STREAMS
Adult Follow Up Survey
June 2018
CONTENTS
Section Page
i. INTRODUCTION 1
A. DEMOGRAPHICS 23
B. RELATIONSHIP ATTITUDES AND SKILLS 31
C. CURRENT RELATIONSHIPS 36
D. CHILDREN 46
E. EMPLOYMENT AND FINANCES 61
F. WELL BEING 69
G. PROGRAM EXPERIENCES 74
PROGRAMMER: PRELOAD program NAMES. |
PROGRAMMER BOX IN0. IF DIAL OUT, GO TO IN1; IF FIELD CALL IN, GO TO IN2; IF RESPONDENT CALL IN, GO TO IN3. |
CALL OUT |
IN1. May I please speak with [NAME]? My name is [FILL INTERVIEWER NAME] and I’m calling from Mathematica Policy Research, a research company in Princeton, New Jersey.
SPEAKING TO [NAME] 1 GO TO IN13
[NAME] COMES TO PHONE 2 GO TO IN13
PERSON ASKS WHAT CALL IS ABOUT 3 GO TO IN4
[NAME] IS NOT AVAILABLE 4 GO TO IN6
[NAME] IS INCARCERATED 5 GO TO IN8
[NAME] HAS MOVED/HAS A DIFFERENT NUMBER 6 GO TO IN9
NEVER HEARD OF [NAME] / WRONG NUMBER 7 IN24, STATUS 1530
[NAME] IS DECEASED 8 GO TO IN12
[NAME] DOES NOT SPEAK ENGLISH 9 IN24, STATUS 1401
HUNG UP 10 STATUS 1240
REFUSED r STATUS 1220
FIELD CALL IN |
IN2. May I have your first name?
(STRING 20)
FIELD INTERVIEWER FIRST NAME
IN2 = ANSWERED (FIELD CALL IN) |
IN2a. And your last name?
(STRING 30)
FIELD INTERVIEWER LAST NAME
IN2a = ANSWERED (FIELD CALL IN) |
IN2b. May I have your field interviewer ID number?
| | | | | |
(0000 - 99999)
IN2b = ANSWERED (FIELD CALL IN) |
IN2c. CODE PURPOSE OF FIELD CALL IN
CALLED TO COMPLETE INTERVIEW 1 GO TO IN13
CALLED TO SAY [NAME] IS DECEASED 2 GO TO IN12
CALLED TO SAY [NAME] IS INCARCERATED 3 GO TO IN8
RESPONDENT CALL IN |
IN3. Thank you for calling. My name is [FILL INTERVIEWER NAME] from Mathematica Policy Research. May I have your name?
SPEAKING TO RESPONDENT ([NAME]) 1 GO TO IN13
SOMEONE ELSE CALLED TO COMPLETE INTERVIEW 2 GO TO IN5
CALLED TO ASK WHY WE CALLED 3 GO TO IN4
CALLED TO SET APPOINTMENT 4 GO TO IN6
CALLED TO REFUSE 5 GO TO IN24
STATUS 1240
CALLED TO SAY [NAME] MOVED/HAS A DIFFERENT NUMBER 6 GO TO IN9
CALLED TO SAY [NAME] IS DECEASED 7 GO TO IN12
CALLED TO SAY [NAME] IS INCARCERATED 8 GO TO IN8
CALLED TO SAY NEVER HEARD OF [NAME] / WRONG NUMBER 9 GO TO IN24
STATUS 1530
HUNG UP 10 STATUS 1240
IN1 = 3 OR IN3 = 3 (WHAT IS CALL ABOUT) |
IF BL A1C=1 FILL HE/HIM IF BL A1C=2 FILL SHE/HER FILL RESPONDENT NAME |
IN4. I would like to speak with [NAME] about a research study [he/she] joined about a year ago when [he/she] consented to join the study. I want to ask [NAME] some questions about how [he/she] has been doing since [we last spoke with [him/her]. [NAME] will be provided $25 for [his/her] participation.
May I please speak with [NAME]?
SPEAKING TO [NAME] 1 GO TO IN13
[NAME] COMES TO PHONE 2 GO TO IN13
[NAME] IS NOT AVAILABLE 3 GO TO IN6
[NAME] IS INCARCERATED 4 GO TO IN8
[NAME] HAS MOVED/HAS A DIFFERENT NUMBER 5 GO TO IN9
NEVER HEARD OF [NAME] / WRONG NUMBER 6 GO TO IN24
STATUS 1530
[NAME] IS DECEASED 7 GO TO IN12
[NAME] DOES NOT SPEAK ENGLISH 8 GO TO IN24
STATUS 1401
HUNG UP 9 STATUS 1240
REFUSED r STATUS 1220
PROGRAMMER SKIP BOX IN4 =6 or in4=8 Interviewer: Thank you for taking time to speak with me. Goodbye. If in4=6 STATUS CASE 1530 if in4=8 status case 1401 |
IN3 = 2 (SOMEONE ELSE CALLED IN TO COMPLETE INTERVIEW) |
IN5. I’m sorry, but I need to speak to [NAME]. May I please speak with [NAME]?
[NAME] COMES TO PHONE 1 GO TO IN13
[NAME] IS NOT AVAILABLE 2 GO TO IN6
[NAME] IS INCARCERATED 3 GO TO IN8
[NAME] HAS MOVED/HAS A DIFFERENT NUMBER 4 GO TO IN9
NEVER HEARD OF [NAME] / WRONG NUMBER 5 GO TO IN24
STATUS 1530
[NAME] IS DECEASED 6 GO TO IN12
[NAME] DOES NOT SPEAK ENGLISH 7 GO TO IN24
STATUS 1401
HUNG UP 8 STATUS 1240
REFUSED r STATUS 1220
PROGRAMMER SKIP BOX IN5 =5 or in5=7 Interviewer: Thank you for taking time to speak with me. Goodbye. If in5=5 STATUS CASE 1530 if in5=7 status case 1401 |
IN1 = 4 OR IN3 = 4 OR IN4 = 3 OR IN5 = 2 (NOT AVAILABLE; SET APPOINTMENT) |
IN6. When would be a good time to call back?
[NAME] COMES TO PHONE 1 GO TO IN13
SET APPOINTMENT 2 GO TO IN7
IN6 = 2 (SET APPOINTMENT) |
IN7. When would be a good time to reach [NAME]?
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
INSTRUCTION: MAKE AN APPOINTMENT USING THE PARALLEL BLOCK.
INSTRUCTION: USE THE ‘APPOINTMENT’ TAB OR PRESS <CTRL-S> TO INVOKE THE APPOINTMENT MAKING DIALOG.
(STRING 20)
IN1 = 5 OR IN2c = 3 OR IN3 = 8 OR IN4 = 4 OR IN5 = 3 (INCARCERATED) |
IN8. What is the name of the place where [NAME] is being held?
(STRING 200)
NAME OF PRISON
DON’T KNOW d
REFUSED r GO TO BOX IN8d.1
IN8 = ANSWERED, d |
IN8a. In what city or town is that located?
(STRING 50)
NAME OF CITY/TOWN
DON’T KNOW d
REFUSED r
IN8 = ANSWERED, d |
IN8b. In what state is that located?
(STRING 20)
NAME OF STATE
DON’T KNOW d
REFUSED r
IN8 = ANSWERED, d |
IN8c. When is [NAME] expected to be released?
PROBE: I just need a month and year. Your best estimate is fine.
INTERVIEWER: ENTER MONTH ON NEXT SCREEN OR CODE DON’T KNOW
programmer:
ENTER DATE ON NEXT SCREEN 1
SERVING A LIFE SENTENCE 2 GO TO IN8d
IN8c_month & IN8c_year When is [NAME] expected to be released?
PROBE: I just need a month and year. Your best estimate is fine.
| | | / | | | | |
(1-12) (2012- 2099)
DON’T KNOW d
REFUSED r
IN8 = ANSWERED, d |
IN8d. And do you know [NAME]’s inmate number?
INTERVIEWER: ENTER NUMBER OR CODE DON’T KNOW
(STRING 20)
INMATE NUMBER
DON’T KNOW d
REFUSED r
PROGRAMMER Box IF IN5=3 GO TO IN24 & STATUS CASE 1541 (PRISON). Else go to in9 or in13 |
IN1 = 6 OR IN3 = 6 OR IN4 = 5 OR IN5 = 4 (MOVED; HAS DIFFERENT PHONE) |
IN9. Do you or does anyone there know how we can reach [NAME]?
YES 1 GO TO IN10
NO 0 STATUS 1530
if in9=0 Interviewer: Thank you for taking time to speak with me. Goodbye. If in5=5 and in9=0 STATUS CASE 1530 |
IN9 = 1 |
IN10. May I please have [his/her] telephone number?
INTERVIEWER: ENTER NUMBER ON NEXT SCREEN OR CODE DON’T KNOW
ENTER NUMBER 1
DON’T KNOW d GO TO IN11
REFUSED r GO TO IN11
IN10 = 1 |
IN10_phone. Please give me the phone number, area code first.
| | | | - | | | | - | | | | |
SOFT CHECK: IF IN10_phone IS NOT 10 NUM DIGITS; THE PHONE NUMBER SHOULD BE 10 NUMERIC DIGITS, NO SPACES, DASHES, PARENTHESES OR OTHER PUNCTUATION. THE FIELD SHOULD ALSO NOT BE EMPTY. |
SOFT CHECK: USE STANDARD PHONE NUMBER CHECKS. |
IN9 = 1 or IN10=DK OR R |
IN11. May I have [his/her] address?
INTERVIEWER: ENTER ADDRESS ON NEXT SCREEN OR CODE DON’T KNOW
ENTER ADDRESS 1
DON’T KNOW d GO TO IN24
REFUSED r GO TO IN24
IN11 = 1 |
IN11_address. What is [NAME]’s address?
STREET 1
STREET 2
STREET 3
CITY
STATE
ZIP
if in11=1 GO TO IN24. IF IN10 = 1 (NEW NUMBER), STATUS CASE 1899
|
IN1 = 8 OR IN2c = 2 OR IN3 = 7 OR IN4 = 7 OR IN5 = 6 (RESPONDENT IS DECEASED) |
I was calling about… IF IN1 = 8 (CALL OUT) |
IN12. I am very sorry to hear that. [I was calling about a research study on behalf of the U.S. Department of Health and Human Services] When did [NAME] pass away?
Thank you. Please accept my condolences. Goodbye.
programmer:
ENTER DATE ON NEXT SCREEN 1
DON’T KNOW d
REFUSED r
IN12_month & IN12_day & IN12_year
Thank you. Please accept my condolences. Goodbye.
| | | / | | | / | | | | |
(1-12) (1 - 31) (2012- 2099)
DON’T KNOW d
REFUSED r
STATUS CASE 1440 (DECEASED).
ALL |
IF BL INTRO1 = 1, fill the MotherWise program IF BL INTRO1 = 2, fill the Career STREAMS program at the MET Center IF BL INTRO1 = 3, fill the Empowering Families program at The Parenting Center |
IN13. [Hello, my name is [FILL INTERVIEWER NAME] and I’m calling from Mathematica Policy Research, a research company in Princeton, New Jersey.] I’m calling you about the STREAMS study you joined when you applied to [the MotherWise program/the Career STREAMS program at the MET Center/the Empowering Families program at The Parenting Center] about a year ago. Before we get started I would like to make sure we have your name recorded correctly.
Can you verify your first name?
BSF 36 Month Follow-up
PROBE: Can you spell that for me please?
(STRING 20)
FIRST NAME
ALL |
BSF 36 Month Follow-up
IN14. And your middle name please?
PROBE: Can you spell that for me please?
(STRING 20)
MIDDLE NAME
ALL |
BSF 36 Month Follow-up
IN15. And your last name please?
PROBE: Can you spell that for me please?
(STRING 20)
LAST NAME
ALL |
Fill [RESP FIRST name] from IN15. |
IN16. Are you usually called [RESP FIRST NAME] or do you go by another name?
BSF 15 Month Follow-up
INSTRUCTION: IF SAME JUST HIT ENTER.
PROBE: Can you spell that for me please?
(STRING 20)
FIRST NAME
[IN1=1 OR 2] OR IN2C=1 OR [IN4=1 OR 2] OR IN5=1 OR IN6=1 |
IN17. You may have received a letter recently to let you know that we would be calling you for a follow-up interview for our study. I’d like to interview you today.
The interview will take about 45 minutes and you will receive $25 for completing the interview. Your participation in the survey is voluntary. You do not have to answer any questions that make you uncomfortable.
We are conducting this survey for the U.S. Department of Health and Human Services. A federal agency may not conduct or sponsor a collection of information unless it has a currently valid OMB control number. The OMB number for this information collection is 0970-0481 and the expiration date is July 31, 2019.
The information you provide will be kept private to the extent permitted by law.
Because we want to get your opinion, it is important that you answer the questions without help from anyone else. Of course, you can share what you said with others after we have completed the interview.
This interview may be recorded so my supervisor can monitor the interview and make sure that the questions are asked correctly. These recordings will be destroyed when the study is completed.
Is now a good time to start?
YES 1 GO TO IN19
NO 0
IN17=0 |
IN18. When would be a good time to do the interview?
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
INSTRUCTION: MAKE AN APPOINTMENT USING THE PARALLEL BLOCK.
INSTRUCTION: USE THE ‘APPOINTMENT’ TAB OR PRESS <CTRL-S> TO INVOKE THE APPOINTMENT MAKING DIALOG.
(STRING 20)
IN17=1 |
BSF 15 month follow up
IN19. First we’d like to verify that we are speaking with the correct person. We are going to ask you some questions that we asked when we last spoke with you.
When you were growing up—that is before you turned 18—did you live most of the time with . . .
PROBE: In which of these living situations did you spend most of your time before you turned 18?
both your biological mother and your biological father, 1
your biological mother only, 2
your biological father only, or 3
neither of your biological parents? 4
DON’T KNOW d
REFUSED r
IN17=1 |
IN20. What is your date of birth?
| | | / | | | / | | | | |
MONTH DAY YEAR
(1-12) (1-31) (1900-1996)
DON’T KNOW d
REFUSED r
PROGRAMMER: IF IN19 = MATCH WITH BL F6 AND IN20 = EXACT MATCH ON BL A2 (DOB), GO TO A1 IF EITHER IN19 OR IN20 ARE NOT MATCHES, GO TO IN21
|
IN17=1 and mismatch on in19 AND/OR IN20 BL INTRO1 = 2 OR 3 |
IN21. And what are the last 4-digits of your Social Security Number?
| | | | | LAST FOUR IF MATCH GO TO A1
(0000-9999)
DON’T KNOW d GO TO IN22
REFUSED r GO TO IN22
IN17=1 and mismatch on in19, IN20, and/or in21 |
IN22. Can you tell me the name of the street that you lived on when you first enrolled in the program on [RA DATE]?
(STRING 20)
INSTRUCTION: Record address given by respondent
IF MATCH GO TO A1
DON’T KNOW d GO TO IN23
REFUSED r GO TO IN23
IN22 = MISMATCH, D, OR R |
IN23. I’m sorry. I need to check my records before I can interview you. Is this the best time to reach you in the future?
YES 1
NO, CALL BACK INFO 0
(STRING 20)
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
IN11=D OR R OR IN18=answer |
IN24. Thank you for taking time to speak with me. Goodbye.
INSTRUCTION: STATUS THIS CASE 1380 FOR SUPERVISOR REVIEW.
IF IN11=D OR R STATUS CASE 1530.
All |
FaMLE
INTERVIEWER: IF YES, PROBE FOR HIGH SCHOOL OR COLLEGE. FOR GED PROGRAMS, CODE 3.
YES, HIGH SCHOOL 1 GO TO A2
YES, GED PROGRAM 5 GO TO A3
YES, COLLEGE 2 GO TO A3
YES, OTHER TYPE OF SCHOOL 3 GO TO A3
NO, NOT IN SCHOOL 4 GO TO A3
DON’T KNOW d GO TO A3
REFUSED r GO TO A3
a1=1 |
FaMLE
LESS THAN 9TH GRADE 1
9TH GRADE 2
10TH GRADE 3
11TH GRADE 4
12TH GRADE 5
DON’T KNOW d
REFUSED r
a1 NE 1 |
A3. What is the highest level of education you have completed?
ACS
INTERVIEWER: IF RESPONDENT SAYS “COLLEGE,” PROBE: Did you receive an associates or a bachelor’s degree?
DID NOT COMPLETE HIGH SCHOOL OR GED 1
HIGH SCHOOL: DIPLOMA 2
HIGH SCHOOL: GENERAL EDUCATION DEVELOPMENT OR GED 3
SOME COLLEGE 4
2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE) 5
VOCATIONAL/TECHNICAL SCHOOL DIPLOMA/CERTIFICATION 6
4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) 7
GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D., JD, MD) 8
DON’T KNOW d
REFUSED r
ALL |
B1. Next I’m going to read you some statements about relationships. For each, tell me whether you strongly agree, agree, disagree, or strongly disagree. [FILL A-M]. Do you strongly agree, agree, disagree, or strongly disagree?
Stanley
and Rhoades
Child
Trends 3M Project
Stanley
and Rhoades
Stanley
and Rhoades
PREP
PREP
Stanley
and Rhoades
Stanley
and Rhoades
|
|
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DON’T KNOW |
REF |
a. A good couple relationship is based on mutual respect. |
1 |
2 |
3 |
4 |
d |
r |
b. In a good couple relationship, you don’t always get your own way. |
1 |
2 |
3 |
4 |
d |
r |
c. Relationships go better if partners make decisions together. |
1 |
2 |
3 |
4 |
d |
r |
d. People are more likely to succeed in their relationships if they take things slowly. |
1 |
2 |
3 |
4 |
d |
r |
e. It is important to know a person well before having sex with them. |
1 |
2 |
3 |
4 |
d |
r |
f. Having a casual sexual relationship with someone is no big deal. |
1 |
2 |
3 |
4 |
d |
r |
g. If you are really in love, you can stop working on your relationship. |
1 |
2 |
3 |
4 |
d |
r |
h. Ending a bad romantic relationship is a good thing. |
1 |
2 |
3 |
4 |
d |
r |
i. There are times when hitting or pushing between people who are a couple is okay. |
1 |
2 |
3 |
4 |
d |
r |
j. Violence between partners can improve a couple’s relationship. |
1 |
2 |
3 |
4 |
d |
r |
k. Some couples need to use violence to solve their problems. |
1 |
2 |
3 |
4 |
d |
r |
l. Sometimes violence is the only way to express your feelings. |
1 |
2 |
3 |
4 |
d |
r |
m. Violence in a couple’s relationship is a personal matter and people should not interfere. |
1 |
2 |
3 |
4 |
d |
r |
Foshee
et al 1992
Foshee
et al 1992
Foshee
et al 1992
Foshee
et al 1992
Foshee
et al 1992
ALL |
B2. Next I’m going to read you some statements about how you think about romantic relationships. For each statement, tell me whether you strongly agree, agree, disagree, or strongly disagree. [FILL A-G]. Do you strongly agree, agree, disagree, or strongly disagree?
INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-F
Venum
and Fincham, 2011
Venum
and Fincham, 2011
Venum
and Fincham, 2011
Baylor
evaluation of ARYA
Venum
and Fincham, 2011
Venum
and Fincham, 2011
Venum
and Fincham, 2011
|
|
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DON’T KNOW |
REF |
a. I believe I will be able to effectively deal with conflicts that arise in my relationships. |
1 |
2 |
3 |
4 |
d |
r |
b. I feel good about my ability to make a romantic relationship last. |
1 |
2 |
3 |
4 |
d |
r |
c. I can recognize the signs of a violent or unhealthy relationship. |
1 |
2 |
3 |
4 |
d |
r |
d. I am very confident when I think of having a stable, long term relationship. |
1 |
2 |
3 |
4 |
d |
r |
e. I have the skills needed for a lasting stable romantic relationship. |
1 |
2 |
3 |
4 |
d |
r |
f. I am able to recognize early on the warning signs in a bad relationship. |
1 |
2 |
3 |
4 |
d |
r |
g. I know what to do when I recognize the warning signs in a bad relationship. |
1 |
2 |
3 |
4 |
d |
r |
ALL |
FaMLE
|
|
|
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DON’T KNOW |
REF |
|
a. Living together is just the same as being married. |
1 |
2 |
3 |
4 |
d |
r |
|
b. It is better for children if their parents are married. |
1 |
2 |
3 |
4 |
d |
r |
ALL |
Buhrmester
et al. 1988
INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-E
|
|
|||||
|
EXTREMELY GOOD |
GOOD |
OKAY |
BAD |
DON’T KNOW |
REF |
a. Admitting that you might be wrong during an argument. |
1 |
2 |
3 |
4 |
d |
r |
b. Avoiding saying things that could turn a disagreement into a fight. |
1 |
2 |
3 |
4 |
d |
r |
c. Accepting another person’s point of view even if you don’t agree with it. |
1 |
2 |
3 |
4 |
d |
r |
d. Listening to another person’s opinion during a disagreement. |
1 |
2 |
3 |
4 |
d |
r |
e. Working through problems without arguing. |
1 |
2 |
3 |
4 |
d |
r |
Next, I’m going to ask you some questions about your relationships.
if (BL c3 = 1 or 2) OR (BL c4 = 1 or 2), In a relationship at Baseline go to c1. if (BL c3 ne 1 or 2) and (BL c4 ne 1 or 2) not in a relationship at baseline, go to c9. |
fill [bl partner] from bl c5 if bl c3 = 1, fill engaged to if bl c3 = 2, fill married to if bl c4 = 1 or 2, fill in a romantic relationship with |
STREAMS
Are you and [BL PARTNER] currently…
engaged, 1 GO TO C16
married, 2
divorced, 3
separated, or 4
have you never been married to each other? 5
WIDOWED/PARTNER DIED 6 GO TO C9
DON’T KNOW d
REFUSED r
IF C1=6 SAY: I’m very sorry to hear that. Our condolences for your loss.
c1=1 |
BSF 15 month follow-up
C2. When are you planning to get married?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR. IF NO MONTH GIVEN, MARK AS MISSING.
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/YYYY
| | | / | | | | | DATE PLANNING TO MARRY
(01-12) (2014-2100)
MONTH YEAR
INTERVIEWER INSTRUCTION: IF NO DATE IS GIVEN, DO NOT PROBE
NO DATE HAS BEEN SET 0
DON’T KNOW d
REFUSED r
C1 ne 2 |
FaMLE
We are romantically involved on a steady basis, 1 GO TO C7
We are involved in an on-again and off-again relationship, or 2 GO TO C7
We are not in a romantic relationship 3 GO TO C4
DON’T KNOW d GO TO C7
REFUSED r GO TO C12
c3=3 |
BSF 15 month follow-up
C4. When did your relationship with [BL PARTNER] end?
| | | / | | | | | DATE RELATIONSHIP ENDED GO TO C5
(01-12) (2012-2100)
MONTH YEAR
PARTNER DIED 0 GO TO C9
DON’T KNOW d GO TO C5
REFUSED r GO TO C5
IF C4=0 SAY: I’m very sorry to hear that. Our condolences for your loss.
C4 NE 0 |
BSF 36-month follow-up
C5. I am going to read you a list of reasons that people give for why their relationships ended. For each reason, tell me if this is why your relationship with [BL PARTNER] ended.
Was it because…
IF C5a – C5f=1 ASK: Was that you, [BL PARTNER], or both of you?
|
CODE ONE PER ROW |
|
|||
|
|
|
Was that you, [BL PARTNER] or both of you? |
||
a. one of you cheated or was unfaithful? |
YES |
1 |
YOU |
1 |
|
|
[BL PARTNER] |
2 |
|||
|
BOTH |
3 |
|||
|
NO |
0 |
|
|
|
b. one of you went to jail or prison? |
YES |
1 |
YOU |
1 |
|
|
[BL PARTNER] |
2 |
|||
|
BOTH |
3 |
|||
|
NO |
0 |
|
|
|
c. one of you was abusive or violent? |
YES |
1 |
YOU |
1 |
|
|
[BL PARTNER] |
2 |
|||
|
BOTH |
3 |
|||
|
NO |
0 |
|
|
|
d. one of you used drugs or alcohol? |
YES |
1 |
YOU |
1 |
|
|
[BL PARTNER] |
2 |
|||
|
BOTH |
3 |
|||
|
NO |
0 |
|
|
|
e. one of you could not keep a job or contribute enough financially to the family? |
YES |
1 |
YOU |
1 |
|
|
[BL PARTNER] |
2 |
|||
|
BOTH |
3 |
|||
|
NO |
0 |
|
|
|
f. one of you was not a good parent or role model? |
YES |
1 |
YOU |
1 |
|
|
[BL PARTNER] |
2 |
|||
|
BOTH |
3 |
|||
|
NO |
0 |
|
|
|
g. the two of you were not communicating well or were arguing too much? |
YES |
1 |
|
|
|
|
NO |
0 |
|
|
|
h. of lack of support from family members? |
YES |
1 |
|
|
|
|
NO |
0 |
|
|
|
i. you and [BL PARTNER] were living too far apart? |
YES |
1 |
|
|
|
|
NO |
0 |
|
|
C4 NE 0 |
BSF
36 Month Follow-up
YES 1 GO TO C5k
NO 0 GO TO C6
DON’T KNOW d GO TO C6
REFUSED r GO TO C6
c5j=1 |
BSF
36 Month Follow-up
____________________________ STRING 100
REASONS RELATIONSHIP ENDED GO TO C6
c4 Ne 0 |
PACT
C6. Do you think it is a good thing for you that you and [BL PARTNER] broke up? Would you say…
Definitely yes, 1
Maybe yes, 2
Maybe no, or 3
Definitely no? 4
DON’T KNOW d
REFUSED r
C1 NE 6 and c4 ne 0 |
FaMLE
C7. Do you currently live with [BL PARTNER] in the same household …
all of the time, 1 GO TO C9
most of the time, 2
some of the time, or 3
none of the time? 4
DON’T KNOW d
REFUSED r
C7 NE 1 |
BSF 15 month FUP
C8. How often do you and [BL PARTNER] see or talk to each other? Is it…
every day or almost every day, 1
a few times a week, 2
a few times a month, 3
about once a month, 4
only a few times in the past year, or 5
hardly ever or never? 6
DON’T KNOW d
REFUSED r
skip if bl c3=2 and c1=2 |
if [bl partner] from bl c5 ne blank, fill please include [bl partner].] |
STREAMS
[Please include [BL PARTNER].]
PROBE: Your best guess is fine.
| | | NUMBER OF PARTNERS
(0-99)
DON’T KNOW d
REFUSED r
PROGRAMMER SKIP BOX C9.1 If c9 = 0, go to C24. else, go to c10. |
[(BL C3 NE 1 OR 2) and (BL C4 NE 1 OR 2)] or [[(bl c3 = 1 or 2) or (BL C4 = 1 or 2)] and [(c1=6 or c3=3, dk or r AND C9 GE 2)] |
C10. Are you currently involved in a romantic relationship with someone?
BSF 15-mo FUP
YES 1 GO TO C11
NO 0 GO TO C23
DON’T KNOW d GO TO C23
REFUSED r GO TO C23
C10=1 |
PACT
INSTRUCTION: IF RESPONDENT INDICATES MORE THAN ONE CURRENT PARTNER, PROBE FOR NAME OF MAIN OR PRIMARY CURRENT PARTNER.
INSTRUCTION: IF RESPONDENT DOES NOT GIVE FULL NAME PROBE FOR A NAME OR INITIALS
____________________________FIRST NAME OF PARTNER
STRING 20
c10=1 |
fill [NEW partner] from c11. IF [NEW PARTNER] = D OR R, fill your new partner |
PACT
MAN 1
WOMAN 2
DON’T KNOW d
REFUSED r
C10=1 |
FILL [NEW PARTNER] from C11. IF [NEW PARTNER] = D OR R, fill your new partner |
BSF
15-mo FUP
YES, MARRIED 1
YES, ENGAGED 2
NO 0
DON’T KNOW d
REFUSED r
C12 = 1 or 2 |
if c12 = 1 Fill did you IF c12 = 2 FILL are you planning to |
BSF
15-mo FUP
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR. IF NO MONTH GIVEN, MARK AS MISSING.
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/YYYY
| | | / | | | | | DATE OF MARRIAGE/PLANNED DATE OF MARRIAGE
(01-12) (2014-2100)
MONTH YEAR
INTERVIEWER INSTRUCTION: IF NO DATE IS GIVEN, DO NOT PROBE
NO DATE HAS BEEN SET 0
DON’T KNOW d
REFUSED r
C10=1 AND C12 NE 1 OR 2 |
FILL [NEW PARTNER] from C11. IF [NEW PARTNER] = D OR R, fill your new partner. |
C14. Which of the following best describes your relationship with [NEW PARTNER]?
FaMLE
We are romantically involved on a steady basis, or 1
We are involved in an on-again and off-again relationship. 2
DON’T KNOW d
REFUSED r
C10=1 |
FILL [NEW PARTNER] from C11. IF [NEW PARTNER] = D OR R, fill your new partner |
FaMLE
C15. Do you currently live with [NEW PARTNER] in the same household …
all of the time, 1
most of the time, 2
some of the time, or 3
none of the time? 4
DON’T KNOW d
REFUSED r
(C1=1 or 2) OR (C3=1 OR 2) OR c10 = 1 |
if [NEW PARtner] from c11 ne blank, fill [new partner]. If [NEW PARTNER] = D or R, fill your new partner if not, fill [bl partner] from BL C5 |
BSF
C16. Now I would like to ask about how you feel about your relationship with [BL PARTNER]/[NEW PARTNER]. On a scale from 0 to 10, where 0 is not at all happy and 10 is completely happy, taking all things together, how happy would you say your relationship with [BL PARTNER]/ [NEW PARTNER] is?
You can choose any number from 0 to 10.
| | |
(0-10)
DON’T KNOW d
REFUSED r
(C1=1 or 2) OR (C3=1 OR 2) OR c10 = 1 |
if [NEW PARtner] from c11 ne blank, fill [new partner]; If [NEW PARTNER] = D or R, fill your new partner; IF C12 = 1, FILL “marriage” ELSE FILL “relationship” if no [NEW PARTNER], fill [bl partner] from BL C5; if c1 = 2, fill “MARRIAGE” ELSE fill “relationship |
PACT
C17. On a scale from 0 to 10, where 0 is not at all committed and 10 is completely committed, how committed are you to your [marriage/relationship] with [[BL PARTNER]/[NEW PARTNER]]?
| | |
(0-10)
DON’T KNOW d
REFUSED r
(C1=1 or 2) OR (C3=1 OR 2) OR c10 = 1 |
if [NEW PARtner] from c11 ne blank, fill [new partner]; IF C12 = 1, FILL “marriage” ELSE FILL “relationship” if no [NEW PARTNER], fill [bl partner] from BL C5 IF ([BL C3=1,2 OR BL C4=1,2] AND [C1=1,2 OR C3=1,2]); if c1 = 2, fill “MARRIAGE” ELSE fill “relationship |
PACT
C18. On a scale from 0 to 10, where 0 is not at all committed and 10 is completely committed, how committed would you say [[BL PARTNER]/[NEW PARTNER]] is to your [marriage/relationship]?
| | |
(0-10)
DON’T KNOW d
REFUSED r
(C1=1 or 2) OR (C3=1 OR 2) OR C10 = 1 |
if [NEW PARtner] from c11 ne blank, fill [new partner]; IF C12 = 1, FILL “marriage” ELSE FILL “relationship” if no [NEW PARTNER], fill [bl partner] from BL C5 IF ([BL C3=1,2 OR BL C4=1,2] AND [C1=1,2 OR C3=1,2]); if c1 = 2, fill “MARRIAGE” ELSE fill “relationship |
I’m going to ask you some questions about [[BL PARTNER]/[NEW PARTNER]].
C19. Tell me whether you strongly agree, agree, disagree, or strongly disagree with the following statements.
[FILL STATEMENT a-i] Do you strongly agree, agree, disagree, or strongly disagree?
PACT
PACT
PACT
BSF
BSF
BSF
BSF
FaMLE
FaMLE
FaMLE
FaMLE
FaMLE
|
CODE ONE PER ROW |
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DK |
REF |
a. [[BL PARTNER]/[NEW PARTNER]] is honest and truthful with me. |
1 |
2 |
3 |
4 |
d |
r |
b. I can trust [[BL PARTNER]/[NEW PARTNER]] completely. |
1 |
2 |
3 |
4 |
d |
r |
c. [[BL PARTNER]/[NEW PARTNER]] can be counted on to help me. |
1 |
2 |
3 |
4 |
d |
r |
d. [[BL PARTNER]/[NEW PARTNER]] knows and understands me. |
1 |
2 |
3 |
4 |
d |
r |
![]() PACT e. [[BL PARTNER]/[NEW PARTNER]] listens to me when I need someone to talk to. |
1 |
2 |
3 |
4 |
d |
r |
f. [[BL PARTNER]/[NEW PARTNER]] respects me. |
1 |
2 |
3 |
4 |
d |
r |
g. [[BL PARTNER]/[NEW PARTNER]] shows love and affection. |
1 |
2 |
3 |
4 |
d |
r |
h. I feel appreciated by [[BL PARTNER]/[NEW PARTNER]]. |
1 |
2 |
3 |
4 |
d |
r |
i. I want my relationship with [[BL PARTNER]/[NEW PARTNER]] to stay strong no matter what rough times we may have. |
1 |
2 |
3 |
4 |
d |
r |
j. [[BL PARTNER]/[NEW PARTNER]] supports me to do the things that are important to me. |
1 |
2 |
3 |
4 |
d |
r |
k. [[BL PARTNER]/[NEW PARTNER]] and I often talk about things that happen to each of us during the day. |
1 |
2 |
3 |
4 |
d |
r |
l. [[BL PARTNER]/[NEW PARTNER]] and I enjoy doing even ordinary, day-to-day things together. |
1 |
2 |
3 |
4 |
d |
r |
(C1=1 or 2) OR (C3=1 OR 2) OR C9 = 1 |
if [NEW PARtner] from c11 ne blank, fill [new partner]; IF C12 = 1, FILL “marriage” ELSE FILL “relationship” if no [NEW PARTNER], fill [bl partner] from BL C5; if c1 = 2, fill “MARRIAGE” ELSE fill “relationship FOR BASELINE PARTNER IF BL C5a=1, FILL “he”; IF BL C5a=2, FILL “she” ELSE IF BL C5A= DK OR R FILL HE OR SHE FOR NEW PARTNER IF C11a=1, FILL “he”; IF C11a=2, FILL “she” ELSE IF C10A= DK OR R FILL HE OR SHE |
C20. Now I am going to read you some statements about things you and [[BL PARTNER]/[NEW PARTNER]] may experience when you are together. Tell me if this never happens, hardly ever happens, sometimes happens, or often happens. [FILL STATEMENT A-P]…Does this happen never, hardly ever, sometimes, or often?
BSF
PACT
PACT
FaMLE
PACT
FaMLE
PACT
FaMLE
FaMLE
FaMLE
FaMLE
FaMLE
FaMLE
FaMLE
FaMLE
|
|
|||||
|
NEVER |
HARDLY EVER |
SOMETIMES |
OFTEN |
DK |
R |
a. [[BL PARTNER]/[NEW PARTNER]] and I are good at working out our differences. |
1 |
2 |
3 |
4 |
d |
r |
b. I feel respected even when [[BL PARTNER]/[NEW PARTNER]] and I disagree. |
1 |
2 |
3 |
4 |
d |
r |
c. [[BL PARTNER]/[NEW PARTNER]] is rude or mean to me when we disagree. |
1 |
2 |
3 |
4 |
d |
r |
d. When [[BL PARTNER]/[NEW PARTNER]] and I have a serious disagreement, we work on it together to find a solution. |
1 |
2 |
3 |
4 |
d |
r |
PACT
HM Baseline
BSF |
1 |
2 |
3 |
4 |
d |
r |
f. During arguments, [[BL PARTNER]/[NEW PARTNER]] and I are good at taking breaks when we need them. |
1 |
2 |
3 |
4 |
d |
r |
g. When [[BL PARTNER]/[NEW PARTNER]] and I argue, past hurts get brought up again. |
1 |
2 |
3 |
4 |
d |
r |
h. Our arguments become very heated. |
1 |
2 |
3 |
4 |
d |
r |
i. [[BL PARTNER]/[NEW PARTNER]] is good at calming me when I get upset. |
1 |
2 |
3 |
4 |
d |
r |
j. Small issues suddenly become big arguments. |
1 |
2 |
3 |
4 |
d |
r |
k. We are pretty good listeners, even when we have different positions on things. |
1 |
2 |
3 |
4 |
d |
r |
l. [[BL PARTNER]/[NEW PARTNER]] or I stay mad at one another after an argument. |
1 |
2 |
3 |
4 |
d |
r |
m. Even when arguing, we can keep a sense of humor. |
1 |
2 |
3 |
4 |
d |
r |
n. When we argue, one of us withdraws and refuses to talk about it anymore. |
1 |
2 |
3 |
4 |
d |
r |
o. When we argue I feel personally attacked. |
1 |
2 |
3 |
4 |
d |
r |
(C1=1 OR 2) OR (C3=1 OR 2) OR C10 = 1 |
if [NEW PARtner] from c11 ne blank, fill [new partner] if no [NEW PARTNER], fill [bl partner] from BL C5 |
PACT
C21. Since [RA DATE], has [BL PARTNER/NEW PARTNER] cheated on you with someone else? Would you say…
Definitely yes, 1
Maybe yes, 2
Maybe no, or 3
Definitely no? 4
DON’T KNOW d
REFUSED r
(C1=1 or 2) OR (C3=1 OR 2) OR C10 = 1 |
if [NEW PARtner] from c11 ne blank, fill [new partner] if no [NEW PARTNER], fill [bl partner] from BL C5 |
PACT
C22. Since [RA DATE], have you cheated on [BL PARTNER/NEW PARTNER] with someone else?
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
If (c1=2 or 4) OR (C12=1), fill: “Including your current marriage,” |
PACT HM
Baseline
C23. [Including your current marriage,] in total, how many times have you been married?
| | | # OF MARRIAGES
(0-99)
DON’T KNOW d
REFUSED r
Next I’m going to read a list of things that might have happened to you in the past year.
ALL |
C24. In the past year, did any romantic partner you’ve been involved with ever…
SHM
SHM
SHM
|
CODE ONE PER ROW |
||||
|
|
In the past year, did this happen… |
|
|
|
a. try to keep you from seeing or talking with your friends? |
YES |
1 |
Once, |
1 |
|
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
b. make you feel stupid? |
YES |
1 |
Once, |
1 |
|
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
c. keep money from you or take your money without asking? |
YES |
1 |
Once, |
1 |
|
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
d. make you feel afraid that they might hurt you? |
YES |
1 |
Once, |
1 |
|
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
e. CTS2S 10 |
YES |
1 |
Once, |
1 |
|
|
|
|
Twice, |
2 |
|
*** SEE NOTE ON PAGE 34 *** |
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
f. CTS2S 12 |
YES |
1 |
Once, |
1 |
|
|
|
|
Twice, |
2 |
|
*** SEE NOTE ON PAGE 34 *** |
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
g. use threats or force to make you have sex or do sexual things you didn’t want to do? |
YES |
1 |
Once, |
1 |
|
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
CTS2S
SHM
BSF
CTS2S
ALL |
BSF
15m FUP, modified
YES 1 GO TO C26
NO 0
DON’T KNOW d
REFUSED r
C25=1 |
PACT
C26. In the past year, did this happen…
Once, 1
Twice, 2
3 to 5 times, 3
6 to 10 times, 4
11 to 20 times, or 5
More than 20 times? 6
DON’T KNOW d
REFUSED r
ALL |
CTS2S
YES 1 GO TO C28
NO 0
DON’T KNOW d
REFUSED r
C27=1 |
CTS2S
C28. CTS2S 9 *** SEE NOTE ON PAGE 34 ***
Once, 1
Twice, 2
3 to 5 times, 3
6 to 10 times, 4
11 to 20 times, or 5
More than 20 times? 6
DON’T KNOW d
REFUSED r
ALL |
CTS2S
YES 1 GO TO C30
NO 0
DON’T KNOW d
REFUSED r
C29=1 |
CTS2S
C30. CTS2S 11 *** SEE NOTE AT BOTTOM OF PAGE ***
Once, 1
Twice, 2
3 to 5 times, 3
6 to 10 times, 4
11 to 20 times, or 5
More than 20 times? 6
DON’T KNOW d
REFUSED r
** NOTE: The specific wording of items C24e, C25f, C27, C28, C29, C30 is not shown on this copy of the survey because the material is from the Conflict Tactics Scale copyright © 2003 by Western Psychological Services. Authorized research translation reprinted by S. Marsh, Mathematica Policy Research, for specific, limited research use under license of the publisher, WPS, 625 Alaska Avenue, Torrance, California, 90503, U.S.A. ([email protected]). No additional reproduction, in whole or in part, by any medium or for any purpose, may be made without the prior written authorization of WPS. All rights reserved.
IF BL INTRO=1 (UNIVERSITY OF DENVER) AND BL D22=1 (PREGNANT AT BASELINE), GO TO D1. IF BL INTRO=1 (UNIVERSITY OF DENVER) AND BL D22=0,D,R (NOT PREGNANT AT BASELINE), GO TO D5. IF BL INTRO = 3 (The Parenting Center) GO TO D10. IF BL INTRO = 2 (FWCA) GO TO D11. |
IF BL INTRO = 1 (University of Denver) AND BL D22=1 (pregnant at baseline) |
FILL [BL CHILD EXPECTED DATE] FROM BL D23 |
BSF 15 FUP
D1. Now I have some questions about children you may have had since [RA DATE]. Our records indicate that you were expecting a baby around [BL CHILD EXPECTED DATE].
Did you have a baby around that time?
INSTRUCTION: IF RESPONDENT REPORTS DATE OF BIRTH, ANSWER “YES” AND ENTER DATE OF BIRTH ON NEXT SCREEN.
INSTRUCTION: IF RESPONDENT REPORTS MULTIPLE BIRTHS, ENTER “YES.” YOU WILL ENTER NUMBER OF BABIES ON ANOTHER SCREEN.
IF RESPONDENT ANSWERS NO, PROBE: I’m sorry. What happened?
YES 1
YES, BUT BABY DIED 2 GO TO D11
NO, MISCARRIAGE 3 GO TO D11
NO, ABORTION 4 GO TO D11
NO, BABY DIED 5 GO TO D11
NO, WAS NOT EXPECTING BABY AT BASELINE 6 GO TO D11
DON’T KNOW d GO TO D11
REFUSED r GO TO D11
IF D1=5 SAY: I’m very sorry to hear that. Our condolences for your loss.
D1=1 |
D1a. For the baby you were expecting on [BL CHILD EXPECTED DATE], what date was the baby born?
BSF
15 month follow-up, modified
| | | / | | | / | | | | | BIRTHDATE
BABY DIED 0 GO TO D11
DON’T KNOW d
REFUSED r
IF D1a=0 SAY: I’m very sorry to hear that. Our condolences for your loss.
D1 = 1 |
BSF 15 month follow-up, modified
D2. ENTER WITHOUT ASKING IF KNOWN: OTHERWISE PROBE:
How many babies did you have on [BIRTHDATE]?
INTERVIEWER INSTRUCTION: ENTER THE NUMBER OF BABIES BORN
INTERVIEWER INSTRUCTION: IF D2=0 (BABY DIED), SAY: “I am sorry for your loss.”
| | | NUMBER OF BABIES BORN GO TO D3
(1-99)
BABY DIED 0 GO TO D11
D1=1 |
If D2>1, fill Thinking of the youngest baby you had on [BIRTHDATE], |
D3. [Thinking of the youngest baby you had on [BIRTHDATE],] What is the baby’s first name?
BSF
15 month follow-up, modified
(STRING 25)
FIRST NAME
DON’T KNOW d
REFUSED r
D1=1 |
Fill [CHILD NAME] from D3 |
PACT
BOY 1
GIRL 2
DON’T KNOW d
REFUSED r
D1=1 OR BL D22=0,D,R |
IF BL D22=1, Fill [CHILD NAME] from D3 IF BL D22=0,D,R, FILL [YOUNGEST CHILD NAME] FROM BL D8 |
IF BL D22=0,D,R then fill INTRO “Now I’d like to ask you some questions about your child, [CHILD NAME], who was born shortly before [RA DATE].” |
FaMLE
ALL OF THE TIME 1
MOST OF THE TIME 2
SOME OF THE TIME 3
NONE OF THE TIME 4
DON’T KNOW d
REFUSED r
IF [BL D22=1 AND BL D24=1] OR IF [BL D22=0,D,R AND BL D16=1] |
IF BL D22=1 Fill [CHILD NAME] from D3 IF BL D22=0,D,R Fill [CHILD NAME] from BL D8 |
STREAMS
YES 1 GO TO D7
NO, DIFFERENT FATHER 0 GO TO D6a
DON’T KNOW d GO TO D6a
REFUSED r GO TO D6a
IF [BL D22=1 AND BL D24 = 2, D, OR R AND D1=1] OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing] |
Fill [CHILD NAME] from D3 IF BL D22=0,D,R Fill [CHILD NAME] from BL D8 |
STREAMS
(STRING 25)
FATHER NAME
FATHER DECEASED 0
DON’T KNOW d
REFUSED r
D1=1 SKIP IF D6a=0, DK OR R |
If [BL D22=1 AND BL D24 = 1 AND D6 = 1] OR [OR [BL D22=0,D,R AND BL D16=1 AND D6=1], fill [FATHER NAME] with [BL PARTNER] IF [BL D22=1 AND BL D24 = 2, D, OR R] OR D6=0 OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing], FILL [FATHER NAME] from D6a If BL D22=0,D,R AND BL D16=2 then fill [FATHER NAME] with [CHILD 1 PARENT] |
IF BL D22=1 Fill [CHILD NAME] from D3 IF BL D22=0,D,R Fill [CHILD NAME] from BL D8 |
FaMLE
All of the time, 1
Most of the time, 2
Some of the time, or 3
None of the time? 4
DON’T KNOW d
REFUSED r
SKIP IF D6a=0, DK OR R |
If [BL D22=1 AND BL D24 = 1 AND D6 = 1] OR [OR [BL D22=0,D,R AND BL D16=1 AND D6=1], fill [FATHER NAME] with [BL PARTNER] IF BL D22=1 AND [BL D24 = 2, D, OR R] OR D6=0 OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing], FILL [FATHER NAME] from D6a If BL D22=0,D,R AND BL D16=2 then fill [FATHER NAME] with [CHILD 1 PARENT] |
IF BL D22=1 Fill [CHILD NAME] from D3 IF BL D22=0,D,R Fill [CHILD NAME] from BL D8 |
BSF
FU CO2
Every day or almost every day, 1
A few times a week, 2
A few times in the past month, 3
Once or twice, or 4
Never? 5
DON’T KNOW d
REFUSED r
SKIP IF D6a=0, DK OR R |
If [BL D22=1 AND BL D24 = 1 AND D6 = 1] OR [OR [BL D22=0,D,R AND BL D16=1 AND D6=1], fill [FATHER NAME] with [BL PARTNER] IF BL D22=1 AND [BL D24 = 2, D, OR R] OR D6=0 OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing], FILL [FATHER NAME] from D6a IF BL D22=0,D,R AND BL D16=2 then fill [FATHER NAME] with [CHILD 1 PARENT]
If D4 = 1, fill his If D4 = 2, fill her IF BL D22=1 and D4 = 1, fill his IF BL D22=1 and D4 = 2, fill her IF BL D22=0,d,r and BL D10 = 1, fill his IF BL D22=0,d,r and BL D10 = 1, fill his
IF BL D22=1 Fill [CHILD NAME] from D3 IF BL D22=0,D,R Fill [CHILD NAME] from BL D8 |
BSF
FU PA12
All or almost all, 1
More than half, 2
About half, 3
Less than half, or 4
Little or none? 5
DON’T KNOW d
REFUSED r
SKIP IF D6a=0, DK OR R |
if BL INTRO = 1 (denver) AND IF [BL D22=1 AND BL D24 = 1 AND D6 = 1] OR [OR [BL D22=0,D,R AND BL D16=1 AND D6=1], fill [FATHER NAME] with [BL PARTNER] if BL INTRO = 1 (denver) AND IF BL D22=1 AND [BL D24 = 2, D, OR R] OR D6=0 OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing], FILL [FATHER NAME] from D6a if BL INTRO = 1 (denver) AND IF BL D22=0,D,R AND BL D16=2 then fill [FATHER NAME] with [CHILD 1 PARENT] IF BL INTRO = 3 (PARENTING CENTER): BL C5=NAME GIVEN AND d16=1 ASK ABOUT PARTNER THEY ENTERED THE STUDY WITH, [BL PARTNER] IF BL INTRO = 3 (PARENTING CENTER): fill Now I have some questions about parenting. |
PAM
**NOTE: The specific wording of items D10a-j is not shown on this copy of the survey because the items are adapted and reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16204 North Florida Avenue, Lutz, Florida 33549, from the Parenting Alliance Measure by Richard Abidin, EdD and Timothy R Konold, PhD, Copyright 1999 by PAR, Inc. Further reproduction is prohibited without permission by PAR, Inc.
|
|
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DK |
R |
a. PAM 13 **SEE NOTE ABOVE ** |
1 |
2 |
3 |
4 |
d |
r |
b. PAM 4 |
1 |
2 |
3 |
4 |
d |
r |
c. PAM 18 |
1 |
2 |
3 |
4 |
d |
r |
d. PAM 14 |
1 |
2 |
3 |
4 |
d |
r |
e. PAM 11 |
1 |
2 |
3 |
4 |
d |
r |
f. PAM 10 |
1 |
2 |
3 |
4 |
d |
r |
g. PAM 3 |
1 |
2 |
3 |
4 |
d |
r |
h. PAM 5 |
1 |
2 |
3 |
4 |
d |
r |
i. PAM 6 |
1 |
2 |
3 |
4 |
d |
r |
j. PAM 7 |
1 |
2 |
3 |
4 |
d |
r |
ALL |
FOR INTRO1=1 AND BL D22=1 THEN FILL CHILD NAME FROM D3 FOR INTRO1=1 AND BL D22=0,D,R THEN FILL CHILD NAME FROM BL D8 If BL D22=0,d,r, fill After If D1 NE 6, DK or R, fill again
FOR INTRO 2 OR 3 If BL A1c=2 , fill been If BL A1c=1, fill gotten someone |
PPA
[BL INTRO1=2 OR 3 (FWCA OR PARENTING CENTER)] Now I have some questions about pregnancies. To the best of your knowledge, since [RA DATE], have you [been/gotten someone] pregnant, even if no child was born?
YES 1
NO 0 GO TO E1
DON’T KNOW d
REFUSED r
D11=1 |
If BL A1c=2 , fill been If BL A1c=1, fill gotten someone |
D12. Since [RA DATE], how many times have you [been/gotten someone] pregnant?
PPA
| | | TIMES
(1-99)
DON’T KNOW d
REFUSED r
D11=1 |
IF D12 > 1, fill Let’s talk about the most recent pregnancy. |
PACT
Definitely yes, 1
Probably yes, 2
Probably no, or 3
Definitely no? 4 GO TO E1
DON’T KNOW d
REFUSED r
d11=1 AND D13 NE 4 |
PACT
SOONER 1
ABOUT RIGHT TIME 2
LATER 3
DIDN’T CARE 4
DIDN’T WANT TO HAVE A(NOTHER) BABY 5
DON’T KNOW d
REFUSED r
all |
FaMLE
In the past month, have you or anyone in your household received any income from [fill statements a-j]?
|
CODE ONE RESPONSE PER ROW |
|||
|
YES |
NO |
DK |
REF |
a. Temporary Assistance for Needy Families, or TANF |
1 |
0 |
d |
r |
b. Supplemental Security Income, or SSI |
1 |
0 |
d |
r |
c. Social Security Disability Insurance, or SSDI |
1 |
0 |
d |
r |
d. food stamps or SNAP |
1 |
0 |
d |
r |
e. Women, Infants, and Children, or WIC |
1 |
0 |
d |
r |
f. Unemployment Insurance |
1 |
0 |
d |
r |
g. housing choice vouchers, sometimes called Section 8 |
1 |
0 |
d |
r |
Now I would like to ask some questions about your work.
ALL |
CSPED
E2. Are you currently working for pay?
Working for pay can include regular paid jobs, odd jobs, temporary jobs, work done in your own business, “under the table” work, “informal” work, or any other types of work you have done for pay.
YES 1 GO TO E3
NO 0 GO TO E2a
DON’T KNOW d GO TO E2a
REFUSED r GO TO E2a
E2 NE 1 |
CSPED
E2a. Have you worked for pay at any time since [RA MONTH YEAR]?
YES 1 GO TO E4b_1
NO 0 GO TO E11
DON’T KNOW d GO TO E11
REFUSED r GO TO E11
CSPED
|
JOB 1 |
JOB 2 |
|
||
E2=1 (CURRENTLY EMPLOYED) E3. First I am going to ask about your current job or jobs. Do you currently have your own business? This includes work you do for multiple people providing a service, such as lawn care or child care. |
YES 1 GO TO E4 NO 0 GO TO E3a DON’T KNOW d GO TO E3a REFUSED r GO TO E3a |
YES 1 GO TO E4 NO 0 GO TO E3a DON’T KNOW d GO TO E3a REFUSED r GO TO E3a |
|
||
E3≠1 E3a. What is the name of the company or organization you currently work for? If you currently work for more than one company, please start with the job where you usually work the most hours. |
COMPANY NAME (SPECIFY) 99 (STRING 50) DON’T KNOW d REFUSED r
PROGRAMMER: IF E3a = D, R, make [Company Name] be “Job 1” for Job 1, “Job 2” for Job 2, etc. INTERVIEWER: IF E3a=D, R, THEN SAY: That’s okay, we’ll just refer to this job as “Job 1” in the next few questions. |
COMPANY NAME (SPECIFY) 99 (STRING 50) DON’T KNOW d REFUSED r |
|
||
E2=1 (CURRENTLY EMPLOYED) E4. Including all types of jobs, do you currently have any other paid jobs? |
YES 1 GO TO E4a, JOB 2 NO 0 GO TO E4c DON’T KNOW d GO TO E4c REFUSED r GO TO E4c |
YES 1 GO TO E4a, JOB 3 NO 0 GO TO E4c DON’T KNOW d GO TO E4c REFUSED r GO TO E4c |
|
||
E2=1 (CURRENTLY EMPLOYED) E4a. Please tell me who you work for on that job? |
|
COMPANY NAME (SPECIFY) 99 (STRING 50) DON’T KNOW d REFUSED r PROGRAMMER: IF E4a = D, R, make [Company Name] be “Job 1” for Job 1, “Job 2” for Job 2, etc. INTERVIEWER: IF E4a=D, R, THEN SAY: That’s okay, we’ll just refer to this job as “Job 2” in the next few questions. ![]() IF E2=1 LOOP E4 AND E4a JOBS UNTIL E4=(0,d, r). WHEN E4= 0,d,or r GO TO E4c.
|
|
||
E2a=1 (NOT CURRENTLY EMPLOYED) E4b_1. Since [RA DATE], have you worked in your own business? This includes working for multiple people in your own business providing a service, such as lawn care or child care. |
YES 1 GO TO E4c NO 0 GO TO E4b_2 DON’T KNOW d GO TO E4b_2 REFUSED r GO TO E4b_2 |
YES 1 GO TO E4c NO 0 GO TO E4b_2 DON’T KNOW d GO TO E4b_2 REFUSED r GO TO E4b_2 |
|
||
E4b_1≠1 E4b_2. Since [RA DATE], please tell me who you worked for? If you worked for more than one company, please start with the job you had most recently. INTERVIEWER INSTRUCTION: ASK RESPONDENT FOR A DIFFERENT NAME THAN GIVEN AT E3a & E4a. |
COMPANY NAME (SPECIFY) 99 (STRING 50) DON’T KNOW d REFUSED r |
COMPANY NAME (SPECIFY) 99 (STRING 50) DON’T KNOW d REFUSED r |
|
||
If E4=(0, d, r) [TOLD INTERVIEWER THAT NO MORE CURRENT JOBS] or E2a=1 [NOT CURRENTLY EMPLOYED BUT EMPLOYED SINCE RA DATE] E4c. Have you had any other paid jobs since [RA MONTH YEAR] that you haven’t told me about? |
YES 1 GO TO E4b, JOB 2 NO 0 GO TO E5 DON’T KNOW d GO TO E5 REFUSED r GO TO E5 ![]() IF E4c=1 LOOP E4b AND E4c UNTIL E4C=0,d, or r . WHEN E4C=0, d, or r GO TO E5.
|
YES 1 GO TO F4b, JOB 3 NO 0 GO TO E5 DON’T KNOW d GO TO E5 REFUSED r GO TO E5 ![]() IF E4c=1 LOOP E4b AND E4c UNTIL E4C=0,d, or r. WHEN E4C=0, d, or r GO TO E5.
|
|
||
E2=1 OR E2a=1 IF E3 or E4b_1 = 1, FILL “YOURSELF;” ELSE FILL “NOW THINKING OF THE JOB YOU [DO/DID] AT [JOB NAME 1].” IF E2=1, FILL “DO” IF E2A=1, FILL “DID” E5. [Now thinking of the job you [do/did] at JOB NAME 1.] When did you start working for [JOB NAME 1/yourself]? INTERVIEWER: RECORD MONTH AND YEAR. NOTE: ALLOW SKIP ON MONTH. |
| | | / | | | | | MONTH YEAR (1-12) (1990-2017) DON’T KNOW d REFUSED r |
| | | / | | | | | MONTH YEAR (1-12) (1990-2017) DON’T KNOW d REFUSED r |
|
||
E2=1 OR E2a=1 E6. Are you still working for [COMPANY NAME/yourself]?
|
YES 1 GO TO E7 NO 0 GO TO E6a DON’T KNOW d REFUSED r
|
YES 1 GO TO E7 NO 0 GO TO E6a DON’T KNOW d REFUSED r
|
|
||
E2=0 E6a. When did you stop working at this job? INTERVIEWER: RECORD MONTH AND YEAR. |
| | | / | | | | | MONTH YEAR (1-12) (2013-2020) STILL AT JOB 98 DON’T KNOW d REFUSED r |
| | | / | | | | | MONTH YEAR (1-12) (2013-2020) STILL AT JOB 98 DON’T KNOW d REFUSED r |
|
||
E2=1 OR E2a=1 SKIP IF E3 or E4b _1= 1 FILL “ARE” IF E6=98, ELSE FILL “WERE” E7. Which of the following best describes your work at [JOB NAME]? [Are/Were] you working . . . |
CODE ONE ONLY as a regular full-time employee, 1 as a regular part-time employee, 2 for a temporary help agency, 3 self-employed, 4 as a seasonal job, temporary job, or day laborer, 5 or something else (PLEASE specify)? 99 (STRING (100)) DON’T KNOW d REFUSED r |
CODE ONE ONLY as a regular full-time employee 1 as a regular part-time employee, 2 for a temporary help agency, 3 self-employed, 4 as a seasonal job, temporary job, or day laborer, 5 or something else (PLEASE specify)? 99 (STRING (100)) DON’T KNOW d REFUSED r |
|
||
E2=1 OR E2a=1 IF E2=1 FILL DO; IF E2a=1, FILL DID E7a. [Do/Did] you have taxes taken out of your paycheck for the work you [do/did] at this job? |
YES 1 NO 0 R VOLUNTEERS: WAS PAID IN CASH 9 DON’T KNOW d REFUSED r |
YES 1 NO 0 R VOLUNTEERS: WAS PAID IN CASH 9 DON’T KNOW d REFUSED r |
|
||
E2=1 OR E2a=1 IF E6=98 FILL “DO”, ELSE FILL “DID” E8. How many hours [do/did] you usually work in a week on this job? Your best estimate is fine. |
| | | HOURS PER WEEK (0-98) 99 OR MORE HOURS PER WEEK 99 DON’T KNOW d ![]() IF E4=1 OR E4c=1 GO TO E5 [JOB 2-6] WHEN (E4 NE 1 AND E4c NE 1) GO TO E10
REFUSED r
|
| | | HOURS PER WEEK (0-98) 99 OR MORE HOURS PER WEEK 99 DON’T KNOW d ![]() IF E4=1 OR E4c=1 GO TO E5 [JOB 2-6] WHEN E4 NE 1 AND E4c NE 1 GO TO E10
REFUSED r
|
|
||
E2=1 OR E2a=1 FILL “IS”, “CURRENT”, and “VARIES” IF E6=98, ELSE FILL “WAS”, “MOST RECENT”, AND “VARIED” E9. What [was/is] your [most recent/current] rate of pay, before taxes and deductions, at that job? PROBE: If your pay [varies/varied], please provide an average amount. ACCEPT MOST CONVENIENT PAY PERIOD. SOFT CHECK: IF ANSWER IS GREATER THAN $50 PER HOUR, $2000 PER WEEK, $4000 ONCE EVERY 2 WEEKS, $4000 TWICE A MONTH, $100,000 PER YEAR, $400 DAY/DAILY, OR $8000 MONTH, SAY: “I RECORDED [E9 AND E9_AMOUNT ANSWER]. IS THAT CORRECT?” |
$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 DAY/DAILY 7 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r |
$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 DAY/DAILY 7 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r
|
|
||
E2=1 OR E2a=1 FILL PAY PER PERIOD WITH AMOUNT AND PERIOD FROM E9 AND E9_AMOUNT. E9a. Did you always earn [PAY PER PERIOD] at this job? that job?
|
YES 1 GO TO E10 NO 0 GO TO E9b DON’T KNOW d REFUSED r |
YES 1 GO TO E10 NO 0 GO TO E9b DON’T KNOW d REFUSED r |
|
||
E9A=0 E9b. How much did you earn when you started? PROBE: If your pay varied, please provide an average amount. ACCEPT MOST CONVENIENT PAY PERIOD. SOFT CHECK: IF ANSWER IS GREATER THAN $50 PER HOUR, $2000 PER WEEK, $4000 ONCE EVERY 2 WEEKS, $4000 TWICE A MONTH, $100,000 PER YEAR, $400 DAY/DAILY, OR $8000 MONTH, SAY: “I RECORDED [E9b AND E9b_AMOUNT ANSWER]. IS THAT CORRECT?” |
$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 DAY/DAILY 7 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r |
$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 DAY/DAILY 7 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r
|
|||
E2=1 SKIP IF E3 or E4b = 2 OR E7=5 E10. Which of the following benefits are available to you on your job (READ EACH ITEM) . . . SELECT IF AVAILABLE, BUT NOT USED. |
CODE ALL THAT APPLY Paid leave for holidays, vacation or illness? 1 Health insurance or membership in an HMO or PPO plan? 2 DON’T KNOW d REFUSED r |
CODE ALL THAT APPLY Paid leave for holidays, vacation or illness? 1 Health insurance or membership in an HMO or PPO plan? 2 DON’T KNOW d REFUSED r |
all |
PACT
E11. Since [RA MONTH YEAR], was there anything else you did for pay, such as odd jobs or any other type of work, that we haven’t already talked about?
YES 1
NO 0 GO TO E13
DON’T KNOW d GO TO E13
REFUSED r GO TO E13
E11=1 |
PACT
E12. What is your best guess of how much money you received from these activities in a typical month since [RA MONTH YEAR]? Please do not include money you made from jobs we talked about earlier.
PROBE: Your best guess is fine.
$| | | , | | | |
(0-99,999)
DON’T KNOW d GO TO E12a
REFUSED r
E12= DON’T KNOW |
E12a. I just need to know a range. Can you tell me if it was . . .
$0 - $200, 1
$201 - $500, 2
$501 to $700, 3
$701 to $900, 4
$901 to $1000, 5
$1000 to $2,000, or 6
more than $2,000? 7
DON’T KNOW d
REFUSED r
E2 = 1 |
If number of CURRENT jobs rostered equals 1 fill “job” If number of CURRENT jobs rostered greater than 1 fill “jobs” |
PACT
E13. How satisfied are you with your current [job/jobs]? Would you say very satisfied, somewhat satisfied, or not satisfied?
VERY SATISFIED 1
SOMEWHAT SATISFIED 2
NOT SATISFIED 3
DON’T KNOW d
REFUSED r
ALL |
NEW
E14. Since [RA DATE], have you done any of the following?
|
CODE ONE RESPONSE PER ROW |
|||
|
YES |
NO |
DK |
REF |
a. Create or update your resume? |
1 |
0 |
d |
r |
b. Look for a job? |
1 |
0 |
d |
r |
c. Submit a job application? |
1 |
0 |
d |
r |
d. Go on a job interview? |
1 |
0 |
d |
r |
ALL |
Hong et al 2012
E15. Now I am going to read you some statements about employment. On a scale from 0 to 10, where 0 is strongly disagree and 10 is strongly agree, please tell me how strongly you agree with each statement. You can choose any number from 0 to 10.
[FILL STATEMENT A-E]… On a scale from 0 to 10, how strongly do you agree with this statement?
|
Scale |
DK |
REF |
a. I am worthy of working in a good job |
[0-10] NUM |
d |
r |
b. I am capable of working in a good job |
[0-10] NUM |
d |
r |
c. I am aware of the skills and resources I have to be employed in a good job |
[0-10] NUM |
d |
r |
d. I know how to use my skills and resources to move toward my career goals |
[0-10] NUM |
d |
r |
e. My current path will take me to where I need to be in my career |
[0-10] NUM |
d |
r |
ALL |
CSPED
E16. The next question asks about bank accounts you might have, such as savings accounts or checking accounts with a bank or credit union. Do you currently have a checking or savings account?
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
Moore 2003
E17. Are you currently saving or putting money aside for a long-term goal such as education, a car, a house, or a vacation?
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
Moore 2003
E18. Do you regularly keep track of your money and how much you are spending?
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
Moore 2003
E19. Do you currently have a written budget or spending plan you use to manage your expenses?
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
STREAMS
E20. In the past 3 months, have you had to pay a late fee on a bill or loan?
YES 1
NO 0
DON’T KNOW d
REFUSED r
All |
PACT
E21. Are you better off financially than you were a year ago?
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
CSPED
E22. Since [RA MONTH YEAR], did you do any of the following because you didn’t have enough money?
CODE ONE RESPONSE PER ROW
|
YES |
NO |
D |
R |
a. Cut the size of your meals or skip meals because you couldn’t afford enough food? |
1 |
0 |
d |
r |
b. Move in with other people, even for a little while, because of financial problems? |
1 |
0 |
d |
r |
c. Ask to borrow money from friends or family? |
1 |
0 |
d |
r |
d. Go without a phone because you could not afford to pay the bill or buy extra cell phone minutes? |
1 |
0 |
d |
r |
e. Sold or pawned your belongings, or taken a payday loan or auto-title loan? |
1 |
0 |
d |
r |
f. Thought about going to the doctor, dentist or hospital, but decided not to because of the cost? |
1 |
0 |
d |
r |
ALL |
FaMLE,
CSPED
Please tell me if the following has made it not at all hard, a little hard, somewhat hard, very hard, or extremely hard for you to find or keep a good job in the past year.
[FILL a-j]. Would you say that made it not at all hard, a little hard, somewhat hard, very hard, or extremely hard for you to find or keep a good job in the past year?
INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-J
CODE ONE RESPONSE PER ROW
|
NOT AT ALL |
A LITTLE |
SOMEWHAT |
VERY HARD |
EXTREMELY |
DK |
REF |
||
a. Not having reliable transportation |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
b. Not having the right clothes for work |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
c. Not having the required documentation for employment, such as a birth certificate |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
d. Not having good enough childcare or family help |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
e. Having a criminal record |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
f. Not having the right skills or education |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
g. Having substance use or mental health problems |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
h. Trouble getting along with other people or controlling your anger |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
i. Your physical health |
0 |
1 |
2 |
3 |
4 |
d |
r |
||
j. A lack of jobs available in your area |
0 |
1 |
2 |
3 |
4 |
d |
R |
These next questions are about how you are doing.
ALL |
F1. In general, how would you describe your health? Would you say it is…
FaMLE
excellent, 1
very good, 2
good, 3
fair, or 4
poor? 5
DON’T KNOW d
REFUSED r
all |
PHQ-8
F2. Over the last two weeks, how often have you been bothered by any of the following problems?
[PROGRAMMER: FILL a-h]
Would you say that the problem happened not at all, several days, more than half the days, or nearly every day in the last two weeks?
INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-H
|
CODE ONE RESPONSE PER ROW |
|||||
|
NOT AT ALL |
SEVERAL DAYS |
MORE THAN HALF THE DAYS |
NEARLY EVERY DAY |
DK |
REF |
a. Little interest or pleasure in doing things. |
0 |
1 |
2 |
3 |
d |
r |
b. Feeling down, depressed, or hopeless. |
0 |
1 |
2 |
3 |
d |
r |
c. Trouble falling or staying asleep, or sleeping too much. |
0 |
1 |
2 |
3 |
d |
r |
d. Feeling tired or having little energy. |
0 |
1 |
2 |
3 |
d |
r |
e. Poor appetite or overeating. |
0 |
1 |
2 |
3 |
d |
r |
f. Feeling bad about yourself—or that you are a failure or have let yourself or your family down. |
0 |
1 |
2 |
3 |
d |
r |
g. Trouble concentrating on things, such as reading or watching television. |
0 |
1 |
2 |
3 |
d |
r |
h. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual. |
0 |
1 |
2 |
3 |
d |
r |
Now I would like to ask you a few questions about your experience with the criminal justice system.
ALL |
PACT
F3. Have you been arrested since [RA DATE]?
YES 1
NO 0 GO TO F6
DON’T KNOW d GO TO F6
REFUSED r GO TO F6
F3= 1 |
PACT
F4. How many times have you been arrested since [RA DATE]?
INTERVIEWER: CODE 0 IF NEVER ARRESTED
| | | TIMES GO TO F6
(1-99)
NEVER ARRESTED 0 GO TO F6
DON’T KNOW d
REFUSED r
F4=d or r |
PACT
F5. Would you say . . .
Once or twice, 1
3 to 5 times, or 2
6 or more? 3
DON’T KNOW d
REFUSED r
ALL |
BSF
F6. Have you ever been convicted of a crime?
YES 1
NO 0 GO TO G1
DON’T KNOW d GO TO G1
REFUSED r GO TO G1
F6=1 |
BSF
F7. Have you been convicted of a crime since [RA DATE]?
YES 1 GO TO F8
NO 0 GO TO G1
DON’T KNOW d
REFUSED r
F7=1 |
CSPED
F8. Since [RA DATE], were you ever in an adult correctional institution like a county, state, or federal jail or prison?
YES 1
NO 0
DON’T KNOW d
REFUSED r
F7=1 AND F8 NE DK OR R |
BSF
F9. Are you currently on parole or probation?
YES 1
NO 0
DON’T KNOW d
REFUSED r
Now, I would like to ask you about some of the services you may have received since [RA DATE].
ALL |
PACT
G1. Since [RA DATE], did you participate in any group activities to help with your romantic relationships? These could be called workshops or classes.
YES 1
NO 0 GO TO G4
DON’T KNOW d GO TO G4
REFUSED r GO TO G4
G1=1 |
PACT
G2. Since [RA DATE], about how many hours in total did you spend in these group activities?
PROBE: Your best estimate of the number of hours is fine.
| | | HOURS GO TO G4
(0-999)
DON’T KNOW d
REFUSED r
G2 = d OR r |
G3. I just need to know a range. Can you tell me if it was…?
PACT
1 - 5 hours, 1
6 - 10 hours, 2
11 - 15 hours, 3
16 - 20 hours, 4
21 - 30 hours, or 5
More than 30 hours? 6
DON’T KNOW d
REFUSED r
ALL |
PACT
G4. Since [RA DATE], did you participate in any group activities to help with parenting? These could be called workshops or classes.
YES 1
NO 0 GO TO G7
DON’T KNOW d GO TO G7
REFUSED r GO TO G7
G4 = 1 |
PACT
G5. Since [RA DATE], about how many hours in total did you spend in these group activities?
PROBE: Your best estimate of the number of hours is fine.
| | | HOURS GO TO G7
(0-999)
DON’T KNOW d
REFUSED r
G5 = d OR r |
G6. I just need to know a range. Can you tell me if it was…?
PACT
1 - 5 hours, 1
6 - 10 hours, 2
11 - 15 hours, 3
16 - 20 hours, 4
21 - 30 hours, or 5
More than 30 hours? 6
DON’T KNOW d
REFUSED r
ALL |
STREAMS
G7. Since [RA DATE], did you participate in any group or one-on-one activities that helped you with money management or financial literacy? For example, they may have helped you develop a budget or spending plan, set financial goals, or open a checking or savings account.
YES 1
NO 0 GO TO G10
DON’T KNOW d GO TO G10
REFUSED r GO TO G10
G7 = 1 |
STREAMS
G8. Since [RA DATE], about how many hours in total did you spend in these group or one-on-one activities?
PROBE: Your best estimate of the number of hours is fine.
| | | HOURS GO TO G10
(0-999)
DON’T KNOW d
REFUSED r
G8 = d or r |
STREAMS
G9. I just need to know a range. Can you tell me if it was… ?
1 - 5 hours, 1
6 - 10 hours, 2
11 - 15 hours, 3
16 - 20 hours, 4
21 - 30 hours, or 5
More than 30 hours? 6
DON’T KNOW d
REFUSED r
ALL |
PACT
G10. Since [RA DATE], did you participate in a training program for a specific job, trade, or occupation?
YES 1
NO 0 GO TO G13
DON’T KNOW d GO TO G13
REFUSED r GO TO G13
G10 = 1 |
G11. Are you participating in the program now?
PACT
YES 1 GO TO G13
NO 0
DON’T KNOW d
REFUSED r
G11= 0, d, r |
G12. Did you complete the program?
PACT
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
PACT
G13. Since [RA DATE], did you participate in any group activities that helped you get a job in other ways? For example, they may have helped you create a resume, practice interviewing, or talk to you about how to look for a job.
YES 1
NO 0 GO TO G16
DON’T KNOW d GO TO G16
REFUSED r GO TO G16
G13 = 1 |
PACT
G14. Thinking about since [RA DATE], about how many hours in total did you attend these group activities?
PROBE: Your best estimate of the number of hours is fine.
| | | HOURS GO TO G16
(0-999)
DON’T KNOW d
REFUSED r
G14 = d OR r |
G15. I just need to know a range. Can you tell me if it was…?
PACT
1 - 5 hours, 1
6 - 10 hours, 2
11 - 15 hours, 3
16 - 20 hours, 4
21 - 30 hours, or 5
More than 30 hours? 6
DON’T KNOW d
REFUSED r
ALL |
PACT
YES 1
NO 0 GO TO END1
DON’T KNOW d GO TO END1
REFUSED r GO TO END1
G16 = 1 |
PACT
G17. Since [RA DATE], about how many hours in total did you spend getting one-on-one assistance for help in getting a job?
PROBE: Your best estimate of the number of hours is fine.
| | | HOURS GO TO END1
(0-999)
DON’T KNOW d
REFUSED r
G17 = d OR r |
G18. I just need to know a range. Can you tell me if it was…?
PACT
1 - 5 hours, 1
6 - 10 hours, 2
11 - 15 hours, 3
16 - 20 hours, 4
21 - 30 hours, or 5
More than 30 hours? 6
DON’T KNOW d
REFUSED r
H. Contact Information
We are almost finished. I just have a few more questions in case we need to contact you again.
ALL |
YB 30 Mth J1-mod
H1. What is your street address?
(STRING 200)
Street Address 1
(STRING 200)
Street Address 2 or Apt
(STRING 200)
City
(STRING 200)
State/Territory
(STRING 10)
Zip
DON’T KNOW d
REFUSED r
ALL |
YB 30 Mth J1a
H2. Is your mailing address the same as your street address?
YES 1 GO TO H4
NO 0 GO TO H3
DON’T KNOW d GO TO H4
REFUSED r GO TO H4
H2 = 0 |
YB 30 Mth J1b
H3. What is your mailing address?
(STRING 200)
Street /PO BOX Address 1
(STRING 200)
Street/ PO BOX Address 2 or Apt
(STRING 200)
City
(STRING 200)
State/Territory
(STRING 10)
Zip
DON’T KNOW d
REFUSED r
ALL |
YB 30 Mth J2
H4. What is your cell phone number?
| | | | - | | | | -| | | | | TELEPHONE
(201-989) (200-999) (0000-9999)
NO CELL PHONE 1 GO TO H6
DON’T KNOW d GO TO H6
REFUSED r GO TO H6
H4 HAS COMPLETE PHONE NUMBER ENTERED |
YB 30 Mth J3
H5. May we send you text messages? Message and data rates may apply.
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
YB 30 Mth J4
H6. What is your home phone number?
| | | | - | | | | -| | | | | TELEPHONE
(201-989) (200-999) (0000-9999)
NO HOME PHONE 1 GO TO H9
DON’T KNOW d GO TO H9
REFUSED r GO TO H9
H6 HAS COMPLETE PHONE NUMBER ENTERED |
YB 30 Mth J4_cell
H7. Is this number, [FILL H6], for a cell phone?
YES 1
NO 0
DON’T KNOW d
REFUSED r
H6 HAS COMPLETE PHONE NUMBER ENTERED |
YB 30 Mth J5
H8. Whose name is that number listed under?
(STRING 20)
First name
(STRING 20)
Middle name
(STRING 20)
Last name
DON’T KNOW d
REFUSED r
PROGRAMMER BOX H8a.1 IF H7 = 1, CONTINUE TO H8b; ELSE, SKIP TO H9. |
H7 = 1 |
YB 30 Mth J5b
H8b. May we send you text messages at this number: ([FILL H6])? Message and data rates may apply.
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
YB 30 Mth J6
H9. What is another phone number where you can be reached?
| | | | - | | | | -| | | | | TELEPHONE
(201-989) (200-999) (0000-9999)
NO OTHER NUMBER 1 GO TO H12
DON’T KNOW d GO TO H12
REFUSED r GO TO H12
H9 HAS COMPLETE PHONE NUMBER ENTERED |
YB 30 Mth J6_cell
H10. Is this number, [H9], for a cell phone?
YES 1
NO 0
DON’T KNOW d
REFUSED r
H9 HAS COMPLETE PHONE NUMBER ENTERED |
YB 30 Mth J7
H11. Whose name is that number listed under?
(STRING 20)
First name
(STRING 20)
Middle name
(STRING 20)
Last name
DON’T KNOW d
REFUSED r
PROGRAMMER BOX H11a.1 IF H10 = 1, CONTINUE TO H11b; ELSE, SKIP TO H12. |
H10 = 1 |
YB 30 Mth J7b
H11b. May we send you text messages at this number: ([FILL H6_phone])? Message and data rates may apply.
YES 1
NO 0
DON’T KNOW d
REFUSED r
ALL |
YB 30 Mth J8a
H12. Are you planning on moving in the next 12 months?
YES 1 GO TO H12a
NO 0 GO TO H13
DON’T KNOW d GO TO H13
REFUSED r GO TO H13
H12 = 1 |
YB 30 Mth J8b
H12a. Where will you be moving to?
PROBE: Please provide as much information as you know at this time. Do you know the city and state?
(STRING 200)
Street Address 1
(STRING 200)
Street Address 2 or Apt
(STRING 200)
City
(STRING 200)
State/Territory
(STRING 10)
Zip
DON’T KNOW d
REFUSED r
PROGRAMMER: THIS DOES NOT HAVE TO BE A COMPLETE ADDRESS |
ALL |
PACT
What is the full name of the first person we should contact?
(STRING 50)
FIRST NAME
(STRING 50)
MIDDLE INITIAL/NAME
(STRING 50)
LAST NAME
DON’T KNOW d GO TO END
REFUSED r GO TO END
H13 NE D AND R |
H14. What is (his/her) address?
PACT
(STRING 200)
Street Address 1
(STRING 200)
Street Address 2 or Apt
(STRING 200)
City
(STRING 200)
State/Territory
(STRING 10)
Zip
DON’T KNOW d
REFUSED r
H13 NE D AND R |
H15. What is (his/her) relationship to you?
PACT
SPOUSE/PARTNER 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
FRIEND 6
OTHER (SPECIFY) 99
(STRING 50)
DON’T KNOW d
REFUSED r
IF OTHER SPECIFY (99): ENTER OTHER RELATIONSHIP TYPE |
H13 NE D AND R |
PACT
| | | | - | | | | -| | | | | TELEPHONE
(201-989) (200-999) (0000-9999)
NO LANDLINE 0
DON’T KNOW d
REFUSED r
H13 NE D AND R |
H17. Does (he/she) have a cell phone?
PACT
NO 0 GO TO H22
DON’T KNOW d GO TO H22
REFUSED r GO TO H22
H17=1 |
H17a. Can I have that number?
PACT
(201-989) (200-999) (0000-9999)
DON’T KNOW d
REFUSED r
H13 NE D AND R |
H18. What is (his/her) work telephone number?
PACT
(201-989) (200-999) (0000-9999)
NO WORK NUMBER 0
DON’T KNOW d
REFUSED r
H13 NE D AND R |
H19. What is (his/her) email address?
PACT
(STRING 50)
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO H25
DON’T KNOW d GO TO H25
REFUSED r GO TO H25
H13 NE D AND R |
H20. Does (he/she) have another email address?
PACT
(STRING 50)
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO H25
DON’T KNOW d
REFUSED r
SECOND CONTACT
ALL |
H21. What is the full name of the second person we should contact?
PACT
FIRST NAME
(STRING 50)
MIDDLE INITIAL/NAME
(STRING 50)
LAST NAME
DON’T KNOW d GO TO END
REFUSED r GO TO END
H21 NE D AND R |
H22. What is (his/her) address?
PACT
STREET 1
STREET 2
APT. #
CITY
STATE
ZIP
DON’T KNOW d
REFUSED r
H21 NE D AND R |
H23. What is (his/her) relationship to you?
PACT
SPOUSE/PARTNER 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
FRIEND 6
OTHER (SPECIFY) 99
(STRING 50)
DON’T KNOW d
REFUSED r
IF OTHER SPECIFY (99): ENTER OTHER RELATIONSHIP TYPE |
H21 NE D AND R |
H24. What is (his/her) home telephone number?
PACT
(201-989) (200-999) (0000-9999)
NO LANDLINE 0
DON’T KNOW d
REFUSED r
H21 NE D AND R |
H25. Does (he/she) have a cell phone?
PACT
NO 0 GO TO H30
DON’T KNOW d GO TO H30
REFUSED r GO TO H30
H25=1 |
H25a. Can I have that number?
PACT
(201-989) (200-999) (0000-9999)
DON’T KNOW d
REFUSED r
H21 NE D AND R |
H26. What is (his/her) work telephone number?
PACT
(201-989) (200-999) (0000-9999)
NO WORK NUMBER 0
DON’T KNOW d
REFUSED r
H21 NE D AND R |
H27. What is (his/her) email address?
PACT
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO H33
DON’T KNOW d GO TO H33
REFUSED r GO TO H33
H21 NE D AND R |
H28. Does (he/she) have another email address?
PACT
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO H33
DON’T KNOW d
REFUSED r
THIRD CONTACT
(H13 NE D AND R) AND (H21 NE D AND R) |
H29. What is the full name of the third person we should contact?
PACT
FIRST NAME
(STRING 50)
MIDDLE INITIAL/NAME
(STRING 50)
LAST NAME
DON’T KNOW d GO TO END
REFUSED r GO TO END
H29 NE D AND R |
H30. What is (his/her) address?
PACT
STREET 1
STREET 2
APT. #
CITY
STATE
ZIP
DON’T KNOW d
REFUSED r
H29 NE D AND R |
H31. What is (his/her) relationship to you?
PACT
SPOUSE/PARTNER 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
FRIEND 6
OTHER (SPECIFY) 99
(STRING 50)
DON’T KNOW d
REFUSED r
IF OTHER SPECIFY (99): ENTER OTHER RELATIONSHIP TYPE |
H29 NE D AND R |
H32. What is (his/her) home telephone number?
PACT
(201-989) (200-999) (0000-9999)
NO LANDLINE 0
DON’T KNOW d
REFUSED r
H29 NE D AND R |
H33. Does (he/she) have a cell phone?
PACT
NO 0 GO TO H38
DON’T KNOW d GO TO H38
REFUSED r GO TO H38
H33=1 |
H33a. Can I have that number?
PACT
(201-989) (200-999) (0000-9999)
DON’T KNOW d
REFUSED r
H29 NE D AND R |
H34. What is (his/her) work telephone number?
PACT
(201-989) (200-999) (0000-9999)
NO WORK NUMBER 0
DON’T KNOW d
REFUSED r
H29 NE D AND R |
H35. What is (his/her) email address?
PACT
(STRING 50)
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO END
DON’T KNOW d GO TO END
REFUSED r GO TO END
H29 NE D AND R |
H36. Does (he/she) have another email address?
PACT
(STRING 50)
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO END
DON’T KNOW d
REFUSED r
END OF CALL
interview completed |
PACT
END1. Thank you very much for your time. Those are all the questions I have right now. You will receive a $25 gift card as a token of our appreciation. Thank you for your participation in the STREAMS study.
i1=0 |
END2. I am sorry to hear that, our condolences for your loss. Thank you for your time.
PACT
INTERVIEWER: BRING THIS CASE TO LOCATING FOR CONFIRMATION OF DEATH.
If MakeDialphone=5 |
END3. Please hand the phone back to our field locator.
PACT
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | STREAMS CATI BILINGUAL |
Subject | CATI |
Author | MATHEMATICA STAFF |
File Modified | 0000-00-00 |
File Created | 2021-01-15 |