2014 National Intimate Partner and Sexual Violence Scree

Attachment E

2014 National Intimate Partner and Sexual Violence Survey

Study Questionnaire

August 5, 2014

OMB No: 0920-0822
Exp. Date: XX/XX/XXXX

Public Reporting burden of this collection of information is estimated at 28 minutes in average per response (3 minutes for reselection and 25 minutes for selected participants), 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 NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-0822).

Table of Contents

Section	Subject	Page
CF	Control Form	3
RC	Respondent Characteristics	9
H	Health	17
V	Victimization	19
PA	Psychological Aggression	20
PV	Physical Violence	21
S	Stalking	25
SFU	Stalking Follow Up	29
SV	Sexual Violence	34
SVFU	Sexual Violence Follow Up	43
R	Relationships	48
FU	General Follow Up Questions	61
W	Wrap-Up	81

Sample Elements:

STATE FIPS (2-digit)

STATE (coded lists)

COUNTY FIPS (5-digit)

Note regarding the CATI codes for Don’t Know and Refused: Abt SRBI’s CATI system cannot use negative values for response codes. Also, if a question requires more than six substantive responses, Abt SRBI’s standard practice is to then use 97 and 99 for Don’t Know and Refuse, increasing to 997 and 999 and beyond as dictated by specific questions needs. However, for the final data presented to CDC, Don’t Know and Refuse will be recoded to -1 and -2 as was done in the past.

Note regarding Skip Instructions: Abt SRBI’s use of skip instructions serves a dual purpose: first, to explain to CATI programmers how the instrument should function, and second, for interviewers and other readers to be able to move through the paper version of the questionnaire document and understand how movement through an interview progresses. While sometimes this may lead to seemingly redundant instructions, Abt SRBI believes that they provide clarity and ease of use and understanding for the different parties that will need to work with the document. For example, GO TO Q#, means for both the CATI programmer to have the program skip to that question, as well as for a reader to move ahead in the paper instrument.

Section CF: Control Form

CFO

Hello, I am calling on behalf of the Centers for Disease Control and Prevention, the CDC. The CDC is conducting an important research study on health and injuries, and if someone in your household is selected to participate we will send that person a check for [$10/$40]. My name is __________, with Abt SRBI; I’m 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.

CF1

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 CF2

2 NO IF NO 18+ AVAILABLE, SCHEDULE CALLBACK

9 (VOL) REFUSED INITIAL REFUSAL

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

CF2

Is this a cell phone?

1 YES GO TO CF2_1

2 NO GO TO CF3

9 (VOL) REFUSED SOFT REFUSAL

CF2_1

Are you driving a vehicle at this moment?

1 YES GO TO CF2_2

2 NO GO TO CF4

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?”]

[SCHEDULE CALLBACK]

ASK CF3 OF LANDLINE RESPONDENTS (CF2=2).

CF3

Is this a private residence?

1 YES GO TO CF4

2 NO GO TO CF3_1

7 (VOL) DON’T KNOW GO TO CF3_1

9 (VOL) REFUSED GO TO CF3_1

CF3_1

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

[TERMINATE INTERVIEW]

CF4

[CATI IF CF2=1 (cell phone), “Including this one, how”; IF CF2=2 (landline) “How”] many working cell phones do you have?

________ [RANGE 1-9 (IF CELL PHONE CF2=1), 0-9 (IF LANDLINE CF2=2)]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

CF5

[CATI IF CF2=1 (cell phone), “How many telephone numbers”; IF CF2=2 (landline) “Including the number I just dialed, how many 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?

_______ [RANGE 0-5 (IF CELL PHONE CF2=1), 1-5 (IF LANDLINE CF2=2)]

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

IF CF2=1 (Cell Phone), SKIP TO CFMOSTLY.

IF CF2=2 (Landline) and CF4=1-9, SKIP TO CFMOSTLY; ELSE ASK CF6

CF6

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

1 YES GO TO CFMOSTLY

2 NO GO TO CFAdltN

3 (VOL) No one else in household GO TO CFAdltN

7 (VOL) DON’T KNOW GO TO CFAdltN

9 (VOL) REFUSED GO TO CFAdltN

CFMOSTLY

Of all the telephone calls that you or your family receives, are….

1. All or most all calls received on cell phones

2. Some received on cell phones and some on regular phones

3. Very few or none on cell phones

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

CFAdltN

IF CF2=2 (landline), ASK: I need to randomly select one adult who lives in your household to be interviewed. [CATI: IF CF6=3 (no other HH members), INSERT THIS SENTENCE: “I know you told me there were no other people in your household, but I need to confirm this information.”] How many members of your household, including yourself, are 18 years of age or older?

IF CF2=1 (cell phone), ASK: How many members of your household, including yourself, are 18 years of age or older?

[RECORD NUMBER OF ADULTS]

_______ [RANGE 0-10, 97, 99]

97 (VOL) DON’T KNOW SOFT REFUSAL

99 (VOL) REFUSED SOFT REFUSAL

ASK CF6Self IF CFAdltN=0; ELSE GO TO CONDITIONALS PRIOR TO CF7.

CF6Self

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

1 YES GO TO CF6End

2 NO RE-ASK CFAdltN

CF6End

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

Thank & End Interview SCREEN OUT, INELIGBLE AGE

IF CELL PHONE RESPONDENT (CF2=1), GO TO CF11.

IF LANDLINE RESPONDENT (CF2=2) AND CFAdltN=1, ASK CF7. IF LANDLINE RESPONDENT (CF2=2) AND CFAdltN>1, GO TO CF8_MEN.

CF7
Are you the adult?

1 YES GO TO CF11

2 NO GO TO CF13_FIRST

CF8_MEN

How many of these adults are men?

_________ [RECORD NUMBER OF MEN] RANGE 0-10, 99

99 (VOL) REFUSED SOFT REFUSAL

CF8_WOMEN

How many of these adults are women?

_________ [RECORD NUMBER OF WOMEN] RANGE 0-10, 99

99 (VOL) REFUSED SOFT REFUSAL

CATI: IF CF8_MEN+CF8_WOMEN DOES NOT EQUAL CFAdltN, WE NEED TO RE-ASK THE QUESTIONS. ASK CFNchk.

CFNChk

I’m sorry, but I need to confirm the responses I entered. I recorded your household has [CFAdltN] total adults, with [CF9_MEN] men and [CF9_WOMEN] women. Would you please help me correct this?

1. Correct number of adults GO BACK TO CFAdltN, THEN SKIP TO CFSelect

2. Correct number of men GO BACK TO CF8_MEN, THEN SKIP TO CFSelect

3. Correct number of women GO BACK TO CF8_WOMEN, THEN SKIP TO CFSelect

9. REFUSED SOFT REFUSAL

CFSelect

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

CATI: IF CFAdltN=2, RANDOMLY SELECT ONE ADULT RESPONDENT.

The person in your household that I need to interview [“you” (if respondent selected)/“the other household adult” (if respondent not selected)].

CATI: IF CFAdltN>=3, USE MOST RECENT BIRTHDAY SELECTION.

The person in your household that I need to interview is the adult with the most recent birthday.

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_INTRO2A

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

CF13_FIRST

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

______________________ [RECORD PERSON’S FIRST NAME ONLY]

[INTERVIEWER: 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 or her]?

1 YES GO TO CF_INTRO1

2 NO SCHEDULE CALLBACK

9 REFUSED SOFT REFUSAL

CF_INTRO1

[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 conducting a study on health and injuries. My name is __________. I am an interviewer with Abt SRBI and I am part of the research team. Let me assure you that this is not a sales call.

CF_INTRO2A

You have been randomly chosen to participate in an important study. This call may be monitored or recorded for quality assurance purposes. The Centers for Disease Control and Prevention (CDC) is doing a telephone study of up to 12,500 people. 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 inform prevention efforts.

The survey will take approximately 25 minutes, on average. Since some of the questions are personal, we suggest that you be in a private setting during the survey.

1. Continue

CF_INTRO2B

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 [replicate assigned: $10; $40 – CATI variable ‘CFAmt’] 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.

1. Continue

CF_INTRO2C

If you choose to receive the {$10; $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, Andrew Evans, at 1-888-772-4269. If you have any questions about your rights as a research participant, please contact our Institutional Review Board toll-free at 1-877-520-6835.

May we begin?

1. YES GO TO CF15

2. NO GO TO CFReasn

9 (VOL) REFUSED GO TO CFReasn

CFReasn

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

1 DOES NOT HAVE TIME SCHEDULE CALLBACK

2 INCONVENIENT NOW SCHEDULE CALLBACK

3 NOT INTERESTED HARD REFUSAL

4 DOES NOT PARTICIPATE IN SURVEYS HARD REFUSAL

5 OPPOSES GOV’T INTRUDING ON PRIVACY HARD REFUSAL

6 TOO PRIVATE/SENSITIVE/EMBARASSING HARD REFUSAL

7 OTHER (specify) ________ HARD REFUSAL

DP SPECIFY VARIABLE: CFReasn_SP (max 75 characters)

8 (VOL) DON’T KNOW HARD REFUSAL

9 (VOL) REFUSED HARD REFUSAL

CF15

I am required to verify your gender; would you identify yourself as … [READ LIST]

1 MALE, GO TO CONFIRMSEX

2 FEMALE, GO TO CONFIRMSEX

3 OR, TRANSGENDERED? GO TO CF16

7 (VOL) DON’T KNOW THANK & END, HARD RESFUSAL

9 (VOL) REFUSED THANK & END, HARD RESFUSAL

CF16

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

1. MALE GO TO CONFIRMSEX

2. FEMALE GO TO CONFIRMSEX

9 REFUSED THANK & END, HARD RESFUSAL

RSPSEX CATI SYSTEM VARIABLE (not asked, used for cati read-ins/displays)

[if cf15=1 or cf16=1, code 1. if cf15=2 or cf16=2, code 2]

1 Male
2 Female

Section RC: Respondent Characteristics

CONFIRMSEX

INTERVIEWER: SELECTED GENDER FOR THIS CASE IS [DISPLAY SELECTED SEX (Male/Female) FROM ‘CF_SELECT’].

THE GENDER OF THE CURRENT RESPONDENT IS: [DISPLAY RSPSEX].

IF GENDER OF RESPONDENT IS DIFFERENT, SCHEDULE A CALLBACK AND NOTIFY SUPERVISOR

IF GENDER IS CORRECT, PRESS “1” TO START INTERVIEW.

1. Start Interview

2. Schedule Callback SCHEDULE CB

RC1m/RC1

In what month and year were you born?

[ELIGIBLE YEARS OF BIRTHS ARE: 1909 – [READ-IN: CURRENT MONTH], 1996]
IF RESPONDENT WILL PROVIDE YEAR OF BIRTH, BUT NOT THE MONTH, RECORD “99” FOR THE MONTH AND THEN THE YEAR.

_ _/_ _ _ _

999999 (VOL) REFUSES MONTH AND YEAR GO TO RC1a

CATI: If year of birth is outside eligible range, go to RC1a. If response is 99/1996, we cannot confirm the respondent is 18 or older, go to RC1a.

RC1a

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.

1. Selected respondent not 18 or older THANK & END

[CATI INSTRUCTION: Calculate the respondent’s age in years (CURAGE=0 to 105) based on RC1m/RC1 (month and year) using a value of 15 for the birth day.]

RC2

What is the highest level of education you have completed?

[DISPLAY: TI: READ LIST AS NEEDED]

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

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

RC3

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

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

RC4 [RC4_1 – RC4_6]

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

(READ LIST, MULTIPLE RECORD)

1 White

2 Black or African American

3 Asian

4 Native Hawaiian or other Pacific Islander, or

5 American Indian or Alaskan Native?

6 (VOL) OTHER (specify) ____________

DP SPECIFY VARIABLE: RC4_SP (max 25 characters)

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

IP2

Are you currently married, divorced, separated, widowed, have you never been married, or not married but living with a partner?

[IF RESPONDENT SAYS THEY ARE “SINGLE” OR “ENGAGED”, PLEASE PROBE FURTHER TO FIND OUT WHICH OF THE LISTED CATEGORIES IS CORRECT: “You stated you are single/engaged, but which of these categories best describes your status.”]

1 MARRIED

2 DIVORCED

3 SEPARATED

4 WIDOWED

5 NEVER MARRIED

6 NOT MARRIED BUT LIVING WITH PARTNER: OF OPPOSITE SEX

7 NOT MARRIED BUT LIVING WITH PARTNER: OF SAME SEX

8 (VOL) OTHER (specify) ____________

DP SPECIFY VARIABLE: IP2_SP (max 25 characters)
97 (VOL) DON’T KNOW

99 (VOL) REFUSED

RC4A

Do you think of yourself as… (READ LIST)

1. Lesbian or gay GO TO RC5

2. Straight, that is, not gay GO TO RC5

3. Bisexual GO TO RC5

4. Something else GO TO RC4AO

7 (VOL) DON’T KNOW GO TO RC4AD

9 (VOL) REFUSED GO TO RC5

RC4AO

By something else, do you mean that… (READ LIST)

1. You are not straight, but identify with another label such as queer, trisexual, omnisexual or pan-sexual GO TO RC5

2. You are transgender or transexual GO TO RC5

3. You have not or are in the process of figuring out
   your sexuality GO TO RC5

4. You do not think of yourself as having a sexuality GO TO RC5

5. You personally reject all labels of yourself GO TO RC5

6. You made a mistake and did not mean to pick
   this answer GO TO RC4A

7. You mean something else (specify) _____ GO TO RC5

DP SPECIFY VARIABLE: RC4AOO (max 100 char)

97 (VOL) DON’T KNOW GO TO RC4AD

99 (VOL) REFUSED GO TO RC5

RC4AD
By Don’t Know, do you mean that… (READ LIST)

1. You don’t understand the words GO TO RC5

2. You understand the words, but you have not or are in the process of figuring out your sexuality GO TO RC5

3. You mean something else (specify) _____ GO TO RC5

DP SPECIFY VARIABLE: RC4ADO (max 100 char)

7 (VOL) DON’T KNOW GO TO RC5

9 (VOL) REFUSED GO TO RC5

RC5

If RC4=5 (American Indian or Alaskan Native?), SKIP TO RC7a

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

1 YES GO TO RC7a

2 NO ASK RC5a

7 (VOL) DON’T KNOW ASK RC5a

9 (VOL) REFUSED ASK RC5a

RC5a [RC5code]

In what country were you born?

[RECORD NAME OF COUNTRY USING COUNTRY CODE LIST]]

OTHER (specify) ________________

DP SPECIFY VARIABLE: RC5O (max 75 characters)

RC5b

How many years have you lived in the United States?

[RECORD NUMBER OF YEARS, or record 0 if LESS THAN ONE YEAR]

______ [RANGE: 0-105, 997, 999]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

CATI: IF CURAGE=DK/REFUSED, OR RC5b =997 OT 999, GO TO RC7a.
RC5b MUST BE <= TO CURAGE, IF SO GO TO RC7a. ELSE CONFIRM THE INFORMATION.

I would like to confirm some responses: I have recorded you are [CURAGE] years old, but you have lived in the United States for [RC5b] years. Can you help me correct this information?

1 Update Age GO TO RC1m/RC1

2 Update years lived in U.S. GO TO RC5b

RC7a

What was the total income from ALL household members during 2013, before taxes. Include income from all sources such as work, investments, child support and public assistance. Was it…

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

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

1. YES GO TO RC7b

2. NO GO TO RC7e

7 (VOL) DON’T KNOW GO TO INCOME

9 (VOL) REFUSED GO TO INCOME

RC7b Less than $20,000? ($15,000 to less than $20,000)

1. YES GO TO RC7c

2. NO GO TO INCOME

7 (VOL) DON’T KNOW GO TO INCOME

9 (VOL) REFUSED GO TO INCOME

RC7c Less than $15,000? ($10,000 to less than $15,000)

1. YES GO TO RC7d

2. NO GO TO INCOME

7 (VOL) DON’T KNOW GO TO INCOME

9 (VOL) REFUSED GO TO INCOME

RC7d Less than $10,000? ($0,001 to less than $10,000)

1. YES GO TO INCOME

2. NO GO TO INCOME

7 (VOL) DON’T KNOW GO TO INCOME

9 (VOL) REFUSED GO TO INCOME

RC7e Less than $35,000? ($25,000 to less than $35,000)

1. YES GO TO INCOME

2. NO GO TO RC7f

7 (VOL) DON’T KNOW GO TO INCOME

9 (VOL) REFUSED GO TO INCOME

RC7f Less than $50,000? ($35,000 to less than $50,000)

1. YES GO TO INCOME

2. NO GO TO RC7g

7 (VOL) DON’T KNOW GO TO INCOME

9 (VOL) REFUSED GO TO INCOME

RC7g Less than $75,000? ($50,000 to less than $75,000)

1. YES GO TO INCOME

2. NO GO TO RC7h

7 (VOL) DON’T KNOW GO TO INCOME

9 (VOL) REFUSED GO TO INCOME

CATI: IF RC7g=2 ‘NO’, CODE RC7h=1 ‘YES’.

RC7h $75,000 or more?

1. YES

2. NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

INCOME CATI: SYSTEM VARIABLE TO STORE HH INCOME AUTO-CODE RESPONSE, THEN GO TO RC10. (system variable – auto-coded, not asked)

1 Less than $10,000 [IF RC7d=1]

2 $10,000 to less than $15,000 [IF RC7c=1]

3 $15,000 to less than $20,000 [IF RC7b=1]

4 $20,000 to less than $25,000 [IF RC7a=1]

5 $25,000 to less than $35,000 [IF RC7e=1]

6 $35,000 to less than $50,000 [IF RC7f=1]

7 $50,000 to less than $75,000 [IF RC7g=1]

8 $75,000 or more [IF RC7h=1]

97 Don’t know / Not sure [IF RC7a=7 OR RC7b=7 OR RC7c=7 OR

RC7d=7 OR RC7e=7 OR RC7f=7 OR RC7g=7]

99 Refused [IF RC7a=9 OR RC7b=9 OR RC7c=9 OR

RC7d=9 OR RC7e=9 OR RC7f=9 OR RC7g=9]

RC10

What is your zip code? [RECORD ZIP CODE]

______________ (Range 01001 – 99950) GO TO RC11

7 (VOL) DON’T KNOW GO TO RC13

9 (VOL) REFUSED GO TO RC13

CATI: If zip code in RC10 doesn’t exist in ZipCode database, go to RC11a.

RC11

Is this in [SAMPLE ELEMENT ‘STATE’]?

1. YES GO TO RC12

2 NO ASK RC11a

9 (VOL) DON’T KNOW/REFUSED BREAKOFF, THANK & END

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

RC11a

What state do you live in?

1 ALABAMA

2 ALASKA

4 ARIZONA

5 ARKANSAS

6 CALIFORNIA

8 COLORADO

9 CONNECTICUT

10 DELAWARE

11 DISTRICT OF COLUMBIA

12 FLORIDA

13 GEORGIA

15 HAWAII

16 IDAHO

17 ILLINOIS

18 INDIANA

19 IOWA

20 KANSAS

21 KENTUCKY

22 LOUISIANA

23 MAINE

24 MARYLAND

25 MASSACHUSETTS

26 MICHIGAN

27 MINNESOTA

28 MISSISSIPPI

29 MISSOURI

30 MONTANA

31 NEBRASKA

32 NEVADA

33 NEW HAMPSHIRE

34 NEW JERSEY

35 NEW MEXICO

36 NEW YORK

37 NORTH CAROLINA

38 NORTH DAKOTA

39 OHIO

40 OKLAHOMA

41 OREGON

42 PENNSYLVANIA

44 RHODE ISLAND

45 SOUTH CAROLINA

46 SOUTH DAKOTA

47 TENNESSEE

48 TEXAS

49 UTAH

50 VERMONT

51 VIRGINIA

53 WASHINGTON

54 WEST VIRGINIA

55 WISCONSIN

56 WYOMING

99 (VOL) DON’T KNOW/REFUSED BREAKOFF, THANK & END

CATI: If zip code in RC10 doesn’t exist in ZipCode database, go to RC12a.

RC12

Do you live in [SAMPLE ELEMENT ‘COUNTY’] county?

[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 TRACT.]

1 YES GO TO SECTION H

2 NO GO TO RC12a

7 (VOL) DON’T KNOW GO TO SECTION H

9 (VOL) REFUSED GO TO SECTION H

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

RC12a

What county do you live in?

[USE, STATE-BASED (RC11a) COUNTY LISTING]

[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 TRACT.

-IF RESPONDENT SAYS THEY LIVE IN DADE COUNTY, FLORIDA CODE AS MIAMI-DADE.

-IF RESPONDENT REPORTS A COUNTY THAT IS NOT LISTED SAY: “LET ME VERIFY THAT YOU SAID ________ COUNTY.” IF THE RESPONDENT SAYS TO THE UNLISTED COUNTY, RECORD COUNTY NAME USING NOTES FUNCTION.]

1. Gave Response GO TO SECTION H

7 (VOL) DON’T KNOW GO TO SECTION H

9 (VOL) REFUSED GO TO SECTION H

CATI: IF NO ZIP CODE IS PROVIDED

RC13

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?

1 ALABAMA

2 ALASKA

4 ARIZONA

5 ARKANSAS

6 CALIFORNIA

8 COLORADO

9 CONNECTICUT

10 DELAWARE

11 DISTRICT OF COLUMBIA

12 FLORIDA

13 GEORGIA

15 HAWAII

16 IDAHO

17 ILLINOIS

18 INDIANA

19 IOWA

20 KANSAS

21 KENTUCKY

22 LOUISIANA

23 MAINE

24 MARYLAND

25 MASSACHUSETTS

26 MICHIGAN

27 MINNESOTA

28 MISSISSIPPI

29 MISSOURI

30 MONTANA

31 NEBRASKA

32 NEVADA

33 NEW HAMPSHIRE

34 NEW JERSEY

35 NEW MEXICO

36 NEW YORK

37 NORTH CAROLINA

38 NORTH DAKOTA

39 OHIO

40 OKLAHOMA

41 OREGON

42 PENNSYLVANIA

44 RHODE ISLAND

45 SOUTH CAROLINA

46 SOUTH DAKOTA

47 TENNESSEE

48 TEXAS

49 UTAH

50 VERMONT

51 VIRGINIA

53 WASHINGTON

54 WEST VIRGINIA

55 WISCONSIN

56 WYOMING

99 (VOL) DON’T KNOW/ REFUSED BREAKOFF, THANK & END

RC13a

What county do you live in?

[USE, STATE-BASED (RC13) COUNTY LISTING]

[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 TRACT.

-IF RESPONDENT SAYS THEY LIVE IN DADE COUNTY, FLORIDA CODE AS MIAMI-DADE.

-IF RESPONDENT REPORTS A COUNTY THAT IS NOT LISTED SAY: “LET ME VERIFY THAT YOU SAID ________ COUNTY.” IF THE RESPONDENT SAYS TO THE UNLISTED COUNTY, RECORD COUNTY NAME USING NOTES FUNCTION.]

1 Gave Response

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

Section H: Health Questions

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…

H1_A Asthma?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H1_IBS Irritable bowel syndrome or IBS?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H1_D Diabetes?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H1_HBP High blood pressure?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H2_FH

Do you have…

Frequent headaches?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H2_CP Chronic pain?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H2_DS Difficulty sleeping?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H3_2013 Do you have serious difficulty hearing?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H4_2013 Are you blind or do you have serious difficulty seeing, even when wearing glasses?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H5_2013 Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H6_2013

Do you have serious difficulty walking or climbing stairs?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H7_2013

Do you have difficulty dressing or bathing?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

H8_2013

Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

Section V: 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 888-812-9285, ext. 30024.

Do you have any questions?

[TI: ANSWER ALL RESPONDENT QUESTIONS, THEN ENTER CONTINUE.]

VIC_INTROa

Shall we continue?

1 YES

2 NO BREAKOFF: THANK & END, DO NOT CB

7 (VOL) DON’T KNOW BREAKOFF: THANK & END, DO NOT CB

9 (VOL) REFUSED BREAKOFF: THANK & END, DO NOT CB

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.

Section PA: Psychological Aggression

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

[RECORD NUMBER OF PARTNERS FOR EACH ITEM]

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

PA1_2013 insulted, humiliated, or made fun of you in front of others?

PA2_2013 kept you from having your own money?

PA3_2013 tried to keep you from seeing or talking to your family or friends?

PA4_2013 kept track of you by demanding to know where you were and what

you were doing?

PA5_2013 made threats to physically harm you?

__ [RANGE 0 – 15 PARTNERS]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

CATI: this is the survey section where we begin collecting names/initials of perpetrators. We will need a system variable that allows up to a total of 94 perpetrator names/initials..

We will also need a counter for the number of behaviors and the number of times.

Section PV: Physical Violence

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…?

[RECORD NUMBER OF PARTNERS FOR EACH ITEM]

PV2 slapped you?

PV3 pushed or shoved you?

PV4 hit you with a fist or something hard?

PV5 kicked you?

PV6 hurt you by pulling your hair?

__ [RANGE 0 – 15 PARTNERS]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

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?

PV10 beaten you?

PV11 burned you on purpose?

PV12 used a knife or gun on you?

CATI: 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

ASK FOR ALL INITIALS DISPLAYED

PVi

[PV_I_2_PVI_1 – PV_I_2_PVI_15 through PV_I_12_PVI_1 – PV_I_12_PVI_15]

Was it [FILL: 1^ST SET OF INITIALS THROUGH 94^TH SET OF INITIALS]?

[SELECT UP TO 15 INITIALS]

1 1^st initials selected

2 2^nd initials selected

…

94 94^th initials selected

95 NONE OF THE ABOVE GO TO PVa

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

IF NEW INITIALS TO ADD [PVi=95], GO TO PVa; IF NOT, GO TO PVb

PVa

[PV_I_2_PVA_1 – PV_I_2_PVA_15 through PV_I_12_PVA_1 – PV_I_12_PVA_15]

[IF 1^ST TIME COLLECTING ANY INITIALS, DISPLAY:]

I’d like for you to tell me some way that we can refer to [IF ANY PV2 – 12 =1, “this person”; IF ANY PV2 – 12 > 1, “these people”], such as their initials or a nickname, so that if I ask you other questions about [IF ANY PV2 – 12 =1, “this person”; IF ANY PV2 – 12 > 1, “these people”] you’ll know who I’m talking about. Please tell me the initials of the [IF ANY PV2 – 12 > 1, “first”] person who [FILL: PV BEHAVIOR]?

[ONCE ANY INITIALS HAVE BEEN RECORDED, THEN ONLY DISPLAY:]

Please tell me the initials of the [IF ANY PV2 – 12 > 1, “first”] person who [FILL: PV BEHAVIOR]?

[IF ANY PV2 – 12 > 1, AFTER FIRST SET OF INITIALS, DISPLAY BELOW TEXT UNTIL # OF SETS OF INITIALS = NUMBER OF REPORTED PARTNERS]

Please tell me the initials of the next person who [FILL: PV BEHAVIOR]?

[RECORD INITIALS FOR IP]

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

[PV behavior fills:

PV2=slapped you

PV3=pushed or shoved you

PV4=hit you

PV5=kicked you

PV6=pulled your hair

PV7=slammed you against something

PV9=tried to choke or suffocate you

PV10=beat you

PV11=burned you

PV12=used a knife or gun on you]

IF COLLECTING NEW INITIALS, ASK PV1a

PV1a

[PV_I_2_PV1A_1 – PV_I_2_PV1A_15 through PV_I_12_PV1A_1 – PV_I_12_PV1A_15]

Is [FILL: INITIALS] male or female?

1. MALE

2. FEMALE

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

ASK FOR EACH SET OF INITIALS LISTED IN PVi AND PVa, UP TO 15

PVb

[PV_I_2_PVB_1 – PV_I_2_PVB_15 through PV_I_12_PVB_1 – PV_I_12_PVB_15]

How many times did [FILL: INITIALS] ever [FILL: PV 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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

PVf

[PV_I_2_PVF through PV_I_12_PVF]

[IF ONLY ONE SET OF INITIALS CHOSEN: “Has this person”; ELSE: “Did any of these people”] [FILL: PV 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; IF ON PV12 GO TO PVj

7 (VOL) DON’T KNOW GO TO NEXT PV ITEM; IF ON PV12 GO TO PVj

9 (VOL) REFUSED GO TO NEXT PV ITEM; IF ON PV12 GO TO PVj

ASK IF MULTIPLE PERPS REPORTED FOR CURRENT PV BEHAVIOR

PVg

[PV_I_2_PVG_1 – PV_I_2_PVG_15 through PV_I_12_PVG_1 – PV_I_12_PVG_15]

Which people did this in the past twelve months?

[SELECT UP TO 15 INITIALS]

[DISPLAY INITIALS FROM PVA/PVI]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

4 Past 12 mo - 4^th initials selected

5 Past 12 mo - 5^th initials selected

6 Past 12 mo - 6^th initials selected

7 Past 12 mo - 7^th initials selected

8 Past 12 mo - 8^th initials selected

9 Past 12 mo - 9^th initials selected

10 Past 12 mo - 10^th initials selected

11 Past 12 mo - 11^th initials selected

12 Past 12 mo - 12^th initials selected

13 Past 12 mo - 13^th initials selected

14 Past 12 mo - 14^th initials selected

15 Past 12 mo - 15^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ASK FOR EACH SET OF INITIALS ENDORSED AT PVg, UP TO 15

PVh

[PV_I_2_PVH_1 – PV_I_2_PVH_15 through PV_I_12_PVH_1 – PV_I_12_PVH_15]

How many times did [FILL: INITIALS] [FILL: PV BEHAVIOR] in the past twelve months? Would you say…

[CATI: ONLY DISPLAY ANSWER OPTIONS LT OR EQUAL TO PVB (REPORTED # OF TIMES EVER)]

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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

LOOP BACK TO NEXT PV BEHAVIOR ITEM UNTIL ALL ARE COMPLETE

AFTER FINAL (PV12) LOOP:

ASK FOR EACH SET OF INITIALS REPORTED IN PV SECTION, UP TO 94

PVj

[PVJ_1 – PVJ_94]

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]?

[INTERVIEWER: IF R ASKS FOR A LIST OF BEHAVIORS ENDORSED READ:

[FILL: LIST OF ENDORSED PV BEHAVIORS]]

[RECORD AGE]

___ [Range 0-99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

[IF AGE in PVj > CURAGE then ask:]

PVj_chk

I would like to confirm some responses: I have recorded you are [CURAGE] years old, but you were [PVj] years old when this first happened. Can you help me correct this information?

1 Update Age GO TO RC1m/RC1

2 Update age when act happened GO TO PVj

Section S: Stalking

IF R ENDORSES 3+ BEHAVIORS IN PV SECTION

CHK1

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?

1 YES GO TO S_INTRO

2 NO BREAKOFF/TERMINATION: PHYSICAL VIOLENCE 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 strangers or someone you knew such as a romantic or sexual partner; a friend, teacher, co-worker, or supervisor; or a family member. 

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]

How many people have ever…?

[RECORD NUMBER OF PEOPLE FOR EACH ITEM]

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?

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

__ [RANGE 0 – 15 PEOPLE]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

How many people have ever…?

[RECORD NUMBER OF PEOPLE FOR EACH ITEM]

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?

__ [RANGE 0 – 15 PEOPLE]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

[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]

[ASK FOR EACH SET OF INITIALS DISPLAYED]

Si

[S_I_4_SI_1 – S_I_4_SI_15 through S_I_3_SI_1 – S_I_3_SI_15]

Was it [FILL: 1^ST SET OF INITIALS THROUGH 94^TH SET OF INITIALS]?

[SELECT UP TO 15 INITIALS]

1 1^st initials selected

2 2^nd initials selected

…

94 94^th initials selected

95 NONE OF THE ABOVE GO TO Sa

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

IF NEW INITIALS TO ADD [Si=95], GO TO Sa; IF NOT, GO TO Sb

Sa

[S_I_4_SA_1 – S_I_4_SA_15 through S_I_3_SA_1 – S_I_3_SA_15]

[IF 1^ST TIME COLLECTING ANY INITIALS, DISPLAY:]

I’d like for you to tell me some way that we can refer to [IF ANY S4–8, S1-3 =1, “this person”; IF ANY S4–8, S1-3 > 1, “these people”], such as their initials or a nickname, so that if I ask you other questions about [IF ANY S4–8, S1-3 = 1, “this person”; IF ANY S4–8, S1-3 > 1, “these people”] you’ll know who I’m talking about. Please tell me the initials of the [IF ANY S4–8, S1-3 > 1, “first”] person who [FILL: S BEHAVIOR]?

[ONCE ANY INITIALS HAVE BEEN RECORDED, THEN ONLY DISPLAY:]

Please tell me the initials of the [IF ANY S4–8, S1-3 > 1, “first”] person who [FILL: S BEHAVIOR]?

[IF ANY S4–8, S1-3 > 1, AFTER FIRST SET OF INITIALS, DISPLAY BELOW TEXT UNTIL # OF SETS OF INITIALS = NUMBER OF REPORTED PARTNERS]

Please tell me the initials of the next person who [FILL: S BEHAVIOR]?

[RECORD INITIALS FOR PERP]

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

[S behavior fills:

S4=watched or followed you

S5=approached you or showed up in places

S6=left items for you to find

S7=sneaked into your home or car

S8=left unwanted messages

S1=made unwanted phone calls

S2=sent unwanted emails

S3=left unwanted presents]

[IF COLLECTING NEW INITIALS]

S1a

[S_I_4_S1A_1 – S_I_4_S1A_15 through S_I_3_S1A_1 – S_I_3_S1A_15]

Is [FILL: INITIALS] male or female?

1. MALE

2. FEMALE

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

[ASK FOR EACH SET OF INITIALS IN Si AND Sa, UP TO 15]

Sb

[S_I_4_SB_1 – S_I_4_SB_15 through S_I_3_SB_1 – S_I_3_SB_15]

How many times did [FILL: INITIALS] ever [FILL: S 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?

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

Sf

[S_I_4_SF through S_I_3_SF]

[IF ONLY ONE SET OF INITIALS CHOSEN: “Has this person”; ELSE: “Did any of these people”] [FILL: S 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; IF LAST S ITEM, GO TO SFU_INTRO

7 (VOL) DON’T KNOW GO TO NEXT S ITEM; IF LAST S ITEM, GO TO SFU_INTRO

9 (VOL) REFUSED GO TO NEXT S ITEM; IF LAST S ITEM, GO TO SFU_INTRO

ASK IF MULTIPLE PERPS REPORTED FOR CURRENT S BEHAVIOR

Sg

[S_I_4_SG_1 – S_I_4_SG_15 through S_I_3_SG_1 – S_I_3_SG_15]

Which people did this in the past twelve months?

[SELECT UP TO 15 INITIALS]

[DISPLAY INITIALS FROM SA/SI]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

4 Past 12 mo - 4^th initials selected

5 Past 12 mo - 5^th initials selected

6 Past 12 mo - 6^th initials selected

7 Past 12 mo - 7^th initials selected

8 Past 12 mo - 8^th initials selected

9 Past 12 mo - 9^th initials selected

10 Past 12 mo - 10^th initials selected

11 Past 12 mo - 11^th initials selected

12 Past 12 mo - 12^th initials selected

13 Past 12 mo - 13^th initials selected

14 Past 12 mo - 14^th initials selected

15 Past 12 mo - 15^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ASK FOR EACH SET OF INITIALS ENDORSED AT Sg, UP TO 15

Sh

[S_I_4_SH_1 – S_I_4_SH_15 through S_I_3_SH_1 – S_I_3_SH_15]

How many times did [FILL: INITIALS] [FILL: S BEHAVIOR] in the past twelve months? Would you say…

[CATI: ONLY DISPLAY ANSWER OPTIONS LT OR EQUAL TO SB (REPORTED # OF TIMES EVER)]

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?

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

LOOP BACK TO NEXT S ITEM UNTIL ALL ARE COMPLETE

Section SFU: Stalking Follow Up

ONE “S” BEHAVIOR, ONE TIME GETS NO FOLLOW-UP QUESTIONS BECAUSE TO MEET DEFINITION OF STALKING THERE EITHER HAS TO BE MORE THAN ONE BEHAVIOR AT LEAST ONE TIME, OR ONE BEHAVIOR MORE THAN ONE TIME ALL BY THE SAME PERPETRATOR

IF R ONLY REPORTS ONE STALKING BEHAVIOR ONE TIME WITH ONE PERPETRATOR SKIP TO SV_INTRO

SFU_ INTRO

Let’s talk some more about your experiences with [FILL: ALL INITIALS IDENTIFIED IN STALKING SECTION].

ESTABLISH LOOP FOR EACH PERP INITIALS COLLECTED, AND CYCLE THROUGH SFU_1 – SFU6 FOR EACH PERP

SFU_1

[SFU_I_1_SFU1 – SFU_I_94_SFU1]

You said that [FILL: FIRST SET OF INITIALS] [FILL: ENDORSED BEHAVIORS].

How old were you the first time [FILL: INITIALS] did [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”] ?

[RECORD AGE]

___ [Range 0-99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

CATI: IF SFU_1 > CURAGE, DO HARD CHECK TO SEE WHICH IS CORRECT

SFU_1chk

I would like to confirm some responses: I have recorded you are [CURAGE] years old, but you were [SFU_1] years old when this first happened. Can you help me correct this information?

1 Update Age GO TO RC1m/RC1

2 Update age when act happened GO TO SFU_1

SFU1a

[SFU_I_1_SFU1A – SFU_I_94_SFU1A]

How old was [FILL: INITIALS] the first time [IF ONLY ENDORSED ONE S BEHAVIOR FOR THIS PERP, FILL: “this”; ELSE: “any of these things”] happened?

[RECORD AGE]

___ [Range 0-99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

SFU2a

[SFU_I_1_SFU2_NO – SFU_I_94_SFU2_NO]

[SFU_I_1_SFU2A_UNIT - SFU_I_94_SFU2A_UNIT]

Think about the time period between the first time [FILL: INITIALS] did [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”] and the last time it happened. About how many years, months, weeks, or days did [FILL: INITIALS] do [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”]?

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

1 _ _ _ Days [RANGE 1 to 365]

2 _ _ Weeks [RANGE 1 to 52]

3 _ _ Months[RANGE 1 to 24]

4 _ _ Years [RANGE 1 to 99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

[CATI: CHECK CALCULATIONS:

YEARS: ANSWER MUST BE = or LT (CURAGE – SFU_1/AGE AT FIRST); MONTHS: ANSWER MUST BE = or LT (CURRENT – SFU_1) + 6 MONTHS;

WEEKS: ANSWER MUST BE = or LT (CURRENT AGE – SFU_1) + 26 WEEKS

DAYS: IF CURRENT AGE = SFU_1, ALLOW UP TO 365 DAYS]

DISPLAY: Number of years or months or weeks you just entered are not possible. First time age = {Fill SFU_1/AGE}; CURRENT age = {fill CURAGE}. Please double check your entry.]

SFU3

[SFU_I_1_SFU3 - SFU_I_94_SFU3]

Were you ever fearful for yourself when [FILL: INITIALS] did [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”]?

1 YES GO TO SFU3a

2 NO GO TO SFU4

7 (VOL) DON’T KNOW GO TO SFU4

9 (VOL) REFUSED GO TO SFU4

SFU3a

[SFU_I_1_SFU3A - SFU_I_94_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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

SFU4

[SFU_I_1_SFU4 - SFU_I_94_SFU4]

Did [FILL: INITIALS] ever damage your personal property or belongings, such as in your home or car?

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

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

SFU5

[SFU_I_1_SFU5 - SFU_I_94_SFU5]

Did [FILL: INITIALS] ever make threats to physically harm you?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

SFU6

[SFU_I_1_SFU6 - SFU_I_94_SFU6]

Did you ever believe you or someone close to you would be seriously harmed or killed when [FILL: INITIALS] did [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”]?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

LOOP BACK TO SFU_1 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

I’m going to ask you some detailed questions about times when you may have experienced unwanted sexual situations with anyone, including strangers or someone you knew such as a romantic or sexual partner; a friend, teacher, co-worker, or supervisor; or a family member. These questions are detailed and the language is explicit, which some people may find upsetting. It is important that I ask the questions this way so that you are clear about what I mean. Your answers will help us to learn how often these things happen. You can skip questions you don’t want to answer and you can stop at any time.

I’m going to ask you about unwanted sexual situations. 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

1. 2 NO BREAKOFF: THANK & END, DO NOT CB

7 (VOL) DON’T KNOW BREAKOFF: THANK & END, DO NOT CB

9 (VOL) REFUSED BREAKOFF: THANK & END, DO NOT CB

How many people have ever…

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?

__ [RANGE 0 – 15 PEOPLE]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

Sometimes unwanted sex happens when a person is unable to consent to it or stop it from happening because they were too 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 alcohol or drugs 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 unable to consent because you were too drunk, high, drugged, or passed out, how many people have ever…?

SV7 made you have vaginal sex? By vaginal sex, we mean that [IF RSPSEX=2: “a man or boy put his penis in your vagina”] [IF RSPSEX=1: “a woman or girl made you put your penis in her vagina”].

[IF RSPSEX=1, ASK SV8; ELSE, DO NOT ASK]

SV8 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?

SV10a put their mouth on your [IF RSPSEX=1: “penis”; IF RSPSEX=2: “vagina”]?

SV10b put their mouth on your anus?

__ [RANGE 0 – 15 PEOPLE]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

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

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 RSPSEX=2, fill: “vagina or”] anus?

__ [RANGE 0 – 15 PEOPLE]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

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 …?

SV12 make you have vaginal sex?

[IF RSPSEX=1, ASK SV13; ELSE, DO NOT ASK]

SV13 make you perform anal sex?

SV14 make you receive anal sex?

SV15a put their mouth on your [IF RSPSEX=1 fill: “penis”; IF RSPSEX=2, fill: “vagina”]?

SV15b put their mouth on your anus?

__ [RANGE 0 – 15 PEOPLE]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

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

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 RSPSEX=2, fill: “vagina or”] anus?

[IF RSPSEX=1, ASK SV18a; ELSE, DO NOT ASK]

SV18a TRY to make you have vaginal sex with them, but sex DID NOT happen?

SV18b TRY to have [IF RSPSEX=2, fill: “vaginal,”] oral, or anal sex with you, but sex DID NOT happen?

__ [RANGE 0 – 15 PEOPLE]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

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?

__ [RANGE 0 – 15 PEOPLE]

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

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

CATI: 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

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

IF R ENDORSES AN SV5-SV21, 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

[SV_I_5_SVI_1 – SV_I_5_SVI_15 through SV_I_21_SVI_1 – SV_I_21_SVI_15]

Was it [FILL: 1^ST SET OF INITIALS THROUGH 94^TH SET OF INITIALS]?

[SELECT UP TO 15 INITIALS]

1 1^st initials selected

2 2^nd initials selected

…

94 94^th initials selected

95 NONE OF THE ABOVE GO TO SVa

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

[IF NEW INITIALS TO ADD [SVi=95], GO TO SVa; IF NOT, GO TO SVb]

SVa

[SV_I_5_SVA_1 – SV_I_5_SVA_15 through SV_I_21_SVA_1 – SV_I_21_SVA_15]

[IF 1^ST TIME COLLECTING ANY INITIALS, DISPLAY:]

I’d like for you to tell me some way that we can refer to [IF ANY SV5 – 21 =1, “this person”; IF ANY SV5 – 21 > 1, “these people”], such as their initials or a nickname, so that if I ask you other questions about [IF ANY SV5 – 21 = 1, “this person”; IF ANY SV5 – 21 > 1, “these people”] you’ll know who I’m talking about. Please tell me the initials of the [IF ANY SV5 – 21 > 1, “first”] person who [FILL: SV BEHAVIOR]?

[ONCE ANY INITIALS HAVE BEEN RECORDED, THEN ONLY DISPLAY:]

Please tell me the initials of the [IF ANY SV5 – 21 > 1, “first”] person who [FILL: S BEHAVIOR]?

[IF ANY SV5 – 21 > 1, AFTER FIRST SET OF INITIALS, DISPLAY BELOW TEXT UNTIL # OF SETS OF INITIALS = NUMBER OF REPORTED PARTNERS]

Please tell me the initials of the next person who [FILL: SV BEHAVIOR]?

[RECORD INITIALS FOR PERP]

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

[SV fill behaviors:

SV5=kissed you in a sexual way

SV6=fondled or touched you

SV7= had vaginal sex with you when you were too drunk, high, drugged, or passed out and unable to consent

SV8=made you perform anal sex when you were too drunk, high, drugged, or passed out and unable to consent

SV9=made you receive anal sex when you were too drunk, high, drugged, or passed out and unable to consent

SV10a= put their mouth on your [FILL: “penis”/”vagina”] when you were too drunk, high, drugged, or passed out and unable to consent

SV10b=put their mouth on your anus when you were too drunk, high, drugged, or passed out and unable to consent

SV11a=made you put your mouth on their vagina or anus when you were too drunk, high, drugged, or passed out and unable to consent

SV11b=made you put your mouth on their penis when you were too drunk, high, drugged, or passed out and unable to consent

SV11c=put their fingers or an object in your vagina or anus when you were too drunk, high, drugged, or passed out and unable to consent

SV12= used physical force or threats to physically harm you to make you have vaginal sex

SV13= used physical force or threats to physically harm you to make you perform anal sex

SV14=used physical force or threats to physically harm you to make you receive anal sex

SV15a= used physical force or threats to physically harm you to put their mouth on your vagina

SV15b=used physical force or threats to physically harm you to put their mouth on your anus

SV16a=used physical force or threats to physically harm you to make you put your mouth on their vagina or anus

SV16b=used physical force or threats to physically harm you to make you put your mouth on their penis

SV17=used physical force or threats to physically harm you to put their fingers or an object in your vagina or anus

SV18a=used physical force or threats to physically harm you to TRY to make you have vaginal sex with them, but sex DID NOT happen

SV18b=used physical force or threats to physically harm you to TRY to have vaginal, oral, or anal sex with you, but sex DID NOT happen

SV19=have vaginal, oral, or anal sex with you 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

SV20= have vaginal, oral, or anal sex with you after they pressured you by wearing you down by repeatedly asking for sex, or showing they were unhappy

SV21= have vaginal, oral, or anal sex with you after they pressured you by using their influence or authority over you]

IF COLLECTING NEW INITIALS, ASK SV1a

SV1a

[SV_I_5_SV1A_1 – SV_I_5_SV1A_15 through SV_I_21_SV1A_1 – SV_I_21_SV1A_15]

Is [FILL: INITIALS] male or female?

1. MALE

2. FEMALE

[ASK FOR EACH SET OF INITIALS IN SVi AND SVa, UP TO 15]

SVb

IF SV7 – SV18b (RAPE OR MADE TO PENETRATE BEHAVIORS), ASK:

[SV_I_5_SVb1_1 – SV_I_5_SVb1_15 through SV_I_21_SVb1_1 – SV_I_21_SVb1_ 15]

How many times did [FILL: INITIALS] ever [FILL: SV BEHAVIOR]?

[RECORD NUMBER OF TIMES]

___ [RANGE = 1 – 100, >100 = 100]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

FOR ALL OTHER ENDORSED BEHAVIORS (NON-RAPE BEHAVIORS) SV5-6, SV19-21, ASK:

[SV_I_5_SVb2_1 – SV_I_5_SVb2_15 through SV_I_21_SVb2_1 – SV_I_21_SVb2_15]

How many times did [FILL: INITIALS] ever [FILL: SV 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?

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

SVf

[SV_I_5_SVF through SV_I_21_SVF]

[IF ONLY ONE SET OF INITIALS CHOSEN: “Has this person”; ELSE: “Did any of these people”] [FILL: SV BEHAVIOR] in the past twelve months, that is since [FILL: DATE, 12 MONTHS AGO]?

1 YES GO TO SVG

2 NO GO TO SVJ

7 (VOL) DON’T KNOW GO TO SVJ

9 (VOL) REFUSED GO TO SVJ

ASK IF MULTIPLE PERPS REPORTED FOR CURRENT SV BEHAVIOR

SVg

[SV_I_5_SVG_1 – SV_I_5_SVG_15 through SV_I_21_SVG_1 – SV_I_21_SVG_15]

Which people did this in the past twelve months?

[SELECT UP TO 15 INITIALS]

[DISPLAY INITIALS FROM SVA/SVI]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

4 Past 12 mo - 4^th initials selected

5 Past 12 mo - 5^th initials selected

6 Past 12 mo - 6^th initials selected

7 Past 12 mo - 7^th initials selected

8 Past 12 mo - 8^th initials selected

9 Past 12 mo - 9^th initials selected

10 Past 12 mo - 10^th initials selected

11 Past 12 mo - 11^th initials selected

12 Past 12 mo - 12^th initials selected

13 Past 12 mo - 13^th initials selected

14 Past 12 mo - 14^th initials selected

15 Past 12 mo - 15^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ASK FOR ALL SETS OF INITIALS ENDORSED AT SVg, UP TO 15

IF SV7 – SV18b, ASK:

SVh1

[SV_I_5_SVh1_1 – SV_I_5_SVh1_15 through SV_I_21_SVh1_1 – SV_I_21_SVh1_ 15]

How many times did [FILL: INITIALS] [FILL: SV BEHAVIOR] in the past 12 months?

[RECORD NUMBER OF TIMES]

___ [RANGE = 1 – 100, >100 = 100]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

FOR ALL OTHER ENDORSED BEHAVIORS (NON-RAPE BEHAVIORS) SV5-6, SV19-21, ASK:

SVh2

[SV_I_5_SVh2_1 – SV_I_5_SVh2_15 through SV_I_21_SVh2_1 – SV_I_21_SVh2_ 15]

How many times did [FILL: INITIALS] [FILL: SV BEHAVIOR] in the past 12 months? Would you say…

[ONLY DISPLAY ANSWER OPTIONS LT OR EQUAL TO SVB (REPORTED # OF TIMES EVER)]

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?

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

SVj

[SV_I_5_SVj_1 – SV_I_5_SVj_15 through SV_I_21_SVj_1 – SV_I_21_SVj_ 15]

Was [FILL: INITIALS] using alcohol, drugs or both the first time he/she [FILL: SV BEHAVIOR]?

1 ALCOHOL

2 DRUGS

3 BOTH ALCOHOL AND DRUGS

4 NEITHER ALCOHOL OR DRUGS

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FOR SV7 – SV11c, SKIP SVk AND GO TO SVl

SVk

[SV_I_5_SVK_1 - SV_I_5_SVK_15 through SV_I_21_SVK_1 - SV_I_21_SVK_15]

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, NOR DRUGS

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

ONLY ASK IF ANY SV7 – SV11c IS ENDORSED

SVl

[SV_I_5_SVL_1 - SV_I_5_SVL_15 through SV_I_21_SVL_1 - SV_I_21_SVL_15]

When [FILL: INITIALS] [FILL: IF SV7 ≥ 1, made you have 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, made you receive or give anal sex; IF SV11c ≥ 1, put their fingers or an object in you] and you were unable to consent because you were too drunk, high, drugged or passed out:

Do you think you were given alcohol without your knowledge?

1. YES

2. NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

ONLY ASK IF ANY SV7 – SV11c IS ENDORSED

SVm

[SV_I_5_SVM_1 - SV_I_5_SVM_15 through SV_I_21_SVM_1 - SV_I_21_SVM_15]

Do you think you were given or may have been given drugs without your knowledge?

1. YES

2. NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

ONLY ASK IF ANY SV7 – SV11c IS ENDORSED

SVn

[SV_I_5_SVN_1 - SV_I_5_SVN_15 through SV_I_21_SVN_1 - SV_I_21_SVN_15]

Had you voluntarily used drugs or alcohol? [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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

LOOP BACK TO NEXT SV ITEM UNTIL ALL ARE COMPLETE

IF R ENDORSES 1 OR MORE BEHAVIORS IN THE SV SECTION

CHK2

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?

1. YES GO TO SVFU_INTRO

2. NO BREAKOFF/TERMINATION: SEXUAL VIOLENCE DISTRESS

7 (VOL) DON’T KNOW BREAKOFF/TERMINATION: SEXUAL VIOLENCE DISTRESS

9 (VOL) REFUSED BREAKOFF/TERMINATION: SEXUAL VIOLENCE DISTRESS

Section SVFU: Sexual Violence Follow Up

ONLY ASK SVFU QUESTIONS FOR THOSE WHO ENDORSE ANY OF SV7 – SV18b, ELSE SKIP TO R_INTRO

SVFU_INTRO

Let’s talk some more about your experiences with [FILL: ALL INITIALS IDENTIFIED IN SV7 – SV18b].

ESTABLISH LOOP FOR EACH PERP INITIALS COLLECTED, AND CYCLE THROUGH SVFU_INTRO2 – SFU7 FOR EACH PERP

SVFU_INTRO2

You said that [FILL: FIRST SET OF INITIALS] [FILL: ENDORSED BEHAVIORS FROM SV7 – SV18b ONLY].

1 CONTINUE

[SV7-SV18b behavior fills:

SV7-SV11b= Had vaginal sex with you (SV7), had anal sex with you (SV8-SV9), and put their mouth on your sexual body part (SV10a-SV10b) or made you put your mouth on theirs (SV11a-SV11b) when you were too drunk, high, drugged, or passed out and unable to consent

SV11c=Put their fingers or an object in you when you were too drunk, high, drugged, or passed out and unable to consent

SV13-SV16b

Used physical force or threats to physically harm you to make you have vaginal sex (SV12), make you have anal sex (SV13-SV14), and put their mouth on your sexual body part (SV15a-SV15b) or made you put your mouth on theirs (SV16a-SV16b)

SV17=used physical force or threats of physical harm to put their fingers or an object in your vagina or anus

SV18a-SV18b used physical force or threats of physical harm to TRY to have vaginal (SV18a), oral or anal sex with you (SV18b), but sex did not happen

SVFU1

[SVFU_I_1_SVFU1 – SVFU_I_94_SVFU1]

Were you ever physically injured when [FILL: INITIALS] did [IF ONLY ONE SV7-18b BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

IF ONLY SV18a OR SV18b ARE ENDORSED, THEN DO NOT ASK SVFU2

SVFU2

[SVFU_I_1_SVFU2 – SVFU_I_94_SVFU2]

Did you ever get an STD or other infection when [FILL: INITIALS] did [IF ONLY ONE SV7-18b BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”]? For example, did you get Chlamydia, Gonorrhea, HIV, or some other STD?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

IF ONLY SV18b OR SV18b ARE ENDORSED, THEN DO NOT ASK SVFU3

ONLY ASK SVFU3 IF SV7 OR SV12 ARE ENDORSED

IF FEMALE ONLY, ELSE SKIP TO SVFU4

SVFU3

[SVFU_I_1_SVFU3 – SVFU_I_94_SVFU3]

Did you ever get pregnant when [FILL: INITIALS] did [IF ONLY ONE SV7-18b BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”]?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

SVFU4

[SVFU_I_1_SVFU4 – SVFU_I_94_SVFU4]

How old were you the first time [IF ONLY ONE SV7-18b BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”] happened with [FILL: INITIALS]?

[RECORD AGE]

___ [Range 0-99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

[IF SVFU4 > CURAGE, DO HARD CHECK TO SEE WHICH IS CORRECT]

SVFU4chk

I would like to confirm some responses: I have recorded you are [CURAGE] years old, but you were [SVFU4] years old when this first happened. Can you help me correct this information?

1 Update Age GO TO RC1m/RC1

2 Update age when act happened GO TO SVFU4

SVFU5

[SVFU_I_1_SVFU5 – SVFU_I_94_SVFU5]

How old was [FILL: INITIALS] the first time [IF ONLY ONE SV7-18b BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”] happened?

[RECORD AGE]

___ [Range 0-99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

SVFU6a

[SVFU_I_1_SVFU6a_NO – SVFU_I_94_SVFU6a_NO]

[SVFU_I_1_SVFU6a_UNIT – SVFU_I_94_SVFU6a_UNIT]

Think about the time period between the first time [FILL: INITIALS] did [IF ONLY ONE SV7-18b BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”] and the last time it happened. About how many years, months, weeks, or days did [FILL: INITIALS] do [IF ONLY ONE SV7-18b BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”]?”

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

1 _ _ _ Days [RANGE 1 to 365]

2 _ _ Weeks [RANGE 1 to 52]

3 _ _ Months[RANGE 1 to 24]

4 _ _ Years [RANGE 1 to 99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

[CATI: CHECK CALCULATIONS:

YEARS: ANSWER MUST BE = or LT (CURAGE – SVFU4/AGE AT FIRST); MONTHS: ANSWER MUST BE = or LT (CURRENT – SVFU4) + 6 MONTHS;

WEEKS: ANSWER MUST BE = or LT (CURRENT AGE – SVFU4) + 26 WEEKS

DAYS: IF CURRENT AGE = SVFU4, ALLOW UP TO 365 DAYS]

DISPLAY: Number of years or months or weeks you just entered are not possible. First time age = {Fill SVFU4/AGE}; CURRENT age = {fill CURAGE}. Please double check your entry.]

Section R: Relationships

R_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.

R1_INTRO

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

[R_I_1_R1_INTRO - R_I_94_R1_INTRO]

You told me previously that [FILL: INITIALS 1] [FILL: ALL ENDORSED BEHAVIORS FROM ALL SECTIONS].

CATI PROGRAMMING NOTE: FROM THIS POINT FORWARD, SHORTENED ENDORSED BEHAVIORS FROM ALL SECTIONS FILLED ABOVE ARE AS FOLLOWS:

PV2=slapped you

PV3=pushed or shoved you

PV4=hit you

PV5=kicked you

PV6=pulled your hair

PV7=slammed you against something

PV9=tried to choke or suffocate you

PV10=beat you

PV11=burned you

PV12=used a knife or gun on you

S4=watched or followed you

S5=approached you or showed up in places

S6=left items for you to find

S7=sneaked into your home or car

S8=left unwanted messages

S1=made unwanted phone calls

S2=sent unwanted emails

S3=left unwanted presents

SV5=kissed you in a sexual way

SV6=fondled or touched you

SV7-SV11b

Had vaginal sex with you (SV7), had anal sex with you (SV8-SV9), and put their mouth on your sexual body part (SV10a-SV10b) or made you put your mouth on theirs (SV11a-SV11b) when you were too drunk, high, drugged, or passed out and unable to consent

SV11c=Put their fingers or an object in you when you were too drunk, high, drugged, or passed out and unable to consent,

SV13-SV16b

Used physical force or threats to physically harm you to make you have vaginal sex (SV12), make you have anal sex (SV13-SV14), and put their mouth on your sexual body part (SV15a-SV15b) or made you put your mouth on theirs (SV16a-SV16b)

SV17=used physical force or threats of physical harm to put their fingers or an object in your vagina or anus

SV18a-SV18b used physical force or threats of physical harm to TRY to have vaginal (SV18a), oral or anal sex with you (SV18b), but sex DID NOT happen

SV19-SV21

Had vaginal, oral, or anal sex with you after they pressured you (SV19, SV20, SV21)

R1

[R_I_1_R1 - R_I_94_R1]

How did you know or what was your relationship to [FILL: INITIALS 1] the first time [IF ONLY ONE BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”] happened?

[INTERVIEWER NOTE: IF RESPONDENT IDENTIFIES THE RELATIONSHIP AS A PARENT OF A MUTUAL CHILD READ THE IP CATEGORIES (codes 1-7) ONCE].

[INTERVIEWER: REMINDER – THE NEXT SCREEN ASKS WHETHER THE INTIMATE PARTNER (IP) WAS A CURRENT OR EX IP. DO NOT USE “OTHER” TO RECORD CURRENT OR EX IP, RATHER GO TO NEXT SCREEN AND CODE ACCORDINGLY.]

(IP CATEGORIES)

1 HUSBAND / WIFE GO TO R1_1

2 LIVE-IN PARTNER GO TO R1_1

3 FIANCE GO TO R1_1

4 BOY / GIRL FRIEND GO TO R1_1

5 DATING PARTNER GO TO R1_1

6 SOMEONE YOU WERE SEEING GO TO R1_1

7 SOMEONE YOU WERE HAVING SEX WITH GO TO R1_1

(NON-IP CATEGORIES)

8 FAMILY MEMBER GO TO R1_2

9 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 GO TO R2

11 OTHER (specify) _____________ GO TO R2

DP SPECIFY VARIABLE: R1_SP (max 50 characters)

97 (VOL) DON’T KNOW GO TO R4

99 (VOL) REFUSED GO TO R4

ASK IF R1=1-7

IP RELATIONSHIPS

R1_1

[R_I_1_R1_1 - R_I_94_R1_1]

[INTERVIEWER: IF R VOLUNTEERED CURRENT OR EX ON PRIOR QUESTION, RECORD RESPONSE HERE AND DO NOT ASK THIS QUESTION.

IF R DID NOT VOLUNTEER RESPONSE, ASK: Was this person your current or ex[FILL RESPONSE FROM R1] the first time [IF ONLY ONE BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”] happened?

1 CURRENT

2 EX

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

ALL R1_1 SKIP TO R2

ASK IF R1=8

R1_2

[R_I_1_R1_2 - R_I_94_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) ________

DP SPECIFY VARIABLE: R1_2SP (max 50 characters)

15 OTHER FEMALE RELATIVE (specify) ________

DP SPECIFY VARIABLE: R1_2SP (max 50 characters)

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ALL R1_2 SKIP TO R2

ASK IF R1=9

R1_3

[R_I_1_R1_3 - R_I_94_R1_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) ________

DP SPECIFY VARIABLE: R1_3SP (max 50 characters)

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ALL R1_3 SKIP TO R2

ASK IF R1=12

R1_4

[R_I_1_R1_4 - R_I_94_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) ________

DP SPECIFY VARIABLE: R1_4SP (max 50 characters)

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ALL R1_4 SKIP TO R2

ASK IF R1=13

R1_5

[R_I_1_R1_5 - R_I_94_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) ________

DP SPECIFY VARIABLE: R1_5SP (max 50 characters)

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

ALL R1_5 SKIP TO R2

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.

CATI: SKIP QUESTION IF ONLY ONE BEHAVIOR WAS REPORTED ONE TIME OR IF R1=8 (FAMILY MEMBER)

R2

[R_I_1_R2 - R_I_94_R2]

How did you know or what was your relationship to [FILL: INITIALS 1] the last time [IF ONLY ONE BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”] happened?

[IF RESPONDENT IDENTIFIES THE RELATIONSHIP AS A PARENT OF A MUTUAL CHILD READ THE IP CATEGORIES ONCE].

[INTERVIEWER: REMINDER – THE NEXT SCREEN ASKS WHETHER THE INTIMATE PARTNER (IP) WAS A CURRENT OR EX IP. DO NOT USE “OTHER” TO RECORD CURRENT OR EX IP, RATHER GO TO NEXT SCREEN AND CODE ACCORDINGLY.]

(IP CATEGORIES)

1 HUSBAND / WIFE GO TO R2_1

2 LIVE-IN PARTNER GO TO R2_1

3 FIANCE GO TO R2_1

4 BOY / GIRL FRIEND GO TO R2_1

5 DATING PARTNER GO TO R2_1

6 SOMEONE YOU WERE SEEING GO TO R2_1

7 SOMEONE YOU WERE HAVING SEX WITH GO TO R2_1

(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 GO TO R2NEWA_1

11 OTHER (specify) __________ GO TO R4

DP SPECIFY VARIABLE: R2_SP (max 50 characters)

97 (VOL) DON’T KNOW GO TO R4

99 (VOL) REFUSED GO TO R4

ASK IF R2=1-7

IP RELATIONSHIPS

R2_1

[R_I_1_R2_1 - R_I_94_R2_1]

[INTERVIEWER: IF R VOLUNTEERED CURRENT OR EX ON PRIOR QUESTION, RECORD RESPONSE HERE AND DO NOT ASK THIS QUESTION.

IF R DID NOT VOLUNTEER RESPONSE, ASK: Was this person your current or ex [FILL RESPONSE FROM R2] the last time [IF ONLY ONE BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”] happened?

1 CURRENT

2 EX

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

ALL R2_1 GO TO R2newa_1

ASK IF R2=8

R2_2

[R_I_1_R2_2 - R_I_94_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) ___________

DP SPECIFY VARIABLE: R2_2SP (max 50 characters)

15 OTHER FEMALE RELATIVE (specify) ___________

CATI SPECIFY VARIABLE: R2_2SP (max 50 characters)

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ALL R2_2 GO TO R2newa_1

ASK IF R2=9

R2_3

[R_I_1_R2_3 - R_I_94_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) ___________

DP SPECIFY VARIABLE: R2_3SP (max 50 characters)

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ALL R2_3 GO TO R2newa_1

ASK IF R2=12

R2_4

[R_I_1_R2_4 - R_I_94_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) ________

DP SPECIFY VARIABLE: R2_4SP (max 50 characters)

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ALL R2_4 GO TO R2newa_1

ASK IF R2=13

R2_5

[R_I_1_R2_5 - R_I_94_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) ________

DP SPECIFY VARIABLE: R2_5SP (max 50 characters)

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

ALL R2_5 GO TO R2newa_1

R2newa_1

[R_I_1_R2NEWA_1 - R_I_94_R2NEWA_1]

CATI:

REPEAT QUESTION FOR EACH INITIALS WHO MEET CRITERIA

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):

[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 [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”]: [FILL: ALL ENDORSED STALKING BEHAVIORS (S1-S8)].

Was [INITIALS] a [FILL: R1] when [FILL: SHE/HE] did [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”]?

0. 1 YES

1. 2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

R2newa_2

[R_I_1_R2NEWA_2 - R_I_94_R2NEWA_2]

Was [INITIALS] a [FILL: R2] when [FILL: SHE/HE] did [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”]?

1. 1 YES

2. 2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

R2new b_1

[R_I_1_R2NEWB_1 - R_I_94_R2NEWB_1]

[REPEAT QUESTION FOR EACH SET OF 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 [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “these things”]: [FILL: ENDORSED RAPE/MADE TO PENETRATE BEHAVIORS (SV7-SV18b)].

Was [INITIALS] a [FILL: R1] when [FILL: SHE/HE] did [IF ONLY ONE SV7-SV18b BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”]?

1. 1 YES

2. 2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

R2newb_2

[R_I_1_R2NEWB_2 - R_I_94_R2NEWB_2]

Was [INITIALS] a [FILL: R2] when [FILL: SHE/HE] did [IF ONLY ONE S BEHAVIOR ENDORSED FOR PERPETRATOR FILL: “this” / ELSE: “any of these things”]?

1. 1 YES

2. 2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

IF RESPONDENT INDICATES IP WAS CURRENT AT R1, AND EX AT R2

R2a

[R_I_1_R2A - R_I_94_R2A]

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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

IF R HAS ONLY REPORTED PV, S OR SV7 – SV18b ITEMS, SKIP R4 – R6a AND GO TO R7

R4

[R_I_1_R4 - R_I_94_R4]

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]

___ [Range 0-99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

CATI: IF R4 > CURAGE, DO HARD CHECK TO SEE WHICH IS CORRECT

R4chk

I would like to confirm some responses: I have recorded you are [CURAGE] years old, but you were [R4] years old when this first happened. Can you help me correct this information?

1 Update Age GO TO RC1m/RC1

2 Update age when act happened GO TO R4

R5

[R_I_1_R5 - R_I_94_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]

___ [Range 0-99]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

R6a

[R_I_1_R6A_NO - R_I_94_R6A_NO]

[R_I_1_R6A_UNIT - R_I_94_R6A_UNIT]

Think about the time period between the first time [FILL: INITIALS] 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”] 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]

1 _ _ _ Days [RANGE 1 to 365]

2 _ _ Weeks [RANGE 1 to 52]

3 _ _ Months[RANGE 1 to 24]

4 _ _ Years [RANGE 1 to 99]

9997 (VOL) DON’T KNOW

9999 (VOL) REFUSED

[CATI: CHECK CALCULATIONS:

YEARS: ANSWER MUST BE = or LT (CURAGE – R4/AGE AT FIRST); MONTHS: ANSWER MUST BE = or LT (CURRENT – R4) + 6 MONTHS;

WEEKS: ANSWER MUST BE = or LT (CURRENT AGE – R4) + 26 WEEKS

DAYS: IF CURRENT AGE = R4, ALLOW UP TO 365 DAYS]

DISPLAY: Number of years or months or weeks you just entered are not possible. First time age = {Fill R4/AGE}; CURRENT age = {fill CURAGE}. Please double check your entry.]

R7

[R_I_1_R7 - R_I_94_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 UNKNOWN FILL: Latina or Latino]?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

R8

[R_I_1_R8_1 - R_I_1_R8_6 through R_I_94_R8_1 - R_I_94_R8_6]

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) ________

DP SPECIFY VARIABLE: R8_SP (max 50 characters)

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

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

IF R HAS REPORTED ONLY PERPETRATORS WHO DID ONLY 1 BEHAVIOR (S) 1 TIME, SKIP SECTION FU FOR THAT PERPETRATOR

IF R HAS REPORTED ONLY 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].

1 CONTINUE

FU1

Were you ever concerned for your safety when [IF ONLY ENDORSED ONE BEHAVIOR, FILL: “this”; IF ENDORSED MORE THAN ONE BEHAVIOR, FILL: “any of these things”] happened with [IF ONLY ONE PERP REPORTED, FILL: INITIALS / ELSE: “any of these people”]?

1 YES GO TO FU1a

2 NO GO TO FU2

7 (VOL) DON’T KNOW GO TO FU2

9 (VOL) REFUSED GO TO FU2

SKIP IF ONLY ONE PERP REPORTED

FU1a

[FU1A_1 – FU1A_94]

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]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ONLY ASK IF FU1=1

FU1_12

Were you concerned for your safety when [IF ONLY ENDORSED ONE BEHAVIOR, FILL: “this”; IF ENDORSED MORE THAN ONE BEHAVIOR, FILL: “any of these things”] happened with [IF ONLY ONE PERP REPORTED, FILL: INITIALS / ELSE: “any of these people”] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?

1 YES GO TO FU1a_12

2 NO GO TO FU2

7 (VOL) DON’T KNOW GO TO FU2

9 (VOL) REFUSED GO TO FU2

SKIP IF ONLY ONE PERP REPORTED

ASK FOR EACH SET OF INITIALS LISTED IN FU1a

FU1a_12

[FU1a_12_1 – FU1a_12_94]

Which of these people made you concerned for your safety when [FILL: this / any of these things] happened in the past 12 months?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

…

94 Past 12 mo - 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

IF RESPONDENT HAS ONLY REPORTED S ITEMS, SKIP TO FU3_1

FU2

Were you ever fearful for yourself or someone close to you 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_1

7 (VOL) DON’T KNOW GO TO FU3_1

9 (VOL) REFUSED GO TO FU3_1

SKIP IF ONLY ONE PERP REPORTED

FU2a

[FU2A_1 – FU2A_94]

Which of these people made you feel fearful?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ONLY ASK IF FU2=1

FU2_12

Were you fearful for yourself or someone close to you when [FILL: this / any of these things] happened with [FILL: initials / any of these people] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

1 YES GO TO FU2a_12

2 NO GO TO FU3_1

7 (VOL) DON’T KNOW GO TO FU3_1

9 (VOL) REFUSED GO TO FU3_1

SKIP IF ONE PERP REPORTED

ASK FOR EACH SET OF INITIALS LISTED IN FU2a

FU2a_12

[FU2a_12_1 – FU2a_12_94]

Which of these people made you fearful for yourself or someone close to you when [FILL: “this”/”any of these things”] happened in the past 12 months?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

…

94 Past 12 mo - 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FOR EACH SET OF INITIALS REPORTED AT FU1a AND/OR FU2a SORTED IN ALPHABETICAL ORDER, ASK LOOP FU3_1 – FU3_4

FU3_1

[FU3_1_FU3_1 – FU3_94_FU3_1]

Did you ever have nightmares because of what [FILL: INITIALS] did to you?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU3_2

[FU3_1_FU3_2 – FU3_94_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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU3_3

[FU3_1_FU3_3 – FU3_94_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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU3_4

[FU3_1_FU3_4 – FU3_94_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

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4

Were you ever injured when [FILL: this / any of these things] happened with [FILL: INITIALS / any of these people]?

1 YES GO TO FU4a

2 NO GO TO FU5_4

7 (VOL) DON’T KNOW GO TO FU5_4

9 (VOL) REFUSED GO TO FU5_4

SKIP IF ONLY ONE PERP REPORTED

FU4a

[FU4A_1 – FU4A_94]

Which of these people caused your injuries?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ONLY ASK IF FU4=1

FU4_12

Were you ever injured when [FILL: “this” / “any of these things”] happened with [FILL: INITIALS /”any of these people”] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO] ?

1 YES GO TO FU4a_12

2 NO GO TO FU4b_1

7 (VOL) DON’T KNOW GO TO FU4b_1

9 (VOL) REFUSED GO TO FU4b_1

ASK FOR EACH SET OF INITIALS LISTED IN FU4a

FU4a_12

[FU4a_12_1 – FU4a_12_94]

Which of these people caused your injuries when [FILL: this/any of these things] happened in the past 12 months?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

…

94 Past 12 mo - 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

[FU4B_1_FU4B_1 – FU4B_94_FU4B_1 through FU4B_1_FU4B_5 – FU4B_94_FU4B_5]

When [FILL: 1^ST SET OF INITIALS FROM FU4A] injured you, did those injuries include:

FU4b_1 minor bruises or scratches?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4b_2 cuts, major bruises, or black eyes?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4b_2a injury to any ligments, muscles or tendons?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4b_3 broken bones or teeth?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4b_3a back or neck injury?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

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

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4b_4a head injury?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4b_6 vaginal or anal injuries?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4b_7 mental or emotional harm?

1 YES

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

FU4b_5 other injuries?

1. YES (specify) ______

DP SPECIFY VARIABLE: FU4b_5SP (max 50 characters)

2 NO

7 (VOL) DON’T KNOW

9 (VOL) REFUSED

[REPEAT FU4b_1-FU4b_5 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_4

Have you ever talked to a crisis hotline operator about what [FILL: INITIALS / any of these people] did?

1 YES GO TO FU5a_4

2 NO GO TO FU6_1

7 (VOL) DON’T KNOW GO TO FU6_1

9 (VOL) REFUSED GO TO FU6_1

SKIP IF ONLY ONE PERP REPORTED

FU5a_4

[FU5a_4_1 – FU5a_4_94]

Which of these people caused you to need a crisis hotline operator?

[TI: THIS QUESTION REFERS TO WHICH PEOPLE EVER CAUSED…]

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[TI: IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

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_1

2 NO GO TO FU6_2

7 (VOL) DON’T KNOW GO TO FU6_2

9 (VOL) REFUSED GO TO FU6_2

SKIP IF ONLY ONE PERP REPORTED

FU6a_1

[FU6A1_FU6A_1_1 - FU6A1_FU6A_1_94]

Which of these people caused you to need medical care?

{TI: THIS QUESTION REFERS TO WHICH PEOPLE EVER CAUSED…}

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ONLY ASK IF FU6a_1=1

FU6_1_12

Did you need medical care because of any of the things that [FILL: INITIALS / any of these people} did in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?

1 YES GO TO FU6a_12_1

2 NO GO TO FU6b_1

7 (VOL) DON’T KNOW GO TO FU6b_1

9 (VOL) REFUSED GO TO FU6b_1

SKIP IF ONLY ONE PERP REPORTED IN FU6a_1

ASK FOR EACH SET OF INITIALS LISTED IN FU6a_1

FU6a_1_12

[FU6a_1_12_1 – FU6a_1_12_94]

Which of these people caused you to need medical care because of any of the things in the past 12 months?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

…

94 Past 12 mo - 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6b_1

[FU6A1_FU6B_1_1 - FU6A1_FU6B_1_94]

Were you able to get the medical care that you needed when [FILL: INITIALS] did [FILL: “this” / “these things”]?

{TI: THIS QUESTION REFERS TO EVER ABLE TO GET SERVICE}

1 YES GO TO FU6_2

2 NO GO TO FU6c_a_1

7 (VOL) DON’T KNOW GO TO FU6_2

9 (VOL) REFUSED GO TO FU6_2

FU6c _a_1

[FU6A1_1_FU6C_A_1 - FU6A1_94_ FU6C_A_5]

Why were you not able to get the medical care that you needed when [FILL: INITIALS] did [FILL: this / these things]?

[CHOOSE ALL THAT APPLY]

1 DID NOT HAVE ENOUGH MONEY

2. MADE TOO MUCH MONEY TO QUALIFY FOR SERVICES

3. SERVICES WERE UNAVAILABLE

4. TOO YOUNG TO RECEIVE SERVICES

6 DID NOT SEEK HELP

7 DID NOT KNOW ABOUT AVAILABLE SERVICES

8 DID NOT HAVE INSURANCE

5 OTHER GO TO FU6c_1

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6c_1 [ASK IF FU6c _a_1=5 “Other”]

[FU6A1_FU6C_1_1 – FU6A1_FU6C_1_94]

[TI: RECORD REASON R NOT ABLE TO GET THE ASSISTANCE NEEDED]

[MAX 250 CHARACTERS]

[RECORD VERBATIM RESPONSE]

[MAX 250 CHARACTERS]

REPEAT FU6b THROUGH FU6c FOR ALL INITIALS REPORTED AT FU6a

[USE: 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?

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

2 NO GO TO FU6_4

7 (VOL) DON’T KNOW GO TO FU6_4

9 (VOL) REFUSED GO TO FU6_4

SKIP IF ONLY ONE PERP REPORTED

FU6a_2

[FU6A2_FU6A_2_1 - FU6A2_FU6A_2_94]

Which of these people caused you to need housing services?

{TI: THIS QUESTION REFERS TO WHICH PEOPLE EVER CAUSED…}

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6b_2

[FU6A2_FU6B_2_1 - FU6A2_FU6B_2_94]

Were you able to get the housing services that you needed when [FILL: INITIALS] did [FILL: “this” / “these things”]?

[TI: THIS QUESTION REFERS TO EVER ABLE TO GET SERVICE]

1 YES GO TO FU6_4

2 NO GO TO FU6c_a_2

7 (VOL) DON’T KNOW GO TO FU6_4

9 (VOL) REFUSED GO TO FU6_4

FU6c _a_2

[FU6A2_1_FU6C_A_1 - FU6A2_94_ FU6C_A_5 through FU6A2_94_FU6C_A_1 - FU6A2_94_FU6C_A_5]

Why were you not able to get the housing services that you needed when [FILL: INITIALS] did [FILL: “this” / “these things”]?

[CHOOSE ALL THAT APPLY]

1 DID NOT HAVE ENOUGH MONEY

2 MADE TOO MUCH MONEY TO QUALIFY FOR SERVICES

3 SERVICES WERE UNAVAILABLE

4 TOO YOUNG TO RECEIVE SERVICES

6 DID NOT SEEK HELP

7 DID NOT KNOW ABOUT AVAILABLE SERVICES

5 OTHER GO TO FU6c_2

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6c_2 [ASK IF FU6c _a_2=5 “Other”]

[FU6A2_FU6C_1_1 – FU6A2_FU6C_1_94]

[TI: RECORD REASON R NOT ABLE TO GET THE ASSISTANCE NEEDED]

[RECORD VERBATIM RESPONSE]

[MAX 250 CHARACTERS]

REPEAT FU6b THROUGH FU6c FOR ALL INITIALS REPORTED AT FU6a

[USE: 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?

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_4

2 NO GO TO FU6_4a

7 (VOL) DON’T KNOW GO TO FU6_4a

9 (VOL) REFUSED GO TO FU6_4a

SKIP IF ONLY ONE PERP REPORTED

FU6a_4

[FU6A4_FU6A_4_1 - FU6A4_FU6A_4_94]

Which of these people caused you to need victim’s advocate services?

[TI: THIS QUESTION REFERS TO WHICH PEOPLE EVER CAUSED…]

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[TI: IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6b_4

[FU6A4_FU6B_4_1 - FU6A4_FU6B_4_94]

Were you able to get the victim’s advocate services that you needed when [FILL: INITIALS] did [FILL: “this” / “these things”]?

[TI: THIS QUESTION REFERS TO EVER ABLE TO GET SERVICE}

1 YES GO TO FU6_4a

2 NO GO TO FU6c_a_4

7 (VOL) DON’T KNOW GO TO FU6_4a

9 (VOL) REFUSED GO TO FU6_4a

FU6c _a_4

[FU6A4_1_FU6C_A_1 - FU6A4_94_ FU6C_A_5 through FU6A4_94_FU6C_A_1 - FU6A4_94_FU6C_A_5]

Why were you not able to get the victim’s advocate services that you needed when [FILL: INITIALS] did [FILL: “this” / “these things”]?

[CHOOSE ALL THAT APPLY]

1 NOT HAVE ENOUGH MONEY

2 MADE TOO MUCH MONEY TO QUALIFY FOR SERVICES

3 SERVICES WERE UNAVAILABLE

4 TOO YOUNG TO RECEIVE SERVICES

6 DID NOT SEEK HELP

7 DID NOT KNOW ABOUT AVAILABLE SERVICES

5 OTHER GO TO FU6c_4

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6c_4 [ASK IF FU6c _a_4=5 “Other”]

[FU6A4_FU6C_1_1 – FU6A4_FU6C_1_94]

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

[RECORD VERBATIM RESPONSE]

[MAX 250 CHARACTERS]

REPEAT FU6b THROUGH FU6c FOR ALL INITIALS REPORTED AT FU6a

[USE: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?]

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_4a

2 NO GO TO FU6_5

7 (VOL) DON’T KNOW GO TO FU6_5

9 (VOL) REFUSED GO TO FU6_5

SKIP IF ONLY ONE PERP REPORTED

FU6a_4a

[FU6a4a_FU6a_4a_1- FU6a4a_FU6a_4a_94]

Which of these people caused you to need help from law enforcement?

[TI: THIS QUESTION REFERS TO WHICH PEOPLE EVER CAUSED…}

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[TI: IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ONLY ASK IF FU6_4a=1

FU6_4a_12

[FU6a4a_FU6_4a_12]

Did you need help from law enforcement because of any of the things that [FILL: INITIALS / “any of these people”] did in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?

1 YES GO TO FU6a_4a_12

2 NO GO TO FU6_5

7 (VOL) DON’T KNOW GO TO FU6_5

9 (VOL) REFUSED GO TO FU6_5

SKIP IF ONLY ONE PERP REPORTED IN FU6a_4a

ASK FOR EACH SET OF INITIALS LISTED IN FU6a_4a

FU6a_4a_12

[FU6a_4a_12_1 – FU6a_4a_12_94]

Which of these people caused you to need help from law enforcement because of any of the things in the past 12 months?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

…

94 Past 12 mo - 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6b_4a

[FU6a4a_FU6b_4a_1- FU6a4a_FU6b_4a_94]

Were you able to get the help from law enforcement that you needed when [FILL: INITIALS] did [fill: “this” / “these things”]?

{TI: THIS QUESTION REFERS TO EVER ABLE TO GET SERVICE}

1 YES GO TO FU6_5

2 NO GO TO FU6c_a_4A

7 (VOL) DON’T KNOW GO TO FU6_5

9 (VOL) REFUSED GO TO FU6_5

FU6c _a_4a

[FU6A4a_1_FU6C_A_1 - FU6A4a_1_ FU6C_A_5 through FU6A4a_94_FU6C_A_1 - FU6A4a_94_FU6C_A_5]

Why were you not able to get the help from law enforcement that you needed when [FILL: INITIALS] did [FILL: this / these things]?

[CHOOSE ALL THAT APPLY]

1 #HOLD CODE (not used)

2 #HOLD CODE (not used)

3 SERVICES WERE UNAVAILABLE

4 TOO YOUNG TO RECEIVE SERVICES

6 DID NOT SEEK HELP

7 DID NOT KNOW ABOUT AVAILABLE SERVICES

5 OTHER GO TO FU6c_4a

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6c_4a

[FU6A4a_FU6C_4a_1 – FU6A4a_FU6C_4a_94]

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

[RECORD VERBATIM RESPONSE]

[MAX 250 CHARACTERS]

REPEAT FU6b THROUGH FU6c FOR ALL INITIALS REPORTED AT FU6a

[USE: 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?]

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_5

2 NO GO TO FU7

7 (VOL) DON’T KNOW GO TO FU7

9 (VOL) REFUSED GO TO FU7

SKIP IF ONLY ONE PERP REPORTED

FU6a_5

[FU6a5_FU6a_5_1 - FU6a5_FU6a_5_94]

Which of these people caused you to need legal services?

[TI: THIS QUESTION REFERS TO WHICH PEOPLE EVER CAUSED…]

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[TI: IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6b_5

[FU6a5_FU6b_5_1 - FU6a5_FU6b_5_94]

Were you able to get the legal service that you needed when [FILL: INITIALS] did [FILL: “this” / “these things”]?

[TI: THIS QUESTION REFERS TO EVER ABLE TO GET SERVICE]

1 YES GO TO FU7

2 NO GO TO FU6c_a_5

7 (VOL) DON’T KNOW GO TO FU7

9 (VOL) REFUSED GO TO FU7

FU6c _a_5

[FU6A5_1_FU6C_A_1 - FU6A5_1_ FU6C_A_5 through FU6A5_94_FU6C_A_1 - FU6A5_94_FU6C_A_5]

Why were you not able to get the legal service that you needed when [FILL: INITIALS] did [FILL: “this” / “these things”]?

[CHOOSE ALL THAT APPLY]

1. DID NOT HAVE ENOUGH MONEY

2. MADE TOO MUCH MONEY TO QUALIFY FOR SERVICES

3. SERVICES WERE UNAVAILABLE

4. TOO YOUNG TO RECEIVE SERVICES

5. DID NOT SEEK HELP

6. DID NOT KNOW ABOUT AVAILABLE SERVICES

11. OTHER GO TO FU6c_5

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU6c_5

[FU6A5_FU6C_5_1 – FU6A5_FU6C_5_94]

[TI: RECORD REASON R NOT ABLE TO GET THE ASSISTANCE NEEDED]

[RECORD VERBATIM RESPONSE]

[MAX 250 CHARACTERS]

REPEAT FU6b THROUGH FU6c FOR ALL INITIALS REPORTED AT FU6a

[USE: 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 when [FILL: “this” / “any of these things”] happened with [FILL: INITIALS / “any of these people”]?

1 YES GO TO FU7a

2 NO GO TO FU7_sch

7 (VOL) DON’T KNOW GO TO FU7_sch

9 (VOL) REFUSED GO TO FU7_sch

SKIP IF ONLY ONE PERP REPORTED

FU7a

[FU7A_1 – FU7A_94]

Which of these people caused you to miss work?

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ASK FOR EACH SET OF INITIALS IDENTIFIED IN FU7a

FU7b

[FU7B_1 – FU7B_94]

How many days of work did [FILL: INITIALS 1, INITIALS 2, ETC.] cause you to miss?

[RECORD NUMBER OF DAYS]

___ [RANGE 1 – 365]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

ONLY ASK IF FU7=1

FU7_12

Did you have to miss days of work when [FILL: “this” / “any of these things”] happened with [FILL: INITIALS / “any of these people”] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?

1 YES GO TO FU7a_12

2 NO GO TO FU7_sch

7 (VOL) DON’T KNOW GO TO FU7_sch

9 (VOL) REFUSED GO TO FU7_sch

SKIP IF ONLY ONE PERP REPORTED IN FU7a

ASK FOR EACH SET OF INITIALS LISTED IN FU7a

FU7a_12

[FU7a_12_1 – FU7a_12_94]

Which of these people caused you to have to miss days of work when [FILL: “this”/”any of these things”] happened in the past 12 months?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

4 Past 12 mo - 4^th initials selected

94 Past 12 mo - 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

ASK FOR EACH SET OF INITIALS IDENTIFIED IN FU7a_12

FU7b_12

[FU7B_12_1 – FU7B_12_94]

How many days of work did [FILL: INITIALS] cause you to miss in the past 12 months?

[CATI DISPLAY: RANGE 1 – FU7b]

[RECORD NUMBER OF DAYS]

___ [RANGE 1 – 365]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

[IF FU7b_12 > FU7b, DO HARD CHECK TO SEE WHICH IS CORRECT]

FU7b_12chk

I would like to confirm some responses: I have recorded you missed [FU7b] days of work in total due to [current perpetrator initials]’s actions, but you missed [FU7b_12] days in the last 12 months. Can you help me correct this information?

1 Update total work days missed GO TO FU7b

2 Update work days missed in last 12 months GO TO FU7b_12

FU7_sch

Did you ever have to miss days of school when [FILL: “this” / “any of these things”] happened with [FILL: INITIALS / “any of these people”]?

1 YES GO TO FU7a_sch

2 NO GO TO IP9

7 (VOL) DON’T KNOW GO TO IP9

9 (VOL) REFUSED GO TO IP9

SKIP IF ONLY ONE PERP REPORTED

FU7a_sch

[FU7A_SCH_1 – FU7A_SCH_94 ]

Which of these people caused you to miss school?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

[IF NECESSARY, PROMPT BY READING AVAILABLE INITIALS]

1 1^st initials selected

2 2^nd initials selected

3 3^rd initials selected

….

94 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU7b_sch

[FU7B_SCH_1 – FU7B_SCH_94]

How many days of school did [FILL: INITIALS 1, INITIALS 2, ETC.] cause you to miss?

[RECORD NUMBER OF DAYS]

___ [RANGE 1 – 365]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

ONLY ASK IF FU7_sch=1

FU7_sch_12

Did you have to miss days of school when [FILL: “this” / “any of these things”] happened with [FILL: INITIALS / “any of these people”] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?

1 YES GO TO FU7a_sch_12

2 NO GO TO IP9

7 (VOL) DON’T KNOW GO TO IP9

9 (VOL) REFUSED GO TO IP9

SKIP IF ONLY ONE PERP REPORTEDIN FU7a_sch

ASK FOR EACH SET OF INITIALS LISTED IN FU7a_sch

FU7a_sch_12

[FU7A_SCH_12_1 – FU7A_SCH_12_94]

Which of these people caused you to have to miss days of school when [FILL: “this” / “any of these things”] happened in the past 12 months?

[OPTIONS TO INCLUDE ALL IDENTIFIED SETS OF INITIALS]

1 Past 12 mo - 1^st initials selected

2 Past 12 mo - 2^nd initials selected

3 Past 12 mo - 3^rd initials selected

94 Past 12 mo - 94^th initials selected

97 (VOL) DON’T KNOW

99 (VOL) REFUSED

FU7b_sch_12

[FU7B_SCH_12_1 – FU7B_SCH_12_94 ]

How many days of school did [FILL: INITIALS] cause you to miss in the past 12 months?

[CATI DISPLAY: RANGE 1 – FU7b_sch]

[RECORD NUMBER OF DAYS]

___ [RANGE 1 – 365]

997 (VOL) DON’T KNOW

999 (VOL) REFUSED

[IF FU7b_sch_12 > FU7b, DO HARD CHECK TO SEE WHICH IS CORRECT]

FU7b_sch_12chk

I would like to confirm some responses: I have recorded you missed [FU7b_sch] days of work in total due to [current perpetrator initials]’s actions, but you missed [FU7b_sch_12] days in the last 12 months. Can you help me correct this information?

1 Update total work days missed GO TO FU7b_sch

2 Update work days missed in last 12 months GO TO FU7b_sch_12

IP9

[DO NOT READ: Interviewer record the language in which the interview was conducted.]

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 [replicate assigned: $10; $40] or donate the [replicate assigned: $10; $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, Andrew Evans, at 1-888-772-4269. If you have any questions about your rights as a research participant, please contact our Institutional Review Board

toll-free at 1-877-520-6835.

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 resources that you can use now or in the future if you want to speak further with someone.  

1. CONTINUE

W6

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). You can reach the National Child Abuse Hotline at 1-800-4-A-Child (1-800-422-4453).

[PAUSE THEN SAY: Would you like me to repeat these numbers?]

W7

That completes the interview. Thank you for your participation.

109

2014 NISVS Survey