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pdfTHE LONGITUDINAL INVESTIGATION OF GENDER,
HEALTH, AND TRAUMA SURVEY (LIGHT Survey)
Time 1
Over one’s lifetime, people experience a wide range
of significant life events. We are specifically
interested in the unique experiences Veterans have
during their lives. This survey will ask you questions
about life experiences, health, attitudes, and
emotions, as well as how you have been supported
and how you generally cope. Thank you in advance
for completing this survey.
Q1
What is your age?
Q2
Are you of Hispanic, Latino/a, or Spanish
origin?
Yes
No
If you wish to participate PLEASE GO TO
QUESTION 1.
Q3
How do you describe your race? Select all
that apply.
Native American or Alaska Native
If you do not wish to participate PLEASE MAIL
BACK THE OPT-OUT FORM TO STOP FUTURE
REQUESTS TO COMPLETE THE SURVEY. You
may also contact our helpdesk at 1-855-462-7577.
Black
Asian
West Asian, Middle Eastern, or North African
Native Hawaiian
INSTRUCTIONS
• Choose one answer for each question unless the
instructions say otherwise.
• Read each question carefully. Different questions
ask about different timeframes.
Other Pacific Islander
White/European
Other: (Please describe)
Q4
What is the highest degree or level of
education you have completed?
Some high school but no diploma or GED
High school diploma / GED
Post-high school vocational or technical
training
This number preserves your confidentiality and allows us to mail you
the incentive as a thank you for your time
Some college credit, no degree
Associate’s degree (for example, AA, AS)
Bachelor’s degree (for example, BA, BS)
Master’s, Doctorate or professional degree
(for example, MA, MSW, MBA, PhD, MD, JD)
Q5
How many children do you have (both your
biological children and other children for whom
you have parenting responsibilities)?
Number of children:
I do not have any children → Go to question 6
Light Survey - Time 1 (M)
1
Q5b
If you have children, what are their ages in
years?
Q7
What is your current living situation?
Rent an apartment, house, or room
Own my house or apartment
Child 1
Live with a relative or friend and not paying
rent
Live in a car, on the street, or in a homeless
shelter
Other (Please describe)
Child 2
Child 3
Child 4
Child 5
Child 6
Q8
Yes
Child 7
Child 8
No
Q9
Child 9
Working for pay part-time (<30 hours/week)
Yes
Not working for pay but actively looking for
paid work
Full-time care of children under the age of 18
or adult (for example, disabled adult
child/parent/spouse)
Full-time homemaker without full-time child or
elder care responsibilities
Retired
No
Disabled
Would you consider yourself the or one of the
primary caregivers for your child/children?
Q10
Q6
What is your current employment status?
Select all the apply.
Working for pay full-time (≥30 hours/week)
Chilid 10
Q5c
Have you ever been homeless?
Do you have family members who are
veterans of the armed services? Select all
that apply.
No, I do not have an immediate or extended
family member who served/serves in the
military
Yes, my grandfather and/or grandmother
served in the military
Yes, my mother and/or father served/serves
in the military
Yes, I have a sibling that served/serves in the
military
Yes, I have a child who served/serves in the
military
Yes, I have an extended family member (e.g.,
aunt, uncle) who served/serves in the military
Light Survey - Time 1 (M)
Please provide an estimate of your
HOUSEHOLD’S yearly income before taxes
are taken out. Include all sources of income
from all earners in your household. If you do
not know the answer, please make your best
guess.
No income
Less than $15,000 per year
$15,000 – 24,999
$25,000 – 34,999
$35,000 – 44,999
$45,000 - 54,999
$55,000 – 74,999
$75,000 – 99,999
$100,000 - $149,999
$150,000 or more per year
2
Q11
Q12
How many people are supported by this
HOUSEHOLD income, including yourself,
your significant other (if you have one), and
anyone else partially or fully supported by this
income whether or not they live with you?
Q18
What was your paygrade on your last day of
military service (for example, E-5, O-6)?
Q19
What was your primary military occupation
during your military service?
Combat arms
Have you ever been incarcerated for longer
than 24 hours?
Combat support
Service support
Yes
No
Q20
Now we will ask you about your military
history and experiences
Q13
Honorable
General under honorable conditions
Under another category besides honorable
(i.e., Other Than Honorable (OTH), Bad
Conduct Discharge (BCD), Dishonorable)
Medical
In what component(s) have you served?
Select all the apply.
Active Duty
Not sure
Reserve
National guard
Q14
In which branch of the military have you spent
the most time?
Army
Marine Corps
Navy
Air Force
Which of the following describes your
discharge from military service?
Q21
Did you ever deploy overseas?
Yes
No
→ Go to question 22
If YES, please answer the following questions
about your deployments. If you never
deployed please skip to question 22.
Q21a How many times were you deployed?
Coast Guard
Q15
How long were you in the military?
Years
Q21b How many total months were you deployed
out of country?
Months
Q16
Q17
At what age did you enlist?
At what age did you separate from military
service?
Light Survey - Time 1 (M)
Q21c Did you experience a deployment in support
of the following wars? Select all that apply
Operation Enduring Freedom/Operation Iraqi
Freedom/Operation New Dawn
(OEF/OIF/OND)
Gulf War (1990-1991)
Other: (Please describe)
3
The statements below are about your combat experiences during your military service.
Please select the response that best fits your answer.
Q22 During your military service…
Never
Once or Twice
Several times
Many times
a. You encountered land or water mines, booby traps, or
roadside bombs (for example, IEDs).
b. You saw refugees who had lost their homes or
belongings.
c. You fired your weapon at enemy combatants
d. You saw civilians after they had been severely
wounded or disfigured.
e. You were involved in searching and/or disarming
potential enemy combatants.
f. You went on combat patrols or missions.
g. You personally witnessed someone from your unit or
an ally unit being seriously wounded or killed.
h. You were exposed to hostile incoming fire.
i. You saw the bodies of dead enemy combatants.
The statements below are about your relationships with other military personnel during your
military service. As used in these statements, the term “unit” refers to those you lived and
worked with on a daily basis during your military service. Please mark how much you agree
or disagree with each statement.
Q23 While I was in the military…
Strongly
Disagree
Somewhat
Disagree
Neither
Agree nor
Disagree
Somewhat
Agree
Strongly
Agree
a. My unit was like family to me.
b. People in my unit were trustworthy.
c. My fellow unit members appreciated my efforts.
d. I felt valued by my fellow unit members.
e. Members of my unit were interested in my well-being.
f. My fellow unit members were interested in what I
thought and how I felt about things.
g. My unit leader(s) were interested in what I thought and
how I felt about things.
h. I felt like my efforts really counted to the leaders in my
unit.
i. My service was appreciated by the leaders in my unit.
j. I could go to unit leaders for help if I had a problem or
concern.
k. The leaders of my unit were interested in my personal
welfare.
l. I felt valued by the leaders of my unit
Light Survey - Time 1 (M)
4
The next set of questions is about your relationships with others (for example, other unit
members, other unit leaders, civilians) during your military service. Please mark how often
you experienced each circumstance.
Q24 While I was in the military, the people I worked with…
Never
Once or twice
Several times
Many times
a. Treated me in an overly critical way.
b. Behaved in a way that was uncooperative when
working with me.
c. Treated me as if I had to work harder than others to
prove myself.
d. Questioned my abilities or commitment to perform my
job effectively.
e. Acted as though my mistakes were worse than
others’.
f. Tried to make my job more difficult to do.
g. “Put me down” or treated me in a condescending way.
h. Threatened my physical safety.
i. Made crude and offensive sexual remarks directed at
me, either publicly or privately.
j. Spread negative rumors about my sexual activities.
k. Tried to talk me into participating in sexual acts when I
didn’t want to.
l. Used a position of authority to pressure me into
unwanted sexual activity.
m. Offered me a specific reward or special treatment to
take part in sexual behavior.
n. Threatened me with some sort of retaliation if I was
not sexually cooperative (for example, the threat of a
negative review or physical violence).
o. Touched me in a sexual way against my will.
p. Physically forced me to have sex.
Light Survey - Time 1 (M)
5
Now we will ask you about experiences you have had starting in your childhood.
Q25 The sentences below refer to your relationship with your family WHEN YOU WERE GROWING UP.
Please describe how much you agree or disagree with each statement by marking the response
that best fits your choice. If you spent time in more than one family setting, please answer these
questions about the family in which you spent the greatest part of your childhood.
Strongly
disagree
Somewhat
disagree
Neither
agree or
disagree
Somewhat
agree
Strongly
agree
a. I got along well with my family members.
b. I felt like I fit in with my family.
c. Family members knew what I thought and how I felt
about things.
d. I felt like my contributions to my family were
appreciated.
e. I shared many common interests and activities with
family members.
f. My opinions were valued by other family members.
g. I was affectionate with family members.
h. I played an important role in my family.
i. I spent as much of my free time with family members
as possible.
j. Family members told me when they were having a
problem.
k. I could be myself around family members.
l. My input was sought on important family decisions.
The following questions ask about experiences you may have had in your life. Please mark
the number of times you experienced these events in each age range. If the event does not
apply to you, mark “Not at all.”
Q26a Serious accident (for example, car/boat accident, accident at work)
Not at all
Once or twice
Several times
Many times
Several times
Many times
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q26b Exposure to toxic substance (for example, dangerous chemicals, radiation)
Not at all
Once or twice
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Light Survey - Time 1 (M)
6
Q26c Witnessed sudden, violent death or aftermath (for example, homicide, suicide)
Not at all
Once or twice
Several times
Many times
Once or twice
Several times
Many times
Once or twice
Several times
Many times
Once or twice
Several times
Many times
Once or twice
Several times
Many times
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q26d Sudden, unexpected death of someone close to you
Not at all
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q26e Serious injury, harm, or death you caused to someone else
Not at all
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q26f Captivity (for example, being kidnapped, held hostage, prisoner of war)
Not at all
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q26g Community violence: terrorist attack, bombing, riots.
Not at all
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Light Survey - Time 1 (M)
7
This section is about violent attacks against you by someone who is NOT a romantic partner
or spouse
Q26h Sexual assault by anyone who is NOT an intimate partner (rape, attempted rape, made to perform any
sexual act through force or threat of harm)
Not at all
Once or twice
Several times
Many times
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q26i Serious physical assault by anyone who is NOT an intimate partner (attacked with or without a weapon,
threatened with a weapon)
Not at all
Once or twice
Several times
Many times
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
This section is about violence against you by someone who WAS/IS a romantic partner or
spouse
Q26j Physical assault (pushed, grabbed, shaken, hit, beat up) by a significant other/spouse
Not at all
Once or twice
Several times
Many times
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q26k Unwanted sexual experience by a significant other/spouse (pressured or forced to do sexual things you
didn’t want to do)
Not at all
Once or twice
Several times
Many times
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Light Survey - Time 1 (M)
8
Q26l Emotional mistreatment by significant other/spouse (name-calling, criticized, not allowed to see
friends/family, humiliated, or denied money)
Not at all
Once or twice
Several times
Many times
Not at all
Once or twice
Several times
Many times
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q26m Other traumatic event: please specify.
Please describe the event:
Childhood (birth – age 17)
Age 18 to enlistment (if applicable)
During military service
After military service until end of May 2018
In the last 3 months
Q27 Think about things that may have happened to you throughout your life that are unusually or especially
frightening, horrible, or traumatic. If you have had one of these experiences, which experience causes
you the most distress? If you have not had an experience like this, please select “I did not have an
experience like this” and proceed to question 30. Check one only.
Combat/ exposure to warzone
Physical assault
Sexual assault
Accident
Natural disaster
Seen someone killed or seriously injured
Death of loved one through homicide or suicide
I did not have an experience like this
→ Go to question 30
Other: (Please describe)
Q28 How old were you when this most distressing trauma occurred?
Light Survey - Time 1 (M)
9
Below is a list of problems that people sometimes have in response to a very stressful
experience. Please read each problem carefully and and then choose one of the responses
below to indicate how much you have been bothered by that problem in the past month.
Please base your answers on problems related to the experience you named as the worst in
question 27.
Q29 Thinking about the experience you named in question 27, in the past month, how much were you
bothered by:
Not at all
A little bit
Moderately
Quite a bit
Extremely
a. Repeated, disturbing, and unwanted memories of the
stressful experience?
b. Repeated, disturbing dreams of the stressful
experience?
c. Suddenly feeling or acting as if the stressful
experience were actually happening again (as if you
were actually back there reliving it)?
d. Feeling very upset when something reminded you of
the stressful experience?
e. Having strong physical reactions when something
reminded you of the stressful experience (for example,
heart pounding, trouble breathing, sweating)?
f. Avoiding memories, thoughts, or feelings related to the
stressful experience?
g. Avoiding external reminders of the stressful
experience (for example, people, places, conversations,
activities, objects, or situations)?
h. Trouble remembering important parts of the stressful
experience?
i. Having strong negative beliefs about yourself, other
people, or the world (for example, having thoughts such
as: I am bad, there is something seriously wrong with
me, no one can be trusted, the world is completely
dangerous)?
j. Blaming yourself or someone else for the stressful
experience or what happened after it?
k. Having strong negative feelings such as fear, horror,
anger, guilt, or shame?
l. Loss of interest in activities that you used to enjoy?
m. Feeling distant or cut off from other people?
n. Trouble experiencing positive feelings (for example,
being unable to feel happiness or have loving feelings for
people close to you)?
o. Irritable behavior, angry outbursts, or acting
aggressively?
p. Taking too many risks or doing things that could cause
you harm?
q. Being “superalert” or watchful or on guard?
r. Feeling jumpy or easily startled?
s. Having difficulty concentrating?
t. Trouble falling or staying asleep?
Light Survey - Time 1 (M)
10
Q30 The next set of items ask about potentially stressful situations you may be currently experiencing. Think
about whether or not the stressful situation described happened in the last month. If the situation IS NOT
occurring for you, choose "N/A" and go to the next item. If the situation IS occurring, please rate the
extent to which it is NOW stressful/distressing to you on a scale from 1-10.
N/A
Not at all
distressing
1
2
3
4
Somewhat
distressing
5
6
7
8
9
Extremely
distressing
10
a. Laid off or fired from work
b. At risk for losing your
home
c. Caring of seriously ill
and/or disabled dependents
(e.g., children, elders)
d. Divorce or separation
from romantic partner
e. Legal problems, court
proceedings, ongoing
litigation
f. Major negative change in
financial status
g. Major problems at
school/At risk of losing spot
at school or Veteran
subsidies
h. Major health problem
i. Major problem with your
significant other or child(ren)
Q31 Over the last two weeks how often have you been bothered by any of the following problems?
Not at all
Several days
More than half Nearly every
the days
day
a. Little interest or pleasure in doing things
b. Feeling down, depressed, or hopeless
c. Trouble falling or staying asleep, or sleeping too much
d. Feeling tired or having little energy
e. Poor appetite or overeating
f. Feeling bad about yourself – or that you are a failure or
have let yourself or your family down
g. Trouble concentrating on things, such as reading the
newspaper or watching television
h. Moving or speaking so slowly that other people could have
noticed. Or the opposite – being so fidgety or restless that
you have been moving around a lot more than usual
i. Thoughts that you would be better off dead, or of hurting
yourself
j. Feeling nervous, anxious, or on edge
k. Not being able to stop or control worrying
l. Worrying too much about different things
m. Trouble relaxing
n. Being so restless that it's hard to sit still
o. Becoming easily annoyed or irritable
p. Feeling afraid as if something awful might happen
Light Survey - Time 1 (M)
11
Q32
Have you ever been diagnosed with any of
the following emotional/mental health
conditions? Select all that apply
Post-traumatic Stress Disorder (PTSD)
Depression
Anxiety Disorder (for example, panic disorder,
generalized anxiety disorder)
Other mental health problem (please specify):
Q33b How often have you thought about killing
yourself in the past year? Check one only.
Never
Rarely (1 time)
Sometimes (2 times)
Often (3-4 times)
Very often (5 or more times)
Q33c Have you ever told someone that you were
going to commit suicide, or that you might do
it? Check one only.
Please check the one box beside the
statement or phrase that best applies to
you.
No
Yes, at one time, but did not really want to die
Yes, at one time, and really wanted to die
Yes, more than once, but did not want to do it
Q33a Have you ever thought about or attempted to
kill yourself? Check one only.
Never
Yes, more than once, and really wanted to do
it
Q33d How likely is it that you will attempt suicide
someday? Check one only.
It was just a brief passing thought
Never
I have had a plan at least once to kill myself
but did not try to do it
I have had a plan at least once to kill myself
and really wanted to die
I have attempted to kill myself, but did not
want to die
I have attempted to kill myself, and really
hoped to die
No chance at all
Rather unlikely
Unlikely
Likely
Rather likely
Very likely
Having thoughts of hurting yourself can be a common response to feeling distressed. We
want you to know that help is available. We recommend that you contact your primary care
provider or call the Veterans Crisis Hotline (1-800-273-8255) if you are experiencing suicidal
thoughts.
Q34 Thinking over the past month, check the option that best describes the amount of time you felt
that way.
None or
All or almost
almost none A little of the Some of the Most of the all of the
of the time
time
time
time
time
a. I found myself getting angry at people or situations.
b. When I got angry, I got really mad.
c. When I got angry, I stayed angry.
d. When I got angry at someone I wanted to hit them.
e. My anger prevented me from getting along with people
as well as I'd have liked to.
Light Survey - Time 1 (M)
12
Q35
What is your current marital status?
Never married
Married - first and only marriage → Go to question 37
Married - second or later marriage → Go to question 37
Separated
Divorced
Widowed
Q36
Are you currently in a romantic relationship?
Currently in a relationship and living as a couple
Currently in a relationship but not living as a couple
Not currently in a relationship → Go to question 38
If you are married or currently in a romantic relationship, please answer the following
questions. If you are not married or in a romantic relationship, please skip to question 38:
Q37 Over the last month, how often have you done the following in your romantic relationship:
Never
Rarely
Sometimes
Often
Most or all of
the time
a. Provided your significant other with the emotional
support they sought
b. Shared your intimate thoughts and feelings
c. Done your fair share of day-to-day tasks. (for example,
grocery shopping, errands, planning activities)
d. Initiated leisure time activities that both you and your
significant other enjoy.
e. Made effort to work through disagreements
respectfully.
f. Expressed interest and/or willingness to engage in
regular sexual or physical intimacy.
Light Survey - Time 1 (M)
13
If you currently have parenting responsibilities for any children 18 or under please answer
the following questions. If not, please skip to question 39.
Q38 All parents have strengths and weaknesses. Over the last month, how often have you:
Never
Rarely
Sometimes
Often
Most or all
of the time
a. Provided a healthy environment for your children. (for
example, preparing healthy meals, caring for their health,
keeping them safe)
b. Been a good example for your children. (for example,
being respectful during disagreements with others,
taking good care of your own health).
c. Been actively involved in your child(ren)’s activities.
(for example, regularly attending sporting and school
events, giving your full attention during time together)
d. Met your children’s needs for physical affection and
emotional support. (for example, giving them hugs, being
sympathetic to their problems)
e. Been able to successfully manage your child(ren)’s
unique challenges. (for example, effectively disciplining
children)
The following questions ask about your neighborhood and community.
Q39 How long have you lived in your current neighborhood (Years / Months)?
Years:
Months:
Q40 Over the course of your adult life, how often have you been involved in….
Never
Rarely
Sometimes
Often
Most or all
of the time
a. Activities that address political topics at the local, state, or
national level (for example, political rallies or fundraisers,
groups that focus on specific political point of views, etc.)
b. Volunteer activities for non-political organizations (for
example, red cross, local organization)
c. Religious or spiritual communities
d. Culture, recreational, or leisure group activities (for example,
sport, music, craft, etc.)
Q41 To what extent do you think these groups or organizations above would offer you help if you request it?
Not involved in these groups/organizations
Very unlikely
Unlikely
Neither likely nor unlikely
Likely
Very likely
Light Survey - Time 1 (M)
14
Q42 How likely are these things to happen in your neighborhood…
Very
Unlikely
Unlikely
Neither likely
nor unlikely
Likely
Very likely
a. People around here are willing to help their neighbors.
b. This is a close-knit neighborhood.
c. People in this neighborhood can be trusted.
d. People in this neighborhood generally don’t get along
with each other.
e. People in this neighborhood do not share the same
values.
Q43 On the whole, how much do you like this neighborhood as a place to live?
Not at all
A little
Somewhat
A great deal
Q44 We are interested in how you feel about the following statements. Read each statement carefully.
Indicate how you feel about each statement.
Strongly
Disagree
Disagree
Agree
Strongly
Agree
a. There is a lot of graffiti in my neighborhood.
b. My neighborhood is noisy.
c. Vandalism is common in my neighborhood.
d. There are a lot of abandoned buildings in
my neighborhood.
e. My neighborhood is clean.
f. People in my neighborhood take good care of their
houses and apartments.
g. There are too many people hanging around on
the streets near my home.
h. There is a lot of crime in my neighborhood.
i. There is too much drug use in my neighborhood.
j. There is too much alcohol use in my neighborhood.
k. I’m always having trouble with my neighbors.
l. In my neighborhood, people watch out for each other.
m. My neighborhood is safe.
Q45
In the last year, how often have you heard
gunshots associated with crime or violence in
your neighborhood?
Q46
How common would you say it is for people to
belong to street gangs in your neighborhood?
Very common
Never
Somewhat common
Once or twice
Somewhat uncommon
Three to five times
Very uncommon
More than five times
Light Survey - Time 1 (M)
15
Q47
How common do you think it is for people to
carry guns in the neighborhood?
Q53
Very common
In this neighborhood, it is sometimes
necessary for people to carry guns to protect
themselves or their family.
Somewhat common
Strongly agree
Somewhat uncommon
Agree
Very uncommon
Disagree
Strongly Disagree
Q48
Have you ever seen someone threatened with
a gun in the neighborhood?
Q54
Yes
In this neighborhood, it is sometimes
necessary for people to join a gang to protect
themselves or their family.
Strongly agree
No
Agree
Q49
Have you ever seen someone shot with a gun
in the neighborhood?
Yes
Strongly disagree
The following questions ask about your
health.
No
Q50
Disagree
If a fight were to break out near your home,
how likely is it that your neighbors would
attempt to break it up?
Q55
During the past month, what time have you
usually gone to bed at night (hh:mm)?
:
Very likely
Q56
Somewhat unlikely
During the past month, how long, has it
usually taken you to fall asleep each night?
Very unlikely
Number of hours:
Somewhat likely
Q51
If a fight were to break out near your home,
how likely is it that the police would be called?
Number of minutes:
Q57
Very likely
Somewhat likely
During the past month, what time have you
usually gotten up in the morning (hh:mm)?
:
Somewhat unlikely
Q58
Very unlikely
Q52 How safe do you feel…
Very
safe
a. Alone inside your
house?
b. Outside in your
neighborhood during the
day?
c. Outside in your
neighborhood at night?
d. Walking alone toward
a group of people that
you don’t know?
Light Survey - Time 1 (M)
Some Some
what
what
Very
safe unsafe unsafe
During the past month, how many hours of
actual sleep did you get at night? (This may
be different from the number of hours you
spent in bed.)
Hours of sleep per night:
Q59
How often do you exercise for 30 minutes or
more?
Daily or almost daily
3 to 4 times per week
2 to 3 times per week
1 to 2 times per week
Fewer than once per week
16
Please answer the following questions
related to your current and history of
substance use. Skip any questions that are
irrelevant to you.
Q60
How many cigarettes did you smoke on an
average day in the last month (if you do not
smoke write 0)?
Q65
In the past month, did you use marijuana? If
YES, how many times in a typical week?
No → Go to question 66
Yes
Times in a week:
Q65a Does your marijuana use cause any
problems?
Yes
For alcohol, one drink equals:
• 4 oz. wine
• 1 wine cooler
• 12 oz. beer
• 1 cocktail with 1 oz. hard liquor
Q61
No
N/A, I do not use marijuana
Q65b Did anyone else think your marijuana use
caused a problem?
Yes
No
How often do you currently have a drink
containing alcohol?
Never
Monthly or less
2-4 times a month
2-3 times a week
4 or more times a week
N/A, I do not use marijuana
Q66 In the past month, did you use other drugs,
other than alcohol or marijuana? If YES, how
many times in a typical week did you use, if at
all? This includes cocaine, crack, heroin, acid,
speed, ecstasy, methamphetamines, steroids,
and medicines prescribed for someone else.
No
Q62
How many standard drinks containing alcohol
do you have on a typical day?
Yes
Times in a week:
1 or 2
3 or 4
5 or 6
Q63
Q66a Does your use of drugs other than alcohol or
marijuana cause any problems?
7 to 9
Yes
10 or more
No
On average, how often do you have 5 or more
drinks on one occasion?
Never
N/A, I do not use drugs, not including alcohol
or marijuana
Q66b Did anyone else think your use of drugs other
than alcohol or marijuana cause a problem?
Less than monthly
Yes
Monthly
No
Weekly
N/A, I do not use drugs, not including alcohol
or marijuana
Daily or almost daily
Q67
Q64
Have you ever been diagnosed with alcohol
abuse or dependence in the past?
Have you ever been diagnosed with drug
(including prescription drugs) abuse or
dependence in the past?
No
No
Yes
Yes
Light Survey - Time 1 (M)
17
If you are prescribed pain medication please answer the following questions, otherwise skip
to item 69.
Q68 In the past 3 months…
Never
Rarely
Sometimes
Often
Almost
Always
Not at all
A little bit
Somewhat
Quite a bit
Very much
a. I abused prescription pain medication
b. I ran out of my prescription pain medication early
c. I got prescription pain medication from someone other
than my healthcare provider
d. I used more of my prescription pain medication than I
was supposed to
e. I experienced cravings for pain medication
f. I used more pain medication before the effects wore
off
Q68a In the past 3 months…
When my prescription for pain medication ran out, I felt
anxious
The following questions are about food and eating behavior
Q69
Please answer yes or no to the following questions:
No
Yes
a. Do you make yourself sick because you feel uncomfortably full?
b. Do you worry that you have lost control over how much you eat?
c. Have you recently lost more than 14 lbs in a 3-month period?
d. Do you believe yourself to be fat when others say you are too thin?
e. Would you say that food dominates your life?
Q70
What is your current height not wearing shoes?
'
Q71
"
What is your current weight?
lbs
Light Survey - Time 1 (M)
18
Q72 Please indicate whether you are currently diagnosed with any of the following conditions:
No
Yes
a.Sleep problem or disorder (for example, insomnia, sleep apnea)
b. Chronic pain or pain related disorder (for example, knee, back, migraines)
c. Sexually transmitted disease
d. Other chronic physical problem (please specify)
Q73
Have you ever experienced any of the
following events? Select all that apply.
Q76
Blast or explosion (IED, RPG, Landmine,
Grenade, etc)
Vehicular accident/crash (any vehicle
including aircraft)
Fragment wound or bullet wound above the
shoulders
Fall
Memory problems or lapses
Balance problems or dizziness
Sensitivity to bright light
Irritability
Headaches
Blow to the head (head hit by falling/flying
object, head hit by another person, head hit
against something, etc)
Strangulation
Shaken violently
None of the above → Go to question 77
Q74
Did you have any of these immediately after
any of the events above? Select all that apply.
Losing consciousness/”knocked out”
Being dazed, confused, or “seeing stars”
Not remembering the event
In the past week, have you had any of the
symptoms from question 73? Select all that
apply.
Sleep problems
None of the above
Q77
Has your significant other ever tried, for a
period of 12 months or longer, to become
pregnant?
Yes, my significant other has tried for 12
months or longer to become pregnant
No → Go to question 78
N/A → Go to question 78
Concussion
Head injury that resulted in broken bones in
head, neck, face, damaged teeth, or ruptured
eardrum
None of the above
Q75
Did any of the following problems begin or get
worse afterwards? Select all that apply.
Memory problems or lapses
Balance problems or dizziness
Sensitivity to bright light
Irritability
Headaches
Sleep problems
Q77a If YES, Did a doctor identify any of the
following reasons for difficulties in your
partner becoming pregnant? Select all that
apply
I did not see a doctor for this problem
No reason identified
Cervical factor
Tubal factor
Ovulation factor
Semen or sperm factor
Hormonal factor
Other (please specify)
None of the above
Light Survey - Time 1 (M)
19
Q77b Did your significant other become pregnant
eventually?
No, and we stopped trying
Q81
Are you currently receiving mental health
services (e.g., seeing a therapist, counselor,
or medications) to help with distress?
No, but we are still trying
Yes → Go to question 82
Yes, we became pregnant naturally
No
Yes, we became pregnant with medical
intervention (for example, IVF)
The following questions ask about your use
of healthcare and thoughts about mental
health treatment.
Q81a If NO, what prevents you from seeking mental
health treatment? Select all that apply.
Concern for job security
Judgment from others
Q78
Do you get any healthcare (physical and/or
mental health) at Veterans’ Administration
(VA) hospitals or clinics?
Distance/transportation to mental healthcare
providers
Don’t think it will help me
Yes → Go to question 79
No insurance coverage
No
I don't need mental health treatment
Q78a If NO, why not?
Other (please specify):
Not eligible
Distance to VA facilities/transportation
concerns
My VA does not provide the services I need.
I don’t feel comfortable seeking services at
the VA.
Preference for my current healthcare
providers
Other (please specify):
Q82 If I thought that I were suffering from serious
depression, anxiety, anger, or fear, I would
seek assistance from (Select all that apply):
Good female friends
Good male friends
Spouse or intimate partner
Q79
Q80
I think that I am suffering from mental health
problems (for example, feeling anxious
depressed, or too angry).
Family member (brother, sister, mother, father,
etc.)
Coworker
Religious leader (e.g. pastor, priest, rabbi)
True
Medical doctor (primary care doctor)
False
Therapist or counselor
I think that I might benefit from mental health
treatment.
True
Information on the internet
Self-help books or magazine articles
Other (please specify):
False
Light Survey - Time 1 (M)
20
Q83 We are interested in your use of mental health services in the past 12 months. If you received any
help (even if it was only once or for a little while), please mark where you received this help. Mark
the no column only if you did not receive any of that type of help in the past 12 months.
No, I did not
get this kind
of help
Yes, from
a VA provider
Yes, from a
community
(non-VA)
provider
Yes, from both
a VA and a
community
provider
a. Medication for a mental health problem (e.g., an
antidepressant)
b. Individual counseling or therapy for a mental health
program
c. Group counseling or therapy for a mental health
problem
d. Family therapy
e. Inpatient or partial hospitalization program for a
mental health problem
f. Another type of mental health treatment (please
specify):
Q84
If you felt as though you needed mental
health treatment other than what you are
currently receiving, do you feel your health
care provider could get it for you?
Q86
If you have received any mental health
treatments, how helpful was this care in
reducing your distress?
Not at all helpful
Yes
Slightly helpful
No
Moderately helpful
N/A
Very helpful
Extremely helpful
N/A
Q87
Q85
Q88
If you have received any mental health
treatments, how satisfied were you with the
care you received?
If you have received any mental health
treatments, how difficult was it to find a
therapist and schedule your mental health
appointments?
Very difficult
Not at all satisfied
Difficult
Slightly satisfied
Moderately difficult
Moderately satisfied
Neutral
Very satisfied
Easy
Extremely satisfied
Very easy
N/A
N/A
How likely would you be to use the following services if they were offered by the VA?
Not at all likely
Slightly likely
Moderately likely
Very likely
Extremely likely
a. Family Education
b. Help with children
c. Help with marriage/relationship
Light Survey - Time 1 (M)
21
Q89 Were you aware that the VA offers services to support the family, including marital, couples, and family
therapy?
Yes
No
The next set of questions ask you about your current support system and coping strategies.
Q90 We are interested in how you feel about the following statements. Read each statement carefully.
Indicate how you feel about each statement.
Very
strongly
disagree
Strongly
disagree
Mildly
disagree
Neutral
Mildly
agree
Strongly
agree
Very
strongly
agree
a. There is a special person who is around
when I am in need.
b. There is a special person with whom I can
share my joys and sorrows.
c. My family really tries to help me.
d. I get the emotional help and support I
need from my family.
e. I have a special person who is a real
source of comfort to me.
f. My friends really try to help me.
g. I can count on my friends when things go
wrong.
h. I can talk about my problems with my
family.
i. I have friends with whom I can share my
joys and sorrows.
j. There is a special person in my life who
cares about my feelings.
k. My family is willing to help me make
decisions.
l. I can talk about my problems with my
friends.
Q91 Please indicate how many times you have done each of these things to someone else in the past six
months.
Once
Twice
Not in the
past 6
months,
but it did This has
More than happen
never
3-5 times 6-10 times 11-20 times 20 times
before
happened
a. I insulted, swore, shouted
or yelled at someone.
b. I pushed, shoved, or
slapped someone.
c. I punched, kicked, or beatup someone.
d. I destroyed something
belonging to someone else or
threatened to hit someone.
Light Survey - Time 1 (M)
22
Q92 Please indicate the extent to which you agree with each of the following statements.
Strongly
Disagree
Disagree
Neutral
Agree
Strongly Agree
a. You tend to bounce back quickly after hard
times.
b. You have a hard time making it through
stressful events.
c.It does not take you long to recover from a
stressful event.
d. It is hard for you to snap back when
something bad happens.
e. You usually come through difficult times
with little trouble.
f. You tend to take a long time to get over set
-backs in your life.
Q93 In your day-to-day life, how often do any of the following things happen to you?
Almost
At least
A few times A few times Less than
everyday once a week a month
a year
once a year
Never
a. You are treated with less courtesy than
other people are.
b. You are treated with less respect than
other people are.
c. You receive poorer service than other
people at restaurants or stores.
d. People act as if they think you are not
smart.
e. People act as if they are afraid of you
f. People act as if they think you are
dishonest.
g. People act as if they’re better than you
are.
h. You are called names or insulted.
i. You are threatened or harassed.
Please answer the following question if you answered “a few times a year” or more
frequently to any of the above questions.
Q94
What do you think is the main reason for these experiences? Select all that apply.
Your Ancestry or National Origins
Your Gender
Your Race
Your Age
Your Religion
Your Height
Your Weight
Some other Aspect of Your Physical Appearance
Your Sexual Orientation
Your Education or Income Level
Light Survey - Time 1 (M)
23
Q95
What is your biological sex?
Q97
Male
How would you describe your current sexual
orientation?
Heterosexual/straight
Female
Homosexual/gay or lesbian
Bisexual
Uncertain
Other (please specify):
Q96
What is your gender identity?
Q98
Male
Female
Transgender
Other (please specify):
There may be opportunities for you to
participate in other studies. May we use your
contact information to inform you about these
opportunities?
Yes
No, not at this time
THANK YOU FOR YOUR PARTICIPATION IN THIS SURVEY.
PLEASE RETURN YOUR SURVEY IN THE ENCLOSED ENVELOPE.
ONCE WE RECEIVE THE SURVEY, $20 WILL BE MAILED TO YOU.
Light Survey - Time 1 (M)
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| File Type | application/pdf |
| File Modified | 2019-06-28 |
| File Created | 2018-08-08 |