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2018 BASELINE SURVEY
The 2018 Baseline Survey is web-only. This paper survey was designed to
provide the study team with an operational document, and is not intended to
be completed by participants or to serve as a substitute for the experience of
completing the web-survey.
The web-survey uses numerous skip patterns and allows for personalization of
questions. By tailoring the survey to each participant’s particular situation, we
hope to increase the quality of the data collected and to enhance the user
experience.
Italicized text is instructional only and will not appear on the survey.
Red text indicates the standardized instruments from which the survey
questions were sourced.
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Millennium Cohort Family Study
Voluntary Consent
Download a copy of this form for your records
What is the study about?
You are being asked to be a volunteer in a longitudinal research study called "The Millennium Cohort Family Study"
conducted by the US Department of Defense (DoD). The purpose of this study is to assess the interrelated health
effects of military service on service members, spouses and their children. You were selected to be a part of this
study because you have been named as a spouse by your sponsor, who is a participant of the Millennium Cohort
Study. For more information on the Millennium Cohort Study, please visit www.MillenniumCohort.org. Participation
is completely voluntary, however, it is very important that you participate in order to evaluate the availability of
resources and the level of support that is needed in the lives of military service members and their families. Your
continued participation is still encouraged even if this person is no longer your sponsor, your sponsor is no longer in
the service, or if you are separated or no longer co-residing.
What will participation involve?
You are being asked to do the following: Complete the survey. The only option for completing this survey is online.
You are also being asked to complete 7 follow-up surveys over 21 years, with one survey to complete every 3
years. The survey will take about 45 minutes to complete each time you complete it. The surveys contain questions
on a broad range of health, medical, and behavioral issues concerning yourself, your spouse, and your children (if
you have any). Some of the questions are of a sensitive nature. We will connect your survey data to other medical
and personnel data maintained by the Department of Defense. If you are a military member and you separate from
service and utilize the Department of Veterans Affairs for your medical services, we also link to those medical and
personnel data. Your child(ren)'s survey data will NOT be linked to any other data, or medical records. You will be
contacted semi-annually to verify your contact information. You are one of approximately 10,000 volunteers being
asked to participate in this very important study.
What risks are involved in the study?
The main risks to you are those associated with the inappropriate disclosure of data that we collect from or about
you. While inappropriate disclosure has the potential to impact your reputation, insurability, or employability, it is
important for you to understand that this research group has collected similar information from numerous studies
over many years without any cases of inappropriate disclosure. There is also the risk of possible discomfort from
answering some sensitive questions, but you may skip any question(s) that make you uncomfortable. If you feel
that you might need medical care or counseling, you should make contact with the appropriate health care
personnel.
How will your data be protected against any risks?
All information collected through the Internet survey is done by using Secure Sockets Layer (SSL) data
transmission lines. SSL encrypts, or scrambles, all survey data sent over the Internet. Information will only be
understandable when it reaches the investigator database. When your data are entered into computer files for
analysis, your answers will be identified only by a special study identification number known to you and research
team members. Your social security number and any other personal identification information will be removed from
your survey and data file. Even if someone outside the research team broke into the data files, it would be
impossible for them to identify your data. To minimize the risk of anyone breaking into the data files, those files will
be maintained on DoD computers protected by all the measures required by DoD computer security regulations. All
members of the research team with access to data files will be trained in DoD computer security procedures
specifically designed to protect sensitive data. Reports of the study findings will contain only group data, so that no
individual study participant can be identified. Similar procedures have been used to protect data in previous studies
conducted within this research center. According to the DoD Policy "Interim Regulations to Improve Privacy
Protections for DoD Medical Records" dated October 31, 2000, the information you provide is for research
purposes only and may not be disclosed except for specifically authorized purposes or with the consent of the
Millennium Cohort Family Study: 2018 Baseline Survey
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individual about whom the information pertains. Uses and disclosures of this information shall comply with
provisions of the Privacy Act and implementing regulations. Individuals from official government agencies may
inspect research records to ensure the rights and safety of all research participants are protected. All data will be
maintained until all research questions have been addressed.
What are the benefits of participating in the study?
While your participation in this study will not directly benefit you, your participation is a critical step in developing
programs and interventions to increase the well-being of service members and their families.
Will you be provided medical care based on your responses?
No. This is a population-based study and data collected will not be used to make decisions about treatment that
any individual should receive. If you feel that you might need medical care or counseling you should make contact
with the appropriate health care personnel.
Do you have to participate?
No, you do not! Your participation must be completely voluntary. If you decide to participate, you can stop at any
time you wish or skip any question you choose. If you choose not to participate or to discontinue your participation,
you will not lose any benefit to which you are otherwise entitled. You may change your mind and revoke your
permission to further collect or use your health information at any time. If you revoke your permission, no new
health information about you will be gathered after that date. However, unless specified otherwise, information that
has already been gathered may still be used for analyses. Collected data will be maintained until all research
questions are answered. To end participation, contact the principal investigators at
[email protected] or (800) 571-9248. Your participation may also be ended by the investigators.
While this is not anticipated, available funding or other logistical considerations could conceivably result in the early
termination of the study.
Who can provide additional information if you need it?
Questions about the research (science) aspects of this study should be directed to the principal investigators of the
Millennium Cohort Family Study at [email protected] or (800) 571-9248. You may also refer to the
web site at www.familycohort.org for more information. Questions about the ethical aspects of this study, your rights
as a volunteer, or any problem related to the protection of research volunteers should be directed to Christopher G.
Blood, JD, MA, Chairperson, Institutional Review Board, Naval Health Research Center, at [email protected] or (619) 553-8386.
Where can you find your records if you wish to review them?
The principal investigators will be responsible for storing the consent form and other research records related to this
study. The records will be stored at the Deployment Health Research Department, Naval Health Research Center,
140 Sylvester Road, San Diego, CA 92106-3521. You can review your electronically submitted survey until the
study ends by contacting the principal investigator at [email protected] or (800) 571-9248.
I consent to participate in the study described above. My consent is completely voluntary. My consent is indicated
by my typing in my name and selecting the "Yes, I agree" box below.
Type Your Name:
__________________________
Yes, I agree
No, I do not agree
Download a copy of this consent form for your records
Millennium Cohort Family Study: 2018 Baseline Survey
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Privacy Act Statement
You have rights under the Privacy Act.
The following statement describes how that ACT applies to this study:
The Privacy Act System of Records Notice (SORN) for this study is N6500-1. The SORN was published on the
Defense Privacy and Civil Liberties Division (DPCLD) website on November 14, 2014 and can be found by
visiting: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Article-View/Article/570396/
n06500-1/
Authority: Authority to request this information is granted under: 10 USC 136, Under Secretary of Defense for
Personnel and Readiness, 10 USC 1782, Surveys of Military Families, 10 USC 2358, Research and Development
Projects, Under Secretary of Defense Memorandum #: 99-028, 30 SEP 99 "Establishment of DoD Centers for
Deployment Health” and Executive Order 9396, Numbering System for Federal Accounts Relating to Individual
Persons.
Purpose: To create a probability-based database of service members and veterans who have, or have not,
deployed overseas so that various longitudinal health and research studies may be conducted over a 67-year
period. The database will be used: (a.) To systematically collect population-based demographic and health
data to evaluate the health of Armed Forces personnel throughout their careers and after leaving the service.
(b.) To evaluate the impact of operational deployments on various measures of health over time including
medically unexplained symptoms and chronic diseases to include cancer, heart disease and diabetes. (c.) To
serve as a foundation upon which other routinely captured medical and deployment data may be added to
answer future questions regarding the health risks of operational deployment, occupations, and general
service in the Armed Forces. (d.) To examine characteristics of service in the Armed Forces associated with
common clinician-diagnosed diseases and with scores on several standardized self-reported health
inventories for physical and psychological functional status. (e.) To provide a data repository and available
representative Armed Forces cohort that future investigators and policy makers might use to study important
aspects of service in the Armed Forces including disease outcomes among an Armed Forces cohort.
In addition to revealing changes in Service member and veteran’ health status over time, the Millennium
Cohort Study will serve as a data repository, providing a solid foundation upon which additional
epidemiological studies may be constructed.
Routine Uses: The information provided in this questionnaire will be maintained in data files at the
Deployment Health Research Department at the Naval Health Research Center and used only for medical
research purposes. Use of these data may be granted to other federal and non-federal medical research
agencies as approved by the Naval Health Research Center's Institutional Review Board. In addition to those
disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information
contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C.
522a(b)(3).
To the Department of Veterans Affairs (DVA) for (1) considering individual claims for benefits for which that
DVA is responsible; and (2) for use in scientific, medical and other analysis regarding health outcomes
research associated with military service. To the Department of Health and Human Services, Centers for
Disease Control and Prevention for use in scientific, medical and other analysis regarding health outcome
research associated with military service.
NOTE: All disclosures to the DVA and HHS must have prior approval of the Naval Health Research Center
Institutional Review Board and a Memorandum of Understanding must be entered into to ensure the right
and obligations of the signatories are clear. Access to data 1) is provided on need-to-know basis only; 2) must
adhere to the rule of minimization in that only information necessary to accomplish the purpose for which the
disclosure is being made is releasable; and 3) must follow strict guidelines established in the data sharing
agreement. To the Social Security Administration (SSA) for considering individual claims for benefits for
which that SSA is responsible. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's
compilation of systems of records notices apply to this system.
OMB CONTROL NUMBER: 0703-0064
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NOTE: This system of records contains individually identifiable health information. The DoD Health
Information Privacy Regulation (DoD 6025.18-R) issued pursuant to the Health Insurance Portability and
Accountability Act of 1996, applies to most such health information. DoD 6025.18-R may place additional
procedural requirements on the uses and disclosures of such information beyond those found in the Privacy
Act of 1974 or mentioned in this system of records notice.
Voluntary Disclosure: Completion of the questionnaire is voluntary. Failure to respond to any of the
questions will NOT result in any disadvantages or penalties except possible lack of representation of your
views in the final results and outcomes.
Agency Disclosure Notice
The public reporting burden for this collection of information, OMB Control Number 0703-0064, is
estimated to average 45minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding the burden estimate or burden reduction suggestions to
the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision
of law, no person shall be subject to any penalty for failing to comply with a collection of information if it
does not display a currently valid OMB control number.
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
BACKGROUND
Before we begin, we would like to ask you some background questions. These questions help to
determine what sections of the survey are most appropriate for your situation.
1. Our records indicate that your name is . Is this correct?
O No
O Yes SKIP to #2
If has never been your name and/or you feel we have not
reached the correct person, please contact the Family Study Team through our Contact Us
page or by calling (800) 571-9248. Thank you!
1a. Please provide us with your preferred name.
First Name:
Middle Name:
Last Name:
2. What is your date of birth?
¯
MM
¯
DD
YY
3. What is your current marital status with ?
O Currently married
3a. In what month and year did you marry ?
MM
YY
O Separated
3a. In what month and year did you and separate?
SKIP Military Life section if separated more than 1 year & participant is NOT
Active Duty or Reserve/National Guard
MM
YY
3b. In what month and year did you marry ?
MM
YY
O Divorced
3a. In what month and year did you and separate?
SKIP Military Life section if separated more than 1 year & participant is NOT
Active Duty or Reserve/National Guard
MM
YY
O Not Applicable
3b. In what month and year did you and divorce?
SKIP Military Life section if separated more than 1 year & participant is NOT
Active Duty or Reserve/National Guard
MM
YY
3c. In what month and year did you marry ?
MM
YY
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3d. Are you remarried? If so, in what month and year did you remarry?
O No
O Yes
MM
YY
Prior to starting YOUR SPOUSE’S DEPLOYMENT and DEPLOYMENT RETURN AND REUNION, spouses
separated/divorced will see a paragraph cautioning them that some of the questions in these sections may be difficult to
answer because of their marital status and that they may skip questions that do not apply to their situation.
O Widowed SKIP: #4 (spouse’s military status), #5-6 (spouse’s employment), Relationship with Spouse, Deployment,
Deployment Return and Reunion, and Work/Military Life
3a. In what month and year did you marry ?
MM
YY
3b. In what month and year did die?
MM
YY
3c. Are you remarried? If so, in what month and year did you remarry?
O No
O Yes
MM
YY
O Single, never married
B1. Including your current relationship, how many times have you been married?
(For example, if you have been married one time only, please mark 1 for your response.)
# of times married
4. Is currently serving in the military (Active Duty, Reserve, and/or National Guard)?
O Yes
O No
5. Which of the following best describes ’s current employment status? (Choose the single
best answer)
O Full-time work (greater than or equal to 30 hours per week)
O Part-time work (less than 30 hours per week)
O Homemaker
O Not employed, looking for work
O Not employed, not looking for work
O Not employed, retired
O Not employed, disabled
O Other (please specify):
6. On average, during the past month, or the most recent month was not deployed, how
many hours did he/she work per week (including weekends)?
hours per week
O is not currently working
O I don’t know
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7. How many total months was away from home in the past year (for example: workrelated travel, deployments, training, temporary duty, TDY/TAD)?
months in the past year
O is not currently working
O I don’t know
8. Have you ever served in the US military? Mark all that apply.
□ Yes, Regular Active Duty (not a member of the National Guard or Reserve)
□ Yes, Activated National Guard or Reserve (full-time Active Duty program: AGR/FTS/AR)
□ Yes, Traditional National Guard or Reserve (e.g., drilling unit, IMA, IPR)
□ No SKIP Your Military Service
If Family Spouse is Active Duty or Reserve/Guard, then have Family spouse answer Military Life section, regardless of MilCo
spouse military status.
8a. Since 2001, have you deployed for more than 30 days?
Question appears if participant selects “Yes” to #8.
O No
O Yes
9. How many children do you have from your current relationship or prior relationship(s)?
(Please include biological, adopted, foster, and stepchildren of all ages)
O 0 If 0, then SKIP #10 and Your Children section
O1
O6
O2
O7
O3
O8
O4
O9
O5
O 10 or more
10. Please record the ages of your children from oldest to youngest.
Question only appears if number of children is greater than 0. Question is populated with number of children indicated from previous
question. If all children are older than 17, SKIP Your Children section.
Information icon appears if “10 or more” children selected in #9: If you have more than 10 children, please provide the ages for your
10 youngest children.
Oldest
Youngest
11. Including yourself, how many people currently reside in your household?
(Please include even if currently deployed, on temporary duty, or in training, if he/she
lives and sleeps in your household the majority of the time. Please do not include anyone that
does not live and sleep in your household the majority of the time, such as visiting relatives.)
adults (18 and older)
children (17 and younger)
12. Does currently reside in your household the majority of the time?
O Yes
O No
B2. Is English your primary language?
O No
O Yes
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B3. Are you Hispanic or Latino?
O Yes, Hispanic or Latino
O No, not Hispanic or Latino
B4. What is your race? Mark all that apply.
□ American Indian or Alaska Native
□ Asian
□ Black or African American
□ Native Hawaiian or Other Pacific Islander
□ White
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PHYSICAL HEALTH
We would like to begin by asking you some questions about your physical health, how you feel, and
how well you are able to do your usual activities. These items allow us to assess changes in your
general health over time and if those changes may be related to other information you provide.
13. How tall are you?
feet
inches
14. What is your current weight? (If you are currently pregnant, please provide your weight before
pregnancy.)
pounds
Short Form - 12 (SF-12)
15. In general, would you say your health is:
O Excellent
O Very good
O Good
O Fair
O Poor
16. The following questions are about activities you might do during a typical day. Does your health
now limit you in these activities? If so, how much?
No, not limited
Yes, limited
Yes, limited
SF-12
Moderate activities, such as moving a table, pushing a
vacuum cleaner, bowling, or playing golf?
Climbing several flights of stairs?
at all
a little
a lot
O
O
O
O
O
O
17. During the past 4 weeks, have you had any of the following problems with your work or other
regular daily activities as a result of your physical health?
No, none
Yes, a little Yes, some
Yes, most
Yes, all of
SF-12
Accomplished less than you would like
Were limited in the kind of work or other
activities
of the time
of the time
of the time
of the time
the time
O
O
O
O
O
O
O
O
O
O
18. During the past 4 weeks, how much bodily pain have you had?
O None
O Very mild
O Mild
O Moderate
O Severe
O Very severe
SF-12
19. During the past 4 weeks, how much did pain interfere with your normal work (including both work
outside the home and housework)? SF-12
O Not at all
O A little bit
O Moderately
O Quite a bit
O Extremely
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20. In the last 12 months, have you taken any of the following regularly (at least once per week)?
No or less
than once
per week
If yes, please indicate total tablets per week
1-2
3-5
6-14
15+
O
O
O
O
O
Over-the-counter pain medication (e.g., Advil, Tylenol,
Bayer, Capsaicin)
O
O
O
O
O
Prescription sleep medication (e.g., Ambien, Lunesta,
Rozerem)
O
O
O
O
O
Over-the-counter sleep medication (e.g., Unisom,
Melatonin, Valerian)
O
O
O
O
O
Prescription mental health medication (e.g., Prozac,
Zoloft, Xanax)
O
O
O
O
O
Over-the-counter mental health medication (e.g., B
vitamins, St. John’s wort, essential oils)
O
O
O
O
O
Prescription pain medication (e.g., Codeine,
OxyContin, Percocet, Vicodin)
21. During the past 4 weeks, how much have you been bothered by any of the following problems?
Bothered
Bothered
Patient Health Questionnaire (PHQ)
Stomach pain
Back pain
Pain in your arms, legs, or joints (knees, hips, etc.)
Pain or problems during sexual intercourse
Headaches
Chest pain
Dizziness
Fainting spells
Feeling your heart pound or race
Shortness of breath
Constipation, loose bowels, or diarrhea
Nausea, gas, or indigestion
Menstrual cramps or other problems with your periods
Only appears if participant is FEMALE
Little or no sexual desire or pleasure during sex
Millennium Cohort Family Study: 2018 Baseline Survey
Not Bothered
a little
a lot
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
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22. How much difficulty have you had with conditions related to any of the following health areas? If
you have experienced more than one condition in a health area, please mark the severity level for
the most severe condition.
Review of Systems (ROS)
Information icon: If you have experienced more than one condition, mark the severity level for the most severe
condition. For example (hover over or click underlined text to see an example of 2 different conditions, with 2
different severities, and how one would endorse the question)
None
Slight
Moderate
Serious
Severe
Eyes, ears, nose, mouth, throat or head (e.g., visual
changes, eye pain/strain, nose bleeds, sinus
pain/infections, ringing in the ears, toothache, sore
throat, headache)
O
O
O
O
O
Cardiovascular (e.g., high blood pressure, high
cholesterol, coronary artery disease, heart attack,
angina)
O
O
O
O
O
Respiratory (e.g., chronic cough, wheezing, shortness
of breath, asthma)
O
O
O
O
O
Digestive (e.g., ulcers, acid reflux, irritable bowel
syndrome)
O
O
O
O
O
Reproductive or Urinary (e.g., infections, pain, loss of
bladder control)
O
O
O
O
O
Musculoskeletal (e.g., pain, stiffness, joint swelling,
arthritis)
O
O
O
O
O
Skin (e.g., rash, lesions, eczema)
O
O
O
O
O
Neurological (e.g., stroke, memory loss, weakness of
arm or leg, poor balance, speech problems)
O
O
O
O
O
Mental health (e.g., depression, anxiety, psychosis,
eating disorder)
O
O
O
O
O
Endocrine (gland) (e.g., thyroid, adrenal, hormonal)
O
O
O
O
O
Blood or Lymphatic (e.g., anemia, blood transfusions,
swelling)
O
O
O
O
O
Auto immune or Allergies (e.g., fibromyalgia, lupus,
anaphylaxis)
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Other (please specify below)
23. Over the past 12 months, approximately how many days were you hospitalized because of illness
or injury (exclude hospitalization for pregnancy and childbirth)?
days
24. Over the past 12 months, approximately how many days were you unable to work or perform your
usual activities because of illness or injury (exclude lost time for pregnancy and childbirth)?
days
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OMB CONTROL NUMBER: 0703-0064
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25. Are you TRICARE eligible?
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
2012 Survey of Reserve Component Spouses (RCSS)
O No
O Yes
26. In the past 3 years, where have you gone for medical care (e.g., medical, behavioral, mental)?
Mark all that apply.
□ Military Treatment Facility (MTF) or other military source
□ VA facility
□ Civilian Provider - TRICARE
□ Civilian Provider – Other
□ Public health centers (free or reduced cost care)
□ I did not use healthcare facilities/providers
□ Other
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OMB CONTROL NUMBER: 0703-0064
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RCS EXPIRATION DATE: XX/XX/XXXX
The section below appears only for female participants.
We would like to end this section by asking about pregnancy and fertility.
27. How old were you when your menstrual periods began?
O 9 or less
O 10
O 11
O 12
O 13
O 14
O 15
O 16
O 17 or more
28. Have you ever been pregnant?
O No SKIP to #30
O Yes
(If YES)
28a. How many times?
28b. Are you currently pregnant?
O No
O Yes
29. How many births (liveborn children or stillbirths) have you had?
Question appears if participant responded “Yes” to #28.
(If 0 SKIP to #30)
(If 1 or more)
29a. How old were you when you first gave birth?
years old
29b. Have you given birth within the last 3 years?
O No
O Yes
29c. How many months in total did you breastfeed (total for all children)?
O Less than 1 month
O 1-2 months
O 3-5 months
O 6-11 months
O 12 or more months
30. Have you ever used oral contraceptives (birth control pills)?
O No
O Yes
(If YES)
30a. Age when first used
years old
30b. Age when last used
years old
30c. How many years in total have you used birth control pills (exclude time periods
when you temporarily stopped)?
O Less than 1 year
O 1-2
O 3-4
O 5-9
O 10-19
O 20 or more
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OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
WELL-BEING
Now we would like to ask you about your mental well-being. These questions are about how you feel
and how things have been going over the last 4 weeks. Some of these questions will seem slightly
repetitive, but we assure you that they are actually different and each has a specific purpose.
Remember, there are no right or wrong answers.
B7. In the last 4 weeks, have you had an anxiety attack – suddenly feeling fear or panic?
O No
O Yes
PHQ
No
Yes
O
O
Do some of these attacks come suddenly out of the blue – that is, in
situations where you don’t expect to be nervous or uncomfortable?
O
O
Do these attacks bother you a lot, or are you worried about having
another attack?
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
(If YES)
Has this ever happened to you before?
Think about your last bad anxiety attack.
Were you short of breath?
Did your heart race, pound, or skip?
Did you have chest pain or pressure?
Did you sweat?
Did you feel as if you were choking?
Did you have hot flashes or chills?
Did you have nausea or an upset stomach, or the feeling that you were
going to have diarrhea?
Did you feel dizzy, unsteady, or faint?
Did you have tingling or numbness in parts of your body?
Did you tremble or shake?
Were you afraid you were dying?
B8. Over the last 4 weeks, how often have you been bothered by any of the following problems?
PHQ
Feeling nervous, anxious, on edge, or worrying a lot about
different things
Not
at all
Several
days
More than half
the days
O
O
O
The questions below only appear if participant selects “Several days” or “More than half the days”
Feeling restless so that it is hard to sit still
O
O
O
Getting tired very easily
O
O
O
Muscle tension, aches, or soreness
O
O
O
Trouble falling asleep or staying asleep
O
O
O
Trouble concentrating on things, such as reading a book or
watching TV
O
O
O
Becoming easily annoyed or irritable
O
O
O
Millennium Cohort Family Study: 2018 Baseline Survey
14
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
31. During the past 4 weeks, how much of the time have you had any of the following problems with
your work or other regular daily activities as a result of any emotional problems (such as feeling
depressed or anxious)?
No,
none of
the time
Yes,
a little of
the time
Yes,
some of the
time
Yes,
most of the
time
Yes,
all of the
time
Accomplished less than you would like
O
O
O
O
O
Didn't do work or other activities as
carefully as usual
O
O
O
O
O
SF-12
32. During the past 4 weeks, how much of the time…
SF-12
None of
the time
A little of
the time
Some of
the time
A good bit
of the time
Most of
the time
All of the
time
Have you felt calm and peaceful?
O
O
O
O
O
O
Did you have a lot of energy?
O
O
O
O
O
O
Have you felt downhearted and
blue?
O
O
O
O
O
O
33. How often in the past 4 weeks did you…
Never
One Time
Two
Times
Three or
four times
Five or
more times
Get angry at someone and yell or shout
at them
O
O
O
O
O
Get angry with someone and
kick/smash something, slam the door,
punch the wall, etc.
O
O
O
O
O
Get into a fight with someone and hit
the person
O
O
O
O
O
34. In the past 4 weeks, how often have you…
Perceived Stress Scale – 4 (PSS-4)
Never
Almost Never
Sometimes
Fairly Often
Very Often
Felt that you were unable to control the
important things in your life
O
O
O
O
O
Felt confident about your ability to handle
personal problems
O
O
O
O
O
Felt that things were going your way
O
O
O
O
O
Felt difficulties were piling up so high that
you could not overcome them
O
O
O
O
O
35. During the past 4 weeks, how much of the time has your physical health or emotional problems
interfered with your social activities (like visiting with friends, relatives)?
O None of the time
SF-12
O A little of the time
O Some of the time
O Most of the time
O All of the time
Millennium Cohort Family Study: 2018 Baseline Survey
15
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
36. Has a doctor or other health professional ever told you that you have any of the following
conditions?
If yes, in what year
were you first
diagnosed?
Mark here
if ever
hospitalized for
the condition *
Schizophrenia or psychosis
O No
O Yes
O
Depression
O No
O Yes
O
Manic-depressive disorder/bipolar disorder
O No
O Yes
O
Posttraumatic stress disorder
O No
O Yes
O
Eating disorder
O No
O Yes
O
* Hospitalized means that you were admitted to the hospital for treatment. Please do not check if you
went to the ER, but were not admitted to the hospital.
Millennium Cohort Family Study: 2018 Baseline Survey
16
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
Below is a list of problems and complaints that people sometimes have in response to stressful life
experiences. Some of these may not apply to you, however, please read each one carefully and mark
the answer that best reflects how much you have been bothered by each problem in the past month.
37. In the past month have you experienced…? PTSD Checklist (PCL-C/PCL-5)
Not at
all
A little
bit
Moderately
Quite a
bit
Extremely
Repeated, disturbing memories of stressful
experiences from the past
O
O
O
O
O
Repeated, disturbing dreams of stressful experiences
from the past
O
O
O
O
O
Suddenly acting or feeling as if stressful experiences
were happening again
O
O
O
O
O
Feeling very upset when something happened that
reminds you of stressful experiences from the past
O
O
O
O
O
Trouble remembering important parts of stressful
experiences from the past
O
O
O
O
O
Loss of interest in activities that you used to enjoy
O
O
O
O
O
Feeling distant or cut off from other people
O
O
O
O
O
Feeling emotionally numb, or being unable to have
loving feelings for those close to you
O
O
O
O
O
Feeling as if your future will somehow be cut short
O
O
O
O
O
Trouble falling asleep or staying asleep
O
O
O
O
O
Feeling irritable or having angry outbursts
O
O
O
O
O
Difficulty concentrating
O
O
O
O
O
Feeling "super-alert" or watchful or on guard
O
O
O
O
O
Feeling jumpy or easily startled
O
O
O
O
O
Physical reactions when something reminds you of
stressful experiences from the past
O
O
O
O
O
Efforts to avoid thinking about your stressful
experiences from the past or avoid having feelings
about them
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Efforts to avoid activities or situations because they
remind you of stressful experiences from the past
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)
Blaming yourself or someone else for a stressful
experience or what happened after it
Having strong negative feelings such as fear, horror,
anger, guilt, or shame
Trouble experiencing positive feelings (for example,
being unable to feel happiness or have loving feelings
for people close to you)
Taking too many risks or doing things that could
cause you harm
Millennium Cohort Family Study: 2018 Baseline Survey
17
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
Now we would like to ask you how you've been feeling in the last 2 weeks.
38. Over the last 2 weeks, how often have you been bothered by any of the following problems?
PHQ
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself - or that you are a failure or
have let yourself or your family down
Trouble concentrating on things, such as reading the
newspaper or watching television
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
Not at all
Several
days
More than
half the days
Nearly
every day
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
39. Over the last 2 weeks, how often have you been bothered by the following problems?
Generalized Anxiety Disorder - 7 (GAD-7)
Feeling nervous, anxious or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen
Not at all
Several
days
More than
half the days
Nearly
every day
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
40. Indicate the degree to which each statement describes your feelings or behavior.
Dimensions of Anger Reactions - 5 (DAR-5) Not at all
A little bit
Moderately
A lot
I often find myself getting angry at people
or situations
My anger prevents me from getting along with
people as well as I’d like to
Very much
O
O
O
O
O
O
O
O
O
O
B9. Do you often feel that you can’t control what or how much you eat? PHQ
O No
O Yes
B10. Do you often eat, within any 2 hour period, what most people would regard as an unusually large
amount of food?
PHQ
O No
O Yes
B11. Has this been as often, on average, as once a week for the last 3 months? PHQ
Question only seen if participant response “Yes” to either B9 or B10.
O No
O Yes
Millennium Cohort Family Study: 2018 Baseline Survey
18
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
SUPPORT AND COPING
We would now like to ask you some questions about your available social support
and how you cope with life's challenges.
41. Please indicate how you feel about each statement. Multidimensional Scale of Perceived Social Support
(MSPSS)
Very
Very
Strongly
Disagree
Strongly
Disagree
Mildly
Disagree
Neutral
Mildly
Agree
Strongly
Agree
Strongly
Agree
There is a special person who is
around when I am in need
O
O
O
O
O
O
O
There is a special person with
whom I can share my joys and
sorrows
O
O
O
O
O
O
O
My family really tries to help me
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
I get the emotional help and
support I need from my family
I have a special person who is a
real source of comfort to me
My friends really try to help me
I can count on my friends when
things go wrong
I can talk about my problems with
my family
I have friends with whom I can
share my joys and sorrows
There is a special person in my
life who cares about my feelings
My family is willing to help me
make decisions
I can talk about my problems with
my friends
42. Indicate the degree to which the follow statements are true in your life.
To a very
To a
To a
Post-Traumatic Growth Inventory (PTGI)
Not at all
I prioritize what is important in life
O
O
O
O
O
O
I have an appreciation for the value of
my own life
O
O
O
O
O
O
I am able to do good things with my life
O
O
O
O
O
O
I have an understanding of spiritual
matters
O
O
O
O
O
O
I have a sense of closeness with others
O
O
O
O
O
O
I have established a path for my life
O
O
O
O
O
O
I know that I can handle difficulties
O
O
O
O
O
O
I have religious faith
O
O
O
O
O
O
I’m stronger than I thought I was
O
O
O
O
O
O
I have learned a great deal about how
wonderful people are
O
O
O
O
O
O
I have compassion for others
O
O
O
O
O
O
Millennium Cohort Family Study: 2018 Baseline Survey
small
degree
moderate To a great
degree
degree
To a very
great
degree
small
degree
19
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
43. Please indicate your level of agreement with these statements: Self-Mastery Scale (SMS)
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
I have little control over the things that
happen to me
O
O
O
O
O
There is really no way I can solve
some of the problems I have
O
O
O
O
O
There is little I can do to change many
of the important things in my life
O
O
O
O
O
I often feel helpless in dealing with the
problems of life
O
O
O
O
O
Sometimes I feel that I am being
pushed around in life
O
O
O
O
O
What happens to me in the future
mostly depends on me
O
O
O
O
O
I can do just about anything I really set
my mind to do
O
O
O
O
O
44. In the last 3 years, how often have you received counseling/mental health services (including
visits for emotional, substance use, or family issues)?
O Never
O Once or twice
O 3-5 times
O 6-10 times
O 11 or more times
44a. You indicated you used counseling/mental health services in the last 3 years. Please
specify whether these were military or civilian services.
Question only appears if #44 is positively endorsed
O Military
O Civilian
O Both
44b. Were any of these visits in the past 12 months?
Question only appears if #44 is positively endorsed
O No
O Yes
45. In the past 3 years, about how often have you participated in any of the following community
groups or organizations?
Never
Once
or twice
Once a
month
Once a
week
More than
once a week
Church, synagogue, or other religious/spiritual
meetings/gatherings
O
O
O
O
O
Professional organizations (e.g., union/guild meetings,
professional conferences)
O
O
O
O
O
Social clubs or recreational groups (e.g.,
fraternities/sororities, Audubon society, travel club, etc.
O
O
O
O
O
Sports, hobby or special interest clubs (e.g., athletic
teams, book club, community theater, knitting circle)
O
O
O
O
O
Service or volunteer organizations/events (e.g., food
bank, local shelter, Kiwanis club, activist groups)
O
O
O
O
O
Educational events, meetings, or classes
O
O
O
O
O
Millennium Cohort Family Study: 2018 Baseline Survey
20
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
46. In the past 3 years, have you used any of the following sources of support to help you or your
family cope with difficult challenges or solve problems?
Yes
No
Online social networking (e.g., blogs, chat groups, Facebook)
O
O
In-person support groups (e.g., family readiness, military spouse, parenting support)
O
O
Self-help information (e.g., Combat Operational Stress Control website, WebMD, books,
downloadable apps)
O
O
Military OneSource
O
O
Non-profit agencies (e.g., Red Cross, Goodwill, Navy Marine Corps Relief Society)
O
O
Federal or State agencies (e.g., Child and Family Services, WIC)
O
O
Religious or spiritual leader (e.g., pastor, chaplain, rabbi)
O
O
Military family service center
O
O
(If “Military OneSource” is selected, the following question will appear)
46a. You indicated you used Military OneSource in the past 3 years. Specifically, did
you: (Mark all that apply)
□ Look at information on the website?
□ Contact the call center?
□ Receive non-medical counseling through their network?
(If “Online social networking”, “In-person support groups”, “Self-help information”, “Non-profit agencies”, or “Religious
or spiritual leader” is selected, the following question(s) will appear)
46b. You indicated you used the following services in the past 3 years. Please specify
whether these were military or civilian services.
(Auto-generates from selections above)
(Auto-generates from selections above)
Millennium Cohort Family Study: 2018 Baseline Survey
Military
Civilian
Both
O
O
O
O
O
O
21
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
LIFE EXPERIENCES
We are aware that many of these questions are quite personal, but we would appreciate your candid
response. We want to assure you that all your answers are strictly confidential.
47. Please indicate how you feel about the statement below. Satisfaction with Life Scale (SWLS)
I am satisfied with my life
Strongly
Disagree
O
Disagree
Slightly
Disagree
Neither
agree nor
disagree
Slightly
Agree
Agree
Strongly
Agree
O
O
O
O
O
O
48. Have you ever had any of the following life events happen to you?
If YES, did this
event occur in the
last 12 months?
Social Readjustment Rating Scale - Revised (SRRS-R)
You were fired or laid-off
O No
O Yes
O No
O Yes
You changed employers or careers
O No
O Yes
O No
O Yes
You or your partner had an unplanned pregnancy
O No
O Yes
O No
O Yes
You experienced infidelity or unfaithfulness in a committed relationship
O No
O Yes
O No
O Yes
You were divorced or separated
O No
O Yes
O No
O Yes
You suffered major financial problems (such as bankruptcy)
O No
O Yes
O No
O Yes
You suffered forced sexual relations or sexual assault
O No
O Yes
O No
O Yes
You experienced sexual harassment
O No
O Yes
O No
O Yes
You were stalked
O No
O Yes
O No
O Yes
You suffered a violent assault (e.g., hit, slapped, kicked)
O No
O Yes
O No
O Yes
You had a family member or loved one who became severely ill
O No
O Yes
O No
O Yes
You had a family member or loved one who died
O No
O Yes
O No
O Yes
You suffered a disabling illness or injury
O No
O Yes
O No
O Yes
You moved or changed primary residence more than once
O No
O Yes
O No
O Yes
You slept in a shelter, on the streets, or in another non-residential
setting
O No
O Yes
O No
O Yes
B12. How much of your childhood was spent growing up in a military family (in other words, your
parent(s) or guardian(s) served in the U.S. military)?
O None
O Less than 4 years
O 4-8 years
O 9-13 years
O 14 or more years
Millennium Cohort Family Study: 2018 Baseline Survey
22
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
B13. The next 8 items are about you when you were growing up, before you were 18 years old. Please
choose the one answer that best describes your experiences.
Adverse Childhood Experiences (ACE) Questionnaire
There was someone to take care of you and protect you
You felt loved
Never
true
Rarely
true
Sometimes
true
Often
true
Very often
true
O
O
O
O
O
O
O
O
O
O
Never
Once or
twice Sometimes Often
Very often
How often did a parent or adult living in your home swear at
you, insult you, or put you down?
O
O
O
O
O
How often did a parent or other adult living in your home
push, grab, shove, slap, or throw something at you?
O
O
O
O
O
How often did a parent or other adult living in your home
push, grab, shove, slap, or throw something at each other?
O
O
O
O
O
How often did an adult ever touch you sexually or try to
make you touch them sexually?
O
O
O
O
O
Did you live with someone who was depressed or mentally ill?
O No
O Yes
Did you live with someone who was a problem drinker or alcoholic?
O No
O Yes
49. Since you were 18 years old, how often have you had unwanted experiences where a person(s)
sexually touched you (e.g., intentional touching of genitalia, breasts, or buttocks), made you
sexually touch them, attempted to or actually made you have sexual intercourse/oral or anal sex
(or sexual penetration with finger/object) without your consent?
O Never
O Once
O Twice
O A few times
O Many times
Sexual Experiences Survey (SES)
DMDC Workplace and Gender Relations Survey
Pop-up message: Your individual answers on this survey are confidential and will not be reported to anyone outside
the Family Study team. If you have experienced any of these situations, please consider calling the toll-free National
Sexual Assault Hotline at 1-800-656-HOPE (4673) or visiting https://rainn.org/.
(If participant indicated “Yes” to #48 item “You suffered forced sexual relations or sexual assault” OR “Once,” “Twice,” “A few times,”
or “Many times” to #49, then #49a-49e appear)
Please think about the situation(s) where you had unwanted sexual experience(s) or experienced
forced sexual relations since you were 18 years old; answer the following questions about the
one event that had the greatest effect on you.
49a. How old were you when your most impactful unwanted sexual experience happened?
years old
49b. During your most impactful unwanted sexual experience, did the offender(s) do any of
the following to you without your consent?
Yes
No
O
O
O
O
O
O
Attempted to make you perform or receive oral sex, anal sex, or penetration by a finger or
object, but was not successful?
O
O
Made you perform or receive oral sex, anal sex, or penetration by a finger or object?
O
O
Sexually touch you (e.g., intentional touching of genitalia, breasts, or buttocks) or made
you sexually touch them but did not attempt to have intercourse with you?
Attempted to make you have sexual intercourse, but was not successful?
Made you have sexual intercourse?
Millennium Cohort Family Study: 2018 Baseline Survey
23
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
49c. During this experience, did the offender(s):
Yes
No
O
O
O
O
Take advantage of you when you couldn’t defend yourself (e.g., too drunk/high or asleep)?
Use physical force/violence, or threaten you/someone close to you with physical harm?
49d. At the time of this experience, were any of the following true?
Yes
No
The offender(s) was your spouse or a romantic/sexual partner you knew well
O
O
The offender(s) was/were Active duty or Reserve/Guard military member(s) other than
your spouse
O
O
O
O
O
O
O
O
The offender(s) was/were in your spouse’s – or your own – military chain of command
You were a military dependent or a military member yourself at the time of the experience
You were a military Service member at the time of the experience
49e. After this experience, did you ever:
Talk with a friend, family member, or co-worker about what happened?
Report what happened to a civilian authority or advocate (civilian law enforcement,
counselor, community support center)?
Report what happened to a military authority or a military advocate (e.g., Sexual Assault
Prevention and Response victim advocate, legal advocate, Family Advocacy Program)?
Millennium Cohort Family Study: 2018 Baseline Survey
Yes
No
O
O
O
O
O
O
24
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
YOUR ALCOHOL USE
Alcoholic beverages include beer, wine, and liquor (such as whiskey, gin, etc.).
For the purpose of this questionnaire:
One drink = one 12-ounce beer, one 4-ounce glass of wine, or one 1.5-ounce shot of liquor
B14. In your entire life, have you had at least 12 drinks of any type of alcoholic beverage?
O No SKIP to Your Tobacco Use section
O Yes
50. In the past year, how often did you typically drink any type of alcoholic beverage?
O Never SKIP to #54 (CAGE Questionnaire)
O Rarely
O Monthly
O Weekly
O Daily
50a. Last week, how many drinks of alcoholic beverages did you have? (# of drinks)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
51. In the past year, how often did you typically have 5 or more drinks of alcoholic beverages within a
2-hour period? Question only asked if participant is MALE
O Never
O Monthly or less
O 2-4 times per month
O More than 4 times per month
52. In the past year, how often did you typically have 4 or more drinks of alcoholic beverages within a
2-hour period? Question only asked if participant is FEMALE
O Never
O Monthly or less
O 2-4 times per month
O More than 4 times per month
53. In the last 12 months, have any of the following happened to you more than once? PHQ
No
Yes
You drank alcohol even though a doctor suggested that you stop drinking because of a
problem with your health
O
O
You drank alcohol, were high from alcohol, or hung over while you were working, going
to school, or taking care of children or other responsibilities
O
O
You missed or were late for work, school, or other activities because you were drinking
or hung over
O
O
O
O
O
O
No
Yes
O
O
O
O
O
O
O
O
You had a problem getting along with people while you were drinking
You drove a car after having several drinks or after drinking too much
54. Have you ever felt any of the following?
CAGE Questionnaire
Felt you needed to cut back on your drinking
Felt annoyed at anyone who suggested you cut back on your drinking
Felt you needed an "eye-opener" or early morning drink
Felt guilty about your drinking
Millennium Cohort Family Study: 2018 Baseline Survey
25
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
YOUR TOBACCO USE
55. In the past year, have you used any of the following tobacco/nicotine products?
No
Yes
Cigarettes (smoke)
O
O
Electronic cigarettes or vape
O
O
Cigars
O
O
Pipes
O
O
Smokeless tobacco (chew, dip, snuff)
O
O
56. In your lifetime, have you smoked at least 100 cigarettes (5 packs)?
O No SKIP to Your Sleep Quality section
O Yes
B15. At what age did you start smoking?
years old
56a. How many years have or did you smoke an average of at least 3 cigarettes per
day (or one pack per week)?
years
56b. When smoking, how many packs per day did you or do you smoke?
O Less than half a pack per day
O Half to 1 pack per day
O 1 to 2 packs per day
O More than 2 packs per day
56c. Have you ever tried to quit smoking?
O Yes, and succeeded
O Yes, but not successfully
O No
57. Do you now smoke cigarettes every day, some days, or not at all?
Question only appears if participant selects “Yes” for “Cigarettes (smoke)” in #55
O Every day
O Some days
O Not at all
58. Do you now smoke e-cigarettes or vape every day, some days, or not at all?
Question only appears if participant selects “Yes” for “Electronic cigarettes or vape” in #55
O Every day
O Some days
O Not at all
Millennium Cohort Family Study: 2018 Baseline Survey
26
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
YOUR SLEEP QUALITY
Even if you are pregnant or have a newborn that is disturbing your sleep, please answer the questions
by reflecting on your current sleep pattern.
59. Over the past month, how many hours of sleep did you get in an average 24-hour period?
hours
60. Please rate your sleep pattern for the past 2 weeks. Insomnia Severity Index (ISI)
Difficulty falling asleep
Difficulty staying asleep
Problem waking up too early
Snoring
None
Mild
Moderate
Severe
Very severe
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
61. How would you rate your current sleep pattern (e.g., the way you fall asleep, your ability to stay
asleep, the way you wake up in the morning)? ISI
Very satisfied
1
2
3
4
Very dissatisfied
5
O
O
O
O
O
62. To what extent do you consider your sleep pattern to interfere with your daily functioning
(daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.)?
O Not at all interfering
O A little
O Somewhat
O Much
O Very much interfering
ISI
63. How noticeable to others do you think your sleep pattern is in terms of impairing the quality of
your life?
ISI
O Not at all noticeable
O Barely
O Somewhat
O Much
O Very much noticeable
64. How worried/distressed are you about your current sleep pattern?
O Not at all
ISI
O A little
O Somewhat
O Much
O Very much
Millennium Cohort Family Study: 2018 Baseline Survey
27
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
EXERCISE
Now we’re going to ask you some questions about your exercise habits.
We realize that some participants may be pregnant, injured, or suffering from an illness when they
take the survey, so please think about your exercise habits in a typical week.
65. In a typical week, how much time do you spend participating in…
(Please mark both your typical “days per week” and “minutes per day” doing these activities)
On those days,
how many
minutes per
day on average
do you exercise
# of days
per week
you
exercise
Strength Training or work that
strengthens your muscles (such as
lifting/pushing/pulling weights)?
Vigorous exercise or work that causes
heavy sweating or large increases in
breathing or heart rate (such as running,
active sports, biking)?
Moderate or Light exercise or work that
causes light sweating or slight increases
in breathing or heart rate (such as
walking, cleaning, slow jogging)?
days
days
days
Millennium Cohort Family Study: 2018 Baseline Survey
AND
AND
AND
minutes
minutes
minutes
OR
O None
O Cannot physically do
OR
O None
O Cannot physically do
OR
O None
O Cannot physically do
28
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
YOUR MILITARY SERVICE
This section is skipped if participant responded “No” to #8 “Have you ever served in the US military?”
66. Are you currently serving in the US military?
O Yes, Regular Active Duty (not a member of the National Guard or Reserve)
O Yes, Activated National Guard or Reserve (full-time Active Duty program: AGR/FTS/AR)
O Yes, Traditional National Guard or Reserve (e.g., drilling unit, IMA, IPR)
O No Continue to #67. If Service member is also not currently in the military, then SKIP Military Life section
66a. (If YES) What is your overall feeling about your military service?
O Negative
O Somewhat negative
O Neither negative or positive
O Somewhat positive
O Positive
67. Since 2001, how often have you experienced the following during deployment?
Never
1 time
More than
1 time
O
O
O
2 0
Being attacked or ambushed
O
O
O
2 0
Receiving small arms fire
O
O
O
2 0
Clearing/searching homes or buildings
O
O
O
2 0
Having an improvised explosive device (IED) or
booby trap explode near you
O
O
O
2 0
Being wounded or injured
O
O
O
2 0
Seeing dead bodies or human remains
O
O
O
2 0
Handling or uncovering human remains
O
O
O
2 0
Knowing someone seriously injured or killed
O
O
O
2 0
Seeing Americans who were seriously injured or
killed
O
O
O
2 0
Having a member of your unit be seriously
injured or killed
O
O
O
2 0
Being directly responsible for the death of enemy
combatant
O
O
O
2 0
Being directly responsible for the death of a noncombatant
O
O
O
2 0
Feeling that you were in great danger of being
killed
Millennium Cohort Family Study: 2018 Baseline Survey
List most recent
year of exposure
29
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
EDUCATION AND EMPLOYMENT
68. What is the highest level of education that you have completed? (Choose the single best answer.)
O Less than high school completion/diploma
O High school degree/GED/or equivalent
O Some college, no degree
O Associate’s degree
O Bachelor's degree
O Master's, doctorate, or professional degree
69. Are you currently a student?
O No
O Yes, full-time
O Yes, part-time
70. Which of the following best describes your current employment status? (Choose the single best
answer.)
O Full-time work (greater than or equal to 30 hours per week)
O Part-time work (less than 30 hours per week)
O Homemaker
O Not employed, looking for work
O Not employed, not looking for work
O Not employed, retired
O Not employed, disabled
O Other (please specify):
(If “Full-time work”, “Part-time work”, or “Homemaker”)
70a. How satisfying is your current employment?
Not
satisfying
1
2
3
4
5
6
Extremely
satisfying
7
O
O
O
O
O
O
O
71. How long did it take you to find employment after your last permanent change of station (PCS)?
O Not Applicable
O Less than 1 month
O 1 to 4 months
O 5 to 8 months
O 9 months to 1 year
O More than 1 year
Millennium Cohort Family Study: 2018 Baseline Survey
30
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
72. What is your total annual household income? Please include Basic Allowance for Housing (BAH),
even if you live in base housing, and any other regular income that your family receives.
O Less than $25,000
O $25,000-$49,999
O $50,000-$74,999
O $75,000-$99,999
O $100,000-$124,999
O $125,000-$149,999
O $150,000 or more
73. Which best describes the financial condition of you and your family?
O Very comfortable and secure
O Able to make ends meet without much difficulty
O Occasionally have some difficulty making ends meet
O Tough to make ends meet but keeping our heads above water
O In over our heads
Millennium Cohort Family Study: 2018 Baseline Survey
31
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
RELATIONSHIP WITH SPOUSE
This section is only seen if participant indicated “Currently Married” or “Separated” in #3.
In order to better understand how military life affects families, this
next section asks you questions about your relationship with your spouse.
Once again, we'd like to remind you that all your answers are strictly confidential.
74. Taking all things together, how would you describe your marriage?
Very
unhappy
1
2
3
4
5
6
Very
happy
7
O
O
O
O
O
O
O
75. Please rate the following statements about your relationship with your spouse:
Quality of Marriage Index (QMI)
Strongly
disagree
Disagree
Neither
agree nor
disagree
Agree
Strongly
agree
I have a good marriage
O
O
O
O
O
My relationship with my spouse is very stable
O
O
O
O
O
I really feel like part of a team with my spouse
O
O
O
O
O
76. How happy are you with each of the following aspects of your marriage?
Very
unhappy
1
2
3
4
5
6
Very
happy
7
The understanding you receive from
your spouse
O
O
O
O
O
O
O
The love and affection you get from
your spouse
O
O
O
O
O
O
O
The amount of time you spend with
your spouse
O
O
O
O
O
O
O
The demands your spouse places on
you
O
O
O
O
O
O
O
Your sexual relationship
O
O
O
O
O
O
O
The way your spouse spends money
O
O
O
O
O
O
O
The work your spouse does around the
house
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Your spouse as a parent
SKIP if no children
77. Please rate the following statement about your relationship with : Dyadic Trust Scale (DTS)
I feel that I can trust my partner
completely.
Strongly
disagree
Disagree
Moderat
ely
disagree
O
O
O
Millennium Cohort Family Study: 2018 Baseline Survey
Neither
agree
nor
disagree
Moderat
ely
agree
Agree
Strongly
agree
O
O
O
O
32
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
78. Please select the picture that best illustrates your current relationship with .
Inclusion of Other in Self (IOS) Scale
79. In the last year, have you or seriously suggested the idea of divorce or permanent
separation?
Question only seen if participant reported being “Currently Married” in #3
O No
O Yes
80. Have you and ever received marital counseling?
O Never
O Once or twice
O 3-5 times
O 6-10 times
O 11 or more times
81. In your opinion, does consume too much alcohol in a typical week when he/she is at
home (or if is currently deployed, please refer to the most recent month was
home)?
O No
O Yes
Sometimes in close relationships, people do or say things that are hurtful during a disagreement or in
a difficult situation. In the next series of questions, please tell us if something like this ever happens
in your relationship.
82. Over the last 12 months, how often did : HITS (Hit/Insult/Threaten/Scream) VA Screener
Never
1
2
3
4
Frequently
5
Insult you or talk down to you?
O
O
O
O
O
Scream or curse at you?
O
O
O
O
O
Threaten you with harm?
O
O
O
O
O
Physically hurt you?
O
O
O
O
O
Pop-up message: If you are experiencing physical or emotional abuse from your spouse, please consider calling the
toll-free National Domestic Violence Hotline at 1-800-799-SAFE (7233) or visiting http://www.hotline.org/.
Millennium Cohort Family Study: 2018 Baseline Survey
33
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
83. Over the last 12 months, how often did you:
Never
1
2
3
4
Frequently
5
Insult or talk down to your spouse?
O
O
O
O
O
Scream or curse at your spouse?
O
O
O
O
O
Threaten your spouse with harm?
O
O
O
O
O
Physically hurt your spouse?
O
O
O
O
O
84. Please rate how frequently you use each of the following styles to deal with arguments or
disagreements with .
Never
1
2
3
4
Always
5
Launching personal attacks
O
O
O
O
O
Focusing on the problem at hand
O
O
O
O
O
Remaining silent for long periods of time
O
O
O
O
O
Not being willing to stick up for myself
O
O
O
O
O
Exploding and getting out of control
O
O
O
O
O
Sitting down and discussing differences constructively
O
O
O
O
O
Reaching a limit, “shutting down”, refusing to talk anymore
O
O
O
O
O
Being too compliant
O
O
O
O
O
Getting carried away and saying things that aren’t meant
O
O
O
O
O
Finding alternatives that are acceptable to each of us
O
O
O
O
O
Tuning the other person out
O
O
O
O
O
Not defending my position
O
O
O
O
O
Throwing insults and digs
O
O
O
O
O
Negotiating and compromising
O
O
O
O
O
Withdrawing, acting distant and not interested
O
O
O
O
O
Giving in with little attempt to present my side of the issue
O
O
O
O
O
Conflict Resolution Style Inventory
Millennium Cohort Family Study: 2018 Baseline Survey
34
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
RELATIONSHIP WITH SPOUSE AFTER DIVORCE
This section is only seen if participant indicated “Divorced” in #3.
In order to better understand how military life affects families, this
next section asks you questions about your relationship with your spouse after your divorce.
Once again, we'd like to remind you that all your answers are strictly confidential.
85. Please select the picture that best illustrates your current relationship with .
IOS Scale
86. Did you and ever receive marital counseling?
O Never
O Once or twice
O 3-5 times
O 6-10 times
O 11 or more times
87. In your opinion, does consume too much alcohol in a typical week when he/she is at
home (or if is currently deployed, please refer to the most recent month was
home)?
O No
O Yes
88. Please indicate the extent to which each of the following reasons contributed to your divorce.
Lack of communication
Too much conflict and arguing
Lack of equality in the relationship
Financial problems
Religious differences
Alcohol or drug abuse
Domestic violence/abuse
Physical or mental health problems
Sexual problems
Infidelity or extramarital affairs
My spouse worked too many hours
How we divided household and/or child care
responsibilities
Differences over raising our children
Other:
Millennium Cohort Family Study: 2018 Baseline Survey
Not at all
Small
extent
Moderate
extent
Large
extent
Very large
extent
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
35
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
89. During the past year, how often have you had any contact with by phone, mail, email or
by visits?
O Not at all
O About once a year
O Several times a year
O One to three times a month
O About once a week
O More than once a week
90. How would you describe your current relationship with ?
O Very unfriendly
O Somewhat unfriendly
O Neither unfriendly nor friendly
O Somewhat friendly
O Very friendly
O Ex-spouse is deceased
O No contact with ex-spouse
Millennium Cohort Family Study: 2018 Baseline Survey
36
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
YOUR FAMILY
This section is only seen if participant indicated “Currently Married” or “Separated” in #3.
91. Please rate the following statements regarding ’s current job(s). Work-Family Conflict Scale
Disagree
Neither
agree nor
disagree
Agree
Strongly
agree
Not
applicable
O
O
O
O
O
O
The amount of time my spouse's job
takes up makes it difficult for him/her to
fulfill family responsibilities
O
O
O
O
O
O
My spouse's job produces stress/strain
that makes it difficult for him/her to fulfill
family responsibilities
O
O
O
O
O
O
My spouse's job produces stress/strain
that makes it difficult for me to fulfill
family responsibilities
O
O
O
O
O
O
Frequent TDY/TAD (training duty)
interferes with our home and family life
O
O
O
O
O
O
Strongly
disagree
The demands of my spouse's work
interfere with our home and family life
92. Please rate the following statements in regard to your family, including you, , and your
children (if applicable).
Family Adaptability and Cohesion Scale - IV Strongly
Generally
Generally
Strongly
(FACES IV)
disagree
disagree
Undecided
agree
agree
Family members are satisfied with how
they communicate with each other
O
O
O
O
O
Family members are very good listeners
O
O
O
O
O
Family members express affection to
each other
O
O
O
O
O
Family members are able to ask each
other for what they want
O
O
O
O
O
Family members can calmly discuss
problems with each other
O
O
O
O
O
Family members discuss their ideas and
beliefs with each other
O
O
O
O
O
When family members ask questions of
each other, they get honest answers
O
O
O
O
O
Family members try to understand each
other's feelings
O
O
O
O
O
When angry, family members seldom
say negative things about each other
O
O
O
O
O
Family members express their true
feelings to each other
O
O
O
O
O
Millennium Cohort Family Study: 2018 Baseline Survey
37
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
93. How satisfied are you with: Family Adaptability and Cohesion Scale - IV (FACES IV)
Very
dissatisfied
Somewhat
dissatisfied
Generally
satisfied
Very
satisfied
Extremely
satisfied
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Your family's ability to resolve conflicts
O
O
O
O
O
The amount of time you spend together
as a family
O
O
O
O
O
The way problems are discussed
O
O
O
O
O
The fairness of criticism in your family
O
O
O
O
O
Family members' concern for each other
O
O
O
O
O
The degree of closeness between family
members
Your family's ability to cope with stress
Your family's ability to be flexible
Your family's ability to share positive
experiences
The quality of communication between
family members
94. In the last 12 months, have you provided unpaid care to any of the following people because of a
special medical need (e.g., illness, injury, or emotional/behavioral problem)?
Spouse
Child(ren)
Other relative
Non-relative
No
Yes
O
O
O
O
O
O
O
O
If “Yes” to any of the above:
94a. How physically stressful would you say providing this care is/was for you?
O Not at all stressful
O Slightly stressful
O Moderately stressful
O Very stressful
94b. How emotionally stressful would you say providing this care is/was for you?
O Not at all stressful
O Slightly stressful
O Moderately stressful
O Very stressful
94c. How financially stressful would you say providing this care is/was for you?
O Not at all stressful
O Slightly stressful
O Moderately stressful
O Very stressful
If “Yes” to Spouse:
94d. Is/was your spouse’s special need a result of a combat-related injury?
O No
O Yes
95. Is your family enrolled in the Exceptional Family Member Program (EFMP)?
Question only appears for Active Duty families (participant and/or spouse is Active Duty)
O Does not apply, no special medical/educational needs for my family
O Yes
O No
Millennium Cohort Family Study: 2018 Baseline Survey
2012 Active Duty Spouse Survey
(ADSS)
38
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
PARENTING
This section is only seen if reported having children in #9 and did not report being “Widowed” in #3.
96. The questions listed below concern what happens between you and . While you may not
find an answer which exactly describes what you think, please mark the answer that comes
closest to what you think. Your first reaction should be your first answer.
Parenting Alliance Inventory (PAI)
Strongly
agree
Agree
Not sure
Disagree
Strongly
disagree
is willing to make personal
sacrifices to help take care of our child(ren)
O
O
O
O
O
pays a great deal of attention to
our child(ren)
O
O
O
O
O
knows how to handle children well
O
O
O
O
O
and I are a good team
O
O
O
O
O
makes my job of being a parent
easier
O
O
O
O
O
97. In general, how well do you feel you are coping with the day-to-day demands of
parenthood/raising children?
O Very well
O Somewhat well
O Fair
O Poorly
O Very poorly
98. In the last year, how often have you done any of the following things for your child(ren)?
NIDCR/ NIDA Child Neglect Study
Never
Sometimes
Frequently
Always
Kissed, hugged, or told your child(ren) that you loved
them
O
O
O
O
Paid attention to your child(ren) when they were upset
or crying
O
O
O
O
Done things with your child(ren) that were fun and
interesting to them
O
O
O
O
Helped your child(ren) learn something new, look at
books/read, or do schoolwork
O
O
O
O
Planned and/or monitored what your child(ren) eat to be
sure they have a healthy diet
O
O
O
O
Taken your child(ren) to a medical provider or dentist
for regular check-ups
O
O
O
O
Made sure there was an adult around to supervise or
help your child(ren) when needed
O
O
O
O
Millennium Cohort Family Study: 2018 Baseline Survey
39
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
DEPLOYMENT
Now, we would like to ask you some questions regarding the deployment experience.
If participant indicated that they are “Separated” or “Divorced” in #3, then they will receive the following caution before
completing SPOUSE’S DEPLOYMENT, RETURN AND REUNION, and MILITARY LIFE sections:
It is very important to understand the health and well-being of spouses and children after a
change in marital status. We have attempted to make the questions in this survey apply to
everyone, but if you feel that a question doesn’t apply to your situation, please feel free to skip
that question.
99. Since 2001, has been deployed for more than 30 days?
O No SKIP to Military Life section
O Yes
O I don’t know SKIP to Military Life section
100. How stressful was your spouse’s most recent deployment for you?
O Not at all stressful
O Slightly stressful
O Moderately stressful
O Very stressful
101. Is currently deployed?
O No
O Yes
O I don’t know
(If “YES”)
101a. Has deployed previously?
O Yes
O No SKIP to Military Life section
102. How much has shared his/her deployment experiences with you from his/her last
completed deployment?
O None
O A little
O Somewhat
O A lot
103. To what degree were/are you bothered by the deployment experiences shared with you?
O Not applicable; my spouse has not shared any experiences with me
O Not at all
O A little bit
O Moderately
O Quite a bit
O Extremely
Millennium Cohort Family Study: 2018 Baseline Survey
40
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
104. How often did you communicate with during his/her last completed deployment?
O Almost daily
O Every few days
O About once a week
O About once or twice a month
O Less than once a month
B16. If there were no limit to how often you could communicate with while deployed, how often
would you have chosen?
O Almost daily
O Every few days
O About once a week
O About once or twice a month
O Less than once a month
105. During ’s last completed deployment, how satisfied were you with his/her access to
communication?
Very dissatisfied
1
2
3
4
Very satisfied
5
O
O
O
O
O
106. Overall, when you communicated with during his/her last completed deployment, how
satisfied were you with your ability to support each other (connect emotionally and/or
spiritually)?
Very dissatisfied
1
2
3
4
Very satisfied
5
O
O
O
O
O
107. Please estimate how much advance notification you had before left for his/her last
completed deployment.
O 24 hours or less
O Less than 1 week
O Less than 1 month
O Less than 3 months
O 3-6 months
O More than 6 months
108. In your opinion, what was the level of danger to during his/her last completed deployment?
Very little danger
1
2
3
4
Extreme danger
5
O
O
O
O
O
109. Was ’s last completed deployment extended beyond what you originally expected?
O No, not extended
O Yes, extended less than 2 weeks
O Yes, extended between 2 weeks and 2 months
O Yes, extended more than 2 months
Millennium Cohort Family Study: 2018 Baseline Survey
41
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
110. During ’s last completed deployment, how satisfied were you with the emotional/social
support you received from family, friends, and your community?
O Very dissatisfied
O Somewhat satisfied
O Generally satisfied
O Very satisfied
O Extremely satisfied
111. Which best describes your permanent household situation during ’s last completed
deployment?
O Military housing, on base
O Military housing, off base
O Civilian housing
112. During ’s last completed deployment, did you voluntarily relocate or have someone
relocate to live with you for more than 30 days for any of the following reasons? Mark all that
apply.
□ No, did not relocate
□ Yes, needed child care
□ Yes, better job opportunities
□ Yes, better educational opportunities
□ Yes, financial problems (making ends meet)
□ Yes, wanted to be near relatives/friends
□ Yes, lack of support at location you moved from
□ Yes, personal safety/security
□ Yes, for other reasons:
113. When do you expect ’s next deployment?
O Does not apply, I do not expect my spouse to be deployed
O Within 3 months
O In 4-6 months
O In 7-9 months
O In 10-12 months
O In 13-18 months
O In 19-24 months
O In more than 24 months
Millennium Cohort Family Study: 2018 Baseline Survey
42
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
DEPLOYMENT RETURN AND REUNION
This section is only seen if participant responded “Yes” to #99.
The deployment return and reunion process can often be challenging.
The next few questions refer to these experiences.
114. Following ’s last completed deployment, please rate the following statement:
The process of reunion/reintegration was stressful.
O Strongly disagree
O Disagree
O Neither agree nor disagree
O Agree
O Strongly agree
O Does not apply
115. Please choose the best answer regarding ’s last completed deployment.
How long did it take for you to adjust to your spouse's
return from being away from home?
How long did it take for your spouse to adjust to
his/her return home?
How long did it take for your children to adjust to
his/her return home?
Less
than one
month
1-2
months
3-5
months
6
months
or more
Not yet
adjusted
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
SKIP if no children currently residing in home
Millennium Cohort Family Study: 2018 Baseline Survey
43
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
MILITARY LIFE
This section is only seen if:
- Participant reported “Currently Married” in #3 AND reported MilCo spouse is in the military in #4
- Participant reported “Separated”/”Divorced” within past year AND MilCo spouse is in the military
- Participant positively endorsed #8 “Have you ever served in the US military?”
Now, we'd like to ask you some questions about the stress of military life
and the military's efforts to help you and your family deal with those stressors.
116. In the past 3 years, have you and your family had any of the following experiences?
If YES, did this
event occur in the
last 12 months?
Problem in military career (e.g., demotion, poor fitness report, passed
over for promotion, etc.)
O No O Yes
O No
O Yes
Unexpected change in military duty station assignment
O No O Yes
O No
O Yes
Potentially dangerous job assignment (not during deployment)
O No O Yes
O No
O Yes
Non-combat injury as result of military duties
O No O Yes
O No
O Yes
Inability to get military support services for you or your family (e.g., family
service center program, military installation housing, military child care)
O No O Yes
O No
O Yes
Foreign residence (e.g., OCONUS, overseas) for you and your family
O No O Yes
O No
O Yes
Remote residence (rural CONUS area or location with no local military
installation) for you and your family
O No O Yes
O No
O Yes
Unaccompanied tour
O No O Yes
O No
O Yes
Unit leadership raised the possibility of forced downsizing or forced
restructuring
O No O Yes
O No
O Yes
Scheduled call to active duty from reserve status
O No O Yes
O No
O Yes
Unscheduled call to active duty from reserve status
O No O Yes
O No
O Yes
(The following are only seen if MilCo or Family participant is in the Reserves):
117. In the past 3 years, have you experienced any of the following due to conflicts between military
duties and civilian employment?
Question only appears for participants in Reserve families.
Financial difficulties
Employment problems
Disruption in healthcare coverage
Yes
No
O
O
O
O
O
O
118. Do you think should stay in or leave the military?
Question is only seen if indicated spouse is currently in the military in #4.
O I strongly favor staying
O I somewhat favor staying
O I have no opinion one way or the other
O I somewhat favor leaving
O I strongly favor leaving
119. How did you feel about leaving the military?
Question is only seen if indicated spouse is NOT currently in the military in #4.
O I strongly favored staying
O I somewhat favored staying
O I had no opinion one way or the other
O I somewhat favored leaving
O I strongly favored leaving
Millennium Cohort Family Study: 2018 Baseline Survey
44
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
120. Overall, how would you rate the military's efforts to help your family deal with the stresses of
military life?
O Excellent
O Very good
O Good
O Fair
O Poor
121. Please indicate to what extent you feel being a military spouse has impacted the following ADSS
aspects of your life:
Question set is NOT seen if dual military dyad (both MilCo and Family participants have served in the military).
Positive
impact
Neither
negative
nor positive
impact
Negative
impact
Very
negative
impact
Not
applicable
O
O
O
O
O
O
Education development
O
O
O
O
O
O
Access to health care for self and family
O
O
O
O
O
O
Access to child care
O
O
O
O
O
O
Overall financial stability
O
O
O
O
O
O
Recreation, travel and entertainment
activities
O
O
O
O
O
O
Very
positive
impact
Career development
122. What is your overall feeling about military life?
O Negative
O Somewhat negative
O Neither negative nor positive
O Somewhat positive
O Positive
123. In the last 3 years, how many times have you experienced a permanent change of station (PCS)
move?
times
(If 1 time or more)
124a. When was your most recent PCS?
O Within the last 12 months
O Within the last 3 years
O More than 3 years ago
124. Which best describes where you currently live?
O Military housing, on base
O Military housing, off base
O Civilian housing
Millennium Cohort Family Study: 2018 Baseline Survey
45
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
YOUR CHILDREN
This section is only seen by participants who reported having children between ages 3 and 17.
Now we would like to ask you about your children. We realize that these questions are sensitive, but it
is important to answer them as accurately as you can. Your answers will provide insight into how
families and children are coping with military life and deployment. If you feel your child needs medical
care or counseling, you should make contact with the appropriate medical personnel.
125. Please answer the following questions for each of your children who are 17 years old or younger.
Relationship
to you
Your ##-year old
(## = Age
autopopulated
from #10
response)
Your ##-year old (## = Age
Dropdown
options:
- Biological
- Adopted
- Stepchild
- Foster
autopopulated
from #10
response)
Has this child
ever lived in the
same
household as
?
Dropdown
options:
- No SKIP to
next section,
except if
participant
served in military
in last 3 years
- Yes
How many years
has this child
lived in the same
household as
for the
majority of the
year?
Please
provide the
date of birth
for this child.
Dropdown options:
- Less than 1
-2
-3
-…
- 17
MM
Please
provide
the gender
of this
child.
O Male
O Female
DD
YY
-
The remainder of the questions in this section will only be asked about children who participant indicates have
lived in the same household as MilCo spouse.
-
If participant indicates that none of their children ever shared a household with the MilCo spouse, they will skip to
the next section (skip the rest of Your Children section), EXCEPT if the participant reported serving in the military
in the last 3 years, in which case all remaining questions will be seen.
Millennium Cohort Family Study: 2018 Baseline Survey
46
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
126. In the last 3 years, where has/have your child(ren) 17 or younger gone for healthcare (medical,
behavioral, mental)? Mark all that apply.
□ Military Treatment Facility (MTF)
□ Civilian Provider - TRICARE
□ Civilian Provider – Other
□ Public health centers (free or reduced cost care)
□ My child(ren) did not use healthcare facilities/providers
127. How often do you use each of the following types of child services/programs in a typical week?
None
Once a
week
Twice a
week
3 to 4 days
a week
5 or more
days a week
O
O
O
O
O
O
O
O
O
O
Civilian child care center or other certified program
(e.g., YMCA, certified home-based provider)
O
O
O
O
O
Informal care (e.g., babysitter, relatives, friends)
O
O
O
O
O
Character development and leadership
development programs
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Military child care program (e.g., Child
Development Center – CDC, Family Child Care –
FCC)
Civilian school-based program (e.g., after-school
program)
Education support and career development
programs
Health and life skills programs
Art programs
Sports, fitness and recreation programs
128. Which of the following describes your overall experience with obtaining child care?
O Not applicable, I do not use child care
O Very easy
O Somewhat easy
O Neither difficult nor easy
O Somewhat difficult
O Very difficult
129. To best understand the dynamics of health care utilization and the needs of Service members and
their families, are you willing to allow us to link your survey data to DoD medical records of any
children you may have that are 17 or younger?
Question only appears if participant did not previously answer this question on 2014-2015 survey.
O No
O Yes
Millennium Cohort Family Study: 2018 Baseline Survey
47
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
Please answer the following questions for your XX-year old
#130-#137 are asked for one child under 18 that has been auto-selected based on closest DOB to that of the Service member AND was
indicated to have shared a household with MilCo Service member.
Strengths and Difficulties
“XX” – Age for each child is auto-populated from #10.
Questionnaire (SDQ)
130. For your child born on XX/XX/XX, please provide your answers on the basis of his/her behavior
in the past month.
Considerate of other people’s feelings
Restless, overactive, cannot stay still for long
Often complains of headaches, stomach-aches or sickness
Shares readily with other children, for example toys, treats, pencils
Often loses temper
Rather solitary, prefers to play alone
Generally well behaved, usually does what adults request
Many worries or often seems worried
Helpful if someone is hurt, upset or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
Often fights with other children or bullies them
Often unhappy, depressed or tearful
Generally liked by other children
Easily distracted, concentration wanders
Nervous or clingy in new situations, easily loses confidence
Kind to younger children
Often lies or cheats
Picked on or bullied by other children
Often offers to help others (parents, teachers, other children)
Thinks things out before acting
Steals from home, school or elsewhere
Gets along better with adults than with other children
Many fears, easily scared
Good attention span, sees work through to the end
Millennium Cohort Family Study: 2018 Baseline Survey
Not true
Somewhat
true
Certainly
true
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
48
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
131. On a typical day, how much time does your XX-year old spend watching TV/videos, using a
computer, or playing video games?
hours per day
132. Please indicate the degree to which your XX-year old was disturbed or upset by your spouse’s
most recent or current deployment, separation, or active duty assignment:
O A lot
O More than just a moderate amount
O A moderate amount
O Only a little
O Not at all
O N/A – no current/recent deployment or active duty assignment
133. During the past month, how often have you felt:
Never
Rarely
Usually
Always
Your ##-year old is much harder to care for than
most children his/her age?
Sometimes
O
O
O
O
O
He/she does things that really bother you a lot?
O
O
O
O
O
Angry with him/her?
O
O
O
O
O
134. Earlier in the survey, you reported that you were providing care for a child with special needs. Is
this child your XX-year old?
Question only appears if participant responded “Yes” to caregiving for child(ren) in #94.
O No
O Yes
135. Has your ##-year old ever received any of these services or been placed in any of the following:
Yes,
Yes,
within past prior to past
No
3 years
3 years
Outpatient or in-home counseling for a mental, emotional, or behavioral health problem
O
O
O
Inpatient or residential treatment for a mental, emotional or behavioral health problem
O
O
O
Self-help/social support groups for a mental, emotional, or behavioral problem
O
O
O
Special education services or school counseling for a mental, emotional, or behavioral problem
O
O
O
Special education services for a learning disability or delayed academic progress
O
O
O
Foster care or other child welfare services
O
O
O
Legal services (e.g., court counselor, juvenile detention, probation)
O
O
O
State-sponsored case management
O
O
O
Millennium Cohort Family Study: 2018 Baseline Survey
49
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
136. Has a doctor or health professional ever told you that your XX-year old has any of the following
conditions?
If YES, would you describe
his/her condition as mild,
moderate, or severe?
No
Yes
Attention Deficit Disorder or
Attention Deficit Hyperactive
Disorder (ADD or ADHD)
O
O
Depression
O
O
Anxiety (or other emotional
problems)
O
O
Behavior or conduct problems
O
O
Autism, Asperger’s Disorder,
pervasive development
disorder, or other autism
spectrum disorder (ASD)
O
O
Developmental delay or
intellectual disability
O
O
Chronic health condition (e.g.,
diabetes, asthma,
hearing/vision problems)
O
O
Overweight or obese
O
O
O
Mild
O
Mild
O
Mild
O
Mild
O
Mild
O
Mild
O
Mild
O
Mild
O
Moderate
O
Moderate
O
Moderate
O
Moderate
O
Moderate
O
Moderate
O
Moderate
O
Moderate
How old was your child when
you were first told by a doctor
or other health care provider
that he/she had the condition?
O
Severe
O
Severe
O
Severe
O
Severe
O
Severe
O
Severe
O
Severe
O
Severe
137. In general, how would you describe your XX-year old’s health?
O Excellent
O Very good
O Good
O Fair
O Poor
Millennium Cohort Family Study: 2018 Baseline Survey
50
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
CONTACT INFORMATION
138. Please provide your current mailing address below:
Address Line 1:
Address Line 2 (optional):
City or (FPO/APO):
State/Province/Region (or AA/AE/AP):
Zip/Postal Code:
Country:
139. Please provide your current email address(es):
Primary:
Secondary:
140. What is your full Social Security
Number?
Only seen if participant did not provide full SSN
previously.
OR
140. What are the last four numbers of your
Social Security Number?
Only seen if participant did provide full SSN
previously.
(The reason we collect your Social Security Number is so that your survey responses can be
included in all future analyses and your identification can be verified against our records. Your
Social Security Number will not be stored with your survey responses and will be confidentially
maintained.)
¯
¯
Millennium Cohort Family Study: 2018 Baseline Survey
51
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
To help us contact you in the future, please provide the name and contact information for two people
who are likely to know where you can be reached. Please do not include individuals that live in your
household. We will NOT share your questionnaire responses with these individuals and they will
ONLY be contacted if we have difficulty contacting you.
141. First Alternate Contact
Name
Phone
Email
142. Second Alternate Contact
Name
Phone
Email
143. Finally, do you have any concerns that are not covered in this questionnaire that you would like
to share? Do not include any Personally Identifiable Information (PII).
Millennium Cohort Family Study: 2018 Baseline Survey
52
OMB CONTROL NUMBER: 0703-0064
OMB EXPIRATION DATE: XX/XX/XXXX
RCS APPROVAL NUMBER: TBD
RCS EXPIRATION DATE: XX/XX/XXXX
THANK YOU FOR YOUR PARTICIPATION
Thank you for your participation in our study. Your survey is now complete. You will receive an email
shortly for your records.
For more information about the survey, research findings, and the study team, please visit the
Millennium Cohort Family Study’s website: www.familycohort.org
| File Type | application/pdf |
| File Modified | 2018-04-23 |
| File Created | 2015-12-21 |