 |
SEXUAL BEHAVIOR:
(Ask highlighted questions in this section, and then probe for accuracy of answers)
The next set of questions is about your sexual activity and practices. Some of these questions are personal but keep in mind that your name is not on the survey and no one else will know your answers. There are no right or wrong answers, and remember that you can skip any question that you don’t feel comfortable answering.
Have you ever had sexual intercourse whether this was something you wanted to do at the time or something you did not want to do? |
YES.......................................................................... NO............................................................................ DON’T KNOW/DECLINED…………………… |
2 99 |
F500 |
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F401 |
How old were you when you had sexual intercourse for the very first time? |
DON’T KNOW/DECLINED…………………… |
99 |
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F402 |
The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were made to have it without your permission? |
wanted to......................................................... made to............................................................... DON’T KNOW/DECLINED……………………... |
1 2 99 |
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F406 |
SEX HISTORY AND RISK TAKING:
In your life, how many sexual partners have you ever had? A sexual partner is any person with whom you have had sexual intercourse whether this was something you wanted to do at the time or something you did not want to do.
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(Interviewers: 0 is not an acceptable answer for this question, if respondent says 0 then refer back to F400 and correct if necessary)
DON’T KNOW/DECLINED……………………………………. |
99 |
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F407 |
Have you had sexual intercourse in the past 12 months?
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NO................................................................................................... DON’T KNOW/DECLINED……………………………………. |
1 2 99
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F500 |
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F408 |
How many partners have you had sexual intercourse with in the past 12 months? |
NUMBER of PARTNERS
DON’T KNOW/DECLINED…………………………………… |
99 |
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F409 |
INTERVIEWER: CONTINUE DOWN THE COLUMN, ASKING ALL THE QUESTIONS FOR PARTNER 1 BEFORE CONTINUING TO PARTNER 2 AND PARTNER 3. |
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F410 |
(Refer back to F406; are answers to this question consistent? The point is to assess whether R is counting all partners or only certain relationships) |
PARTNER 1 MOST RECENT
What is/was your relationship to the most recent person with whom you had sexual intercourse? |
PARTNER 2 SECOND MOST RECENT
Now think back to the partner you had sexual intercourse with before the partner we just talked about.
What is/was your relationship to the person with whom you had sexual intercourse? |
PARTNER 3 THIRD MOST RECENT
Now think back to the partner you had sexual intercourse with before the partner we just talked about.
What is/was your relationship to the person with whom you had sexual intercourse? |
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HUSBAND..................... LIVE-IN PARTNER...... BOYFRIEND NOT LIVING WITH YOU...... SOMEONE YOU PAID FOR SEX……………… SOMEONE WHO PAID YOU FOR SEX............... CASUAL ACQUINTANCE............ FRIEND.......................... OTHER(SPECIFY)________________________ DK/DTA......................... |
1 2
3
4
5
6 7
88 99 |
HUSBAND..................... LIVE-IN PARTNER....... BOYFRIEND NOT LIVING WITH YOU...... SOMEONE YOU PAID FOR SEX………………. SOMEONE WHO PAID YOU FOR SEX............... CASUAL ACQUINTANCE............ FRIEND.......................... OTHER(SPECIFY)_________________________ DK/DTA......................... |
1 2
3
4
5
6 7
88 99 |
HUSBAND..................... LIVE-IN PARTNER....... BOYFRIEND NOT LIVING WITH YOU...... SOMEONE YOU PAID FOR SEX………………. SOMEONE WHO PAID YOU FOR SEX............... CASUAL ACQUINTANCE............ FRIEND........................... OTHER(SPECIFY)__________________________ DK/DTA........................... |
1 2
3
4
5
6 7
88 99 |
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F411 |
In the past 12 months, how often did you or this partner use a condom during sexual intercourse? Would you say always, sometimes, or never? |
ALWAYS........................ SOMETIMES.................. NEVER........................... DON’T KNOW / DECLINED..................... |
1 2 3
99 |
ALWAYS........................ SOMETIMES.................. NEVER........................... DON’T KNOW / DECLINED...................... |
1 2 3
99 |
ALWAYS........................ SOMETIMES.................. NEVER........................... DON’T KNOW / DECLINED.................... |
1 2 3
99 |
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F412 |
INTERVIEWER: CHECK NUMBER OF PARTNERS REPORTED IN F408 |
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PARTNER 3
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GO TO F500 |
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F403 |
(Ask highlighted questions in this section, and then probe for accuracy of answers)
ASK PREGNANCY QUESTIONS ONLY OF FEMALES 13-24 YEARS OF AGE.
PREGNANCY: The next questions are about pregnancy.
Have you ever been pregnant? |
NO.................................................................................................... DON’T KNOW/DECLINED……………………………………. |
1 2 99 |
F406 |
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F404 |
How old were you the first time that you got pregnant? |
YEARS OLd:
DON’T KNOW/DECLINED……………………………………. |
99 |
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F405 |
Have you ever had a pregnancy that did not end in a live birth? |
YES................................................................................................. NO.................................................................................................. DON’T KNOW/DECLINED……………………………………. |
1 2 99 |
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1
IF
F408=1 F500
F500 |
SEXUAL VIOLENCE : NON-CONTACT SEXUAL VIOLENCE/EXPLOITATION
The next set of questions is about different kinds of sexual violence. Some of these questions are personal but keep in mind that your name is not on the survey and no one else will know your answers. There are no right or wrong answers, and remember that you can skip any question that you don’t feel comfortable answering. |
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F501 |
NON CONTACT SEXUAL VIOLENCE
Has anyone ever made you upset by speaking to you in a sexual way or writing sexual things about you?
(Ensure that R is not limiting answer to certain types of relationships) |
A)
YES.... 1
DK/ F502 DTA.... 99
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B) How old were you when this first happened: 0-5, 6-11, 12-17, 18 or older? |
C) How old were you the most recent time this happened?
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D) Did this happen in the last 12 months?
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0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older...... DON’T KNOW / DECLINED……... |
1 2 3 4
99 |
0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older...... DON’T KNOW / DECLINED……... |
1 2 3 4
99 |
YES.................... NO...................... DON’t KNOW/ DECLINED........ |
1 2
99 |
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E) How well did you know the person who did this to you? |
not at all…………...…………. not very well………………... very well……………………… don’t KNOW/DECLINED……… |
1 2 3 99 |
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F502 |
Has anyone made you witness sexual activities or sexual abuse, even without making you participate (e.g. images/photos, videos, online)? |
A)
YES.... 1
DK/ F503 DTA.... 99
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B) How old were you when this first happened: 0-5, 6-11, 12-17, 18 or older? |
C) How old were you the most recent time this happened? |
D) Did this happen in the last 12 months?
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0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older...... DON’T KNOW / DECLINED……... |
1 2 3 4
99 |
0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older...... DON’T KNOW / DECLINED……... |
1 2 3 4
99 |
YES.................... NO...................... DON’t KNOW/ DECLINED........ |
1 2
99 |
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E) How well did you know the person who did this to you? |
not at all………………....…. not very well…………..….. very well………………….… don’t KNOW/DECLINED…..... |
1 2 3 99 |
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F503 |
Has anyone made you participate in a sex video or in sexual photos? |
A)
YES.... 1
DK/ F504 DTA.... 99
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B) How old were you when this first happened: 0-5, 6-11, 12-17, 18 or older? |
C) How old were you the most recent time this happened? |
D) Did this happen in the last 12 months?
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0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older...... DON’T KNOW / DECLINED……... |
1 2 3 4
99 |
0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older...... DON’T KNOW / DECLINED……... |
1 2 3 4
99 |
YES.................... NO...................... DON’t KNOW/ DECLINED........ |
1 2
99 |
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E) How well did you know the person who did this to you? |
not at all………………....…. not very well…………..….. very well………………….… don’t KNOW/DECLINED…..... |
1 2 3 99 |
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F504 |
Has anyone made you look at their sexual body parts or made you show them yours? |
A)
YES.... 1
DK/ F505 DTA.... 99
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B) How old were you when this first happened: 0-5, 6-11, 12-17, 18 or older? |
C) How old were you the most recent time this happened? |
D) Did this happen in the last 12 months?
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0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older...... DON’T KNOW / DECLINED……... |
1 2 3 4
99 |
0 to 5 years...... 6 to 11 years.... 12 to 17 years.. 18 or older...... DON’T KNOW / DECLINED……... |
1 2 3 4
99 |
YES.................... NO...................... DON’t KNOW/ DECLINED........ |
1 2
99 |
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E) How well did you know the person who did this to you? |
not at all…………...………. not very well…………….. very well…………………… don’t KNOW/DECLINED…… |
1 2 3 99 |
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F505 |
SEXUAL VIOLENCE : MONEY, GOODS OR FAVORS EXCHANGED FOR SEX/EXPLOITATION
Has anyone ever given you money, food, gifts, or any favors to have sexual intercourse or perform any other sexual acts with them? |
NO.................................................................................. DON’T KNOW / DECLINED....................................... |
1 2 99 |
F600 |
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F600 |
SEXUAL VIOLENCE: SEXUAL ABUSE (Ask highlighted questions in this section, and then probe for accuracy of answers)
SV1: TOUCHING WITHOUT PERMISSION- LIFETIME
How many times in your life has anyone touched you in a sexual way without your permission, but did not try and force you to have sex of any kind? Touching without permission includes being fondled, pinched, grabbed, or touched without your permission |
0.................................................................. 1..................................................................
don’t know/DECLINED.....................
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F700 F613
F601
F700 |
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F601 |
SV1A: TOUCHING – MOST RECENT
How old were you the most recent time this happened? |
don’t know/DECLINED................................................... |
99 |
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F602 |
This most recent time, did more than one person touch you in a sexual way without your permission?
|
no, one person only...................................................... don’t know/DECLINED................................................... |
1 2 99 |
F605 |
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F603 |
This most recent time, how many people touched you in a sexual way without your permission?
|
don’t know/DECLINED................................................... |
99 |
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F604 |
Of these people who touched you in a sexual way without your permission this most recent time, think of the person you know the best for the following questions: |
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F605 |
What was your relationship to the person who did this to you? |
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Male BoyFRIEND/ROMANTIC Partner…………... Husband…………………………………………. father…………………......................................... STEP FATHER……………………………………... brother………………………………………….. STEP BROTHER………………………………… uncle……………………………………………... OTHER RELATIVE (SPECIFY)_______________ Male Teacher...................................................... Male POlice.......................................................... Male SECURITY PERSON................................... Male Employer................................................... Male in my neighborhood………………... Male COMMUNITY LEADER………………….. Male Religious Leader.................................. Male Friend…………………………………….. Male Stranger………………………………... OTHER Male (SPECIFY) ___________________ |
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 |
Female Girlfriend/Romantic Partner………………………. wife……………………………………………………………. mother……………………………………………………….. STEP MOTHER………………………………………………... sister………………................................................................. STEP SISTER…………………………………………………... aunt…………………………………………………………… OTHER RELATIVE (SPECIFY)________________________ FEMale Teacher................................................................... fEMale POlice........................................................................ FEMale SECURITY PERSON…............................................ FEMale Employer................................................................ FEMale in my neighborhood………………................. FEMale COMMUNITY LEADER…………………………… FEMale Religious Leader................................................ FEMale Friend……………………………………………... FEMale Stranger………………………………................ OTHER FEMALE (SPECIFY) __________________________ |
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 |
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Wearing Mask/It was dark/Couldn’t see…..……88 Don’t Know/DECLINED …………………………………99 |
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F606 |
Was the person older than you, younger than you, or about the same age? |
older............................................................................. younger...................................................................... about same age....................................................... don’t know/DECLINED............................... |
2 3 99 |
F608 |
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1
F607 |
Would you say this person was more than 10 years older than you, 5-10 years older or less than 5 years older? |
more than 10 years older................................ 5-10 YEARS OLDER…………………………………. less than 5 years older..................................... don’t know/DECLINED.......................................... |
1 2 3 99 |
|
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F608
|
Where were you when this happened to you? |
MY HOME………................................... PERPETRATOR’S HOME…………….. SOMEONE ELSE’S HOME…………… ON A ROAD/STREET…….…………… MARKET/SHOP/MALL……………….. SCHOOL………………………………... |
1 2 3 4 5 6 |
INSIDE A CAR/BUS......................................... LAKE, RIVER, OTHER BODY OF WATER... FIELD OR OTHER OUTDOOR AREA……… Bar/Restaurant/Disco/Club………… OTHER LOCATION (SPECIFY):__________ don’t know/DECLINED............................. |
7 8 9 10 88 99 |
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F609 |
About what time of day did this happen? |
MORNING (SUNRISE TO NOON)............................. AFTERNOON (noon to sunset).......................... EVENING (SUNSET TO MIDNIGHT)....................... LATE AT NIGHT (Midnight to sunrise).......... don’t know/DECLINED......................................... |
1 2 3 4 99 |
|
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F610 |
Was the person that did this to you drunk or on any illegal drugs when the touching happened? |
YES................................................................................. NO.................................................................................. don’t know/DECLINED......................................... |
1 2 99 |
|
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F611 |
Were you drinking, drunk, high, drugged, passed out or on any illegal drug when someone touched you without your permission this most recent time? |
YES................................................................................. NO.................................................................................. don’t know/DECLINED......................................... |
1 2 99 |
|
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F612 |
Did this happen to you within the past 12 months? |
YES................................................................................. NO.................................................................................. don’t know/DECLINED......................................... |
1 2 99 |
|
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F700 |
SV2: ATTEMPTED SEX- LIFETIME
How many times in your life has anyone tried to make you have sexual intercourse of any kind without your permission, but did not succeed? |
0............................................................................................ 1............................................................................................
don’t know/DECLINED............................................... |
|
F800 F713
F701
F800 |
F800 |
SV3: PRESSURED INTO SEX- LIFETIME
Have you ever had sexual intercourse of any kind with anyone, male or female, after they pressured you by doing things like telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you? |
yes....................................................................... no........................................................................ don’t know/DECLINED................................ |
1 2 99 |
|
F801 |
Have you ever had unwanted sexual intercourse of any kind with anyone, male or female, after they pressured you by repeatedly asking for sex, or showing they were unhappy? |
yes....................................................................... no………………………..................................... don’t know / Declined………………...... |
1 2 99 |
|
F802 |
Have you ever had unwanted sexual intercourse of any kind with anyone, male or female, after they pressured you using their influence or authority over you, for example, saying they will give you bad grades, that they will fire you, or that they will arrest you? |
yes....................................................................... no………………………..................................... don’t know / Declined………………..... |
1 2 99 |
|
F900 |
SV4: PHYSICALLY FORCED SEX- LIFETIME
How many times in your life have you been physically forced to have sexual intercourse of any kind regardless of whether you did or did not fight back? By physical force, we mean things like being pinned or held down or use of violence like pulling your hair, pushing, shoving, punching, using or threatening to use a weapon, or threatening to physically harm you or a loved one. |
0......................................................................... 1.........................................................................
write number if
don’t know/declined............................
|
|
F931 F916
F901
F931
|
0
1
F931 |
|
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F932 |
SV: HELP-SEEKING AND REPORTING
I would like you to think back to all the sexual experiences that happened without your permission. These experiences may include: unwanted sexual touching, attempted sex, pressured sex, or physically forced sex. |
|
|
|
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Did you ever tell anybody about any of these experiences of unwanted touching, attempted sex, pressured sex, or physically forced sex? |
YES.....................................................................................
DON’T KNOW/DECLINED............................................. |
1 2 99
|
F934
|
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F933 |
Were there any sexual experiences that you did not tell anyone about? |
YES.....................................................................................
DON’T KNOW/DECLINED............................................. |
1 2 99 |
F935 |
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F934 |
Why didn’t you tell anyone about these experiences?
(Circle all mentioned) |
AFRAID OF GETTING INTO TROUBLE....... embarrassed FOR SELF/FAMILY........... DEPENDENT ON PERPETRATOR................. PERPETRATOR THREATENED ME.............. DIDN’T THINK IT WAS A PROBLEM........... FELT IT WAS MY FAULT............................... |
A B C D E F |
Didn’t want abuser to get in trouble AFRAID OF BEING ABANDONED....................... OTHER REASON (SPECIFY):________________ __________________________________________ DON’T KNOW/DECLINED...................................... |
G H
X Z |
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F935 |
SV SERVICES
Did you talk to or receive services from:
|
other person/place (specify):_______________________________
|
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F936 |
skip
if
f935a and f935b and f935c and f935d aND F935E=2/99
|
|||||||||||||||||||||||||||||||||||
F937 |
What was the main reason you did not talk to or receive services? |
did not know where to go……………………..… aFRAID OF causing more violence or GETTING IN TROUBLE …………………………............. embarrassed FOR SELF OR my FAMILY................. DID NOT WANT ABUSER TO GET IN TROUBLE........... TOO FAR TO SERVICES..................................................... AFRAID OF BEING ABANDONED.................................... did not think it was a problem............................ COULD NOT AFFORD TRANSPORT................................ COULD NOT AFFORD SERVICE FEES............................. DID NOT NEED/WANT SERVICES................................... NO ONE TO HELP ME......................................................... Felt it was useless………………………………….. Other (specify):______________________________ DON’t know/DECLINED................................................. |
1
2 3 4 5 6 7 8 9 10 11 12 88 99 |
|
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F938 |
Were there any professional services that you would have wanted but were not available? |
No................................................................................... DON’t know/DECLINED......................................... |
1 2 99 |
F940 |
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F939 |
What services would you have wanted? (Circle all mentioned) |
COUNSELING SERVICES......................... MEDICAL SERVICES................................ LEGAL COUNSEL..................................... TRADITIONAL HEALER SERVICES...... POLICE SERVICES.................................... EDUCATIONAL PROGRAMS………… |
A B C D E F |
SHELTER…………………………………... OTHER (SPECIFY):__________________ DON’T KNOW/DECLINED.........................
|
G X Z |
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F940 |
Was there anyone else that you spoke to regarding any sexual experiences that happened without your permission? (Circle all mentioned)
|
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MOTHER………………………………………… Father…………………………………………. SISTER…………………………………………… BROTHER……………………………………….. other relative……………………………... HUSBAND………………………………………. bOYFRIEND/rOMANTIC PARTNER………… friend…………………………………………... NEIGHBOR………………………………………. |
A B C D E F G H I |
TRADITIONAL HEALER……………………………... HOTLINE………………………………………………. NGO WORKER………………………………………... Teacher……………………………………………… employer……………………………………………. community leader…………………………….... religious leader……………………………….... OTHER (SPECIFY)____________________________ don’t know/declined………………………….. |
L M N O P Q R X Z |
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F941 |
Have any of these incidents caused you to do any of the following: (Read categories below)
|
OTHER (SPECIFY):_________________________________ |
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F1031 |
The next two questions ask about things that have ever happened to you.
Have you ever had thoughts of ending your life? |
YES.................................................................................
DON’T KNOW / DECLINED....................................... |
1 2 99 |
F1033 |
F1034 |
Have you ever been tested for HIV? |
YES................................................................................. NO.................................................................................. DON’T KNOW / DECLINED....................................... |
2
|
F1036 F1036 |
F1035 |
What is the main reason you have never been tested? |
DON’T KNOW WHERE TO GET HIV TEST……... test costs too much........................................... transport to test site is too much............ test site too far awaY...................................... afraid others will know about test/test results.................................................. don’t need test/Low risk................................. don’t want to know if I have the aids virus............................................................................ can’t get treatment if i have Aids............. other(specify)____________________________ DON’T KNOW / DECLINED....................................... |
1 2 3 4 5
6 7
8 9 88 99 |
F1038 |
F1038 |
Have you ever had a sexually transmitted infection? |
YES................................................................................. NO................................................................................... DON’T KNOW/DECLINED......................................... |
1 2 99 |
|
DEBRIEFING:
Do you feel that the time you took to answer these questions was worthwhile and will be useful to the Philippines in addressing the problem of violence? Did you find it upsetting or stressful to answer any of these questions? Which questions did you find upsetting or stressful to answer? The questions on physical violence, emotional violence, sexual violence, or other questions? How has talking about these things made you feel?
RESPONSE PLAN CHECKLIST: DID RESPONDENT REPORT ANY VIOLENCE IN THE PAST 12 MONTHS?
DID THE RESPONDENT BECOME VISIBLLY UPSET AT ANY POINT DURING THE INTERVIEW?
DID THE RESPODENT REPORT FEELING UNSAFE IN CURRENT LIVING SITUATION AT ANY POINT DURING INTERVEW?
IF NO WAS SELECTED FOR ALL OF THE ABOVE AND THE RESPONDENT DID NOT DISCLOSE ANY VIOLENCE, CONTINUE TO FINISH OPTION 1. IF NO WAS SELECTED FOR ALL OF THE ABOVE BUT THE RESPONDENT DISCLOSED VIOLENCE, CONTINUE TO FINISH OPTION 2. IF YES WAS SELECTED FOR ANY OF THE ABOVE, CONTINUE TO FINISH OPTION 3.
FINISH OPTION 1: RESPONDENT DID NOT DISCLOSE ANY VIOLENCE
I would like to thank you very much for helping me. I appreciate the time that you have taken. I realize that these questions may have been difficult for you to answer, but it is only by hearing from [girls and young women/boys and young men] like you that we can really understand about [women’s/men’s health] and life experiences in the Philippines.
Here is a list of organizations that provide various types of services that may be of interest to you. Please contact them if you need help.
FINISH OPTION 2: RESPONDENT DISCLOSED VIOLENCE BUT DID NOT MEET THE CRITERIA LISTED ABOVE
I would like to thank you very much for helping us. I appreciate the time that you have taken. I realize that these questions may have been difficult for you to answer, but it is only by hearing from [girls and young women/boys and young men] like you that that we can really understand about health and experiences of violence in the Philippines.
From what you have told me, I can tell that you have had some very difficult times in your life. No one has the right to treat someone else in that way. However, from what you have told me I can see also that you are strong, and have survived through these difficult circumstances.
Here is a list of organizations that provide support to people like you who may have experienced violence. Please contact them if you would like to talk over your situation with anyone. You can go whenever you feel ready, either soon or later on.
FINISH OPTION 3: OFFER RESPONSE PLAN TO RESPONDENT I would like to thank you very much for helping us. I appreciate the time that you have taken. I realize that these questions may have been difficult for you to answer, but it is only by hearing from [girls and young women/boys and young men] like you that that we can really understand about health and experiences of violence in the Philippines.
From what you have told me, I can tell that you have had some very difficult times in your life. No one has the right to treat someone else in that way. However, from what you have told me I can see also that you are strong, and have survived through these difficult circumstances.
I wanted to offer you some more immediate help if this would be something you need and want. A counselor can talk to you about the things that have happened to you and/or connect you to other services that might be helpful. If you decide that you would like to talk to a counselor, I would only share the information that you want me to share. As I told you in the beginning, your answers are confidential and I will not share these with the counselor. Would you like to speak with a counselor?
It is fine that you do not want to speak with a counselor now. I wanted to give you this list of organizations that provide support, legal advice and counseling services to people like you who may have experiences of violence. If you change your mind in the future, please contact them if you would like to talk over your situation with someone. You can go whenever you feel ready, either soon or later on. |
YES
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | jpa7 |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |
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