The National Intimate Partner and Sexual Violence Survey

Attachment G

National Intimate Partner and Sexual Violence Survey (NISVS) Instrument

2012 National Intimate Partner and Sexual Violence Survey Revised Study Questionnaire

November 23, 2011

Table of Contents

Section	Subject	Question Numbers	Page
CF	Control Form	CF1-CF17	3
RC	Respondent Characteristics	RC1-RC10	11
H	Health	H1-H10	17
PA	Psychological Aggression	PA - PAh	21
CCE	Coercive Control and Entrapment	CCE - CCEh	23
PV	Physical Violence	PV - PVh	26
12PA	12 Month Psychological Aggression (age 70+)	12PA2_INTRO – 12PA2b	29
12CCE	12 Month Coercive Control and Entrapment (age 70+)	12CCE2 – 12CCEb	30
12PV	12 Month Physical Violence (age 70+)	12PV2 – 12PVb	32
S	Stalking	S_INTRO - Sh	34
SFU	Stalking Follow-Up	SFU_INTRO-SFU6	37
SV	Sexual Violence	SV_INTRO - SVq	39
SVFU	Sexual Violence Follow Up	SVFU_INTRO -SVFU7	46
R	Relationships	R_INTRO – R8	48
FU	General Follow Up Questions	FU_INTRO – FU8	59
IP	Intimate Partner Information	IP1-IP4	67
W	Wrap-Up	W1 – W7	70

Conventions used in this document are as follows:

Programmer instructions are in curly brackets (i.e., “{ }”).

Interviewer instructions to be included in the CATI instrument are in flat brackets (i.e.,

“[ ]”).

Text for interviewers to read is in bold font.

Section CF: Control Form

S1

Hello, I am calling on behalf of the Centers for Disease Control and Prevention, the CDC. The CDC is doing a research study on health and injuries {if nonresponse sample:, and if someone in your household is selected to participate we will send that person a check for $40 for completing the survey}. My name is __________. I am an interviewer with RTI International and I am part of the research team. Let me assure you that this is not a sales call. Your phone number has been chosen randomly to represent thousands of others in the country.

Are you 18 years of age or older?

[TI: IF NO, ASK TO SPEAK TO SOMEONE OVER 18. IF SOMEONE OVER 18 COMES TO THE PHONE, RE-READ PARAGRAPH ABOVE. IF CAN’T GET SOMEONE OLDER THAN 18, BREAKOFF]

1 YES {go to CF1}

2 NO {go to BREAKOFF}

98 (VOL) DK {go to CF1}

99 (VOL) RF {go to BREAKOFF}

CF1

Is this {fill: phone number}?

1 YES {go to CF2}

2 NO {go to CF1_1}

5 LANGUAGE BARRIER {go to BREAKOFF}

6 REFUSED {go to BREAKOFF}

9 MORE CODES {go to NC}

98 (VOL) DK {go to CF1_1}

99 (VOL) RF {go to BREAKOFF}

CF1_1

I seem to have dialed the wrong number. Thank you very much for your assistance.

[TI: REDIAL NUMBER TO CONFIRM INCORRECT]

CF2

I need to ask you a few questions in order to determine your eligibility for CDC’s study.

Is this a cell phone?

1 YES {go to CF2_1}

2 NO {go to CF3}

98 (VOL) DK {go to BREAKOFF}

99 (VOL) RF {go to BREAKOFF}

(cell phone path = CF2_1 – CF7_1A) (landline path = CF3 – CF11)

CF2_1

Are you driving a vehicle at this moment?

1 YES {go to CF2_2}

2 NO {go to CF2_3A}

CF2_2

When would be a better time to call you?

[If respondent indicates that they are willing to talk now: “I’m sorry, but for your safety we’re not able to do the interview while you’re driving. When would be a better time to call you?”]

[SET CALLBACK]

CF2_3A

Including this one, how many working cell phones do you have?

[RECORD NUMBER OF CELL PHONES] {go to CF2_4A}

[RANGE 1-9]

98 (VOL) DK

99 (VOL) RF

CF2_4A

Now excluding cell phones, how many telephone numbers do you have in your household that are used for talking rather than only for machines like faxes and computers?

[RECORD NUMBER OF OTHER PHONE NUMBERS] {go to CF2_5}

[RANGE 0-5]

98 (VOL) DK

99 (VOL) RF

CF2_5

Including yourself, how many people who are 18 or older reside in your household?

[RECORD NUMBER OF PEOPLE]

[RANGE 1-9]

98 (VOL) DK

99 (VOL) RF

{go to CF7_1A}

CF7_1A

[IF NECESSARY: Please tell me your gender.]

1 MALE

2 FEMALE

3 TRANSGENDERED

98 (VOL) DK

99 (VOL) RF

{go to CF11}

{end of cell phone path, beginning landline path}

CF3

Is this a private residence?

1 YES {go to CFTEL1}

2 NO {go to CF3_1}

98 (VOL) DK {go to CF3_1}

99 (VOL) RF {go to CF3_1}

CF3_1

Thank you very much, but we are only interviewing people in private residences.

[TERMINATE INTERVIEW]

CFTEL1

Including the number I just dialed, how many different telephone numbers do you have in your household that are used for talking, excluding cell phones or telephone lines that are used only for machines like faxes and computers?

[RECORD NUMBER OF TELEPHONE NUMBERS]

[RANGE 1-5]

98 (VOL) DK

99 (VOL) RF

CFTEL2

How many working cell phones do you have?

[RECORD NUMBER OF CELL PHONES] {if 0, go to CFTEL3; else go to NUM_ADULTS}

[RANGE 0 - 9]

98 (VOL) DK

99 (VOL) RF

CFTEL3

Does anyone else in your household have a working cell phone?

1 YES {go to NUM_ADULTS}

2 NO {go to NUM_ADULTS}

98 (VOL) DK {go to NUM_ADULTS}

99 (VOL) RF {go to NUM_ADULTS}

NUM_ADULTS

We need to randomly select one adult who lives in your household to be interviewed. Including yourself, how many adults age 18 or older currently live in your household?

[RECORD NUMBER OF ADULTS] {if NUM_ADULTS =0, go to CF11_1; if NUM_ADULTS =1, go to CF7; if NUM_ADULTS=2, go to CF8_1; if NUM_ADULTS > 2, go to CF8_MEN}

[RANGE 1 – 10]

98 (VOL) DK

99 (VOL) RF

CF11_1

Did you include yourself when you said that no one is 18 years old?

1 YES {go to CF6_1}

2 NO {go to NUM_ADULTS}

CF6_1

We are only interviewing adults age 18 or older, so those are all the questions I have for you. Thank you for your time.

[TERMINATE INTERVIEW – CODE AS INELIGIBLE AGE]

CF7

Are you the adult?

1 YES {go to CF7_1}

2 NO {go to CF13A}

98 (VOL) DK

99 (VOL) RF

CF7_1

Are you male or female?

[IF NECESSARY: Please tell me your gender.]

1 MALE (go to CF11}

2 FEMALE {go to CF11}

3 TRANSGENDERED {go to CF7_2}

98 (VOL) DK

99 (VOL) RF

CF7_2

{if CF7_1 = 3}

Would you prefer to be referred to as male or female?

1. MALE (go to CF11}

2. FEMALE {go to CF11}

CF8_1

Is the other person male or female?

1. MALE

2. FEMALE

98 (VOL) DK

99 (VOL) RF

CF8_2

[IF NECESSARY: Are you male or female?]

1. MALE

2. FEMALE

98 (VOL) DK

99 (VOL) RF

{go to CF9_1}

CF8_MEN

How many of these adults are men?

[RECORD NUMBER OF MEN]

98 (VOL) DK

99 (VOL) RF

CF8_WOMEN

How many of these adults are women?

[RECORD NUMBER OF WOMEN]

98 (VOL) DK

99 (VOL) RF

{go to CF9}

CF9_1

My computer will randomly select the adult from your household that will be interviewed.

The other adult is the person that I need to interview. {go to CF13_FIRST}

OR

You are the person that I need to interview. {go to CF11}

CF9

My computer will randomly select the adult from your household that will be interviewed.

The person in your household that I need to interview is the {fill: man / woman} with the most recent birthday.

[ENTER 1 TO CONTINUE]

CF10

Are you that person?

1 YES {go to CF11}

2 NO {go to CF13_FIRST}

CF11

May I have your first name in case we get disconnected? Please do not tell me your last name, your address, or any other information that would identify you.

[RECORD RESPONDENT’S FIRST NAME ONLY] {go to CF_INTRO1A}

[IF RESPONDENT REFUSES, ASK FOR A FIRST INITIAL OR SOME OTHER IDENTIFIER. IF RESPONDENT STILL REFUSES, LEAVE BLANK AND CONTINUE.]

CF_INTRO1A

You have been randomly chosen to participate in an important study. This call may be monitored for quality assurance purposes. The Centers for Disease Control and Prevention (CDC) is doing a telephone study of up to 12,500 people. You may have received a letter from us. Men and women age 18 and older will be asked questions about their health and injuries they may have experienced. The data we are collecting are very important, and will be used to guide national policies.

The survey will take approximately 25 minutes, on average. We will do this survey over the phone right now or at another time that is better for you. Since some of the questions are personal, we suggest that you be in a private setting during the survey.

{ENTER 1 TO CONTINUE}

CF_INTRO1B

There are minimal benefits or risks to being in this voluntary study. In order to keep your information private, the answers you give us will be combined with the answers from other people who are in the survey. No information that could personally identify you will be given to the CDC or anyone else. You can skip any question or stop the survey at any time.

If you complete the survey, as a token of our appreciation we will send you a check for {if not nonresponse: $10; if nonresponse: $40} or make a donation to the United Way on your behalf, whichever you prefer. We will ask your preference at the end of the survey.

{ENTER 1 TO CONTINUE}

CF_INTRO1C

If you choose to receive the {if not nonresponse: $10; if nonresponse: $40}, I will go to a separate computer file after we finish the survey and collect your name and address so that we can mail the check to you. Your name and address will not be connected to the information you provide in the survey, and will be erased from our files at the end of this study.

If you have questions or concerns about participating in the study, you may call the Survey Manager, Susan Rooker, at 1-877-287-3782. If you have any questions about your rights as a research participant, please contact RTI’s Office of Research Protection toll-free at 1-866-214-2043.

May we begin?

1. YES {go to RC_1}

2. NO {go to CF12}

98 (VOL) DK {go to CF12}

99 (VOL) RF {go to CF12}

CF12

Could you please tell me why you do not wish to participate in the study?

1 DOES NOT HAVE TIME {go to BREAKOFF, set callback}

2 INCONVENIENT NOW {go to BREAKOFF, set callback}

3 NOT INTERESTED

4 DOES NOT PARTICIPATE IN SURVEYS

5 OPPOSES GOV’T INTRUDING ON PRIVACY

6 TOO PRIVATE/SENSITIVE/EMBARASSING

7 OTHER (SPECIFY) _____________ (max 50 characters)

98 (VOL) DK

99 (VOL) RF

CF13A

Is this person male or female?

1. MALE

2. FEMALE

3. TRANSGENDERED (MALE)

4. TRANSGENDERED (FEMALE)

98 (VOL) DK

99 (VOL) RF

CF13_FIRST

May I have this person’s first name in case we get disconnected?

[RECORD RESPONDENT’S FIRST NAME ONLY]

[IF RESPONDENT REFUSES, ASK FOR A FIRST INITIAL OR SOME OTHER IDENTIFIER. IF RESPONDENT STILL REFUSES, LEAVE BLANK AND CONTINUE.]

CF14

May I speak with {fill: name from CF13_FIRST OR him/her}?

1 YES {go to CF_INTRO2}

2 NO {go to BREAKOFF}

CF_INTRO2

[WHEN SELECTED RESPONDENT COMES TO THE PHONE]

Hello, I am calling on behalf of the Centers for Disease Control and Prevention, the CDC. The CDC is doing a study on health and injuries. My name is __________. I am an interviewer with RTI International and I am part of the research team. Let me assure you that this is not a sales call.

CF_INTRO3A

You have been randomly chosen to participate in an important study. This call may be monitored for quality assurance purposes. The Centers for Disease Control and Prevention (CDC) is doing a telephone study of up to 12,500 people. You may have received a letter from us. Men and women age 18 and older will be asked questions about their health and injuries they may have experienced. The data we are collecting are very important, and will be used to guide national policies.

The survey will take approximately 25 minutes, on average. We will do this survey over the phone right now or at another time that is better for you. Since some of the questions are personal, we suggest that you be in a private setting during the survey.

CF_INTRO3B

There are minimal benefits or risks to being in this voluntary study. In order to keep your information private, the answers you give us will be combined with the answers from other people who are in the survey. No information that could personally identify you will be given to the CDC or anyone else. You can skip any question or stop the survey at any time.

If you complete the survey, as a token of our appreciation we will send you a check for {if not nonresponse: $10; if nonresponse: $40} or make a donation to the United Way on your behalf, whichever you prefer. We will ask your preference at the end of the survey.

CF_INTRO3C

If you choose to receive the {if not nonresponse: $10; if nonresponse: $40}, I will go to a separate computer file after we finish the survey and collect your name and address so that we can mail the check to you. Your name and address will not be connected to the information you provide in the survey, and will be erased from our files at the end of this study.

If you have questions or concerns about participating in the study, you may call the Survey Manager, Susan Rooker, at 1-877-287-3782. If you have any questions about your rights as a research participant, please contact RTI’s Office of Research Protection toll-free at 1-866-214-2043.

May we begin?

1. YES {go to RC_INTRO}

2. NO {go to CF17}

98 (VOL) DK {go to CF17}

99 (VOL) RF {go to CF17}

CF17

Could you please tell me why you do not wish to participate in the study?

1 DOES NOT HAVE TIME {go to BREAKOFF, set callback}

2 INCONVENIENT NOW {go to BREAKOFF, set callback}

3 NOT INTERESTED

4 DOES NOT PARTICIPATE IN SURVEYS

5 OPPOSES GOV’T INTRUDING ON PRIVACY

6 TOO PRIVATE/SENSITIVE/EMBARASSING

7 OTHER (SPECIFY) _____________ (max 50 characters)

98 (VOL) DK

99 (VOL) RF

Section RC: Respondent Characteristics

RC1

In what month and year were you born?

[ELIGIBLE YEARS OF BIRTHS ARE: ]

[INTERVIEWER: IF YEAR OF BIRTH IS OUTSIDE ELIGIBLE RANGE, SAY: “I’m sorry, but we’re only speaking with people age 18 and older. I will have to end the interview now. Thank you for your interest, and have a nice day / evening.”]

RC2

What is the highest level of education you have completed?

1 NO SCHOOLING

2 1st‑8th GRADE

3 SOME HIGH SCHOOL

4 HIGH SCHOOL GRADUATE

5 TECHNICAL OR VOCATIONAL SCHOOL (ATTENDED OR GRADUATED)

6 SOME COLLEGE

7 4-YEAR COLLEGE DEGREE

8 POSTGRADUATE

9 ASSOCIATES DEGREE

10 NURSING SCHOOL DEGREE

98 (VOL) DK

99 (VOL) RF

RC3

Are you of Hispanic or {if female: Latina; if male: Latino} origin?

1 YES {go to RC3a}

2 NO {go to RC4}

98 (VOL) DK

99 (VOL) RF

RC3a

Which of these Hispanic, Latino, or Spanish groups best describes you?

1 Mexican, Mexican American, Mexicano, Chicano,

2 Puerto Rican,

3 Cuban/Cuban American,

4 Dominican [IF NECESSARY: from the Dominican Republic],

5 Central or South American, or

6 Spanish [IF NECESSARY: from Spain]

7 OTHER, SPECIFY {max 25 characters}

RC4

What is your race? You may identify more than one category. Would you say you are . . .

[CODE ALL THAT APPLY]

1 White

2 Black or African American

3 Asian

4 Native Hawaiian or other Pacific Islander, or

5 American Indian or Alaskan Native? {go to RC6, else go to RC5}

6 OTHER, SPECIFY {max 25 characters}

98 (VOL) DK

99 (VOL) RF

RC5

Were you born in the United States, including U.S. territories and U.S. military bases?

1 YES {go to RC7_1}

2 NO {go to RC5a}

98 (VOL) DK

99 (VOL) RF

RC5a

In what country were you born?

[RECORD NAME OF COUNTRY USING COUNTRY CODE LIST] {max 25 characters} {go to RC5b}

RC5b

How many years have you lived in the United States?

[RECORD NUMBER OF YEARS, or record LESS THAN ONE YEAR] {go to RC7_1}

RC6

Are you affiliated or enrolled with a tribe or village?

1 YES {go to RC6a}

2 NO {go to RC6b}

98 (VOL) DK

99 (VOL) RF

RC6a

Which tribe or village are you affiliated or enrolled with?

[RECORD NAME OF TRIBE/VILLAGE USING TRIBE LIST] {max 25 characters} {go to RC6b}

RC6b

Have you ever lived within reservation boundaries or in an Alaska Native village?

1 YES {go to RC6c}

2 NO {go to RC7_1}

98 (VOL) DK

99 (VOL) RF

RC6c

Have you lived within reservation boundaries or in an Alaska Native village during the past 12 months, that is since {fill: date, 12 mos. ago}?

1 YES {go to RC6d}

2 NO {go to RC7_1}

98 (VOL) DK

99 (VOL) RF

RC6d

On what reservation did you live during the past 12 months?

[RECORD NAME OF RESERVATION –max 50 characters]

RC7_1

Are you currently employed or working a job for which you get paid?

1 YES {go to RC7_2}

2 NO {go to RC7_3}

98 (VOL) DK {go to RC7}

99 (VOL) RF {go to RC7}

RC7_2

Are you currently employed full-time or part-time?

1. EMPLOYED FULL-TIME

2. EMPLOYED PART-TIME

98 (VOL) DK

99 (VOL) RF

{go to RC7_4}

RC7_3

Why are you currently not employed? Are you…

1. Keeping house,

2. Going to school,

3. Retired,

4. Disabled,

5. Unable to work for other health reasons, or

7. Laid off?

8. OTHER

98 (VOL) DK

99 (VOL) RF

RC7_4

Now please think about your employment status or work situation over the past 12 months, that is since {fill date 12 months ago}.

What were you doing for most of the past 12 months? Were you…

1. Employed full-time, {go to RC7_5}

2. Employed part-time, {go to RC7_5}

3. Keeping house, {go to RC7}

4. Going to school, {go to RC7}

5. Retired, {go to RC7}

6. Disabled, {go to RC7}

7. Unable to work for other health reasons, or {go to RC7}

8. BLANK INTENTIONALLY – WAS LOOKING FOR WORK

7. Laid off? {go to RC7}

8. OTHER {go to RC7}

98 (VOL) DK {go to RC7}

99 (VOL) RF {go to RC7}

RC7_5

How are you generally paid for the work you do? Are you….

1 Paid by salary,

2 Paid by the hour,

3 Paid by the job or task, or

4 Paid some other way?

98 (VOL) DK {go to RC7}

99 (VOL) RF {go to RC7}

RC7

What was the total income from ALL household members during {fill: most recently ended calendar year}, before taxes. Include income from all sources such as work, investments, child support and public assistance. Was it…

[TI NOTE: STUDENTS SHOULD NOT INCLUDE THEIR PARENT’S INCOME.]

RC7a Less than $25,000? {If RC7a=2, go to RC7e; if RC7a=1, go to RC7b}

($20,000 to less than $25,000)

RC7b Less than $20,000? {if RC7b=2, go to RC8; if RC7b=1 go to RC7c}

($15,000 to less than $20,000)

RC7c Less than $15,000? {if RC7c=2, go to RC8; if RC7c=1 go to RC7d}

($10,000 to less than $15,000)

RC7d Less than $10,000? {go to RC8}

RC7e Less than $35,000? {If RC7e=2, go to RC7f; if RC7e=1, go to RC8}

($25,000 to less than $35,000)

RC7f Less than $50,000? {If RC7f=2, go to RC7g; if RC7f=1, go to RC8}

($35,000 to less than $50,000)

RC7g Less than $75,000? {If RC7g=2, go to RC7h; if RC7g=1, go to RC8}

($50,000 to less than $75,000)

RC7h $75,000 or more?

98 (VOL) DK

99 (VOL) RF

RC8

Have you been without any telephone service for more than two weeks at any point since {insert date one year before today’s date}?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

RC10

What is your zip code?

[RECORD ZIP CODE] {go to RC11}

98 (VOL) DK {go to RC13}

99 (VOL) RF {go to RC13}

RC11

Is this in {prefill state using file}?

1 YES {go to RC12}

2 NO {go to RC11a}

[IF YES, PRE-FILLED STATE IS SAVED IN RC11a]

RC11a

What state do you live in?

[USE LOOK UP FILE]

RC12

Do you live in {prefill county using file} county?

1 YES {go to H1}

2 NO {go to RC12a}

[IF YES, PRE-FILLED COUNTY IS SAVED IN RC12a]

RC12a

What county do you live in?

[USE LOOK UP FILE]

{go to H1}

{add soft check when county name does not match selected zip code}

[INTERVIEWER NOTE:  IN LOUISIANA A COUNTY MAY BE REFERRED TO AS A PARISH.  IN ALASKA A COUNTY MAY BE REFERRED TO AS A BOROUGH OR CENSUS TRACK.]

RC13 [IF NO ZIP CODE IS PROVIDED} I understand that people sometimes do not know their ZIP code, but for statistical purposes we need to know in what area you live.

What state do you live in?

[USE LOOK UP FILE]

RC13a

What county do you live in?[USE LOOK UP FILE]

[INTERVIEWER NOTE:  IN LOUISIANA A COUNTY MAY BE REFERRED TO AS A PARISH.  IN ALASKA A COUNTY MAY BE REFERRED TO AS A BOROUGH OR CENSUS TRACK.]

Section H: Health Questions

H1

The following questions are about health care and health problems.

Have you ever been told by a doctor, nurse, or other health professional that you had…

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

H1_A Asthma?

H1_IBS Irritable bowel syndrome or IBS?

H1_D Diabetes?

H1_HBP High blood pressure?

H2

Do you have…

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

H2_FH Frequent headaches?

H2_CP Chronic pain?

H2_DS Difficulty sleeping?

H3

There are many different factors that can affect a person’s health, including worry and stress.

In the past 12 months, how often would you say you were worried or stressed about having enough money to pay your rent or mortgage? Would you say…

1. Always,

1. Usually,

2. Sometimes,

3. Rarely, or

4. Never?

H4

In the past 12 months, how often would you say you were worried or stressed about having enough money to buy nutritious meals? Would you say…

1. Always,

2 Usually,

3 Sometimes,

4 Rarely, or

5 Never?

H5

Was there a time in the past 12 months when you needed to see a doctor but could not because you could not afford it?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

H6

Are any of your activities limited in any way because of physical, mental, or emotional problems?

1 YES {go to H6a}

2 NO {go to H7}

98 (VOL) DK

99 (VOL) RF

H6a

How long have you been limited in this way? Would you say. . .

1 Less than 1 year

2 More than 1 year but less than 3 years

3 3 or more years

98 (VOL) DK

99 (VOL) RF

H7

Do you have any health problems that require you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?

[TI INSTRUCTION: INCLUDE OCCASIONAL USE OR USE IN CERTAIN CIRCUMSTANCES.]

1 YES {go to H7a}

2 NO {go to H8}

98 (VOL) DK

99 (VOL) RF

H7a

How long have you been using this equipment? Would you say. . .

1 Less than 1 year

2 More than 1 year but less than 3 years

3 3 or more years

98 (VOL) DK

99 (VOL) RF

H8

Would you say that in general your physical health is…

1 Excellent,

2 Very good,

3 Good,

4 Fair, or

5 Poor

98 (VOL) DK

99 (VOL) RF

H9

Would you say that in general your mental health is…

1 Excellent,

2 Very good,

3 Good,

4 Fair, or

5 Poor

98 (VOL) DK

99 (VOL) RF

H10

As an adult, have you ever lived with and cared for any children under the age of 18?

1 YES {go to VIC_INTRO}

2 NO {go to VIC_INTRO}

98 (VOL) DK

99 (VOL) RF

victimization questions

VIC_INTRO

The next set of questions asks about experiences that may or may not have happened to you. There will be some questions about physical injuries, harassing behaviors and unwanted sexual activity.

Remember, you don’t have to answer any question that you don’t want to. We suggest that you be in a private setting during the survey. If, at any time, you do not feel physically or emotionally safe, you can just say “Goodbye”. I will understand and I will not call you back. You can call me back if you’d like at 1-877-287-3782.

VIC_INTROa

Do you have any questions? {PAUSE, THEN ASK:} Shall we continue?

1 YES [ANSWER ALL QUESTIONS] {go to VIC_INTROb}

2 NO {BREAKOFF}

98 (VOL) DK

99 (VOL) RF

VIC_INTROb

The next questions ask about experiences you may have had with your romantic or sexual partners. When I ask about your romantic or sexual partners, I want you to think about anybody you have been involved with romantically or sexually, which might include spouses, boyfriends, girlfriends, people you have dated, people you were seeing, or people you hooked up with.

Psychological Aggression (PA)

PA

How many of your current or ex romantic or sexual partners have ever…?

[RECORD NUMBER OF PARTNERS FOR EACH ITEM]

[RANGE 0 – 15 PARTNERS]

PA1 acted very angry towards you in a way that seemed dangerous?

[TI NOTE: IF R ASKS IF THEY SHOULD INCLUDE, OR IF THEY INDICATE INCLUDING PHYSICAL VIOLENCE, PHYSICAL VIOLENCE SHOULD NOT COUNT HERE.]

PA2 told you that you were a loser, a failure, or not good enough?

PA3 called you names like ugly, fat, crazy, or stupid?

How many of your current or ex romantic or sexual partners have ever…?

PA4 insulted, humiliated, or made fun of you in front of others?

PA5 told you that no one else would want you?

{if R endorses an item, ask PAa – PAh for that item, then loop back to next PA item, or if multiple perps for an item, ask PAa – PAh for each perp, then loop back to next PA item}

{once initials are collected 1^st time, for each additional endorsed item, ask PAi}

PAi

Was it {fill: 1^st set of initials}?

1 YES {go to PAb}

2 NO {if any other initials recorded, ask PAi for 2^nd set of initials; 3^rd set of initials, etc. until all have been asked; if no other initials recorded, go to PAa}

98 (VOL) DK

99 (VOL) RF

PAa

{if 1^st time collecting ANY initials, read: I’d like for you to tell me some way that we can refer to {fill: if any PA1 – 5 =1, this person; if any PA1 – 5 > 1, these people}, such as their initials or a nickname, so that if I ask you other questions about {fill: if any PA1 – 5 =1, this person; if any PA1 – 5 > 1, these people} you’ll know who I’m talking about.} Please tell me the initials of the {fill: if any PA1 – 5 > 1, first} person who {fill: behavior}?}

[RECORD INITIALS FOR IP]

{if any PA1 – 5 > 1, ask Please tell me the initials of the next person who {fill: behavior}?, until # of sets of initials = number of reported partners}

{once ANY initials have been recorded, then only display: Please tell me the initials of the {fill: if any PA1 – 5 > 1, first} person who {fill: behavior}?}

{if PAa = DK or RF, skip out of loop – either go on to ask for next set of initials, or skip to the next behavior}

PA1a

[If 1^st time collecting initials]

Is {fill: initials} male or female?

1. MALE

2. FEMALE

PAb

{for each set of initials, fill initials 1, initials 2, etc. up to 15}

How many times did {fill: initials} ever {fill: behavior}? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

{CATI will keep count of the number of times this question is asked across all sections. Once question has been asked 3 times, and all response categories have been read 3 times to R, program will change to show response options in ALL CAPS, indicating that response options do not have to be read aloud unless necessary}

PAf

{Fill: Has this person / Did any of these people} {fill: behavior} in the past twelve months, that is since {fill: date, 12 months ago}?

1 YES {go to PAg}

2 NO {go to next PA item}

98 (VOL) DK

99 (VOL) RF

PAg

{if multiple perps}

Which people did this in the past twelve months?

[RECORD INITIALS OF PARTNERS]

PAh

{for all sets of initials endorsed at PAg, fill initials 1, initials 2, etc. up to 15}

How many times did {fill: initials} {fill: behavior} in the past twelve months? Would you say…

[TI: ONLY POSSIBLE ANSWER OPTIONS ARE LISTED]

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

{CATI will keep count of the number of times this question is asked across all sections. Once question has been asked 3 times, and all response categories have been read 3 times to R, program will change to show response options in ALL CAPS, indicating that response options do not have to be read aloud unless necessary}

{loop back to next PA item until all are complete}

Coercive Control and Entrapment (CCE)

CCE

How many of your current or ex romantic or sexual partners have ever…?

[RECORD NUMBER OF PARTNERS FOR EACH ITEM]

[RANGE 0 – 15 PARTNERS]

CCE1 tried to keep you from seeing or talking to your family or friends?

CCE2 made decisions for you that should have been yours to make, such as the clothes you wear, things you eat, or the friends you have?

CCE3 kept track of you by demanding to know where you were and what you were doing?

How many of your current or ex romantic or sexual partners have ever…?

CCE4 threatened to hurt him or herself or commit suicide when he or she was upset with you?

CCE5 threatened to hurt a pet or threatened to take a pet away from you?

CCE6 threatened to hurt someone you love?

How many of your current or ex romantic or sexual partners have ever…?

CCE7 hurt someone you love?

CCE8 {if H10=1} threatened to take your children away from you?

[TI NOTE: CUSTODY BATTLES CAN BE INCLUDED HERE.]

CCE9 kept you from leaving the house when you wanted to go?

How many of your current or ex romantic or sexual partners have ever…?

CCE10 kept you from having money for your own use?

CCE11 destroyed something that was important to you?

CCE12 said things like “If I can’t have you, then no one can”?

CCE13 {if female, fill: tried to get you pregnant when you did not want to become pregnant; if male, fill: tried to get pregnant when you did not want them to get pregnant} or tried to stop you from using birth control?

CCE14 refused to use a condom when you wanted them to use one?

{if R endorses an item, ask CCEa – CCEh for that item, then loop back to next CCE item, or if multiple perps for an item, ask CCEa – CCEh for each perp, then loop back to next CCE item}

{once initials are collected 1^st time, for each additional endorsed item, ask CCEi}

CCEi

Was it {fill: 1^st set of initials}?

1 YES {go to CCEb}

2 NO {if any other initials recorded, ask CCEi for 2^nd set of initials; 3^rd set of initials, etc. until all have been asked; if no other initials recorded, go to CCEa}

98 (VOL) DK

99 (VOL) RF

CCEa

{if 1^st time collecting ANY initials, read: I’d like for you to tell me some way that we can refer to {fill: if any CCE1 – 13 =1, this person; if any CCE1 – 13 > 1, these people}, such as their initials or a nickname, so that if I ask you other questions about {fill: if any CCE1 – 13 =1, this person; if any CCE1 – 13 > 1, these people} you’ll know who I’m talking about.} Please tell me the initials of the {fill: if any CCE1 – 13 > 1, first} person who {fill: behavior}?

[RECORD INITIALS FOR IP]

{if any CCE1 – 13 > 1, ask Please tell me the initials of the next person who {fill: behavior}?, until # of sets of initials = number of reported partners}

{once ANY initials have been recorded, then only display: Please tell me the initials of the {fill: if any CCE1 – 13 > 1, first} person who {fill: behavior}?}

CCE1a

[If 1^st time collecting initials]

Is {fill: initials} male or female?

1. MALE

2. FEMALE

CCEb

{for each set of initials, fill initials 1, initials 2, etc. up to 15}

How many times did {fill: initials} ever {fill: behavior}? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

CCEf

{Fill: Has this person / Did any of these people} {fill: behavior} in the past twelve months, that is since {fill: date, 12 months ago}?

1 YES {go to CCEg}

2 NO {go to next CCE item}

98 (VOL) DK

99 (VOL) RF

CCEg

Which people did this in the past twelve months?

[RECORD INITIALS OF PARTNERS]

CCEh

{for all sets of initials endorsed at CCEg, fill initials 1, initials 2, etc. up to 15}

How many times did {fill: initials} {fill: behavior} in the past twelve months? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

{loop back to next CCE item until all are complete}

Physical VIOLENCE (PV)

PV

How many of your current or ex romantic or sexual partners have ever…?

[RECORD NUMBER OF PARTNERS FOR EACH ITEM]

[RANGE 0 – 15 PARTNERS]

PV1 made threats to physically harm you?

The next questions are related to physical acts you may have experienced.

How many of your current or ex romantic or sexual partners have ever…?

PV2 slapped you?

PV3 pushed or shoved you?

How many of your current or ex romantic or sexual partners have ever…?

PV4 hit you with a fist or something hard?

PV5 kicked you?

PV6 hurt you by pulling your hair?

How many of your current or ex romantic or sexual partners have ever…?

PV7 slammed you against something?

PV9 tried to hurt you by choking or suffocating you?

How many of your current or ex romantic or sexual partners have ever…?

PV10 beaten you?

PV11 burned you on purpose?

PV12 used a knife or gun on you?

{if R endorses an item, ask PVa – PVh for that item, then loop back to next PV item, or if multiple perps for an item, ask PVa – PVh for each perp, then loop back to next PV item}

{once initials are collected 1^st time, for each additional endorsed item, ask PVi}

PVi

Was it {fill: 1^st set of initials}?

1 YES {go to PVb}

2 NO {if any other initials recorded, ask PVi for 2^nd set of initials; 3^rd set of initials, etc. until all have been asked; if no other initials recorded, go to PVa}

98 (VOL) DK

99 (VOL) RF

PVa

{if 1^st time collecting ANY initials, read: I’d like for you to tell me some way that we can refer to {fill: if any PV1 – 12 =1, this person; if any PV1 – 12 > 1, these people}, such as their initials or a nickname, so that if I ask you other questions about {fill: if any PV1 – 12 =1, this person; if any PV1 – 12 > 1, these people} you’ll know who I’m talking about.} Please tell me the initials of the {fill: if any PV1 – 12 > 1, first} person who {fill: behavior}?

[RECORD INITIALS FOR IP]

{if any PV1 – 12 > 1, ask Please tell me the initials of the next person who {fill: behavior}?, until # of sets of initials = number of reported partners}

{once ANY initials have been recorded, then only display: Please tell me the initials of the {fill: if any PV1 – 12 > 1, first} person who {fill: behavior}?}

PV1a

[if collecting new initials]

Is {fill: initials} male or female?

1. MALE

2. FEMALE

PVb

{for each set of initials, fill initials 1, initials 2, etc. up to 15}

How many times did {fill: initials} ever {fill: behavior}? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

PVf

{Fill: Has this person / Did any of these people} {fill: behavior} in the past twelve months, that is since {fill: date, 12 months ago}?

1 YES {go to PVg}

2 NO {go to next PV item}

98 (VOL) DK

99 (VOL) RF

PVg

{if multiple perps}

Which people did this in the past twelve months?

[RECORD INITIALS OF PARTNERS]

PVh

{for all sets of initials endorsed at PVg, fill initials 1, initials 2, etc. up to 15}

How many times did {fill: initials} {fill: behavior} in the past twelve months? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

{loop back to next PV item until all are complete}

PVj

[ask for each set of initials, fill initials 1, initials 2, etc.]

How old were you the first time {if only endorsed one behavior for this perp, fill: this physical act; if endorsed more than one behavior for this perp, fill: any of these physical acts} happened with {fill: initials 1}?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

12 month non-ip psychological aggression (AMONG ELDERS)

{if R is 70 or older, ask; else skip to S_INTRO}

12PA2_INTRO

The previous questions have only asked about your experiences with romantic or sexual partners. Now I’m going to ask some questions about your experiences with anyone else, such as caregivers, friends, people who help you with things you need, or family members other than a spouse.

12PA2

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

[RECORD NUMBER OF PEOPLE FOR EACH ITEM]

[RANGE 0 – 15 PEOPLE]

12PA2_1 acted very angry towards you in a way that seemed dangerous?

12PA2_2 told you that you were a loser, a failure, or not good enough?

12PA2_3 called you names like ugly, fat, crazy, or stupid?

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

12PA2_4 insulted, humiliated, or made fun of you in front of others?

12PA2_5 told you that no one else would want you?

{if R endorses an item, ask 12PA2a – 12PA2b for that item, then loop back to next 12PA2 item, or if multiple perps for an item, ask 12PA2a – 12PA2b for each perp, then loop back to next 12PA2 item}

{once initials are collected 1^st time, for each additional endorsed item, ask 12PA2i}

{only include initials given in 12PA2, 12CCE2, or 12PV2 – not initials given in IP modules}

12PA2i

Was it {fill: 1^st set of initials}?

1 YES {go to 12PA2b}

2 NO {if any other initials recorded, ask 12PA2i for 2^nd set of initials; 3^rd set of initials, etc. until all have been asked; if no other initials recorded, go to 12PA2a}

98 (VOL) DK

99 (VOL) RF

12PA2a

{if 1^st time collecting ANY initials, read: I’d like for you to tell me some way that we can refer to {fill: if any 12PA2_1 – 5 =1, this person; if any 12PA2_1 – 5 > 1, these people}, such as their initials or a nickname, so that if I ask you other questions about {fill: if any 12PA2_1 – 5 =1, this person; if any 12PA2_1 – 5 > 1, these people} you’ll know who I’m talking about.} Please tell me the initials of the {fill: if any 12PA2_1 – 5 > 1, first} person who{fill: behavior} in the past 12 months?

[RECORD INITIALS FOR PERP]

{if any 12PA2_1 – 5 > 1, ask Please tell me the initials of the {fill: if any 12PA2_1 – 5 > 1, next} person who {fill: behavior} in the past 12 months?, until # of sets of initials = number of reported people}

{once ANY initials have been recorded, then only display: Please tell me the initials of the {fill: if any 12PA2_1 – 5 > 1, first} person who {fill: behavior}?}

12PA2a1

[if collecting new initials]

Is {fill: initials} male or female?

1. MALE

2. FEMALE

12PA2b

How many times did {fill: initials} {fill: behavior} in the past 12 months? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

{loop back to next 12PA2 item until all are complete}

12 Month non-ip Coercive Control and Entrapment (AMONG ELDERS)

{if R is 70 or older, ask; else skip to S_INTRO}

12CCE2

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

[RECORD NUMBER OF PEOPLE FOR EACH ITEM]

[RANGE 0 – 15 PEOPLE]

12CCE2_1 tried to keep you from seeing or talking to your family or friends?

12CCE2_2 made decisions for you that should have been yours to make, such as the clothes you wear, things you eat, or the friends you have?

12CCE2_3 kept track of you by demanding to know where you were and what you were doing?

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

12CCE2_4 threatened to hurt him or herself or commit suicide when he or she was upset with you?

12CCE2_5 threatened to hurt a pet or threatened to take a pet away from you?

12CCE2_6 threatened to hurt someone you love?

12CCE2_7 hurt someone you love?

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

12CCE2_8 threatened to keep you from seeing your children or grandchildren?

12CCE2_9 kept you from leaving the house when you wanted to go?

12CCE2_10 kept you from having money for your own use?

12CCE2_11 destroyed something that belonged to you?

{if R endorses an item, ask 12CCE2a – 12CCE2b for that item, then loop back to next 12CCE2 item, or if multiple perps for an item, ask 12CCE2a – 12CCE2b for each perp, then loop back to next 12CCE2 item}

{once initials are collected 1^st time, for each additional endorsed item, ask 12CCE2i}

{only include initials given in 12PA2, 12CCE2, or 12PV2 – not initials given in IP modules}

12CCE2i

Was it {fill: 1^st set of initials}?

1 YES {go to 12CCE2b}

2 NO {if any other initials recorded, ask 12CCE2i for 2^nd set of initials; 3^rd set of initials, etc. until all have been asked; if no other initials recorded, go to 12CCE2a}

98 (VOL) DK

99 (VOL) RF

12CCE2a

{if 1^st time collecting ANY initials, read: I’d like for you to tell me some way that we can refer to {fill: if any 12CCE2_1 – 11 =1, this person; if any 12CCE2_1 – 11 > 1, these people}, such as their initials or a nickname, so that if I ask you other questions about {fill: if any 12CCE2_1 – 11 =1, this person; if any 12CCE2_1 – 11 > 1, these people} you’ll know who I’m talking about.} Please tell me the initials of the {fill: if any 12CCE2_1 – 11 > 1, first} person who {fill: behavior} in the past 12 months?

[RECORD INITIALS FOR PERP]

{if any 12CCE2_1 – 11 > 1, ask Please tell me the initials of the {fill: if any 12CCE2_1 – 11 > 1, next} person who {fill: behavior} in the past 12 months?, until # of sets of initials = number of reported people}

{once ANY initials have been recorded, then only display: Please tell me the initials of the {fill: if any 12CCE2_1 – 10 > 1, first} person who {fill: behavior}?}

12CCE2a1

[if collecting new initials]

Is {fill: initials} male or female?

1. MALE

2. FEMALE

12CCE2b

How many times did {fill: initials} {fill: behavior} in the past 12 months? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

{loop back to next 12CCE2 item until all are complete}

12 month non-ip physical violence (AMONG ELDERS)

{if R is 70 or older, ask; else skip to S_INTRO}

12PV2

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

[RECORD NUMBER OF PEOPLE FOR EACH ITEM]

[RANGE 0 – 15 PEOPLE]

12PV2_1 made threats to physically harm you?

12PV2_2 slapped you?

12PV2_3 pushed or shoved you?

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

12PV2_4 hit you with a fist or something hard?

12PV2_5 kicked you?

12PV2_6 hurt you by pulling your hair?

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

12PV2_7 slammed you against something?

12PV2_9 tried to hurt you by choking or suffocating you?

During the past 12 months, since {fill: month, year 12 mos. ago}, how many people have…?

12PV2_10 beaten you?

12PV2_11 burned you on purpose?

12PV2_12 used a knife or gun on you?

{if R endorses an item, ask 12PV2a – 12PV2b for that item, then loop back to next 12PV2 item, or if multiple perps for an item, ask 12PV2a – 12PV2b for each perp, then loop back to next 12PV2 item}

{once initials are collected 1^st time, for each additional endorsed item, ask 12PV2i}

{only include initials given in 12PA2, 12CCE2, or 12PV2 – not initials given in IP modules}

12PV2i

Was it {fill: 1^st set of initials}?

1 YES {go to 12PV2b}

2 NO {if any other initials recorded, ask 12PV2i for 2^nd set of initials; 3^rd set of initials, etc. until all have been asked; if no other initials recorded, go to 12PV2a}

98 (VOL) DK

99 (VOL) RF

12PV2a

{if 1^st time collecting ANY initials, read: I’d like for you to tell me some way that we can refer to {fill: if any 12PV2_1 – 12 =1, this person; if any 12PV2_1 – 12 > 1, these people}, such as their initials or a nickname, so that if I ask you other questions about {fill: if any 12PV2_1 – 12 =1, this person; if any 12PV2_1 – 12 > 1, these people} you’ll know who I’m talking about.} Please tell me the initials of the {fill: if any 12PV2_1 – 12 > 1, first} person who{fill: behavior} in the past 12 months?

[RECORD INITIALS FOR PERP]

{if any 12PV2_1 – 12 > 1, ask Please tell me the initials of the {fill: if any 12PV2_1 – 12 > 1, next} person who {fill: behavior} in the past 12 months?, until # of sets of initials = number of reported people}

{once ANY initials have been recorded, then only display: Please tell me the initials of the {fill: if any 12PV2_1 – 12 > 1, first} person who {fill: behavior}?}

12PV2a1

[if collecting new initials]

Is {fill: initials} male or female?

1. MALE

2. FEMALE

12PV2b

How many times did {fill: initials} {fill: behavior} in the past 12 months? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

{loop back to next 12PV2 item until all are complete}

Section S: Stalking

CHK1

{If R endorses 3+ behaviors across the PA, CCE, and PV sections (which includes 12PA, 12CCE, and 12PV for respondents over 70 years old)}

I’d like to check in with you to make sure you’re feeling alright and would like to continue the interview.  Shall we continue?

1YES {go to S_INTRO}

2 NO {BREAKOFF AND CODE AS DISTRESS}

S_INTRO

I’m going to ask you some detailed questions about times when you may have been contacted, followed or harassed. When answering, please think about anyone who may have done these things to you, including romantic or sexual partners, other people you knew, or strangers. Please do not include bill collectors, telephone solicitors, or other sales people.

[TI NOTE: IF RESPONDENT REPORTS SUSPISCION OF PERSON HAVING DONE SOMETHING, BUT NO PROOF, THEY SHOULD COUNT THAT PERSON]

S

How many people have ever…?

[RECORD NUMBER OF PEOPLE FOR EACH ITEM]

[RANGE 0 – 15 PEOPLE]

S4 watched or followed you from a distance, or spied on you with a listening device, camera, or GPS [IF NECESSARY: global positioning system]?

S5 approached you or showed up in places, such as your home, workplace, or school when you didn’t want them to be there?

S6 left strange or potentially threatening items for you to find?

How many people have ever…?

S7 sneaked into your home or car and did things to scare you by letting you know they had been there?

S8 left you unwanted messages? This includes text or voice messages.

S1 made unwanted phone calls to you? This includes hang-up calls.

S2 sent you unwanted emails, instant messages, or sent messages through websites like MySpace or Facebook?

S3 left you cards, letters, flowers, or presents when they knew you didn’t want them to?

(NOTE: one behavior, one time gets no follow-up questions – for stalking either has to be more than one behavior at least one time, or one behavior more than one time)

{if R endorses an item, ask Sa – Sh for that item, then loop back to next S item, or if multiple perps for an item, ask Sa – Sh for each perp, then loop back to next S item}

{once initials are collected 1^st time, for each additional endorsed item, ask Si}

Si

Was it {fill: 1^st set of initials}?

1 YES {go to Sb}

2 NO {if any other initials recorded, ask Si for 2^nd set of initials; 3^rd set of initials, etc. until all have been asked; if no other initials recorded, go to Sa}

98 (VOL) DK

99 (VOL) RF

Sa

{if 1^st time collecting ANY initials, read: I’d like for you to tell me some way that we can refer to {fill: if any S1 – 7 =1, this person; if any S1 – 7 > 1, these people}, such as their initials or a nickname, so that if I ask you other questions about {fill: if any S1 – 7 =1, this person; if any S1 – 7 > 1, these people} you’ll know who I’m talking about.} Please tell me the initials of the {fill: if any S1 – 7 > 1, first} person who {fill: behavior}?

[RECORD INITIALS FOR PERP]

{if any S1 – 7 > 1, ask Please tell me the initials of the next person who {fill: behavior}?, until # of sets of initials = number of reported partners}

{once ANY initials have been recorded, then only display: Please tell me the initials of the {fill: if any S1 – 7 > 1, first} person who {fill: behavior}?}

S1a

[if collecting new initials]

Is {fill: initials} male or female?

1. MALE

2. FEMALE

Sb

{for each set of initials, fill initials 1, initials 2, etc. up to 15}

How many times did {fill: initials} ever {fill: behavior}? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

Sf

{Fill: Has this person / Did any of these people} {fill: behavior} in the past twelve months, that is since {fill: date, 12 months ago}?

1 YES {go to Sg}

2 NO {go to next S item}

98 (VOL) DK

99 (VOL) RF

Sg

{if multiple perps}

Which people did this in the past twelve months?

[RECORD INITIALS OF PARTNERS]

Sh

{for all sets of initials endorsed at Sg, fill initials 1, initials 2, etc. up to 15}

How many times did {fill: initials} {fill: behavior} in the past twelve months? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

{loop back to next S item until all are complete}

STALKING FOLLOW-UP QUESTIONS

SFU_INTRO

{establish loop for each perp initials collected, and cycle through SFU_INTRO2 – SFU6 for each perp}

Let’s talk some more about your experiences with {fill: all initials identified in S}.

SFU_INTRO2

You said that {fill: first set of initials} {fill: endorsed behaviors}.

SFU1

How old were you the first time {fill: initials} did {fill: this / these things}?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

SFU1a

How old was {fill: initials} the first time {if only endorsed one behavior for this perp, fill: this; if endorsed more than one behavior for this perp, fill: any of these things} happened?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

SFU2

How old were you the last time {fill: initials} did {fill: this / these things}?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

SFU2a

{if respondent age for SFU1 and SFU2 are equal or equal plus one, then ask SFU2a}Think about the time period between the first time {fill: initials} did {fill: this/these things} and the last time it happened. About how many years, months, weeks, or days did {fill: initials} do {fill: this/these things}?

[RECORD NUMBER, THEN MARK YEARS, MONTHS, WEEKS, OR DAYS]

SFU3

Were you ever fearful when {fill: initials} did {fill: this / these things}?

1 YES {go to SFU3a}

2 NO {go to SFU4}

98 (VOL) DK

99 (VOL) RF

SFU3a

Thinking about when you were the most fearful, how fearful were you about the things {fill: initials} did? Were you…

1 Very fearful,

2 Somewhat fearful, or

3 A little fearful

98 (VOL) DK

99 (VOL) RF

SFU4

[TI NOTE: IF RESPONDENT SUSPECTS, BUT CANNOT PROVE, THAT THIS HAPPENED, THEY SHOULD STILL COUNT THIS AS A YES]

Did {fill: initials} ever damage your personal property or belongings, such as in your home or car?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

SFU5

Did {fill: initials} ever make threats to physically harm you?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

SFU6

Did you ever believe you or someone close to you would be seriously harmed or killed when {fill: initials} did {fill: this / these things}?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

{loop back to SFUINTRO_2 and continue with 2^nd set of initials, 3^rd set of initials, etc. until all perps have received follow-up questions SFU1 – SFU6}

Section SV: Sexual Violence

SV_INTRO

Women and men may experience unwanted and uninvited sexual situations by strangers or people they know well, such as a romantic or sexual partner, friend, teacher, coworker, supervisor, or family member. Your answers will help us learn how often these things happen. Some of the language we use is explicit, but it is important that I ask the questions this way so that you are clear about what I mean. The questions we ask are detailed and some people may find them upsetting. The information you are providing will be kept private. You can skip questions you don’t want to answer and you can stop at anytime.

I’m going to ask you about different types of unwanted sexual situations. In general, these are: unwanted sexual situations that did NOT involve touching and situations that DID involve touching. I will also ask you about situations in which you were unable to provide consent to sex because of alcohol or drugs, and about your experiences with unwanted sex that happened when someone used physical force or verbal pressure.

Shall we continue?

0. 1 CONTINUE

SV

How many people have ever done any of the following things when you didn’t want it to happen? How many people have ever…

[RECORD NUMBER OF PEOPLE FOR EACH ITEM]

[RANGE 0 – 15 PEOPLE]

SV1 exposed their sexual body parts to you, flashed you, or masturbated in front of you?

SV2 made you show your sexual body parts to them when you didn’t want it to happen?

SV3 made you look at or participate in sexual photos or movies?

How many people have ever…

SV4 verbally harassed you while you were in a public place in a way that made you feel unsafe?

SV5 kissed you in a sexual way when you didn’t want it to happen?

SV6 fondled, groped, grabbed, or touched you in a way that made you feel unsafe?

Sometimes sex happens when a person is unable to consent to it or stop it from happening because they were drunk, high, drugged, or passed out from alcohol, drugs, or medications. This can include times when they voluntarily consumed alcohol or drugs or they were given drugs or alcohol without their knowledge or consent. Please remember that even if someone uses alcohol or drugs, what happens to them is not their fault.

When you were drunk, high, drugged, or passed out and unable to consent, how many people have ever had…?

SV7 vaginal sex with you? By vaginal sex, we mean that {if female: a man or boy put his penis in your vagina} {if male: a woman or girl made you put your penis in her vagina}.

When you were drunk, high, drugged, or passed out and unable to consent, how many people have ever…?

SV8 {if male} made you perform anal sex, meaning they made you put your penis into their anus.

SV9 made you receive anal sex, meaning they put their penis into your anus?

When you were drunk, high, drugged, or passed out and unable to consent, how many people have ever…?

SV10a put their mouth on your {if male, fill: penis; if female, fill: vagina}?

SV10b put their mouth on your anus?

SV11a made you put your mouth on their vagina or anus?

SV11b made you put your mouth on their penis?

SV11c put their fingers or an object in your {if female, fill: vagina or} anus?

Some people are threatened with harm or physically forced to have sex when they don’t want to, for example, by being pinned or held down, or by the use of violence.

How many people have ever used physical force or threats to physically harm you to make you…?

SV12 have vaginal sex?

SV13 {if male} perform anal sex?

SV14 receive anal sex?

How many people have ever used physical force or threats of physical harm to…?

SV15a put their mouth on your {if male, fill: penis; if female, fill: vagina}?

SV15b put their mouth on your anus?

SV16a make you put your mouth on their vagina or anus?

SV16b make you put your mouth on their penis?

SV17 put their fingers or an object in your {if female, fill: vagina or} anus?

How many people have ever used physical force or threats of physical harm to…?

SV18a {if male} TRY to make you have vaginal sex with them, but sex did not happen?

SV18b TRY to have {if female, fill: vaginal,} oral, or anal sex with you, but sex did not happen?

The following questions are asking about other experiences with unwanted sex beyond what you have already told me.

Sometimes unwanted sex happens after a person is pressured in a nonphysical way.

How many people have you had vaginal, oral, or anal sex with after they pressured you by …

SV19 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?

SV20 Wearing you down by repeatedly asking for sex, or showing they were unhappy?

SV21 Using their influence or authority over you, for example, your boss or your teacher?

{if R endorses any SV7 – SV11, and then endorses any SV12 – SV18b and gives identical initials, ask:

SV22

Previously you told me that {fill: initials} {fill: behavior from SV7 – SV11} and you just reported that {fill: initials} {fill: behavior from SV12 – SV18b}. Did these things happen on the same occasion?

1 YES {count follow-up questions already answered for SV7 – SV11, do not ask follow-ups for behavior endorsed from SV12 – SV18b}

2 NO {continue to ask all follow-ups for behavior endorsed from SV12 – SV18b}

98 (VOL) DK

99 (VOL) RF

SEXUAL VIOLENCE FOLLOW UP QUESTIONS

{if R endorses an item, ask SVa – SVn for that item, then loop back to next SV item, or if multiple perps for an item, ask SVa – SVn for each perp, then loop back to next SV item}

{once initials are collected 1^st time, for each additional endorsed item, ask SVi}

SVi

Was it {fill: 1^st set of initials}?

1 YES {go to SVb}

2 NO {if any other initials recorded, ask SVi for 2^nd set of initials; 3^rd set of initials, etc. until all have been asked; if no other initials recorded, go to SVa}

98 (VOL) DK

99 (VOL) RF

SVa

{if 1^st time collecting ANY initials, read: I’d like for you to tell me some way that we can refer to {fill: if any SV1 – 21 =1, this person; if any SV1 – 21 > 1, these people}, such as their initials or a nickname, so that if I ask you other questions about {fill: if any SV1 – 21 =1, this person; if any SV1 – 21 > 1, these people} you’ll know who I’m talking about.} Please tell me the initials of the {fill: if any SV1 – 21 > 1, first} person who {fill: behavior}?

[RECORD INITIALS FOR PERP]

{if any SV1 – 21 > 1, ask Please tell me the initials of the next person who {fill: behavior}?, until # of sets of initials = number of reported partners}

{once ANY initials have been recorded, then only display: Please tell me the initials of the {fill: if any SV1 – 21 > 1, first} person who {fill: behavior}?}

SV1a

[if collecting new initials]

Is {fill: initials} male or female?

1. MALE

2. FEMALE

SVb

{for each set of initials, fill initials 1, initials 2, etc. up to 15}

{if SV7 – SV18b (rape or made to penetrate behaviors), ask}

How many times did {fill: initials} ever {fill: behavior}?

[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]

{for all other endorsed behaviors (non-rape behaviors), ask}

How many times did {fill: initials} ever {fill: behavior}? Would you say…

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

SVf

{Fill: Has this person / Did any of these people} {fill: behavior} in the past twelve months, that is since {fill: date, 12 months ago}?

1 YES {go to SVg}

2 NO {go to next SV item}

98 (VOL) DK

99 (VOL) RF

SVg

{if multiple perps}

Which people did this in the past twelve months?

[RECORD INITIALS OF PARTNERS]

SVh

{for all sets of initials endorsed at SVg, fill initials 1, initials 2, etc. up to 15}

{if SV7 – SV18b, ask}

How many times did {fill: initials} {fill: behavior} in the past 12 months?

[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]

{for all other endorsed behaviors, ask}

1 One time,

2 Two times,

3 Three to five times,

4 Six to ten times,

5 Eleven to twenty times, or

6 More than twenty times?

98 (VOL) DK

99 (VOL) RF

SVj

Was {fill: initials} using alcohol, drugs or both the first time he/she {fill: behavior}?

1 ALCOHOL

2 DRUGS

3 BOTH ALCOHOL AND DRUGS

4 NEITHER ALCOHOL OR DRUGS

98 (VOL) DK

99 (VOL) RF

SVk

{if yes to any SV7 – SV11c, skip SVk and go to SVl}

Were you using alcohol, drugs or both the first time {fill: initials} {fill: behavior}? {if this is the 1^st time these questions are being asked, display: Please remember that even if someone uses alcohol or drugs, what happens to them is not their fault. After displaying one time, do not display again.}

1 ALCOHOL

2 DRUGS

3 BOTH ALCOHOL AND DRUGS

4 NEITHER ALCOHOL OR DRUGS

98 (VOL) DK

99 (VOL) RF

SVl

{only ask if any SV7 – SV11c is endorsed}

Before {fill: initials} {fill: if SV7 ≥ 1, had vaginal sex with you; if SV10a ≥ 1, put their mouth on your {if male, fill: penis; if female, fill: vagina}; if SV10b ≥ 1, put their mouth on your anus; if SV11a ≥ 1, made you put your mouth on their vagina or anus; if SV11b ≥ 1, made you put your mouth on their penis; if SV8 or SV9 ≥ 1, had anal sex with you; if SV11c ≥ 1, put their fingers or an object in you} when you were drunk, high, drugged, or passed out and unable to consent, do you think you were given alcohol without your knowledge?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

SVm

{only ask if any SV7 – SV11c is endorsed}

Before {fill: initials} {fill: if SV7 ≥ 1, had vaginal sex with you; if SV10a ≥ 1, put their mouth on your {if male, fill: penis; if female, fill: vagina}; if SV10b ≥ 1, put their mouth on your anus; if SV11a ≥ 1, made you put your mouth on their vagina or anus; if SV11b ≥ 1, made you put your mouth on their penis; if SV8 or SV9 ≥ 1, had anal sex with you; if SV11c ≥ 1, put their fingers or an object in you} when you were drunk, high, drugged, or passed out and unable to consent, do you think you were given or may have been given drugs without your knowledge?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

SVn

{only ask if any SV7 – SV11c is endorsed}

Before {fill: initials} {fill: if SV7 ≥ 1, had vaginal sex with you; if SV10a ≥ 1, put their mouth on your {if male, fill: penis; if female, fill: vagina}; if SV10b ≥ 1, put their mouth on your anus; if SV11a ≥ 1, made you put your mouth on their vagina or anus; if SV11b ≥ 1, made you put your mouth on their penis; if SV8 or SV9 ≥ 1, had anal sex with you; if SV11c ≥ 1, put their fingers or an object in you} when you were drunk, high, drugged, or passed out and unable to consent, had you voluntarily used alcohol or drugs? {if this is the 1^st time these questions are being asked, display: Please remember that even if someone uses alcohol or drugs, what happens to them is not their fault. After displaying one time, do not display again.}

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

{loop back to next SV item until all are complete}

{once all gate questions have been asked, and all perps recorded, if respondent has reported more than one perpetrator total (i.e., more than one set of initials} from SV7 – SV18b, ask SVo}

SVo

You’ve told me that {fill: all sets of initials} {fill: behaviors}.

Did any of these things ever involve more than one person having sex with you on the same occasion?

1 YES {go to SVp}

2 NO {go to SVFU_INTRO}

98 (VOL) DK

99 (VOL) RF

SVp

How many times has more than one person had sex with you on the same occasion?

[RECORD NUMBER OF TIMES] [RANGE = 1 – 5]

SVq

How many people were involved {if SVp > 1, fill: the first time this happened, the second time this happened, etc.}?

[RECORD NUMBER OF PEOPLE] [RANGE = 1 – 5]

CHK2

{If R endorses 1 or more behaviors in the SV section}

I’d like to check in with you to make sure you’re feeling alright and would like to continue the interview.  Shall we continue?

2. YES {go to SVFU_INTRO}

2 NO {BREAKOFF AND CODE AS DISTRESS}

SEXUAL VIOLENCE FOLLOW-UP QUESTIONS

SVFU_INTRO

{only ask SVFU questions for those who endorse any of SV7 – SV18b, else skip to FU_INTRO}

{establish loop for each perp initials collected, and cycle through SVFU_INTRO2 – SFU7 for each perp}

Let’s talk some more about your experiences with {fill: all initials identified in SV7 – SV18b}.

SVFU_INTRO2

You said that {fill: first set of initials} {fill: endorsed behaviors from SV7 – SV18b only}.

SVFU1

Were you ever physically injured when {fill: initials} did {fill: this / any of these things}? For example, did you have bruises, {if female, fill: vaginal or} anal tears, or other internal or external injuries?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

{If only SV18 a or SV18b are endorsed, then do not ask SVFU2}

SVFU2

Did you ever get an STD or other infection when {fill: initials} did {fill: this / any of these things}? For example, did you get Chlamydia, Gonorrhea, HIV, or some other STD?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

{If only SV18 a or SV18b are endorsed, then do not ask SVFU3}

SVFU3 {if female only, else skip to SVFU4}

Did you ever get pregnant when {fill: initials} did {fill: this / any of these things}?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

SVFU4

How old were you the first time {if only endorsed one behavior for this perp, fill: this; if endorsed more than one behavior for this perp, fill: any of these things} happened with {fill: initials}?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

SVFU5

How old was {fill: initials} the first time {if only endorsed one behavior for this perp, fill: this; if endorsed more than one behavior for this perp, fill: any of these things} happened?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

SVFU6

{skip if only one incident reported}

How old were you the last time {if only endorsed one behavior for this perp, fill: this; if endorsed more than one behavior for this perp, fill: any of these things} happened with {fill: initials 1}?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

SVFU6a

{if respondent age for SVFU4 and SVFU6 are equal or equal plus one, then ask SVFU6a}Think about the time period between the first time {fill: initials} did {fill: this/these things} and the last time it happened. About how many years, months, weeks, or days did {fill: initials} do {fill: this/these things}?”

[RECORD NUMBER, THEN MARK YEARS, MONTHS, WEEKS, OR DAYS]

SVFU7

{if RC4 = 5, else skip}

Did {if only endorsed one behavior for this perp, fill: this; if endorsed more than one behavior for this perp, fill: any of these things} happen within reservation boundaries or within an Alaska Native village?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

SECTION R: RELATIONSHIPS

R1_INTRO

Now I’m going to ask you some questions about how you knew some of the people that you told me about. I will want you to tell me if they were someone you knew, or were a stranger. If you knew the person, I’ll ask how you knew them. I’d like you to tell me if they were a current or ex romantic or sexual partner, a family member, someone in a position of authority over you like a boss, coach, or teacher, or were someone you knew some other way, such as a neighbor, friend, someone you knew by sight only, or someone you knew for less than 24 hours.

[TI NOTE: PLEASE READ THIS SCREEN IN A RESPECTFUL MANNER.]

You told me previously that {fill: initials 1} {fill: all endorsed behaviors from all sections}.

R1

How did you know or what was your relationship to {fill: initials 1} the first time {fill: this / any of these things} happened?

[IP CATEGORIES:

1 HUSBAND / WIFE

2 LIVE-IN PARTNER

3 FIANCE

4 BOY / GIRL FRIEND

5 DATING PARTNER

6 SOMEONE YOU WERE SEEING

7. SOMEONE YOU WERE HAVING SEX WITH]

[NON-IP CATEGORIES:

7. FAMILY MEMBER {go to R1_2}

8. ACQUAINTANCE {go to R1_3}

12 PERSON OF AUTHORITY {go to R1_4}

13 PERSON KNOWN FOR A SHORT TIME {go to R1_5}

10 STRANGER

11 OTHER, SPECIFY {max 25 characters}} {go to R1sp}]

R1_2

{FAMILY MEMBER SUB-CATEGORIES}

1 FATHER / MOTHER

2 STEP-FATHER / MOTHER

3 FOSTER PARENT (MALE / FEMALE)

16 FATHER/MOTHER-IN_LAW

4 BROTHER / STEP-BROTHER

5 SISTER / STEP – SISTER

17 FOSTER BROTHER/FOSTER SISTER

6 BROTHER / SISTER IN-LAW

7 UNCLE / AUNT

8 COUSIN

9 GRANDFATHER / MOTHER

10 SON/STEP-SON

11 DAUGHTER/STEP-DAUGHTER

18 FOSTER SON/FOSTER DAUGHTER

19 SON/DAUGHTER-IN-LAW

12 GRANDSON/STEP-GRANDSON

13 GRANDDAUGHTER/STEP-GRANDDAUGHTER

20 NIECE/NEPHEW

14 OTHER MALE RELATIVE (SPECIFY) {go to R1_2sp}

15 OTHER FEMALE RELATIVE (SPECIFY) {go to R1_2sp}

R1_3

{ACQUAINTANCE SUB-CATEGORIES}

1 FIRST DATE

3 FRIEND

4 FAMILY FRIEND

5 NEIGHBOR

13 CLASSMATE

14 FRIEND OF A FRIEND

7CO-WORKER / CUSTOMER / CLIENT

12 OTHER ACQUAINTANCE (SPECIFY) {go to R1_3sp}

R1_4

{PERSON OF AUTHORITY SUB-CATEGORIES}

1. BOSS / SUPERVISOR / SUPERIOR IN COMMAND

2. TEACHER / PROFESSOR / TEACHING ASSISTANT, COACH

3. CLERGY MEMBER

4. DOCTOR / NURSE / THERAPIST

5. CAREGIVER

6. OTHER PERSON OF AUTHORITY (SPECIFY) {go to R1_4sp}

R1_5

{PERSON KNOWN FOR A SHORT TIME SUB-CATEGORIES}

1. SOMEONE KNOWN FOR LESS THAN 24 HOURS

2. SOMEONE KNOWN BY SIGHT ONLY

3. SOMEONE YOU JUST MET

4. OTHER PERSON KNOWN FOR A SHORT TIME (SPECIFY) {go to R2_5sp}

{if R1 = DK/RF, go to R4

Note: R1a is not asked here, since it is asked earlier question will automatically be filled. Variable will remain in the data set for analysis.

R1_1

{IP relationships}

[INTERVIEWER PROBE: Was this person your current or ex{fill response from R1} the first time {fill: this / any of these things} happened?

[1 CURRENT

2 EX]

{if R1_1 = DK/RF, go to R2}

R2

{skip question if only one behavior was reported one time}

How did you know or what was your relationship to {fill: initials 1} the last time {fill: this

/ any of these things} happened?

[IP CATEGORIES:

1 HUSBAND / WIFE

2 LIVE-IN PARTNER

3 FIANCE

4 BOY / GIRL FRIEND

5 DATING PARTNER

2. SOMEONE YOU WERE SEEING

7 SOMEONE YOU WERE HAVING SEX WITH]

[NON-IP CATEGORIES:

8 FAMILY MEMBER {go to R2_2}

9 ACQUAINTANCE {go to R2_3}

12 PERSON OF AUTHORITY {go to R2_4]

13 PERSON KNOWN FOR A SHORT TIME {go to R2_5}

10 STRANGER

11 OTHER, SPECIFY{max 25 characters}}{go to R2sp}]

R2_2

{FAMILY MEMBER SUB-CATEGORIES}

1 FATHER / MOTHER

2 STEP-FATHER / MOTHER

3 FOSTER PARENT (MALE / FEMALE)

16 FATHER/MOTHER-IN-LAW

4 BROTHER / STEP-BROTHER

5 SISTER / STEP – SISTER

17 FOSTER BROTHER/FOSTER SISTER

6 BROTHER / SISTER IN-LAW

7 UNCLE / AUNT

8 COUSIN

9 GRANDFATHER / MOTHER

10 SON/STEP-SON

11 DAUGHTER/STEP-DAUGHTER

18 FOSTER SON/FOSTER DAUGHTER

19 SON/DAUGHTER-IN-LAW

12 GRANDSON/STEP-GRANDSON

13 GRANDDAUGHTER/STEP-GRANDDAUGHTER

20 NIECE/NEPHEW

14 OTHER MALE RELATIVE (SPECIFY) {go to R2_2sp}

15 OTHER FEMALE RELATIVE (SPECIFY) {go to R2_2sp}

R2_3

{ACQUAINTANCE SUB-CATEGORIES}

1 FIRST DATE

3 FRIEND

4 FAMILY FRIEND

5 NEIGHBOR

13 CLASSMATE

14 FRIEND OF A FRIEND

7 CO-WORKER / CUSTOMER / CLIENT

12 OTHER ACQUAINTANCE (SPECIFY) {go to R2_3sp}

R2_4

{PERSON OF AUTHORITY SUB-CATEGORIES]

1. BOSS / SUPERVISOR / SUPERIOR IN COMMAND

2. TEACHER / PROFESSOR / TEACHING ASSISTANT, COACH

3. CLERGY MEMBER

4. DOCTOR / NURSE / THERAPIST

5. CAREGIVER

6. OTHER PERSON OF AUTHORITY (SPECIFY) {go to R2_4sp}

R2_5

{PERSON KNOWN FOR A SHORT TIME SUB-CATEGORIES}

1. SOMEONE KNOWN FOR LESS THAN 24 HOURS

2. SOMEONE KNOWN BY SIGHT ONLY

3. SOMEONE YOU JUST MET

4. OTHER PERSON KNOWN FOR A SHORT TIME (SPECIFY) {go to R2_5sp}

{if R2 = DK/RF, go to R3}

R2_1

{IP relationships}

[INTERVIEWER PROBE: Was this person your current or ex {fill response from R2} the last time {fill: this / any of these things} happened?

[1 CURRENT

2 EX]

{if R2_1 = DK/RF, go to R3}

{If no stalking or SV7-SV18b endorsed, skip to R2a}

Note: If relationship bucket changes between R1 and R2, we would then follow up with those respondents for stalking and rape or made to penetrate.

Note: If relationship is “other” at R1 and/or R2, we would then follow up with those respondents for stalking and rape or made to penetrate.

For stalking and rape or made to penetrate (if reported for that specific perpetrator):

R2newa_1

[repeat question for each initials who meet criteria]

{If reported stalking behavior and:

R1=1-7 and R2=1-7, then skip to R2newb_1,

R1=8 and R2=8, then skip to R2newb_1,

R1=9 and R2=9 then skip to R2newb_1,

R1=12 and R2=12 then skip to R2newb_1,

R1=13 and R2=13 then skip to R2newb _1,

R1=10 and R2=10 then skip to R2newb_1,

else ask:

If R1=11 or R1_2=14 or 15, or R1_3=12, or R1_4=6 or R1_5=4 then ask:

{If stalking = yes}

You told me previously that [initials] did {fill: this / these things}: {fill: all endorsed stalking behaviors (S1-S8)}.

Was [initials] a {fill: R1} when {fill: she/he} did {fill: this / any of these things?

0. 1 YES

1. 2 NO

98 (VOL) DK

99 (VOL) RF

R2newa_2

Was [initials] a {fill: R2} when {fill: she/he} did {fill: this / any of these things}?

1. 1 YES

2. 2 NO

98 (VOL) DK

99 (VOL) RF

R2new b_1

[repeat question for each initials who meet criteria]

{If reported SV7-SV18b behavior and:

R1=1-7 and R2=1-7, then skip to R2a,

R1=8 and R2=8, then skip to R2a,

R1=9 and R2=9 then skip to R2a,

R1=12 and R2=12 then skip to R2a,

R1=13 and R2=13 then skip to R2a,

R1=10 and R2=10 then skip to R2a,

else ask:

If R1=11 or R1_2=14 or 15, or R1_3=12, or R1_4=6 or R1_5=4 then ask:

{If rape/made to penetrate = yes}

You told me previously that [initials] did {fill: this / these things}: {fill: endorsed rape/made to penetrate behaviors (SV7-SV18b)}.

Was [initials] a {fill: R1} when {fill: she/he} did {fill: this / any of these things}?

1. 1 YES

2. 2 NO

98 (VOL) DK

99 (VOL) RF

R2newb_2

Was [initials] a {fill: R2} when {fill: she/he} did {fill: this / any of these things}?

1. 1 YES

2. 2 NO

98 (VOL) DK

99 (VOL) RF

R2a

{if respondent indicates IP was current at R1, and EX at R2}

Were the things that {fill: initials} did more severe before your relationship ended, after your relationship ended, or during the time your relationship was ending?

1. BEFORE RELATIONSHIP ENDED

2. AFTER RELATIONSHIP ENDED

3. DURING RELATIONSHIP ENDING

4. NOT SEVERE AT ALL

98 (VOL) DK

99 (VOL) RF

R3

{only ask if R1 is NOT a family member} {do not ask if R2 = 10}

Do you currently know or have a relationship with {fill: initials 1}?

1 YES {go to R3a}

2 NO {go to R4}

98 (VOL) DK

99 (VOL) RF

{if R3 = DK/RF, go to R4}

R3a

{only ask if R1 is NOT a family member}

What is your current relationship to {fill: initials 1}?

[IP CATEGORIES:

1 HUSBAND / WIFE

2 LIVE-IN PARTNER

3 FIANCE

4 BOY / GIRL FRIEND

5. DATING PARTNER

6 SOMEONE YOU WERE SEEING

7 SOMEONE YOU WERE HAVING SEX WITH]

[NON-IP CATEGORIES:

8 FAMILY MEMBER {go to R3_2}

9 ACQUAINTANCE {go to R3_3}

12 PERSON OF AUTHORITY {go to R3_4}

13 PERSON KNOWN FOR A SHORT TIME {go to R3_5}

10 STRANGER

11 OTHER, SPECIFY {max 25 characters}} {go to R3asp}]

R3a_2

{FAMILY MEMBER SUB-CATEGORIES}

1 FATHER / MOTHER

2 STEP-FATHER / MOTHER

3 FOSTER PARENT (MALE / FEMALE)

16 FATHER/MOTHER-IN-LAW

4 BROTHER/STEP-BROTHER

5 SISTER/STEP-SISTER

17 FOSTER BROTHER/FOSTER SISTER

6 BROTHER/SISTER-IN-LAW

7 UNCLE/AUNT

8 COUSIN

9 GRANDFATHER/MOTHER

10 SON/STEP-SON

11 DAUGHTER/STEP-DAUGHTER

18 FOSTER SON/FOSTER DAUGHTER

19 SON/DAUGHTER-IN-LAW

12 GRANDSON/STEP-GRANDSON

13 GRANDDAUGHTER/STEP-GRANDDAUGHTER

20 NIECE/NEPHEW

14 OTHER MALE RELATIVE (SPECIFY) {go to R3_2sp}

15 OTHER FEMALE RELATIVE (SPECIFY) {go to R3_2sp}

R3a_3

{ACQUAINTANCE SUB-CATEGORIES}

1 FIRST DATE

3 FRIEND

4 FAMILY FRIEND

5 NEIGHBOR

13 CLASSMATE

14 FRIEND OF A FRIEND

7 CO-WORKER / CUSTOMER / CLIENT

12 OTHER ACQUAINTANCE (SPECIFY) {go to R3a_3sp}

R3_4

{PERSON OF AUTHORITY SUB-CATEGORIES]

1. BOSS / SUPERVISOR / SUPERIOR IN COMMAND

2. TEACHER / PROFESSOR / TEACHING ASSISTANT, COACH

3. CLERGY MEMBER

4. DOCTOR / NURSE / THERAPIST

5. CAREGIVER

6. OTHER PERSON OF AUTHORITY (SPECIFY) {go to R3_4sp}

R3_5

{PERSON KNOWN FOR A SHORT TIME SUB-CATEGORIES}

1. SOMEONE KNOWN FOR LESS THAN 24 HOURS

2. SOMEONE KNOWN BY SIGHT ONLY

3. SOMEONE YOU JUST MET

4. OTHER PERSON KNOWN FOR A SHORT TIME (SPECIFY) {go to R2_5sp}

{if respondent has only endorsed items in sections 12PA2, 12CCE2, or 12PV2, and no other sections, they only get R5, R7, R7a, and R8; if respondent endorsed items in 12PA2, 12CCE2, or 12PV2 and other items in other sections, ask R5, R7, R7a, and R8 about the perps reported in 12PA2, 12CCE2, or 12PV2 and ask all for perps reported in other sections then go to section FU to ask about the perps reported in other sections besides 12PA2, 12CCE2, or 12PV2}

R4

{if R has only reported PV, S or SV7 – SV18b items, skip R4 – R6 and go to R7}

Thinking about all of the things you told me {fill: initials} did

how old were you the first time {if only endorsed one behavior for this perp, fill: this; if endorsed more than one behavior for this perp, fill: any of these things} happened with {fill: initials 1}?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

R5

How old was {fill: initials} the first time {if only endorsed one behavior for this perp, fill: this; if endorsed more than one behavior for this perp, fill: any of these things} happened?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

R6

{If the perpetrator has done only one behavior one time, R6 should not be asked. If the perpetrator did one behavior more than one time, or if the perpetrator did more than one behavior, R6 should be asked.}

How old were you the last time {if only endorsed one behavior for this perp, fill: this; if endorsed more than one behavior for this perp, fill: any of these things} happened with {fill: initials 1}?

[RECORD AGE]

98 (VOL) DK

99 (VOL) RF

R6a

{if respondent age for R4 and R6 are equal or equal plus one, then ask R6a}Think about the time period between the first time {fill: initials} did {fill: this/these things} and the last time it happened. About how many years, months, weeks, or days did {fill: initials} do {fill: this/these things}?

[RECORD NUMBER, THEN MARK YEARS, MONTHS, WEEKS, OR DAYS]

R7

{fill Latina/Latino from sex reported first time perp listed}

Is {fill: initials} Hispanic or {if female: Latina; if male: Latino; if perp sex unkown fill: Latina or Latino}?

1 YES {go to R7a}

2 NO {go to R8}

98 (VOL) DK

99 (VOL) RF

R7a

Which of these Hispanic, Latino, or Spanish groups best describes {fill: initials}?

1 Mexican, Mexican American, Mexicano, Chicano,

2 Puerto Rican,

3 Cuban/Cuban American,

4 Dominican [IF NECESSARY: from the Dominican Republic],

5 Central or South American, or

6 Spanish [IF NECESSARY: from Spain]

7 OTHER, SPECIFY {max 25 characters}

R8

What is {fill: initials}’s race? You may identify more than one category. Would you say. . .

[CODE ALL THAT APPLY]

1 White

2 Black or African American

3 Asian

4 Native Hawaiian or other Pacific Islander, or

5 American Indian or Alaskan Native?

6 OTHER, SPECIFY {max 25 characters}

98 (VOL) DK

99 (VOL) RF

{CATI will keep count of the number of times this question is asked for each perpetrator. Once question has been asked 3 times, and all response categories have been read 3 times to R, program will change to show response options in ALL CAPS, indicating that response options do not have to be read aloud unless necessary}

{loop back to complete relationship questions for each set of initials until all are completed}

Section FU: General follow-up Questions

{do not ask FU questions about any perps reported in 12PA2, 12CCE2, or 12PV2}

{if R has reported any PA, CCE, or S perpetrators who did only 1 behavior (PA, CCE, or S) 1 time, skip section FU for that perpetrator}

{if R has reported any S1, S2, or S8 perpetrator, but then SFU3, SFU4, SFU5, and SFU6 all = 2, skip section FU for that perpetrator}

FU_INTRO

Now I’d like for you to think about all of your experiences with {fill: all initials identified in all modules}.

FU1

Were you ever concerned for your safety when {fill: this / any of these things} happened with {fill: {initials} / any of these people}?

1 YES {go to FU1a}

2 NO {go to FU2}

98 (VOL) DK

99 (VOL) RF

FU1a

{skip if only one perp reported}

Which of these people made you feel concerned for your safety?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

FU2

{if respondent has only reported S items, skip to FU2_1}

Were you ever fearful when {fill: this / any of these things} happened with {fill: {initials} / any of these people}?

1 YES {go to FU2a}

2 NO {go to FU3}

98 (VOL) DK

99 (VOL) RF

FU2a

{skip if only one perp reported}

Which of these people made you feel fearful?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

FU2b

Thinking about when you were the most fearful, how fearful were you about the things {fill: initials} did? Were you…

1 Very fearful,

2 Somewhat fearful, or

3 A little fearful

98 (VOL) DK

99 (VOL) RF

FU3_1

{for each set of initials reported at FU1a and/or FU2a loop through FU3_1 – FU3_4}

Did you ever have nightmares because of what {fill: initials} did to you?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

FU3_2

Did you ever try hard not to think about or go out of your way to avoid being reminded of what {fill: initials} did to you?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

FU3_3

Did you ever feel like you were constantly on guard, watchful, or easily startled because of what {fill: initials} did to you?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

FU3_4

Did you ever feel numb or detached from others, your activities, or your surroundings because of what {fill: initials} did to you?

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

FU3a

Had {fill: {initials}/ any of these people} been using alcohol, drugs, or both at the time when {fill: this / any of these things} happened?

1 YES {go to FU3a_1}

2 NO {go to FU4}

98 (VOL) DK

99 (VOL) RF

FU3a_1

Which of these people used alcohol, drugs, or both when {fill: this / any of these things} happened?

{OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS}

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

FU3a_2

{for each set of initials reported at FU3a_1}

Would you say that {fill: 1^st set of initials from FU3a_1, etc.} used alcohol, drugs, or both always, almost always, sometimes, or never when {fill: this / any of these things} happened?

1. ALWAYS

2. ALMOST ALWAYS

3. SOMETIMES, OR

4. NEVER

FU4

{ask if endorsed behaviors in PV, S, or SV only, else skip to FU5}

Were you ever injured when {fill: this / any of these things} happened with {fill: {initials} / any of these people}?

1 YES {go to FU3a}

2 NO {go to FU4}

98 (VOL) DK

99 (VOL) RF

FU4a

{skip if only one perp reported}

Which of these people caused your injuries?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

FU4b

When{fill: 1^st set of initials from FU4a} injured you, did those injuries include:

1 YES

2 NO

98 (VOL) DK

99 (VOL) RF

FU4b_1 minor bruises or scratches?

FU4b_2 cuts, major bruises, or black eyes?

FU4b_3 broken bones or teeth?

FU4b_4 being knocked out after getting hit, slammed against something, or choked?

FU4b_6 vaginal or anal injuries?

FU4b_7 mental or emotional harm?

FU4b_5 other injuries? [SPECIFY, MAX 75 CHARACTERS]

{repeat FU4b for all initials reported at FU4a: You also said that {fill: 2^nd set of intials, 3^rd set, etc.} injured you. Did those injuries include: …}

FU5_2

Have you ever talked to a doctor or nurse about what {fill: {initials} / any of these people} did?

1 YES {go to FU5a}

2 NO {go to FU6}

98 (VOL) DK

99 (VOL) RF

FU5_3

Have you ever talked to a psychologist or counselor about what {fill: {initials} / any of these people} did?

1 YES {go to FU5a}

2 NO {go to FU6}

98 (VOL) DK

99 (VOL) RF

FU5_4

Have you ever talked to a crisis hotline operator about what {fill: {initials} / any of these people} did?

1 YES {go to FU5a}

2 NO {go to FU6}

98 (VOL) DK

99 (VOL) RF

FU5_5

Have you ever talked to a friend about what {fill: {initials} / any of these people} did?

1 YES {go to FU5a}

2 NO {go to FU6}

98 (VOL) DK

99 (VOL) RF

FU5_6

Have you ever talked to a family member about what {fill: {initials} / any of these people} did?

1 YES {go to FU5a}

2 NO {go to FU6}

98 (VOL) DK

99 (VOL) RF

FU5_7

Have you ever talked to a romantic or sexual partner about what {fill: {initials} / any of these people} did?

1 YES {go to FU5a}

2 NO {go to FU6}

98 (VOL) DK

99 (VOL) RF

FU5_8

Have you ever talked to anyone else about what {fill: {initials} / any of these people} did?

1 YES {go to FU5a} (SPECIFY, MAX 50 CHARACTERS)

2 NO {go to FU6}

98 (VOL) DK

99 (VOL) RF

FU5a

{skip if only one perp reported}

Which people did you talk to {fill: type, i.e. the police} about?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

FU5b

When you spoke to {fill: type, i.e. the police} about {fill: initials}, how helpful was it to you? Was it…

        1       Very helpful,
        2       Somewhat helpful,
        3       A little bit helpful, or
        4       Not at all helpful

FU6_1

Did you ever need medical care because of any of the things that {fill: {initials} / any of these people} did?

1 YES {go to FU6a}

2 NO {go to FU7}

98 (VOL) DK

99 (VOL) RF

FU6_2

Did you ever need housing services because of any of the things that {fill: {initials} / any of these people} did?

1 YES {go to FU6a}

2 NO {go to FU7}

98 (VOL) DK

99 (VOL) RF

FU6_4

Did you ever need victim’s advocate services because of any of the things that {fill: {initials} / any of these people} did?

1 YES {go to FU6a}

2 NO {go to FU7}

98 (VOL) DK

99 (VOL) RF

FU6_4a

Did you ever need help from law enforcement because of what {fill;{initials}/ any of these people} did?

1 YES {go to FU6a}

2 NO {go to FU7}

98 (VOL) DK

99 (VOL) RF

FU6_5

Did you ever need legal services because of any of the things that {fill: {initials} / any of these people} did?

1 YES {go to FU6a}

2 NO {go to FU7}

98 (VOL) DK

99 (VOL) RF

FU6a

{skip if only one perp reported}

Which people caused you to need {fill:{service}?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

{repeat FU6a for all servcies reported}

FU6b

Were you able to get the {fill: service} that you needed when {fill: initials} did {fill: this / these things}?

1 YES

2 NO {go to FU6c}

98 (VOL) DK

99 (VOL) RF

FU6c _a

Why were you not able to get the assistance that you needed when {fill: initials} did {fill: this / these things}?

[CHOOSE ALL THAT APPLY]

2. NOT HAVE ENOUGH MONEY

3. MADE TOO MUCH MONEY TO QUALIFY FOR SERVICES

4. SERVICES WERE UNAVAILABLE

5. TOO YOUNG TO RECEIVE SERVICES

6. OTHER, SPECIFY {go to FU6c}

FU6c

{TI: RECORD REASON R NOT ABLE TO GET THE ASSISTANCE NEEDED}

[RECORD VERBATIM RESPONSE]

[MAX 250 CHARACTERS]

{repeat FU6b and FU6c for all initials reported at FU6a} You also said that you needed services, because of what fill: 2nd set of initials from FU6a, 3^rd set of initials, etc.} did. Were you able to get those services that you needed?

FU7

Did you ever have to miss days of work or school when {fill: this / any of these things} happened with {fill: {initials} / any of these people}?

1 YES {go to FU7a}

2 NO {go to IP1}

98 (VOL) DK

99 (VOL) RF

FU7a

Which people caused you to miss work or school?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

FU7b

How many days of work or school did {fill: initials 1, initials 2, etc.} cause you to miss?

[RECORD NUMBER OF DAYS] [RANGE 1 – 365]

Section IP: Intimate partner Questions

IP1a

The last few questions are general questions about your relationships.

Do you consider yourself to be…

1. Heterosexual or straight,

2. Gay or lesbian, or

3. Bisexual

4. TRANSGENDERED

98 (VOL) DK

99 (VOL) RF

IP1

During your lifetime, have you had sex with only men, only women, or both men and women?

1 ONLY MEN

2 ONLY WOMEN

3 BOTH MEN AND WOMEN

4 OTHER, SPECIFY {max 25 characters}

5 NEITHER

98 (VOL) DK

99 (VOL) RF

IP2

Are you currently married, divorced, separated, widowed, or have you never been married? [PROBE: TI: IF RESPONDENT SAYS THEY ARE “SINGLE” OR “ENGAGED” PLEASE PROBE FURTHER TO FIND OUT WHICH OF THE LISTED CATEGORIES IS CORRECT]

1 MARRIED {go to IP5}

2 DIVORCED {go to IP3}

3 SEPARATED {go to IP3}

4 WIDOWED {go to IP3}

5 NEVER MARRIED {go to IP3}

6 OTHER (specify __________)(max 25 characters) {go to IP3}

98 (VOL) DK {go to IP3}

99 (VOL) RF {go to IP3}

IP3

Are you currently living with a man or a woman as a couple at least part of the time? By couple I mean romantically or sexually involved, not just roommates.

1 YES {go to IP5}

2 NO {go to IP4}

98 (VOL) DK {go to IP4}

99 (VOL) RF {go to IP4}

IP4

Are you currently romantically or sexually involved with someone like a boyfriend or girlfriend? This would include someone you are seeing or dating.

1 YES {go to IP5}

2 NO {go to W1}

8 (VOL) DK {go to W1}

9 (VOL) RF {go to W1}

IP5

{if IP4 = 1} Is the person you are romantically or sexually involved with a man or a woman?

{if IP3 = 1} Is the person you are living with as a couple male or female?

{if IP2 < 2} Is your spouse male or female?

1 MALE

2 FEMALE

98 (VOL) DK

99 (VOL) RF

IP6

{if IP2=1 or IP3=1}

Now please think about the employment status or work situation of your partner over the past 12 months, that is since {fill date 12 months ago}.

What was your partner doing for most of the past 12 months? Was he / she…

1. Employed full-time, {go to IP7}

2. Employed part-time, {go to IP7}

3. Keeping house, {go to W1}

4. Going to school, {go to W1}

5. Retired, {go to W1}

6. Disabled, {go to W1}

7. Unable to work for other health reasons, or {go to W1}

9. Laid off? {go to W1}

7. OTHER {go to W1}

98 (VOL) DK {go to W1}

99 (VOL) RF {go to W1}

IP7

How is your partner generally paid for the work he or she does? Is he or she….

1 Paid by salary,

2 Paid by the hour,

3 Paid by the job or task, or

4 Paid some other way?

98 (VOL) DK {go to IP8}

99 (VOL) RF {go to IP8}

IP8

{if RC7_1 = 2, skip IP8}

Do you get paid more than your partner, paid about the same amount as your partner, or paid less than your partner?

1 PAID MORE

2 PAID ABOUT THE SAME

3 PAID LESS

98 (VOL) DK

99 (VOL) RF

IP9

TI: WAS THIS INTERVIEW COMPLETED IN ENGLISH OR SPANISH?

1. ENGLISH

2. SPANISH

Section W: Wrap-up

W1

That’s my last question in this survey. To thank you for your participation, we will either mail you a check for {if not nonresponse: $10; if nonresponse: $40} or donate the {if not nonresponse: $10; if nonresponse: $40} to the United Way on your behalf. Which would you prefer?

1. RECEIVE INCENTIVE {go to W2}

2. DONATE INCENTIVE {go to W3}

W2

In order to mail you your check for {if not nonresponse: $10; if nonresponse: $40}, I need to collect your full name and mailing address. This information will never be connected with your answers in the survey.

[RECORD NAME AND ADDRESS] {go to W4}

W3

Thank you for your donation.

W4

If you have any questions or concerns about participating in the survey, please feel free to call the survey manager, Susan Rooker at 1-877-287-3782. You will hear an option to speak with a project staff member.

W5

Thank you for participating in CDC’s study of health and injuries. We realize that some of the topics covered are quite personal and can be difficult to think and talk about.  We appreciate your willingness to be a part of this study and want you to know that we recognize the important contribution you have made.   Sometimes when people have participated in a study like this, they realize that they are interested in following up on some of the issues that they have been asked about in the study with someone who is professionally trained to deal with these kinds of issues. We are going to provide you the toll-free numbers of {if 70+: 3, else: 2} resources that you can use now or in the future if you want to speak further with someone.  

1. CONTINUE

W6

{if 70+: You can reach the National Center on Elder Abuse at 1-800-677-1116.}

You can reach the National Domestic Violence Hotline at 1-800-799-SAFE (7233).  You can reach the Rape, Abuse and Incest National Network at 1-800-656-HOPE (4673). [PAUSE THEN SAY: Would you like me to repeat these numbers?]

W7

That completes the interview. Thank you for your participation.

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