Form 0920-0822 National Intimate Partner and Sexual Violence Survey (NI

The National Intimate Partner and Sexual Violence Survey (NISVS)

AttE_NISVS_Survey_English_clea

National Intimate Partner and Sexual Violence SURVEY - General Population

OMB: 0920-0822

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

All or most calls received on cell phones

Some received on cell phones, some on regular phones

Very few or none received on cell phones

DON’T KNOW

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0822 can be found here:

Document [docx]

Download: docx | pdf

ATTACHMENT E

National Intimate Partner and Sexual Violence Survey (NISVS) 3.0

General Population Survey - FINAL

Table of Contents

Section	Description .	Pages
--	Control Form ………………………………………………………………………………….	1 – 6
A	Respondent Characteristics ……..........................................................	7 – 12


B	Health Questions ……………………………………………………………………………	18
--	Victimization Introduction ……………………………………………………………..	19
C	Stalking …………………………………………………………………………………………	20 – 26
D	Sexual Violence Part 1 Sexual Harassment, Unwanted Touching and Coerced Sex ….	27 – 38
E	Sexual Violence Part 2 Rape and Made to Penetrate …………………………………………………..….	39 – 75
F	Psychological Aggression ……………………………………………………………….	76 - 78
G	Physical Violence ……………………………………………………………………………	79 - 82
H	Intimate Partner Violence Follow-up ……………………………………………..	83 - 87
J	Normative Behaviors ……………………………………………………………………..	88 - 90
--	Wrap-up ………………………………………………………………………………………..	91 - 92

General Notes:

The question numbers are the variable names. Question numbers in parenthesis are for administrative purposes and will not appear on the final data set. CATI-System and other contractor-created variables are included in the survey instrument, are surrounded by brackets, and may be included on the final data set.

Response options in all UPPER CASE should not be read. Responses of Don’t Know, Refused and LEGIT SKIP will be represented using codes -1, -2 and -3, respectively. Blank fields will be interpreted as inadvertent skips.

The following abbreviations are used within the instrument: LEGITIMATE SKIP is LEGIT SKIP, DK is Don’t Know, REF is Refused, MTP is Made to Penetrate, and PTSD is Posttraumatic Stress Disorder.

This survey will be administered both in English and in Spanish (following translation).

Interviewers will not read answer options listed in ALL CAPS. Answer options listed in both upper and lower case are read to the respondent.

Anytime a respondent reports his/her age at first > 18, or DK, or Ref, the program will skip perpetrator age questions.

The minimum number of relationships identified should equal the minimum number of perpetrators calculated. If 996 is entered before the minimum is reached a soft error check should appear. For example, If D03=2 and D04 = 4, then the minimum number should be equal 4. If 996 is entered for D05_02 or D05_03 or D05_04, the soft check will appear.

The age at first occurrence of a behavior should be younger than the current age specified in A1_CHK. If the age a behavior first occurred is older than current age, CATI will display a soft check: “It looks as though I may have entered your current age wrong. We just entered {fill: response from current question} but earlier I put your current age as {fill: A1_CHK}. Would you like me to go back and change your current age or the age I just entered?” The interviewer can then choose to either revise current age, age at first for the behavior, or suppress the check and keep the inconsistent responses.

[General Population]

(CF_INTRO)

Hello, I am calling on behalf of the Centers for Disease Control and Prevention, the CDC. In addition to preventing diseases, the CDC also focuses on a range of health topics, including injuries. The CDC is conducting an important research study on health and injuries, and if someone in your household is selected to participate and completes the interview, we will send that person a check for {FILL: $10 / $40 (NONRESPONSE FOLLOW-UP PHASE)}. My name is __________, with RTI International and I’m part of the research team. Let me assure you that this is not a sales call. Your phone number has been chosen randomly to represent thousands of others in the country.

Continue {Go to CF1}

CF2	I need to ask you a few questions in order to determine your eligibility for CDC’s study. Is this a cell phone?
	1	YES …………………….	{GO TO CF2_1}
	2	NO …………………….	{GO TO CF1}
	3	YES, BUT TOO BUSY NOW	{GO TO TEXT_CONSENT}
CF2_1	Are you driving a vehicle at this moment?
	1	YES …………………….	{GO TO CF2_2}
	2 3	NO ……………………. YES BUT TOO BUSY NOW	{GO TO CF1} GO TO TEXT_CONSENT} 3 3

(CF2_2)

When would be a better time to call you?

INTERVIEWER: IF “R” INDICATES THAT THEY ARE WILLING TO TALK NOW, READ: “I’m sorry, but for your safety we’re not able to do the interview while you’re driving. When would be a better time to call you?”

[SCHEDULE CALLBACK]

CF1	Are you 18 years of age or older? INTERVIEWER: IF NO, ASK TO SPEAK TO SOMEONE OVER 18. IF SOMEONE OVER 18 COMES TO THE PHONE, RE-READ PARAGRAPH ABOVE. IF CAN’T GET SOMEONE OLDER THAN 18, BREAKOFF
	1	YES …………………….	{GO TO CF2}
	2	NO …………………….	{LANDLINE CASES: IF NO 18+ AVAILABLE, SCHEDULE UNSPEC CALLBACK} {CELL PHONE CASES: IF SM IS NOT 18 YEARS OF AGE, CODE OUT AS AGE INELIGIBLE}
	3	YES BUT TOO BUSY NOW	{GO TO TEXT CONSENT}
	-2	REFUSED …………..	{INITIAL REFUSAL}

TEXT_CONSENT For legal purposes, I need to record your verbal consent to receive a text message from us with more information about the study. Do I have your consent to send this message?

Yes {GO TO CONFIRM_CELL}
No {SCHEDULE CALL BACK}

-1 DON’T KNOW {SCHEDULE CALL BACK}

-2 REFUSED {SCHEDULE CALL BACK}

TEXT_THANKS Thank you for giving us permission to send you a text message with more information about the study. You can expect to receive the message within 24-48 hours.

1 Continue [CODES CASE OUT AS: NEED TEXT]

ASK CF3 OF LANDLINE RESPONDENTS (CF2=2).

CF3	Is this a private residence?
	1	YES …………………….	{GO TO CF4}
	2	NO ……………………..	{GO TO CF3_1}
	-1	DON’T KNOW …….	{GO TO CF3_1}
	-2	REFUSED ……………	{GO TO CF3_1}

(CF3_1)

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

[TERMINATE INTERVIEW]

CF4	{FILL: “Including this one” (CF2=1: CELL PHONE)} “How many working cell phones do you have?
	_	RANGE [0-9 IF CF2=2:LANDLINE; 1-9 IF CF2=1:CELL PHONE]
	-1	DON’T KNOW
	-2	REFUSED

CF5	{FILL: “Including the number I just dialed” (CF2=2: LANDLINE)} “How many telephone numbers do you have in your household that are used for talking, EXCLUDING cell phones or telephone lines that are used only for machines like faxes and computers?
	_	RANGE [0-5 IF CF2=1: CELL PHONE; 1-5 IF CF2=2: LANDLINE]
	-1	DON’T KNOW
	-2	REFUSED

CATI:

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

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

CF6	Does anyone else in your household have a working cell phone?
	1	YES ………………………….	{GO TO CFMOSTLY}
	2	NO ………………………….	{GO TO NUM_ADULTS}
	3	NO ONE ELSE IN HH ..	{GO TO NUM_ADULTS}
	-1	DON’T KNOW ………….	{GO TO NUM_ADULTS}
	-2	REFUSED …………………	{GO TO NUM_ADULTS}

NUM_ADULTS	{IF CF2=2, FILL: “I need to randomly select one adult who lives in your household to be interviewed.} How many members of your household, including yourself, are 18 years of age or older?
		_ _	RANGE [0-10 PEOPLE]
		-1	DON’T KNOW ………	{SOFT REFUSAL}
		-2	REFUSED ……………	{SOFT REFUSAL}

[IF CF2=1, GO TO CF11]

CATI:

IF NUM_ADULTS=0 ASK CF6SELF. ELSE CODE AS LEGIT SKIP

CF6SELF	Did you include yourself when you said that no one is 18 years old?
	1	YES ………………………….	{GO TO (CF6_1)}
	2	NO ………………………….	{GO TO NUM_ADULTS; ASK AGAIN}

(CF6_1)

We are only interviewing adults age 18 or older, so those are all the questions I have for you. Thank you for your time. [END INTERVIEW; SCREEN OUT, INELIGBLE AGE]

CATI:

IF LANDLINE RESPONDENT (CF2 = 2) AND NUM_ADULTS = 1, ASK CF7.

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

IF CELL PHONE RESPONDENT (CF2 = 1), GO TO (CF11); CODE CF7 – CF10 AS LEGIT SKIP.

CF7	Are you the adult?
	1	YES ………………………….	{GO TO CF11}
	2	NO ………………………….	{GO TO CF13_FIRST}

CF8_MEN	How many of these adults are men?
	_ _	RANGE [0-10 Men]
	-2	REFUSED ……………	[SOFT REFUSAL]

CF8_WOMEN		How many of these adults are women?
	_ _		RANGE [0-10 Women]
	-2		REFUSED ……………	[SOFT REFUSAL]

CATI:

IF CF8_MEN + CF8_WOMEN DOES NOT EQUAL NUM_ADULTS, WE NEED TO RE-ASK THE QUESTIONS.

ASK CFNCHK.

(CFNCHK)

I’m sorry, but it seems I entered something incorrectly. I recorded your household has [NUM_ADULTS] total adults, with [CF8_MEN] men and [CF8_WOMEN] women. Would you please help me correct this?

1	CORRECT NUMBER ADULTS …………….	GO TO NUM_ADULTS, THEN SKIP TO CFSELECT
2	CORRECT NUMBER MEN …………………	GO TO CF8_MEN, THEN SKIP TO CFSELECT
3	CORRECT NUMEBR WOMEN …………..	GO TO CF8_WOMEN, THEN SKIP TO CFSELECT
-2	REFUSED ………………………………………..	SOFT REFUSAL

(CFSELECT)

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

CATI:

IF NUM_ADULTS = 2, RANDOMLY SELECT ONE ADULT RESPONDENT.

The person in your household that I need to interview is {FILL: “you” (IF “R” SELECTED)/“the other household adult” (IF “R” NOT SELECTED)].

CATI:

IF NUM_ADULTS > 3, USE MOST RECENT BIRTHDAY SELECTION.

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

CF10

CATI:

IF NUM_ADULTS < 2, DISPLAY…]

IS THE PERSON ON THE PHONE THE SELECTED RESPONDENT?

CATI:

IF NUM_ADULTS >2, DISPLAY…]

Are you that person?

	1		YES ………………………….	{GO TO (CF11)}
	2		NO ………………………….	{GO TO CF12_FIRST}

(CF11)

May I have your first name in case we get disconnected? Please do not tell me your last name, your address, or

any other information that would identify you. ______________________ {GO TO CF_INTRO1b}

INTERVIEWER: RECORD RESPONDENT’S FIRST NAME ONLY.

IF RESPONDENT REFUSES, ASK FOR A FIRST INITIAL OR SOME OTHER IDENTIFIER.
IF RESPONDENT STILL REFUSES, LIST DESCRIPTIVE CHARACTERISTICS (e.g.,, FHHM 40 = Female Household Member, 40 years old) IN CASE WE NEED TO CALL BACK, AND CONTINUE.

(CF12_FIRST)

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

______________________

INTERVIEWER: RECORD RESPONDENT’S FIRST NAME ONLY.

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

(CF13)	May I speak with [fill: name from CF12_FIRST OR him or her]?
	1	YES ………………………….	{GO TO CF_INTRO1a}
	2	NO ………………………….	{SCHEDULE CALLBACK}
	-2	REFUSED …………………	[SOFT REFUSAL]

(CF_INTRO1a)

[WHEN SELECTED RESPONDENT COMES TO THE PHONE …]

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

Continue {Go to CF_INTRO1b}

(CF_INTRO1b)

You have been randomly chosen to participate in an important study. This call may be monitored or recorded

for quality assurance purposes. The Centers for Disease Control and prevention (CDC) is doing a telephone study

of up to {fill: 13,000 / 16,000 (Option Year)} people. Men and women age 18 and older will be asked questions about their health and injuries they may have experienced. The data we are collecting are very important, and will be used to inform prevention efforts.

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

Continue {GO TO CF_Intro1c}

(CF_INTRO1c)

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

If you complete the survey, as a token of our appreciation we will send you a check for {FILL: $10 / $40 (NON-RESPONSE FOLLOW-UP PHASE)}

Continue {GO TO CF_INTRO1d}

Continue {GO TO CF_INTRO1d}

(CF_INTRO1d)

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

You may want to have a pen or pencil and paper available to write down a few phone numbers. If you have questions or concerns about participating in the study, you may call the Survey Manager, Jessica Williams, at 866-800-9181. If you have any questions about your rights as a research participant, please contact RTI’s Office of Research Protection toll-free at 866-214-2043.

May we begin?
1	YES ………………………….	{GO TO CF15}
2	NO ………………………….	{GO TO (CF14)}
-1	DON’T KNOW …………	{GO TO (CF14)}
-2	REFUSED …………………	{GO TO (CF14)}

(CF14)	Could you please tell me why you do not wish to participate in the study at this time?
CF14_01	1	DOES NOT HAVE TIME .……………………………………………….	{SCHEDULE CALLBACK}
CF14_02	2	INCONVENIENT NOW………………………………………………….	{SCHEDULE CALLBACK}
CF14_03	3	NOT INTERESTED ……………..…………………………………………	{HARD REFUSAL}
CF14_04	4	DON’T PARTICIPATE IN SURVEYS …………………………………	{HARD REFUSAL}
CF14_05	5	OPPOSES GOVERNMENT INTRUDING ON PRIVACY ……..	{HARD REFUSAL}
CF14_06	6	TOO PRIVATE/SENSITIVE/ EMBARRASSING …………………	{HARD REFUSAL}
CF14_07	7	OTHER (SPECIFY) …………………………………………………………	{GO TO CF14SPEC}
	-1	DON’T KNOW ……………………………………………………………..	{HARD REFUSAL}
	-2	REFUSED …………………………………………………………………….	{HARD REFUSAL}

CATI:

CODE ALL OF CF14_01 – CF14_06 THAT ARE MENTIOED AS 1(YES). CODE REMAINDER AS 2(NO). IF RESPONSE IS DK OR REF, CODE ALL AS SUCH. IF CF14_07 NE 1(YES), SKIP TO CF15; CODE CF14SPEC AS LEGIT SKIP.

CF14SPEC		SPECIFY OTHER REASON FOR NOT PARTICIPATING [MAXIMUM OF 40 CHARACTERS] ___________________________________________________
	-3		LEGIT SKIP
	-1		DON’T KNOW
	-2		REFUSED

CF15	I’d like to confirm your gender; would you currently describe yourself as …
	1	Male ……………………….	{SKIP TO NEXT SECTION}
	2	Female ……………………	{SKIP TO NEXT SECTION}
	3	Or Transgender …..	{GO TO CF16}
	-1	DON’T KNOW ……..…	{THANK “R” AND END; HARD REFUSAL}
	-2	REFUSED …………………	{THANK “R” AND END; HARD REFUSAL}

CATI:

IF CF15 IS MALE OR FEMALE, AUTO—FILL RESPSEX AND SKIP TO THE NEXT SECTION; CODE CF16 AS LEGIT SKIP.

CF16	Would you prefer to be referred to as male or female?
	1	MALE
	2	FEMALE
	-1	DON’T KNOW …………	{THANK “R” AND END; HARD REFUSAL}
	-2	REFUSED …………………	{THANK “R” AND END; HARD REFUSAL}
	-3	LEGIT SKIP

A1MO/A1YR		In what month and year were you born? INTERVIEWER: IF R PROVIDES YEAR OF BIRTH BUT NOT MONTH, CODE MONTH AS REFUSED. CODE YEAR WITH R ANSWER.
	_ _ / _ _ _ _ [MM / YYYY] (numeric) .…………..			{ SKIP TO A2}
	1		January
	2		Febuary
	3		March
	4		April
	5		May
	6		June
	7		July
	8		August
	9		September
	10		October
	11		November
	12		December
	-1 /-1		DON’T KNOW
	-2 / -2		REFUSED

CATI:

ELIGIBLE YEARS OF BIRTH ARE: 1909-[READ-IN: CURRENT MONTH], CURRENT YEAR. IF YEAR OF BIRTH IS OUTSIDE ELIGIBLE RANGE, GO TO (A1a). IF RESPONSE IS -2/-1, WE CANNOT CONFIRM THE RESPONDENT IS 18 OR OLDER, GO TO A1a.

(A1a)

I’m sorry, but we are only speaking with people who are age 18 and older. I will have to end the interview now. Thank you for your interest, and have a nice day/evening.

INTERVIEWER: IF R VOLUNTEERS THEY ARE 18+, SELECT OPTION 2 TO CONTINUE.

R IS LESS THAN 18, THANK AND END

{BREAKOFF}

R VOLUNTEERS AGE 18+

{GO TO A1_CHK}

A1_CHK	How old are you? [RECORD AGE IN YEARS]
	_ _ _	[RANGE 18-110 YEARS] {IF AGE < 18, GO TO (A1b)}
	-2	R VOLUNTEERED 18+ BUT REFUSES TO PROVIDE AGE	{GO TO (A1b) }
	-3	LEGIT SKIP

(A1b)

I’m sorry, but we are only speaking with people who are age 18 and older. I will have to end the interview now. Thank you for your interest, and have a nice day/evening.

CATI:

CALCULATE CATI SYSTEM VARIABLE RESPONDENT AGE IN YEARS [RANGE: 18-110] BASED ON A1MO/A1YR (BIRTH MONTH/YEAR) USING A VALUE OF 15 FOR BIRTHDAY AND STORE IN VARIABLE [“RESPAGE”]. IF A1_CHK IS ANSWERED, COPY THAT AGE INTO THE NEW VARAIBLE. VARIABLE RESPAGE SHOULD BE RETAINED ON THE DATA SET.

A2		What is the highest level of education you have completed? INTERVIEWER: IF NECESSARY: READ RESPONSE OPTIONS 1-9
	1		NO SCHOOLING
	2		1^st-8^th GRADE
	3		SOME HIGH SCHOOL
	4		HIGH SCHOOL GRADUATE/GED
	5		TECHNICAL OR VOCATIONAL SCHOOL (ATTENDED/GRADUATED)
	6		SOME COLLEGE
	7		ASSOCIATES (2-YEAR) DEGREE
	8		BACHELOR’S (4-YEAR COLLEGE) DEGREE
	9		POSTGRADUATE DEGREE (MASTER’S, MA, MS, DOCTORATE, PhD, MD, JD)
	-1		DON’T KNOW
	-2		REFUSED

A3	Are you of Hispanic or {FILL: “Latina” (FEMALE) / “Latino” {MALE)} origin?
	1	YES
	2	NO
	-1	DON’T KNOW
	-2	REFUSED

(A4)	What is your race? You may identify more than one category. Would you say ...
A4_01	1	White
A4_02	2	Black or African American
A4_03	3	Asian
A4_04	4	Native Hawaiian or Pacific Islander
A4_05	5	American Indian or Alaska Native

	-1	DON’T KNOW
	-2	REFUSED

CATI:

CODE ALL OF A4_01-A4_05 THAT ARE MENTIOED AS 1(YES). CODE REMAINDER AS 2(NO). IF RESPONSE IS DK OR REF, CODE ALL AS SUCH. .

A5		Are you currently married, divorced, separated, widowed, not married but living with a partner, or have you never been married? INTERVIEWER: IF RESPONDENT SAYS THEY ARE “SINGLE” OR “ENGAGED” PLEASE PROBE FURTHER TO FIND OUT WHICH OF THE LISTED CATEGORIES IS CORRECT
	1		Married .......................................	{SKIP TO A6}
	2		Divorced ………………………………………….	{SKIP TO A6}
	3		Separated ………………………………………..	{SKIP TO A6}
	4		Widowed …………………………………………	{SKIP TO A6}
	5		NOT MARRIED BUT LIVING WITH A PARTNER	{SKIP TO A6}
	6		NEVER MARRIED	{SKIP TO A6}
	7		SOMETHING ELSE (SPECIFY) …….………..	{GO TO A5SPEC}
	-1		DON’T KNOW ……………………………………	{SKIP TO A6}
	-2		REFUSED …………………………………………..	{SKIP TO A6}

CATI:

IF A5 NE 7, SKIP TO A6; CODE A5SPEC AS LEGIT SKIP.

A5SPEC		SPECIFY “SOMETHING ELSE” [MAXIMUM OF 25 CHARACTERS] ___________________________________________________
		-3		LEGIT SKIP
		-1		DON’T KNOW
		-2		REFUSED
CATI:	ASK A6 Only of the General Population Sample.
A6	Do you think of yourself as …
	1		Lesbian or gay ……………………........		{SKIP TO A7}
	2		Straight, that is, not gay ……………		{SKIP TO A7}
	3		Bisexual …………………………………….		{SKIP TO A7}


	-2		REFUSED.…...……………...................		{SKIP TO A7}

CATI:

A6 SHOULD RESTRICT USE OF THE DON’T KNOW FUNCTION.

CATI:

IF “R” IS NATIVE AMERICAN/ALASKA NATIVE (A4_05=1), SKIP TO A8; CODE A7 AND A7a AS LEGIT SKIP.

[IF A4_05 = YES (American Indian or Alaskan Native), SKIP TO A8]

A7	Were you born in the United States, including U.S. territories and U.S. military bases?
	1	YES …………………………….	{SKIP TO A8}
	2	NO
	-1	DON’T KNOW …………….	{SKIP TO A8}
	-2	REFUSED ……………………	{SKIP TO A8}

CATI:

IF A7 is YES, DK, REF, SKIP TO A8; CODE A7a AS LEGIT SKIP.

A7a	How many years have you lived in the United States? INTERVIEWER: IF R ANSWERS LESS THAN 1 YEAR CODE AS 0. [RECORD NUMBER OF YEARS; A VALUE OF 0 = LESS THAN 1 YEAR; NUMBER ENTERED SHOULD NOT BE MORE THAN RESPONDENT AGE]
	_ _ _	[RANGE 0-110 YEARS]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

(A8)

What was the total income from ALL household members during 2015, before taxes. Include income

from all sources such as work, investments, child support, and public assistance.

Was it….

INTERVIEWER: STUDENTS SHOULD NOT INCLUDE THEIR PARENTS INCOME

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
A8a	… Less than $25,000?	1	2	-1	-2
	SKIP TO …	{A8b}	{A8e}	{ A9 }
A8b	… Less than $20,000?	1	2	-1	-2	-3
	SKIP TO …	{A8c}	{ A9 }
A8c	… Less than $15,000?	1	2	-1	-2	-3
	SKIP TO …	{A8d}	{ A9 }
A8d	… Less than $10,000?	1	2	-1	-2	-3
	SKIP TO …	{ A9 }
A8e	… Less than $35,000?	1	2	-1	-2	-3
	SKIP TO …	{ }A9	{A8f} { A9 }
A8f	… Less than $50,000?	1	2	-1	-2	-3
	SKIP TO …	{ }A9	{ A8g} { A9 }
A8g	… Less than $75,000?	1	2	-1	-2	-3
	SKIP TO …	{ }A9	{A8h} { A9 }
[DO NOT ASK – CODED AS 1 BY CATI WHEN A8g = 2 BELOW]
A8h	$75,000 OR MORE (NOT ASKED)	1	2	-1	-2	-3

A9	What is your zip code? [REFER TO ZIP CODE LOOK-UP DATABASE]
	_ _ _ _ _	[RANGE 00001--99950]
	-1	DON’T KNOW …...……………	{ SKIP TO A12}
	-2	REFUSED ………………………..	{ SKIP TO A12}

	CATI:	IF A09 IS DK/REF, SKIP TO A12; CODE A10, A10a, A11 AND A11a AS LEGIT SKIP. IF ZIP CODE IS NOT FOUND IN LOOK-UP DATABASE SKIP TO A10a, DO NOT ASK A10.

A10				Is this in {FILL: STATE BASED ON RESPONSE TO A9}?
				1	Yes	{FILL A10a with STATE ABBREVIATION AND SKIP TO A11}
				2	No	{GO TO A10a }
				-1	DON’T KNOW
				-2	REFUSED
			-3		LEGIT SKIP

CATI:

IF A10=1 (YES), SKIP TO A11 AND CODE PRE-FILLED STATE ABBREVIATION IN A10a.

IF ZIP CODE IS NOT FOUND IN LOOK-UP DATABASE, SKIP TO A11a. IF SELECTED STATE IS “DC”, SET A11 TO 1 AND A11a TO “District of Columbia

A10a		What state do you live in? [CHOOSE FROM STATE DROP-DOWN LIST (STATE FIPS CODE-APPENDIX III)]
	_ _		[RANGE XX-XX]
	-1		DON’T KNOW …...……………	{ SKIP TO A12}
	-2		REFUSED ………………………..	{ SKIP TO A12}
	-3		LEGIT SKIP

A11		Do you live in {FILL: COUNTY FROM LIST LINKING COUNTY TO ZIP CODE} county? INTERVIEWER: IN LOUISIANA A COUNTY MAY BE REFERRED TO AS A PARISH. IN ALASKA A COUNTY MAY BE REFERRED TO AS A BOROUGH OR CENSUS TRACT.
		1	Yes		{FILL A11a, SKIP TO NEXT SECTION}
		2	No		{SKIP TO A11a}
		-1	DON’T KNOW		{SKIP TO NEXT SECTION}
		-2	REFUSED		{SKIP TO NEXT SECTION}
	-3		LEGIT SKIP

CATI:

IF A11 IS YES, FILL A11a WITH A11 COUNTY NAME FILLED IN A11 AND GO TO NEXT SECTION; CODE A12 AND A12a AS LEGIT SKIP.

A11a

What county do you live in?

INTERVIEWER: “I heard you say that you live in [REPEAT BACK RESPONSE]. Is this the name of the city you live in or the county that your city is in?” IF CITY, ASK AGAIN FOR NAME OF COUNTY. IF DK COUNTY OR INSISTS CITY IS THE COUNTY, ENTER RESPONSE INTO OTHER SPECIFY: COUNTY NOT LISTED.

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

- IF RESPONDENT REPORTS A COUNTY THAT IS NOT LISTED SAY: “LET ME VERIFY THAT YOU SAID _________COUNTY.”

- IF THE RESPONDENT SAYS YES TO THE UNLISTED COUNTY, SELECT “OTHER-SPECIFY: COUNTY NOT LISTED

[STRING OF CHARACTER VARIABLES (UP TO 33 CHARACTERS)]

_____________________________________________________ {IF OTHER SPECIFY SKIP TO A11aSPEC ELSE SKIP TO NEXT SECTION}

-1

DON’T KNOW

-2

REFUSED

CATI:

IF A11a IS OTHER SPECIFY, THEN ANSWER MUST BE PROVIDED TO CONTINUE.

A11aSPEC OTHER-SPECIFY: COUNTY NOT LISTED

[STRING OF CHARACTER VARIABLES (UP TO 33 CHARACTERS)]

A12		I understand that people sometimes do not know their zip code, but for statistical purposes we need to know in what area you live. What state do you live in? [CHOOSE FROM STATE ABBREVIATION DROP-DOWN LIST – (APPENDIX __)]
	_ _		[RANGE XX-XX]
	-1		DON’T KNOW	{SKIP TO NEXT SECTION}
	-2		REFUSED	{SKIP TO NEXT SECTION}
	-3		LEGIT SKIP

CATI:

IF A12a IS OTHER SPECIFY, THEN ANSWER MUST BE PROVIDED TO CONTINUE.

A12aSPEC OTHER-SPECIFY: COUNTY NOT LISTED

[STRING OF CHARACTER VARIABLES (UP TO 33 CHARACTERS)]

CATI:

DEFINE CATI SYSTEM VARIABLE RESPONDENT STATE BASED ON A10a OR A12 AND STORE IN VARIABLE ["RESPSTATE"]. DEFINE CATI SYSTEM VARIABLE RESPONDENT COUNTY FIPS CODE BASED ON A11a OR A12a AND STORE IN VARIABLE ["RESPCFIPS"].

IF COUNTY CANNOT BE FOUND IN SELECTED STATE OR IS NOT SELECTED, RESPCFIPS IS SET TO 99999 OR IS MISSING.

(B_INTRO)

The following questions are about health conditions that you may have.

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

INTERVIEWER: THE LEAD-IN PHRASE MUST BE READ AT LEAST TWICE IN EACH SECTION BELOW. READ AS NECESSARY FOR THE REMAINING ITEMS.

ITEM	QUESTION	YES	NO	DK	REF
B01	… Asthma?	1	2	-1	-2
B02	… Irritable Bowel Syndrome or IBS?	1	2	-1	-2
B03	… Diabetes?	1	2	-1	-2
B04a	… High Blood Pressure?	1	2	-1	-2
B04b	[Ask ONLY of the General Population …] …HIV/AIDS	1	2	-1	-2

Now I am going to ask you about current health issues you may be experiencing.

Do you have …

ITEM	QUESTION	YES	NO	DK	REF
B05	… frequent headaches?	1	2	-1	-2
B06	… chronic pain?	1	2	-1	-2
B07	… difficulty sleeping?	1	2	-1	-2
B08	… serious difficulty hearing?	1	2	-1	-2

ITEM	QUESTION	YES	NO	DK	REF
B09	Are you blind or do you have serious difficulty seeing, even when wearing glasses?	1	2	-1	-2

Do you have…

ITEM	QUESTION	YES	NO	DK	REF
B10	… serious difficulty walking or climbing stairs?	1	2	-1	-2
B11	… difficulty dressing or bathing?	1	2	-1	-2

Because of a physical, mental, or emotional condition, do you have difficulty…

ITEM

QUESTION

YES

REF

B12

… concentrating, remembering or making decisions?

-1

-2

B13

… doing errands alone such as visiting a doctor’s

office or shopping?

-1

-2

(V_INTRO)

When we began this survey, I told you we’d be discussing health and injuries. The next set of questions asks about experiences that can directly impact your health or may have resulted in injury. These experiences may or may not have happened to you. There will be some questions about physical injuries, harassing behaviors, and unwanted sexual activity.

Remember, you don’t have to answer any question that you don’t want to. We suggest that you be in a private setting during the survey. If, at any time, you do not feel physically or emotionally safe, you can just say “Goodbye”. I will understand and I will not call you back. You can call me back if you’d like at 800-613-2408.

Do you have any questions? ANSWER ALL “R” QUESTIONS BEFORE CONTINUING

CONTINUE

V_CHK

Shall we continue?

1	YES
2	NO ……………………………..	{BREAKOFF: THANK & END}
-1	DON’T KNOW …………….	{BREAKOFF: THANK & END}
-2	REFUSED ……………………	{BREAKOFF: THANK & END}

CATI Note:

If NO, DON’T KNOW, REFUSED, Code as a Break-Off; Thank “R” and end the interview. For any hostile refusals or distressed cases do not call back.

(C_INTRO)

I’m going to ask you some detailed questions about times in your life when someone may have ever given you unwanted attention by repeatedly contacting you, following you, or harassing you. When answering, please think about anyone who may have done these things to you, including strangers, a romantic or sexual partner, a family member, a friend, teacher, co-worker or supervisor, or someone you have known briefly.

Please DO NOT include bill collectors, telephone solicitors, other sales people, or others following or contacting you as part of their job.

ITEM	QUESTION	YES	NO	DK	REF
Has anyone ever … INTERVIEWER: THE LEAD-IN PHRASE (“HAS ANYONE EVER”) MUST BE READ AT LEAST TWICE IN EACH SECTION. READ AS NECESSARY FOR THE REMAINING ITEMS.
C01	… followed you around and watched you when you did not want them to?	1	2	-1	-2
C02	… approached you or showed up in places, such as your home, work, or school when you did not want them to?	1	2	-1	-2
C03	… used GPS technology or equipment to monitor or track your location when you did not want them to? This includes GPS technology used in a phone or in social media, such as Facebook. IF NECESSARY: We are talking about times when you knew or you thought someone was using GPS technology to monitor you. IF NECESSARY: GPS is Global Positioning Tracking	1	2	-1	-2
Has anyone ever …
C04	… left strange or potentially threatening items for you to find?	1	2	-1	-2
C05	… sneaked into your home or car and did things to scare you by letting you know they had been there?	1	2	-1	-2
C06	… used technology such as a hidden camera, recorder, or computer software to spy on you from a distance?	1	2	-1	-2
Has anyone ever …
C07	… made unwanted phone calls to you, including hang-ups and voice messages?	1	2	-1	-2
C08	… sent you unwanted text messages, photo messages, emails, or messages through Facebook, Twitter, or other social media?	1	2	-1	-2
C09	… sent you cards, letters, flowers, or presents when they knew you didn’t want them to?	1	2	-1	-2

CATI:

IF “R” ENDORSES 0 BEHAVIORS FOR C01-C09 (INCLUDES RESPONSES OF DK AND REF), THEN SKIP TO

D_INTRO1a; CODE C10 – C20_05 AS LEGIT SKIP.

You said that someone had {FILL: LIST OF STALKING BEHAVIORS ENDORSED FROM ABOVE – USE THE

STALKING BEHAVIOR FILLS (APPENDIX II); SEPARATE LAST TWO BEHAVIORS WITH THE WORD “and”}.

C10	How many people did any of these things to you on more than one occasion? [A VALUE OF 10 = 10 OR MORE]
	_ _	[RANGE 0-10]	{IF = 0 SKIP TO D_INTRO1a}
	-1	DON’T KNOW ………….	{SKIP TO D_INTRO1a}
	-2	REFUSED …………………	{SKIP TO D_INTRO1a}
	-3	LEGIT SKIP

CATI:

IF “R” RESPONDS 0, DK OR REF TO C10, SKIP TO D_INTRO1a; CODE C11a – C20_05 AS LEGIT SKIP.

C11a	Now, thinking ONLY about the {fill: “person” (C10=1)/ people”} who followed, contacted or harassed you on more than one occasion, how many of those people ever made you fearful or feel threatened, or concerned for your safety or the safety of others? [A VALUE OF 10 = 10 OR MORE PEOPLE]
	_ _	[RANGE 0-10]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

C11b	Now, thinking ONLY about the {fill: “person” (C10=1)/ people”} who followed contacted or harassed you on more than one occasion, how many of those people ever made threats to physically harm you? Please include ALL people who made threats to physically harm you EVEN IF you did not take the threat seriously or did not feel fearful, threatened, or concerned for your safety or the safety of others. [A VALUE OF 10 = 10 OR MORE PEOPLE]
	_ _	[RANGE 0-10]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF R RESPONDS ZERO, DK OR REF TO C11a AND C11b, SKIP TO D_INTRO1a; CODE C12_01 – C20_05 AS LEGIT SKIP.
MAXIMUM NUMBER OF RELATIONSHIPS IN C12_ SHOULD EQUAL THE MINIMUM NUMBER ENTERED IN EITHER C10 OR C11A + C11B

C12_01		Now I’d like you to only think about the {fill: “person” (C10=1)/ C10=>1“people”} who {FILL: LIST OF STALKING BEHAVIORS ENDORSED IN C01 – C09} AND made you feel fearful or, made threats to physically harm you, or made you feel concerned for your safety or the safety of others. The first time these things happened to you, how did you know the person who did any of these things to you? IF NECESSARY: Was this person male or female? [USE THE RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]
		_ _ _		[RANGE 100-XXX]
		-1		DON’T KNOW
		-2		REFUSED
		-3		LEGIT SKIP
C13	How old were you the first time this person did any of these things to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _		[RANGE 0-110 YEARS] …………		{IF AGE > 18, SKIP TO C12_02}
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < C13 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (C13) > 18 YEARS AND C10 > 1, SKIP TO C12_02; CODE C14a, C14b AS LEGIT SKIP.

IF AGE AT FIRST (C13) > 18 YEARS AND C10 = 1, SKIP TO C15; CODE C14a-C15, C12_02-12_10 AS LEGIT

SKIP.

C14a		Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-239, 300-339, 400-439, 500-539, 600, 700, 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-289, 350-389, 450-489, 550-589, 650, 750, 760)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
		_ _ _		[RANGE 0-110 YEARS] ……….. {SKIP TO C12_02}
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST (C14a) NOT DK/REF, SKIP TO (C12); CODE C14b AS LEGIT SKIP.

C14b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER	:
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF C10=1 THEN SKIP TO C15; CODE C12_02 –

C12_10 AS LEGIT SKIP.

The first relationship has already been coded in C12_01. Code additional relationships in the “C12_”

variables below using the Relationship/Sex template (Appendix I). Relationship categories may be

repeated.

(C12)

[IF MINIMUM VALUE BETWEEN C10 or C11a+C11b >1 ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
C12_02	Now I’m going to ask you about any additional people who may have done these things to you. Remember, we are only talking about anyone who followed, contacted or harassed you on more than one occasion and made you feel fearful, or made threats to physically harm you, or made you feel concerned for your safety or the safety of others. How did you know the 2^nd person who did any of these things to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT	_ _ _	996	-1	-2	-3
C12_03	How did you know the 3^rd person who did any of these things to you?	_ _ _	996	-1	-2	-3
C12_04	The 4^th person?	_ _ _	996	-1	-2	-3
C12_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
C12_09	The 9^th person?	_ _ _	996	-1	-2	-3
C12_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE C12_## THAT ARE < THE MINIMUM VALUE BETWEEN C10 OR C11A + C11B ONCE CODE 996 IS USED, REMAINING “C12_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF C12_## THAT CAN BE ANSWERED MUST BE THE MINIMUM VALUE BETWEEN C10 OR C11A + C11B

EXAMPLE: IF C10=3, C11a=2 AND C11b=3, C12_04 – C12_10 MUST BE CODED LEGIT SKIP.

NOTE: ITEMS C12_02-C12_05 MAY NOT ALL HAVE RELATIONSHIP INFORMATION AS THE NUMBER IN C10 IS FURTHER RESTRICTED TO THOSE WHO WERE COUNTED IN C11a (fearful) AND/OR C11b (threatened with physical harm).

CATI:	IF NONE OF “C12_” ITEMS ARE AN INTIMATE PARTNER (ALL > 200), SKIP TO C19; CODE C15 – C18b AS LEGIT SKIP.
C15		I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODE 107, 157)/ “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM C12_01 – C12_10}. Is this correct?
		1	YES …………………………….	{SKIP TO C17}
		2	NO	{GO TO C16}
		-1	DON’T KNOW	{SKIP TO C17}
		-2	REFUSED	{SKIP TO C17}
		-3	LEGIT SKIP	{SKIP TO C17}

CATI:

IF C15=1, RECORD FIRST INTIMATE PARTNER RESPONSE FROM C12_01 – C12_10 IN C16.

C16		What was your relationship to the first romantic or sexual partner who did any of these things to you?
	_ _ _		[RANGE 100-199]
	-3		LEGIT SKIP

CATI:

IF 100 < C16 < 199 AND C16 = C12_01 THEN SKIP TO C19; FILL C17 = C13, C18a = C14a, C18b = C14b.

C17	How old were you the first time this person did any of these things to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110 YEARS]	{IF AGE > 18 YEARS, SKIP TO C19}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < C17 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (C17) > 18 YEARS, SKIP TO C19; CODE C18a, C18b AS LEGIT SKIP.

C18a		Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139,) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
		_ _ _		[RANGE 0-110 YEARS] ….. { SKIP TO C19}
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST (C18a) IS NOT DK/REF, SKIP TO C19; CODE C18b AS LEGIT SKIP.

C18b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

C19	Think about the {FILL: “person” (C10=1)/”people”} who {FILL: LIST OF STALKING BEHAVIORS ENDORSED IN C01 – C09; USE THE STALKNG BEHAVIOR FILLS (APPENDIX II)}).} AND made you feel fearful or made threats to physically harm you, or made you feel concerned for your safety or the safety of others. How many people did any of these things to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 = 5 OR MORE PEOPLE]
	_	[RANGE: 0 - 5] ………………………………. {IF 0, SKIP TO D_INTRO1a}
	-1	DON’T KNOW ...……………..................	{SKIP TO D_INTRO1a}
	-2	REFUSED ……………………………………….	{SKIP TO D_INTRO1a}
	-3	LEGIT SKIP

CATI:

IF C19 IS CODED AS ZERO, DK OR REF, SKIP TO D_INTRO1a; CODE C20a, C20_01-C20_05 AS LEGIT SKIP.

CHECK: THE VALUE OF C19 MUST BE < THE MINIMUM VALUE BETWEEN C10 or C11a + C11b.

CATI:

IF ONE RELATIONSHIP EVER (C12_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (C12_01=201-239,251-289) AND ONE RELATIONSHIP PAST 12 MONTHS (C19=1), CODE C20_01 WITH VALUE FROM C12_01, AND SKIP TO D_INTRO1a; CODE C20a, C20_02-C20_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (C12_02 = 996) AND ONE RELATIONSHIP PAST 12 MONTHS (C19=1), AND NOT A FAMILY MEMBER, READ C20a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF C19 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (C20).

IF MORE THAN ONE RELATIONSHIP EVER (C12_02 < 996) AND C19 = 1, GO TO (C20)

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED. ANY RELATIONSHIP RESPONSE IS ACCEPTABLE.

User Note:

↓

Relationships coded in the “C20_” items below.

Code relationships specified using the Relationship/Sex template (Appendix II).

Note that relationships can change over time therefore past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned more than once.

[IF C12_01 ANSWERED AND C12_01 NOT 200-239, 250-289 AND C12_02=996 or C12_02=-3 LEGIT SKIP, READ …]

C20a	I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 710, 760, 800)/ “your” ANY OTHER RELATIONSHIP CODES AT C12_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN C20_01 AND SKIP TO D_INTRO1a; CODE C20_02 – C20_05 AS LEGIT SKIP}
	1	YES …………………………….	{SKIP TO D_INTRO1a}
	2	NO	{GO TO C20_01}
	-1	DON’T KNOW	{SKIP TO D_INTRO1a}
	-2	REFUSED	{SKIP TO D_INTRO1a}
	-3	LEGIT SKIP	{SKIP TO C20_01}

CATI:

IF C20a IS CODED AS 1, -1, -2, FILL C20_01 WITH “FILL” VALUE FROM C20a AND SKIP TO (D_INTRO1a); CODE

C20_02 – C20_05 AS LEGIT SKIP.

(C20)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	DK	REF	NA

How did you know the “person” (C19=1) / ”people” who did these things to you in the past 12 months? [DO NOT READ C20_01-C20_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
C20_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
C20_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
C20_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
C20_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
C20_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE C20_## THAT ARE < C19. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF C19 = 2, THEN C20_01 AND C20_02 MUST BE ANSWERED, AND C20_03 – C20_05 MUST BE CODED

LEGIT SKIP.

(D_INTRO1a)

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

First, I’m going to ask you about unwanted sexual situations, including verbal harassment and unwanted touching.

D_CHK1

Shall we continue?

1	YES
2	NO ………………………………...	{BREAK-OFF: THANK & END}
-1	DON’T KNOW ………………..	{BREAK-OFF: THANK & END}
-2	REFUSED ……………………….	{BREAK-OFF: THANK & END}

CATI

If “R” responds NO, DON’T KNOW, or REFUSED, code as a break-off. Thank “R” and end the interview. For any hostile refusals or distressed cases do not call back.

ITEM

QUESTION

RANGE

[1-10]

NONE

REF

LEGIT SKIP

D01

While you were in a public place, how many people have ever verbally harassed you in a sexual way that made you feel uncomfortable?

_ _

{SKIP

-1

-2

D03}

-3

D02

How many people have done this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

_ _

-1

-2

-3

ITEM	QUESTION	RANGE [1-10]	NONE	DK		REF	LEGIT SKIP
How many people have ever …
D03	… kissed you in a sexual way when you did not want it to happen?	_ _	0		-1	-2		-3
D04	… fondled, groped, grabbed, or touched you in a sexual way when you did not want it to happen?	_ _	0		-1	-2		-3

CATI:

IF NEITHER D03 NOR D04 ENDORSED, SKIP TO D_INTRO2a; CODE D05-D14 AS LEGIT SKIP.

D05_01	Think about the first time anyone EVER {FILL: LIST OF UNWANTED TOUCHING BEHAVIORS ENDORSED IN D03 – D04) – USE THE UNWANTED TOUCHING BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} when you did not want them to. The first time these things happened to you, how did you know the person who did any of these things to you? IF NECESSARY: “Was this person male or female?” [CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]
	_ _ _	[RANGE 100 – XXX]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

D06	How old were you the first time this person did any of these things to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110 YEARS] …..	{IF AGE > 18 SKIP TO (D05)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < D06 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF D06 (AGE AT FIRST) > 18 YEARS, SKIP TO (D05); CODE D07a – D07b AS LEGIT SKIP.

D07a	Approximately how old was “this person” the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-139, 300-339, 400-439, 500-539, 600, 700, 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-189, 350-389, 450-489, 550-589, 650, 750, 760)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110 YEARS] ………. {SKIP TO (D05) }
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST (D07a) NOT DK/REF, SKIP TO (D05); CODE D07b AS LEGIT SKIP.

D07b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

Note:

↓

The first relationship has already been coded in D05_01. Code additional relationships in “D05_” items below using the Relationship/Sex template (Appendix I). Note that relationship categories may be repeated.

(D05)

[IF D03+D04>1, ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGITSKIP
D05_02	Now I’m going to ask you about any additional people who may have done these things to you. How did you know the 2^nd person who did {FILL: “this” (JUST D03) / “any of these things”} to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.	_ _ _	996	-1	-2	-3
D05_03	How did you know the 3^rd person who did {FILL: “this” (JUST D03) / “any of these things”} to you?	_ _ _	996	-1	-2	-3
D05_04	The 4^th person?	_ _ _	996	-1	-2	-3
D05_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
D05_09	The 9^th person?	_ _ _	996	-1	-2	-3
D05_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE D05_## THAT ARE < THE SUM OF D03+D04 (THE MAXIMUM POSSIBLE)

ONCE CODE 996 IS USED, REMAINING “D05_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “D05_##” THAT CAN BE ANSWERED MUST BE < SUM (D03+D04).

EXAMPLE: IF D03=2 AND D04=3, D05_06-D05_10 MUST BE CODED LEGIT SKIP.

CATI:

IF NONE OF “D05_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO D12; CODE D08–

D10 AS LEGIT SKIP.

D08		I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM D05_01 – D05_10}. Is this correct?
	1		YES …………………………….	{CODE RELATIONSHIP IN D09}
	2		NO
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

D09		What was your relationship to the first romantic or sexual partner who did {FILL: “this” (JUST D03) / “any of these things”} to you?
	_ _ _		[RANGE 100-199]
	-3		LEGIT SKIP

CATI:

IF 100 < D09 < 199 AND D09= D5_01 THEN SKIP TO D12; FILL D10 = D06, D11a = D07a, D11b = D07b.

D10	How old were you the first time this person did {FILL: “this” (JUST D03) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110 YEARS] ……….	{IF AGE > 18 YEARS, SKIP TO D12}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < D10 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (D10) > 18 YEARS, OR DK OR REF, SKIP TO D12; CODE D11a, D11b AS LEGIT SKIP.

D11a		Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
		_ _ _		[RANGE 0-110] …….. {SKIP TO D12}
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

IF D11a NOT DK/REF, SKIP TO D12; CODE D11b AS LEGIT SKIP.

D11b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

D12	Thinking about the {FILL: “person” (ONLY ONE OF D03 OR D04, ONE PERSON) / “people”} who {FILL: D03 AND/OR D04 BEHAVIORS AS APPROPRIATE – USE THE SEXUAL VIOLENCE BEHAVIOR FILLS (APPENDIX II)} how many people did {FILL: “this” (JUST D03) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 = 5 OR MORE PEOPLE]
	_	[RANGE: 0 - 5]
	-1	DON’T KNOW ...……………………..........	{SKIP TO D_INTRO2a}
	-2	REFUSED ……………………………………….	{SKIP TO D_INTRO2a}
	-3	LEGIT SKIP

CATI:

IF D12 IS CODED AS NONE, DK OR REF, SKIP TO D_INTRO2a; CODE D13a, D13_01-D13_05, D14 AS LEGIT SKIP.

CHECK: D12 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN D05_01 – D05_10.

CATI:

IF ONE RELATIONSHIP EVER (D05_01 ANSWERED AND D05_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER (D05_01 = 201 - 239, 251 - 289), CODE D13_01 WITH THE RELATIONSHIP FROM D05_01 AND SKIP TO D14; CODE D13a, D13_02 - D13_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (D05_01 ANSWERED, D05_02= 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (D12 = 1), READ D13a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF D12 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (D13).

IF MORE THAN ONE RELATIONSHIP EVER (D05_02 < 996) AND D12=1, GO TO (D13)

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “D13_” items below.

If one relationship EVER (D05_01 answered, D05_02 = 996) and one relationship past 12 months (D12=1), read text to confirm that the relationship has not change: If no change, code D13_01 with the value of D05_01. Otherwise code relationship reported. If more than one relationship EVER (answered at least D05_01, D05_02), read alternate text and code relationships specified using the Relationship/Sex template (Appendix II).

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned more than once.

[IF D05_01 ANSWERED AND D05_01 NOT 200-239, 250-289 AND D05_02=996 or D05_02=-3 LEGIT SKIP READ …]

D13a	I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 710, 760, 800)/ “your” ANY OTHER RELATIONSHIP CODES AT D05_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN D13_01 AND SKIP TO D14; CODE D13_02 – D13_05 AS LEGIT SKIP}
	1	YES …………………………….	{SKIP TO D14}
	2	NO	{GO TO D13_01}
	-1	DON’T KNOW	{SKIP TO D14}
	-2	REFUSED	{SKIP TO D14}
	-3	LEGIT SKIP	{SKIP TO D14}

CATI:

IF D13a IS CODED AS 1, -1, -2, FILL D13_01 WITH “FILL” VALUE FROM D13a AND SKIP TO D14; CODE D13_02 –

D13_05 AS LEGIT SKIP.

(D13)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	DK	REF	LEGIT SKIP

How did you know the “person” (D12=1) / ”people” who did ”this” (JUST D03) / ”these things” to you in the past 12 months? [DO NOT READ D13_01-D13_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
D13_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
D13_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
D13_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
D13_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
D13_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE D13_## THAT ARE < D12. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF D12 = 2, THEN D13_01 AND D13_02 MUST BE ANSWERED, AND D13_03 – D13_05 MUST BE

CODED LEGIT SKIP.

CATI:

QUESTION D14 IS ASKED AS OPEN-ENDED, HOWEVER THE CLOSED FORM DISPLAY OPTIONS SHOULD BE PRESENTED ON THE SCREEN. THE INTERVIEWER WILL CLASSIFY THE OPEN-ENDED RESPONSE INTO ONE OF THE AVAILABLE CLOSED FORM CATEGORIES.

D14		Approximately how many times in total did {FILL: “this” (IF JUST D03) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer”; IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW; IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (IF JUST D03) / “these things”} to you in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

USER NOTE: ITEMS D15 –D24b ARE INCLUDED TO GET AT COERCED SEX

(D_INTRO2a)

Sometimes unwanted sex happens after a person is pressured into it, such as through verbal and emotional pressure and other nonphysical kinds of pressure. The following questions are about times in your life when someone may have ever used verbal or other nonphysical pressure to make you have sex when you didn’t want to. This could be anyone, including strangers or someone you knew such as a romantic or sexual partner, a family member, a friend, teacher, co-worker or supervisor, or someone you have known for only a short time.

How many people have you had vaginal, oral, or anal sex with after they pressured you by doing any of the

following?

ITEM	QUESTION	RANGE [1-10]	NONE			DK		REF		LEGIT SKIP
D15	Telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you?	_ _		0			-1		-2		-3
D16	Wearing you down by repeatedly asking for sex, or showing they were unhappy?	_ _			0		-1		-2		-3
D17	Using their influence or authority over you, for example, your boss or your teacher? IF NECESSARY: “We are asking about people other than parents or other family members”	_ _			0		-1		-2		-3

CATI:

IF NONE OF D15-D17 ARE ENDORSED, SKIP TO E_INTRO1a; CODE D18_01 - D29 AS LEGIT SKIP.

D18_01

The first time these things happened to you, how did you know the person who did any of these things to you?

IF NECESSARY: “Was this person male or female?”

[CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]

_ _ _

[RANGE 100-XXX]

-1

DON’T KNOW

-2

REFUSED

-3

LEGIT SKIP

D19	How old were you the first time this person did any of these things to you? [RECORD AGE IN YEARS; A VAUE OF 0 = LESS THAN 1 YEAR]
	_ _ _	[RANGE 0-110 YEARS] ………	{IF AGE > 18, SKIP TO (D18)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < D19 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (D19) > 18 YEARS, SKIP TO D21; CODE D20a, D20b AS LEGIT SKIP.

D20a		Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-239, 300-339, 400-439, 500-539, 600, 700, 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-289, 350-389, 450-489, 550-589, 650, 750, 760 } did {FILL: “this” / “any of these”} things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
		_ _ _		[RANGE 0-110] …….. {SKIP TO (D18)}
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

IF D20a IS NOT DK/REF, SKIP TO (D18); CODE D20b AS LEGIT SKIP.

D20b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

Note:

↓

The first relationship has already been coded in D18_01. Code additional relationships in “D18_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(D18)

[IF SUM D15- D17 > 1), ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
D18_02	Now I’m going to ask you about any additional people who may have done these things to you. How did you know the 2^nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things” to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.	_ _ _	996	-1	-2	-3
D18_03	How did you know the 3^rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?	_ _ _	996	-1	-2	-3
D18_04	The 4^th person?	_ _ _	996	-1	-2	-3
D18_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
D18_09	The 9^th person?	_ _ _	996	-1	-2	-3
D18_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE D18_## THAT ARE < THE SUM OF D15-D17 (THE MAXIMUM POSSIBLE).

ONCE CODE 996 IS USED, REMAINING “D18_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “D18_##” THAT CAN BE ANSWERED MUST BE < SUM(D15,D16,D17).

EXAMPLE: IF D15=2 AND D16=1 AND D17=2, D18_06-D18_10 MUST BE CODED LEGIT SKIP.

CATI:

IF NONE OF “D18_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO D25; CODE D21–

D24b AS LEGIT SKIP.

D21		I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {FILL: “this” (JUST D17) / “any of these things“} to you was {FILL: (INTIMATE RELATIONSHIP CODES 107,157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM D18_01-D18-10}. Is this correct?
	1		YES …………………………….	{CODE RELATIONSHIP IN D22}
	2		NO
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

D22		What was your relationship to the first romantic or sexual partner who did {FILL: “this” (JUST D17) / “any of these things”} to you?
	_ _ _		[RANGE 100-199]
	-3		LEGIT SKIP

CATI:

IF 100 < D20 < 199 AND D22 = D18_01 THEN SKIP TO D25; FILL D23 = D19, D24a = D20a, D24b = D20b.

D23	How old were you the first time this person did {FILL: “this” (JUST D17) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110 YEARS] ……….	{IF AGE > 18 YEARS, SKIP TO D25}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < D23 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (D23) > 18 YEARS, SKIP TO D25; CODE D24a, D24b AS LEGIT SKIP.

D24a		Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
		_ _ _		[RANGE 0-110] …….. {SKIP TO D25}
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST D24a NOT DK/REF, SKIP TO D25; CODE D24b AS LEGIT SKIP.

D24b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

USER NOTE: ITEMS D25 AND D26 ARE INCLUDED TO GET AT THE CONSEQUENCES OF COERCED SEX

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
D25	Did you ever get a sexually transmitted disease or other infection when {FILL: “this” (JUST D17) / “any of these things”} happened? For example, did you get Chlamydia, Gonorrhea, HIV, or some other STD?	1	2	-1	-2	-3
[IF FEMALE “R” ASK …]
D26	Did you ever get pregnant when FILL: “this” (JUST D17) / “any of these things”} happened?	1	2	-1	-2	-3

CATI:

IF RESPONDENT IS NOT FEMALE, CODE D26 AS LEGIT SKIP.

D27		Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF COERCIVE BEHAVIORS ENDORSED IN D15 – D17 – USE THE COERCIVE BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”}, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 = 5 OR MORE PEOPLE]
		_ _	[RANGE: 0 – 5]
		-1	DON’T KNOW ...………………..……..	{SKIP TO E_INTRO1a}
		-2	REFUSED ………………………………….	{SKIP TO E_INTRO1a}
		-3	LEGIT SKIP

CATI:	IF D27 IS CODED AS NONE, DK OR REF, SKIP TO NEXT SECTION; CODE D28a, D28_01-D28_05, D29 AS LEGIT SKIP. CHECK: D27 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSHIPS LISTED IN D18_01 – D18_10.

CATI:

IF ONE RELATIONSHIP EVER (D18_01 ANSWERED, D18_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (D18_01 = 201 - 239, 251 - 289) CODE D28_01 WITH VALUE FROM D18_01, AND SKIP TO D29; CODE D28a, D28_02 – D28_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (D18_01 ANSWERED, D18_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (D27 = 1), READ D28a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF D27 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (D28).

IF MORE THAN ONE RELATIONSHIP EVER (D18_02 < 996) AND D27=1, GO TO (D28)

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

[IF D18_01 ANSWERED AND D18_01 NOT 200-239, 250-289 AND D18_02=996 or D18_02=-3 LEGIT SKIP, READ …]

D28a	I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 700, 710, 760, 800)/ “your” ANY OTHER RELATIONSHIP CODES AT D18_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN D28_01 AND SKIP TO D29; CODE D28_02 – D28_05 AS LEGIT SKIP}
	1	YES …………………………….	{SKIP TO D29}
	2	NO	{GO TO D28_01}
	-1	DON’T KNOW	{SKIP TO D29}
	-2	REFUSED	{SKIP TO D29}
	-3	LEGIT SKIP	{SKIP TO D29}

CATI:

IF D28a IS CODED AS 1, -1, -2, FILL D28_01 WITH RELATIONSHIP FILL FROM D28a AND SKIP TO D29; CODE D28_02

– D28_05 AS LEGIT SKIP.

Note:

↓

Code Relationships in the “D28_” items below.

If one relationship EVER (D18_01 answered, D18_02 = 996) and one relationship past 12 months (D27=1) AND relationship is NOT a family member, read text to confirm that the relationship has not changed: If no change, code D28_01 with the value of D18_01. ELSE

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

(D28)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-569]	DK	REF	LEGIT SKIP

How did you know the “person” (D27=1) / “people” who did “this” (ONE BEHAVIOR) / “these things” to you in the past 12 months? [DO NOT READ ED28 _01-D28_05; CODE RELATIONSHIPS MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
D28_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
D28_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
D28_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
D28_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
D28_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE D28_## THAT ARE < D27. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF D27 = 2, THEN D28_01 AND D28_02 MUST BE ANSWERED, AND D28_03 – D28_05 MUST BE

CODED LEGIT SKIP.

CATI:

QUESTION D29 IS ASKED AS OPEN-ENDED, HOWEVER THE CLOSED FORM DISPLAY OPTIONS SHOULD BE PRESENTED ON THE SCREEN. THE INTERVIEWER WILL CLASSIFY THE OPEN-ENDED RESPONSE INTO ONE OF THE AVAILABLE CLOSED FORM CATEGORIES.

D29		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer” IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

ALCOHOL AND DRUG FACILITATED UNWANTED SEX

E_INTRO1a

In this section I will ask you about situations in your life in which you ever experienced unwanted sex or sexual contact. By this I mean sexual contact that you did not consent to and that you did not want to happen.

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

E_CHK1a

I heard you say that you have never used alcohol or drugs. We are also asking about times when you may have been given alcohol or drugs without your knowledge, or were using medication that could have impaired your ability to give consent.


	INTERVIEWER NOTE: PRESS “1” TO CONTINUE. PRESS “7” IF RESPONDENT VOLUNTEERED THAT THEY HAVE NEVER BEEN DRUNK, HIGH, DRUGGED OR PASSED OUT FROM ALCOHOL OR DRUGS.
1		CONTINUE
7		R VOLUNTEEREED NEVER DRUNK/HIGH …………	{SKIP TO E_INTRO2a}
-3		LEGIT SKIP

CATI:

IF “R” CONTINUES TO VOLUNTEER THAT THEY HAVE NEVER BEEN DRUNK, HIGH, DRUGGED, OR PASSED OUT FROM ALCOHOL OR DRUGS, CODE E_CHK1a AS 7 AND SKIP TO E_INTRO2a; CODE E01 – E32 AS LEGIT SKIP.

CATI:

IF MALE RESPONDENT, SKIP TO E06; CODE E01 – E05 AS LEGIT SKIP.

[IF FEMALE “R” ASK …]

ITEM	QUESTION	RANGE: [1-10]		NONE		DK		REF	LEGIT SKIP
When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many PEOPLE ever did the following when you did not want them to?
E01	Put their mouth on your vagina or anus?	_ _	0		-1		-2		-3
E02	Put their fingers or an object in your vagina or anus?	_ _	0		-1		-2		-3
When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many MALES ever did the following when you did not want them to …
E03	Put their penis in your vagina?	_ _	0		-1		-2		-3
E04	Put their penis in your anus?	_ _	0		-1		-2		-3
E05	Put their penis in your mouth?	_ _	0		-1		-2		-3

CATI:

IF FEMALE RESPONDENT, SKIP TO E13; CODE E06 – E12 AS LEGIT SKIP.

[IF MALE “R” ASK …]

ITEM	QUESTION	RANGE: [1-10]		NONE		DK		REF	LEGIT SKIP
When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many PEOPLE ever did the following when you did not want them to?
E06	Put their fingers or an object in your anus?	_ _	0		-1		-2			-3
When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many FEMALES ever did the following when you did not want them to …
E07	Made you put your penis in their vagina?	_ _	0		-1		-2			-3
E08	Put their mouth on your penis?	_ _	0		-1		-2			-3
E09	Made you put your mouth on their vagina?	_ _	0		-1		-2			-3
When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many MALES ever did the following when you did not want them to …
E10a	Put their mouth on your penis?	_ _	0		-1		-2			-3
E10b	Made you put your penis in their anus?	__	0		-1		-2			-3
E11a	Put their penis in your mouth?	_ _	0		-1		-2			-3
E11b	Put their penis in your anus?	_ _	0		-1		-2			-3
E12	Put their mouth on your anus?	_ _	0		-1		-2			-3

↑

Note:

If at any point while answering E01 – E05 (FEMALE “R”) / E06 – E12 (MALE “R”), “R” volunteers that they have never been drunk, high, drugged, or passed out from alcohol or drugs, code E_CHK1a as 7 and follow the appropriate skip pattern. If “R” volunteers this information AND has non-zero response to any of the E01-E05 (FEMALE “R”) / E06 - E12 (MALE “R”) items already answered, probe as to whether or not that answer is correct BEFORE recoding E_CHK1a to 7 and skipping out of this section.

CATI:

IF NONE OF E01 – E05 (FEMALE “R”) / E06 – E12 (MALE “R”) ARE ENDORSED, SKIP TO E_INTRO2a; CODE E13-E32 AS LEGIT SKIP.

IF “R” VOLUNTEERS THAT THEY HAVE NEVER BEEN DRUNK, HIGH, DRUGGED, OR PASSSED OUT FROM ALCOHOL OR DRUGS, AND INTERVIEWER GOES BACK AND CODE E_INTRO1a AND E_CHK1a AS 7, SKIP TO E_INTRO2a; CODE E13 – E32 AS LEGIT SKIP. IF SOME OF THE E01 – E05 (FEMALE “R”) / E06 – E12 (MALE “R”) HAVE BEEN ANSWERED AS NONE, DK OR REF, RECODE TO LEGIT SKIP.

The next two questions are about your exposure to alcohol or drugs. Thinking about the times when {FILL: “this” (ONE BEHAVIOR) / “any of these things”} happened to you when you were unable to consent to sex or stop it from happening …

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
E13	… do you think you were ever given alcohol without your knowledge?	1	2	-1	-2	-3
E14	… do you think you were ever given other drugs without your knowledge?	1	2	-1	-2	-3

CATI:

IF FEMALE “R” AND ANY OF E01 – E05 ENDORSED; OR IF MALE RESPONDENT AND ANY OF E06, E11a – E12

ENDORSED, ASK E15_01. ELSE SKIP TO E_INTRO1c; CODE E15_01 – E24 AS LEGIT SKIP.

USER NOTE: ITEMS E15_01 – E24 ARE INTENDED TO GET AT ALCOHOL/DRUG (A/D) FACILITATED RAPE.

E15_01	Think about the first time anyone EVER {FILL: LIST OF A/D RAPE BEHAVIORS ENDORSED IN E01 – E05 (FEMALE “R”) / E06, E11a – E12 (MALE “R”) – USE THE RAPE BEHAVIOR FILLS (APPENDIX II); SEPARATE LAST TWO BEHAVIORS WITH THE WORD “or” } when you were unable to consent to sex or stop it from happening , because you were too drunk, high, drugged, or passed out from alcohol or drugs. The first time these things happened to you, how did you know the person who did any of these things to you? IF NECESSARY: “Was this person male or female?” [CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)
	_ _ _	[RANGE 100-XXX]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E16	How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VAUE OF 0 = LESS THAN 1 YEAR]
	_ _ _	[RANGE 0-110] ……………………	{IF AGE > 18, SKIP TO (E15)}
	-3	LEGIT SKIP
	-1	DON’T KNOW
	-2	REFUSED

CATI:	IF CURRENT AGE (A1_CHK) < E16 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (E16) > 18 YEARS, SKIP TO (E15); CODE E17a, E17b AS LEGIT SKIP.

E17a		Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-239, 300-339, 400-439, 500-539, 600, 700, 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-289, 350-389, 450-489, 550-589, 650, 750, 760)} did {FILL: “this” / “any of these things”} to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
		_ _ _		[RANGE 0-110] …….. {SKIP TO (E15)}
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

IF E17a NE DK/REF, SKIP TO (E15); CODE E17b AS LEGIT SKIP.

E17b	Was this person less than 5 years older than you or 5 or more years older than you the first time {he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

Note:

↓

The first relationship has already been coded in E15_01. Code additional relationships in “E15_” items below using the Relationship/Sex template (Appendix I). Note that relationship categories may be repeated.

(E15)

[IF SUM E01- E05 (FEMALES) / E06, E11 – E12 (MALES) > 1, THEN ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
E15_02	Now I’m going to ask you about any additional people who may have done these things to you. How did you know the 2^nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things” to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.	_ _ _	996	-1	-2	-3
E15_03	How did you know the 3^rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?	_ _ _	996	-1	-2	-3
E15_04	The 4^th person?	_ _ _	996	-1	-2	-3
E15_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
E15_09	The 9^th person?	_ _ _	996	-1	-2	-3
E15_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE E15_## THAT ARE < THE SUM OF E01-E05 (FEMALES) / E06, E11a-E12 (MALES) (THE MAXIMUM POSSIBLE). ONCE CODE 996 IS USED, REMAINING “E15_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “E15_##” THAT CAN BE ANSWERED MUST BE < THE SUM OF E01-E05 (FEMALES) / E06, E11-E12 (MALES).

EXAMPLE: IF E06=2 AND E11=1 AND E12=2, E15_06-E15_10 MUST BE CODED LEGIT SKIP.

CATI:

IF NONE OF “E15_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO E22; CODE E18 – E21b

AS LEGIT SKIP.

E18		I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157)/ “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM E15_01 – E15_10}. Is this correct?
	1		YES …………………………….	{CODE RELATIONSHIP IN E19]
	2		NO
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

E19		What was your relationship to the first romantic or sexual partner who did any of these things to you?
	_ _ _		[RANGE 100-189]
	-3		LEGIT SKIP

CATI:

IF 100 < E19 < 199 AND E19 = E15_01 THEN SKIP TO E22; FILL E20 = E16, E21a = E17a, E21b = E17b.

E20	How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] ……………………….	{IF AGE > 18, SKIP TO E22}

	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E20 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF E20 (AGE AT FIRST) > 18 YEARS, SKIP TO E22; CODE E21a, E21b AS LEGIT SKIP.

E21a	Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110 YEARS] ….. {SKIP TO E22}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST (E21a) NOT DK/REF, SKIP TO E22; CODE E21b AS LEGIT SKIP.

E21b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E22	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF A/D RAPE BEHAVIORS ENDORSED IN E01 – E05 (FEMALE “R”) / E06, E11a – E12 (MALE “R”) – USE THE RAPE BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”..} when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? [A VALUE OF 0 = 5 OR MORE PEOPLE]
	__	[RANGE: 0 – 5]
	-1	DON’T KNOW ...………………..….....	{SKIP TO E_INTRO1c}
	-2	REFUSED ………………………………….	{SKIP TO E_INTRO1c}
	-3	LEGIT SKIP

CATI:

IF E22 IS CODED AS NONE, DK OR REF, SKIP TO E_INTRO1c; CODE E23a, E23_01 – E23_05, E24 AS LEGIT SKIP.

CHECK: E22 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN E15_01 – E15_10.

CATI:

IF ONE RELATIONSHIP EVER (E15_01 ANSWERED, E15_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (E15_01 = 201 - 239, 251 - 289) CODE E23_01 WITH VALUE FROM E15_01, AND SKIP TO E24; CODE E23a, E23_02 – E23_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (E15_01 ANSWERED, E15_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (E22 = 1), READ E23a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF E22 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (E23).

IF MORE THAN ONE RELATIONSHIP EVER (E15_02 < 996) AND E22=1, GO TO (E23)

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “E23_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned

more than once.

[IF E15_01 ANSWERED AND E15_01 NOT 200-239, 250-289 AND E15_02 = 996 or E15_02=-3 LEGIT SKIP, READ …]

E23a	I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 710, 760, 800)/ “your” ANY OTHER RELATIONSHIP CODES AT E15_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN E23_01 AND SKIP TO E24; CODE E23_02 – E23_05 AS LEGIT SKIP}
	1	YES …………………………….	{SKIP TO E24}
	2	NO	{GO TO E23_01}
	-1	DON’T KNOW	{SKIP TO E24}
	-2	REFUSED	{SKIP TO E24}
	-3	LEGIT SKIP	{SKIP TO E24}

CATI:

IF E23a IS CODED AS 1, -1, -2, FILL E23_01 WITH RELATIONSHIP FILL FROM E23a AND SKIP TO E24; CODE E23_02

– E23_05 AS LEGIT SKIP.

(E23)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	DK	REF	LEGIT SKIP

How did you know the “person” (E22=1)/ ”people” who did {FILL: ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months? [DO NOT READ E23_01-E23_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
E23_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
E23_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
E23_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
E23_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
E23_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE E23_## THAT ARE < E22. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF E22 = 3, THEN E23_01, E23_02 AND E23_03 MUST BE ANSWERED, AND E23_04 – E23_05 MUST BE

CODED LEGIT SKIP.

CATI:

QUESTION E24 IS ASKED AS OPEN-ENDED, HOWEVER THE CLOSED FORM DISPLAY OPTIONS SHOULD BE PRESENTED ON THE SCREEN. THE INTERVIEWER WILL CLASSIFY THE OPEN-ENDED RESPONSE INTO ONE OF THE AVAILABLE CLOSED FORM CATEGORIES.

E24		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer”; IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW; IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

USER NOTE: ITEMS E25 – E32 ARE INTENDED TO GET AT ALCOHOL/DRUG FACILITATED MADE TO PENETRATE (MTP)

CATI:

IF FEMALE “R” OR IF MALE “R” AND NONE OF E07-E10b ENDORSED SKIP TO (E_INTRO2a); CODE E25_01 – E32 AS LEGIT SKIP.

IF MALE “R” AND ANY OF E07 – E10b ENDORSED ( > 1) AND ANY OF E15_01 - E24 ANSWERED, THEN DISPLAY

(E_INTRO1c)

IF MALE “R” AND ANY OF E07 – E10b ENDORSED ( > 1) AND NONE of E15_01 – E24 ANSWERED, THEN GO TO E25_01

(E_INTRO1c)

[IF MALE “R” AND ANY OF E07 – E10b IS ENDORSED AND ANY OF E15_01 – E24 ANSWERED (ENDORSED MALE RAPE

QUESTIONS), THEN READ …]

“Now I am going to ask you about some of the other things that have happened to you.

E25_01	Think about the first time anyone EVER {FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES, E07 – E10) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”; IF E08 and E10a are both endorsed (E08>0 and E10a>0) display fill only once } when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs? The first time these things happened to you, how did you know or what was your relationship to the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: “Was this person male or female?” [CODE USING THE RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]
	_ _ _			[RANGE 100-XXX]
	-1			DON’T KNOW
	-2			REFUSED
	-3			LEGIT SKIP
E26		How old were you the first time anyone did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
		_ _ _	[RANGE 0-110] ……..		{IF AGE > 18, SKIP TO (E25)}
		-1	DON’T KNOW
		-2	REFUSED
		-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E26 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (E26) >18 YEARS, SKIP TO (E25); CODE E27a, E27b AS LEGIT SKIP.

E27a	Approximately how old was “this person” the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-239, 300-339, 400-439, 500-539, 600, 700, 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-289, 350-389, 450-489, 550-589, 650, 750, 760)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110 YEARS] ……	{SKIP TO (E25)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST (E27a) NOT DK/REF, SKIP TO (E25); CODE E27b AS LEGIT SKIP.

E27b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

Note:

↓

The first relationship has already been coded in E25_01. Code additional relationships in “E25_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(E25)

[IF SUM E07 – E10b (MALES) > 1, ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
E25_02	Now I’m going to ask you about any additional people who may have done these things to you. How did you know the 2^nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.	_ _ _	996	-1	-2	-3
E25_03	How did you know the 3^rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?	_ _ _	996	-1	-2	-3
E25_04	The 4^th person?	_ _ _	996	-1	-2	-3
E25_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
E25_09	The 9^th person?	_ _ _	996	-1	-2	-3
E25_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE E25_ ## ITEMS THAT ARE < THE SUM (E07 – E10b: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “E25_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “E25_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM (E07-E10b: MALES).

EXAMPLE: IF E07=2 AND E08=3 AND E09=1 AND E10=0, E25_ 07 – E25_10 MUST BE CODED LEGIT SKIP.

CATI:

IF NONE OF “E25_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO E30; CODE E26 –

E29b AS LEGIT SKIP.

E27c		I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM E25_01 – E25_10}. Is this correct?
	1		YES …………………………….	{CODE RELATIONSHIP IN E27]
	2		NO
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

IF 100 < E27d < 199 AND E27d = E25_01 THEN SKIP TO E30; FILL E28 = E26, E29a = E27a, E29b = E27b.

E28	How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] …………………………	{IF AGE > 18, SKIP TO E30}
	-3	LEGIT SKIP
	-1	DON’T KNOW
	-2	REFUSED

CATI:	IF CURRENT AGE (A1_CHK) < E28 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF E28 (AGE AT FIRST) > 18 YEARS, SKIP TO E30; CODE E29a, E29b AS LEGIT SKIP.

E29a	Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110 YEARS]	{SKIP TO E30}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST (E29a) NOT DK/REF, SKIP TO E30; CODE E29b AS LEGIT SKIP.

E29b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E30	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”)} who {FILL: LIST OF MTP BEHAVIORS ENDORSED IN E07 – E10b (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”..} when you were unable to consent to sex or stop it from happening , because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 = 5 OR MORE PEOPLE]
	__	[RANGE: 0 – 5]
	-1	DON’T KNOW ...……………............	{SKIP TO E_INTRO2a}
	-2	REFUSED ………………………………….	{SKIP TO E_INTRO2a}
	-3	LEGIT SKIP

CATI:

IF E30 IS CODED AS NONE, DK OR REF, SKIP TO E33; CODE E31a, E31_01-E31_05, E32 AS LEGIT SKIP.

CHECK: E30 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN “E25_”.

CATI:

IF ONE RELATIONSHIP EVER (E25_01 ANSWERED, E25_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (E25_01 = 201 - 239, 251 - 289) CODE E31_01 WITH VALUE FROM E25_01, AND SKIP TO E32; CODE E31a, E31_02 – E31_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (E25_01 ANSWERED, E25_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (E30 = 1), READ E31a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF E30 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (E31).

IF MORE THAN ONE RELATIONSHIP EVER (E25_02 < 996) AND E30=1, GO TO (E31)

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “E31_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned

more than once.

[IF E25_01 ANSWERED AND E25_01 NOT 200-239, 250-289 AND E25_02 = 996 or E25_02=-3 LEGIT SKIP, READ …]

E31a	I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 710, 760, 800)/ “your” ANY OTHER RELATIONSHIP CODES AT E25_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN E31_01 AND SKIP TO E32; CODE E31_02 – E31_05 AS LEGIT SKIP}
	1	YES …………………………….	{SKIP TO E32}
	2	NO	{GO TO E31_01}
	-1	DON’T KNOW	{SKIP TO E32}
	-2	REFUSED	{SKIP TO E32}
	-3	LEGIT SKIP	{SKIP TO E32}

CATI:

IF E31a IS CODED AS 1, -1, -2, FILL E31_01 WITH RELATIONSHIP FILL FROM E31a AND SKIP TO E32; CODE E31_02

– E31_05 AS LEGIT SKIP.

(E31)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	DK	REF	LEGIT SKIP

How did you know the {FILL: “person” (E30=1)/”people”} who did ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months? [DO NOT READ E31_01-E31_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
E31_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
E31_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
E31_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
E31_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
E31_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE E31_## THAT ARE < E30. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF E30 = 3, THEN E31_01, E31_02 AND E31_03 MUST BE ANSWERED, AND E31_04 – E31_05 MUST BE

CODED LEGIT SKIP.

CATI:

QUESTION E32 IS ASKED AS OPEN-ENDED, HOWEVER THE CLOSED FORM DISPLAY OPTIONS SHOULD BE PRESENTED ON THE SCREEN. THE INTERVIEWER WILL CLASSIFY THE OPEN-ENDED RESPONSE INTO ONE OF THE AVAILABLE CLOSED FORM CATEGORIES.

E32		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer”; IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW; IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

UNWANTED SEX DUE TO THREATS OF HARM/PHYSICAL FORCE

(E_INTRO2a)

Some people are threatened with harm or physically forced to have sex or sexual contact when they don’t want to. Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no. To be clear, we are now asking only about times in your life when sex was unwanted and you did not give consent.

CATI:

IF MALE RESPONDENT, SKIP TO E38; CODE E33 – E37 AS LEGIT SKIP.

Note:

↓

The lead in-phrase (“How many PEOPLE have ever used physical force or ... harm to”) MUST be read before the first item below in each section. Read as necessary for the remaining items.

[IF FEMALE “R” ASK …]

ITEM	QUESTION	RANGE: [1-10]		NONE		DK		REF	LEGIT SKIP
How many PEOPLE have ever used physical force or threats of physical harm to …
E33	… put their mouth on your vagina or anus?	_ _	0		-1		-2			-3
E34	… put their fingers or an object in your vagina or anus?	_ _	0		-1		-2			-3
How many MALES have ever used physical force or threats of physical harm to …
E35	… put their penis in your vagina?	_ _	0		-1		-2			-3
E36	… put their penis in your anus?	_ _	0		-1		-2			-3
E37	… put their penis in your mouth?	_ _	0		-1		-2			-3

CATI:

IF FEMALE RESPONDENT, SKIP TO E45; CODE D38-E44

AS LEGIT SKIP.

[IF MALE “R” ASK …]

ITEM	QUESTION	RANGE: [1-10]		NONE		DK		REF	LEGIT SKIP
How many PEOPLE have ever used physical force or threats of physical harm to …
E38	… put their fingers or an object in your anus?	_ _	0		-1		-2			-3
How many FEMALES have ever used physical force or threats of physical harm to …
E39	… make you put your penis in their vagina?	_ _	0		-1		-2			-3
E40	… put their mouth on your penis?	_ _	0		-1		-2			-3
E41	… make you put your mouth on their vagina?	_ _	0		-1		-2			-3
How many MALES have ever used physical force or threats of physical harm to …
E42a	… put their mouth on your penis?	_ _	0		-1		-2			-3
E42b	… make you put your penis in their anus?	_ _	0		-1		-2			-3
E43a	… put their penis in your mouth?	_ _	0		-1		-2			-3
E43b	…put their penis in your anus?
E44	… put their mouth on your anus?	_ _	0		-1		-2			-3

CATI:

IF NONE OF E33 – E37 (FEMALE “R”) / E38 – E44 (MALE “R”) ENDORSED, SKIP TOE_Intro3a; CODE E45_01-E64 AS LEGIT SKIP.

CATI:

IF FEMALE “R” AND ANY OF E33 – E37 ENDORSED; OR IF MALE RESPONDENT AND ANY OF E38, E43a – E44

ENDORSED, ASK E45_01. ELSE SKIP TO E_INTRO2b; CODE D45_01 – E54 AS LEGIT SKIP.

USER NOTE: ITEMS E45_01 – E54 ARE INTENDED TO GET AT FORCED RAPE

E45_01	Think about the first time anyone EVER {FILL: LIST OF FORCED RAPE BEHAVIORS ENDORSED IN E33- E37 (FEMALE “R”) / E38, E43a-E44 (MALE “R”) – USE THE RAPE BEHAVIOR FILLS (APPENDIX II); SEPARATE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm . The first time these things happened to you, how did you know the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: “Was this person male or female?” [CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)
	_ _ _	[RANGE 100-XXX]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E46	How old were you the first time this person did any of these things to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] ….. {IF AGE > 18, SKIP TO (E45)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E46 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (E46) > 18 YEARS, SKIP TO (E45); CODE E47a, E47b AS LEGIT SKIP.

E47a	Approximately how old was “this person” the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-239, 300-339, 400-439, 500-539, 600, 700, 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-289, 350-389, 450-489, 550-589, 650, 750, 760)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110] ….. {SKIP TO (E45)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST (E47a) NE DK/REF, SKIP TO (E45); CODE E47b AS LEGIT SKIP.

E47b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

Note:

↓

The first relationship has already been coded in E45_01. Code additional relationships in “E45_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(E45)

[IF SUM E33 – E37 (FEMALES) / E38, E43a-E44 (MALES) > 1, THEN ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
E45_02	Now I’m going to ask you about any additional people who may have done these things to you. How did you know the 2^nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things” to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.	_ _ _	996	-1	-2	-3
E45_03	How did you know the 3^rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?	_ _ _	996	-1	-2	-3
E45_04	The 4^th person?	_ _ _	996	-1	-2	-3
E45_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
E45_09	The 9^th person?	_ _ _	996	-1	-2	-3
E45_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE E45_## ITEMS THAT ARE < THE SUM (E33-E37: FEMALES) OR SUM(E38, E43a – E44: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “E45_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “E45_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM (E33-E37: FEMALES) OR < SUM (E38, E43a – E44: MALES).

CATI:

IF NONE OF “E45_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO (E53); CODE E48 – E51b AS LEGIT SKIP.

E48		I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM THE PULL-DOWN MENU}. Is this correct?
	1		YES …………………………….	{CODE RELATIONSHIP IN E49]
	2		NO
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

E49		What was your relationship to the first romantic or sexual partner who did any of these things to you?
	_ _ _		[RANGE 100-189]
	-3		LEGIT SKIP

CATI:

IF 100 < E49 < 199 AND E49 = E45_01 THEN SKIP TO E52; FILL E50 = E46, E51a = E47a, E51b = E47b.

E50	How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] …………………………	{IF AGE > 18, SKIP TO E52}
	-3	LEGIT SKIP
	-1	DON’T KNOW
	-2	REFUSED

CATI:	IF CURRENT AGE (A1_CHK) < E50 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF D50 (AGE AT FIRST) > 18 YEARS, OR DK OR REF, SKIP TO E52; CODE E51a, E51b AS LEGIT SKIP.

E51a	Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110] ..…. {SKIP TO E52}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF PERPETRATOR AGE AT FIRST (E51a) NOT DK/REF, SKIP TO E52; CODE E51b AS LEGIT SKIP.
E51b		Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
		1	LT 5 YEARS OLDER
		2	5+ YEARS OLDER
		-1	DON’T KNOW
		-2	REFUSED
		-3	LEGIT SKIP

E52		Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF FORCED RAPE BEHAVIORS ENDORSED IN E33 – E37 (FEMALES) / E38, E43a – E44 (MALES) – USE THE RAPE BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 0 = 5 OR MORE PEOPLE]
		_ _	[RANGE: 0 – 5]
		-1	DON’T KNOW ...………………..….....	{SKIP TO (E_INTRO2b)}
		-2	REFUSED ………………………………….	{SKIP TO (E_INTRO2b)}
		-3	LEGIT SKIP
CATI:	IF E52 IS CODED AS NONE, DK OR REF, SKIP TO (E_INTRO2b); CODE E53a, E53_01-E53_05, E54 AS LEGIT SKIP. CHECK: E52 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN E45_01 – E45_10.

CATI:

IF ONE RELATIONSHIP EVER (E45_01 ANSWERED, E45_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (E45_01=201-239,251-289) CODE E53_01 WITH VALUE FROM E45_01, AND SKIP TO E54; CODE E53a, E53_02 – E53_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (E45_01 ANSWERED, E45_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (E52=1), READ E53a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF E52 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (E53).

IF MORE THAN ONE RELATIONSHIP EVER (E45_02 < 996) AND E52=1, GO TO (E53)

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “E53_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned

more than once.

[IF E45_01 ANSWERED AND E45_01 NOT 200-239, 250-289 AND E45_02 = 996 or E45_02=-3 LEGIT SKIP, READ …]

E53a			I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 710, 760, 800)/ “your” ANY OTHER RELATIONSHIP CODES AT E45_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN E53_01 AND SKIP TO E54; CODE E53_02 – E53_05 AS LEGIT SKIP}
			1	YES …………………………….	{SKIP TO E54}
			2	NO	{GO TO E53_01}
			-1	DON’T KNOW	{SKIP TO E54}
			-2	REFUSED	{SKIP TO E54}
			-3	LEGIT SKIP	{SKIP TO E54}

	CATI:	IF E53a IS CODED AS 1, -1, -2, FILL E53_01 WITH RELATIONSHIP FILL FROM E53a AND SKIP TO E54; CODE E53_02 – E53_05 AS LEGIT SKIP.

(E53)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	DK	REF	NA

How did you know the “person (E52=1)/”people” who did ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months? [DO NOT READ E53_01-E53_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
E53_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
E53_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
E53_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
E53_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
E53_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE E53_## THAT ARE < E52. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF E52 = 3, THEN E53_01, E53_02 AND E53_03 MUST BE ANSWERED, AND E53_04 – E53_05 MUST BE

CODED LEGIT SKIP.

CATI:

QUESTION E54 IS ASKED AS OPEN-ENDED, HOWEVER THE CLOSED FORM DISPLAY OPTIONS SHOULD BE PRESENTED ON THE SCREEN. THE INTERVIEWER WILL CLASSIFY THE OPEN-ENDED RESPONSE INTO ONE OF THE AVAILABLE CLOSED FORM CATEGORIES.

E54		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer”; IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW; IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

USER NOTE: ITEMS E55_01 – E64 ARE INTENDED TO GET AT FORCED MADE TO PENETRATE (MTP)

CATI:

1) IF FEMALE “R” OR IF MALE “R” AND NONE OF E39-E42b ENDORSED SKIP TO (E_Intro3a); CODE E55_01– E64 AS LEGIT SKIP.

2) IF MALE “R” AND ANY OF E39 – E42b ENDORSED ( > 1) AND ANY OF E38a, E43a-E44, E45-E54 ANSWERED, THEN DISPLAY (E_INTRO2b).

3) IF MALE “R” AND ANY OF E39 – E42B ENDORSED (> 1) AND NONE OF E38A, E43A-E44, E45-E54 ENDORSED, GOT TO E55_01

(E_INTRO2b)

[IF MALE “R” AND ANY OF E39 – E42b IS ENDORSED AND ANY OF E45 – E54 ANSWERED (ENDORSED MALE RAPE

QUESTIONS), THEN READ …]

“Now I am going to ask you about some of the other things that have happened to you.

E55_01	Think about the first time anyone EVER FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES, E39 – E42b) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or” ; IF E40 and E42a are both endorsed (E40>0 and E42a>0) display fill only once } using physical force or threats of harm. The first time these things happened to you, how did you know the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: “Was this person male or female?” [CODE USING THE RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]
	_ _ _	[RANGE 100-XXX]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E56	How old were you the first time this person did any of these things to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] ….. {IF AGE > 18, SKIP TO (E55)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E56 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (E56) > 18 YEARS, SKIP TO (E55); CODE E57a, E57b AS LEGIT SKIP.

E57a	Approximately how old was “this person” the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-239, 300-339, 400-439, 500-539, 600, 700, 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-289, 350-389, 450-489, 550-589, 650, 750, 760)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110] ….. {SKIP TO (E55)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF PERPETRATOR AGE AT FIRST (E57a) > 18 YEARS, SKIP TO (E55); CODE E57b AS LEGIT SKIP.

E57b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

Note:

↓

The first relationship has already been coded in E55_01. Code additional relationships in “E55_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(E55)

[IF MALE “R” AND SUM (E39 – E42b) > 1, ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
E55_02	Now I’m going to ask you about any additional people who may have done these things to you. How did you know the 2^nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.	_ _ _	996	-1	-2	-3
E55_03	How did you know the 3^rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?	_ _ _	996	-1	-2	-3
E55_04	The 4^th person?	_ _ _	996	-1	-2	-3
E55_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
E55_09	The 9^th person?	_ _ _	996	-1	-2	-3
E55_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE E55_## ITEMS THAT ARE < THE SUM (E39 – E42b: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “E55_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “E55_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM (E39 – E42b: MALES).

CATI:

IF NONE OF “E55_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO E62; CODE E58 – E61b

AS LEGIT SKIP.

E58		I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM E55_01 – E55_10}. Is this correct?
	1		YES …………………………….	{CODE RELATIONSHIP IN E59]
	2		NO
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

E59		What was your relationship to the first intimate partner who did any of these things to you?
	_ _ _		[RANGE 100-189]
	-3		LEGIT SKIP

CATI:

IF 100 < E59 < 199 AND E59 = E55_01 THEN SKIP TO E62; FILL E60 = E56, E61a = E57a, E61b = E57b.

E60	How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] ……………………….	{IF AGE > 18, SKIP TO E62}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E60 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF E60 (AGE AT FIRST) > 18 YEARS, SKIP TO E62; CODE E61a, E61b AS LEGIT SKIP.

E61a	Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110 YEARS] ………. {SKIP TO E62}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF E61a NOT DK/REF, SKIP TO E62; CODE E16b AS LEGIT SKIP.

E61b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E62	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF MTP BEHAVIORS ENDORSED IN E39 – E42b (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of violence, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 = 5 OR MORE PEOPLE]
	_ _	[RANGE: 0 – 5]
	-1	DON’T KNOW ...……………............	{SKIP TO E_INTRO3a}
	-2	REFUSED ………………………………….	{SKIP TO E_INTRO3a}
	-3	LEGIT SKIP

CATI:

IF E62 IS CODED AS ZERO, DK OR REF, SKIP TO E_INTRO3a; CODE E63a, E63_01-E63_05, E64 AS LEGIT SKIP.

CHECK: E62 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN E55_01 – E55_10.

CATI:

IF ONE RELATIONSHIP EVER (E55_01 ANSWERED, E55_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (E55_01 = 201 - 239, 251 - 289) CODE E63_01 WITH VALUE FROM E55_01, AND SKIP TO E64; CODE E63a, E63_02 – E63_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (E55_01 ANSWERED, E55_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (E62 = 1), READ E63a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF E62 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (E63).

IF MORE THAN ONE RELATIONSHIP EVER (E55_02 < 996) AND E62=1, GO TO (E63)

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “E63_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

[IF E55_01 ANSWERED AND 55_01 NOT 200-239, 250-289 AND E55_02= 996 or E55_02=-3 LEGIT SKIP, READ …]

E63a	I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 710, 760, 800)/ “your” RELATIONSHIP E55_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN E63_01 AND SKIP TO E64; CODE E63_02 – E63_05 AS LEGIT SKIP}
	1	YES …………………………….	{SKIP TO E64}
	2	NO	{GO TO E63_01}
	-1	DON’T KNOW	{SKIP TO E64}
	-2	REFUSED	{SKIP TO E64}
	-3	LEGIT SKIP	{SKIP TO E64}

CATI:

IF E63a IS CODED AS 1, -1, -2, FILL E63_01 WITH RELATIONSHIP FILL FROM E63a AND SKIP TO E64;

CODE E63_02 – E63_05 AS LEGIT SKIP.

(E63)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	DK	REF	LEGIT SKIP

How did you know the “person” (E62=1)/ ”people” who did ”this” (ONE BEHAVIOR) /”these things” to you in the past 12 months? [DO NOT READ E63_01-E63_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT IF NECESSARY: Was this person male or female?
E63_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
E63_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
E63_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
E63_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
E63_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE E63_## THAT ARE < E62. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF E62 = 3, THEN E63_01, 63_02 AND E63_03 MUST BE ANSWERED, AND E63_04 – E63_05 MUST BE

CODED LEGIT SKIP.

CATI:

QUESTION E64 IS ASKED AS OPEN-ENDED, HOWEVER THE CLOSED FORM DISPLAY OPTIONS SHOULD BE PRESENTED ON THE SCREEN. THE INTERVIEWER WILL CLASSIFY THE OPEN-ENDED RESPONSE INTO ONE OF THE AVAILABLE CLOSED FORM CATEGORIES.

E64		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer”; IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW; IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

ATTEMPTED PHYSICALLY FORCED SEX

(E_INTRO3a)

The next set of questions are about times in your life when someone ever ATTEMPTED to have sex or sexual contact with you by using physical force or threats of harm but sex did NOT happen. Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no. To be clear, we are now asking only about times when sex was unwanted and you did not give consent, and sex did not happen.

CATI:

IF MALE RESPONDENT, SKIP TO E67; CODE E65 – E66 AS LEGIT SKIP.

[IF FEMALE “R” ASK …]

ITEM	QUESTION	RANGE: [1-10]		NONE		DK		REF	LEGIT SKIP
How many PEOPLE have ever used physical force or threats of physical harm to …
E65	… TRY to put their mouth on your vagina or anus but it did not happen?	_ _	0		-1		-2		-3
How many MALES have ever used physical force or threats of physical harm to …
E66	…TRY to put their penis in your vagina, anus or mouth, but it did not happen?	_ _	0		-1		-2		-3

CATI:

IF FEMALE RESPONDENT, SKIP TO E72_01; CODE E67 – E71 AS LEGIT SKIP.

[IF MALE “R” ASK …]

ITEM	QUESTION	RANGE: [1-10]		NONE		DK		REF	LEGIT SKIP
How many PEOPLE have ever used physical force or threats of physical harm to …
E67	… TRY to put their mouth on your penis, but it did not happen?	_ _	0		-1		-2		-3
How many FEMALES have ever used physical force or threats of physical harm to …
E68	… TRY to make you put your penis in their vagina, but it did not happen?	_ _	0		-1		-2		-3
E69	… TRY to make you put your mouth on their vagina but it did not happen?	_ _	0		-1		-2		-3
How many MALES have ever used physical force or threats of physical harm to …
E70	… TRY to put their penis in your mouth or anus, but it did not happen	_ _	0		-1		-2		-3
E71	… TRY to put their mouth on your anus, but it did not happen?	_ _	0		-1		-2		-3

CATI:

IF NONE OF E65 – E66 (FEMALE “R”) / E67 – E71 (MALE “R”) ARE ENDLORSED, SKIP TO (E_Intro4); CODE E72_01 – E91 AS LEGIT SKIP.

CATI:

IF FEMALE “R” AND ANY OF E65-E66 ENDORSED; OR IF MALE RESPONDENT AND ANY OF E70 – E71

ENDORSED, ASK E72_01. ELSE SKIP TO (E_INTRO3b); CODE E72 – E81 AS LEGIT SKIP.

USER NOTE: ITEMS E72_01– E81 ARE INTENDED TO GET AT ATTEMPTED RAPE

E72_01	Think about the first time anyone EVER {FILL: LIST OF RAPE BEHAVIORS ENDORSED IN E65-E66 (FEMALES) / E70-E71 (MALES) – USE THE RAPE BEHAVIOR FILLS (APPENDIX II); SEPARATE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm, but sex DID NOT happen? The first time these things happened to you, how did you know the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: “Was this person male or female?” [CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)
	_ _ _	[RANGE 100-XXX]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E73	How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] …..	{IF AGE > 18, SKIP TO (E72)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E73 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE AT FIRST (E73) > 18 YEARS, SKIP TO (E72); CODE E74a, E74b AS LEGIT SKIP.

E74a	Approximately how old was “this person” the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-239, 300-339, 400-439, 500-539, 600, 700, 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-289, 350-389, 450-489, 550-589, 650, 750, 760)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110] ….. {SKIP TO (E72)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF PERP AGE AT FIRST (E74aa) NE DK/REF, SKIP TO (E72); CODE E74b AS LEGIT SKIP.

E74b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

Note:

↓

The first relationship has already been coded in E72_01. Code additional relationships in “E72_” below using the Relationship/Sex Template (Appendix I). Note that relationship categories may be repeated.

(E72)

[IF SUM E65 – E66 (FEMALES) / E70 – E71 (MALES) > 1, THEN ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]		NO MORE	DK	REF	LEGIT SKIP
E72_02	Now I’m going to ask you about any additional people who may have done these things to you. How did you know the 2^nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things” to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.		_ _ _	996	-1	-2	-3
E72_03	How did you know the 3^rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?		_ _ _	996	-1	-2	-3
E72_04	The 4^th person?		_ _ _	996	-1	-2	-3
E72_05	The 5^th person?		_ _ _	996	-1	-2	-3
:	:
E72_09	The 9^th person?		_ _ _	996	-1	-2	-3
E72_10	The 10^th person?		_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE E72_## ITEMS THAT ARE < THE SUM (E65-E66: FEMALES) / SUM(E70-E71: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “E72_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “E72_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM (E65-E66: FEMALES) / SUM(E70-E71: MALES).

CATI:

IF NONE OF “E72_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO E79 ; CODE E75– E78b

AS LEGIT SKIP.

E75	I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM E75_01 – E75_10}. Is this correct?
		1	YES …………………………….	{CODE RELATIONSHIP IN E76}
		2	NO
		-1	DON’T KNOW
		-2	REFUSED
		-3	LEGIT SKIP

E76		What was your relationship to the first intimate partner who did any of these things to you?
	_ _ _		[RANGE 100-189]
	-3		LEGIT SKIP

CATI:

IF 100 < E76 < 199 AND E76 = E72_01 THEN SKIP TO E79; FILL E77 = E73, E78a = E74a, E78b = E74b.

E77	How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] ………………………	{IF AGE > 18, SKIP TO E79}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E77 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF E77 (AGE AT FIRST) > 18 YEARS, SKIP TO E79; CODE E78a, E78b AS LEGIT SKIP.

E78a	Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110 YEARS] …… {SKIP TP E79}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF E78a IS NOT DK/REF, SKIP TO E79; CODE E78b AS LEGIT SKIP.

E78b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E79	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF ATTEMPTED RAPE BEHAVIORS ENDORSED IN E65-E66 (FEMALES) / E70 – E71 (MALES) – USE THE ATTEMPTED RAPE BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm but sex did not happen, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 0 = 5 OR MORE PEOPLE]
	__	[RANGE: 0 – 5]
	-1	DON’T KNOW ...………………..….....	{SKIP TO E_INTRO3b}
	-2	REFUSED ………………………………….	{SKIP TO E_INTRO3b}
	-3	LEGIT SKIP

CATI:

IF E79 IS CODED AS NONE, DK OR REF, SKIP TO D_INTRO3b; CODE E80a, E80_01-E80_05, E81 AS LEGIT SKIP.

CHECK: E79 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN E72_01 – E72_10.

CATI:

IF ONE RELATIONSHIP EVER (E72_01 ANSWERED, E72_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (E72_01 = 201 - 239, 251 - 289) CODE E80_01 WITH VALUE FROM E72_01, AND SKIP TO E81; CODE E80a, E80_02-E80_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (E72_01 ANSWERED, E72_02= 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (E79=1), READ E80a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF E79 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (E80).

IF MORE THAN ONE RELATIONSHIP EVER (E72_02 < 996) AND E79 = 1, GO TO (E80)

PAST 12 MONTH RELTIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “E80_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

[IF E72_01 ANSWERED AND E72_01 NOT 200-239, 250-289 AND E72_02_02= 996 or E72_02=-3 LEGIT SKIP, READ …]

E80a	I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 710, 760, 800)/ “your” ANY OTHER RELATIONSHIP CODES AT E72_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN E80_01 AND SKIP TO E81; CODE E80_02 – E80_05 AS LEGIT SKIP}
	1	YES …………………………….	{SKIP TO E81}
	2	NO	{GO TO E80_01}
	-1	DON’T KNOW	{SKIP TO E81}
	-2	REFUSED	{SKIP TO E81}
	-3	LEGIT SKIP	{SKIP TO E81}

CATI:

IF E80a IS CODED AS 1, -1, -2, FILL 80_01 WITH RELATIONSHIP FILL FROM E80a AND SKIP TO E81; CODE E80_02

– E80_05 AS LEGIT SKIP.

(E80)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	DK	REF	LEGIT SKIP
How did you know the “person” (E79=1)/” people” who did ”this” (ONE BEHAVIOR) /”these things” to you in the past 12 months? [DO NOT READ E80_01-E80_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
E80_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
E80_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
E80_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
E80_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
E80_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE E80_## THAT ARE < E79. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF E80 = 3, THEN E80_01, 80_02 AND E80_03 MUST BE ANSWERED, AND E80_04 – E80_05 MUST BE

CODED LEGIT SKIP.

CATI:

QUESTION E81 IS ASKED AS OPEN-ENDED, HOWEVER THE CLOSED FORM DISPLAY OPTIONS SHOULD BE PRESENTED ON THE SCREEN. THE INTERVIEWER WILL CLASSIFY THE OPEN-ENDED RESPONSE INTO ONE OF THE AVAILABLE CLOSED FORM CATEGORIES.

E81		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer”; IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW; IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

USER NOTE: ITEMS E82_01 - E91 ARE INTENDED TO GET AT ATTEMPTED MADE TO PENETRATE (MTP) - MALES

CATI:

IF FEMALE “R” OR IF MALE “R” AND NONE OF E67 – E69 ENDORSED ( > 1) SKIP TO (E_Intro4). CODE E82_01 – E91 AS LEGIT SKIP.

IF MALE “R” AND ANY OF E67 – E69 ENDORSED ( > 1) AND ANY OF E70, E71, E72_01-E81 ANSWERED, THEN DISPALY (E_INTRO3b).

IF MALE “R” AND ANY OF E67 – E69 ENDORSED ( > 1) AND NONE OF E70, E71, E72_01-E81 ANSWERED, GO TO E82_01

(E_INTRO3b)

[IF MALE “R” AND ANY OF E67 – E69 IS ENDORSED AND ANY OF E72_01 – E81 ANSWERED (ENDORSED ATTEMPTED

MALE RAPE) THEN READ …]

“Now I am going to ask you about some of the other things that have happened to you.

E82_01	Think about the first time anyone EVER {FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES, E67 – E69) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm. The first time these things happened to you, how did you know the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: “Was this person male or female?” [CODE USING THE RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]
	_ _ _	[RANGE 100-XXX]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E83	How old were you the first time this person did {FILL: “this” / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110 YEARS]	{IF AGE > 18, SKIP TP (E81)}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E83 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF AGE GE AT FIRST (E83) > 18 YEARS, SKIP TO (E82); CODE E84a, E84b AS LEGIT SKIP.

E84a	Approximately how old was “this person” the first time {FILL: “he” (RELATIONSHIP CODES 100-139, 200-239, 300-339, 400-439, 500-539, 600, 700 710, 800) / “she” (RELATIONSHIP CODES 150-189, 250-289, 350-389, 450-489, 550-589, 650, 750, 760)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110] ….. {SKIP TO (E82) }
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF PERPETRATOR AGE AT FIRST (E84a) NOT DK/REF, SKIP TO (E82); CODE E84b AS LEGIT SKIP.
E84b		Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
		1	LT 5 YEARS OLDER
		2	5+ YEARS OLDER
		-1	DON’T KNOW
		-2	REFUSED
		-3	LEGIT SKIP

Note:

↓

The first relationship has already been coded in E82_01. Code additional relationships in “E82_” below using the Relationship/Sex Template (Appendix I). Note that relationship categories may be repeated.

(E82)

[IF SUM E67 – E69 (MALES) > 1, ASK …]

ITEM	QUESTION	RELATIONSHIP	NO MORE	DK	REF		LEGIT SKIP
E82_02	Now I’m going to ask you about any additional people who may have done these things to you. How did you know the 2^nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: Was this person male or female? INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.	_ _ _	996	-1	-2	-3
E82_03	How did you know the 3^rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?	_ _ _	996	-1	-2	-3
E82_04	The 4^th person?	_ _ _	996	-1	-2	-3
E82_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
E82_09	The 9^th person?	_ _ _	996	-1	-2	-3
E82_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE E81_## ITEMS THAT ARE < THE SUM (E67-E69: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “E82_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “E82_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM (E67 – E69: MALES).

CATI:

IF NONE OF “E82_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO E89; CODE E85 – E88b

AS LEGIT SKIP.

E85	I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM E81_02 – E82_10}. Is this correct?
		1	YES …………………………..	{CODE RELATIONSHIP IN E86}
		2	NO
		-1	DON’T KNOW
		-2	REFUSED
		-3	LEGIT SKIP

E86	What was your relationship to the first romantic or sexual partner who did any of these things to you?
		_ _ _	[RANGE 100-189]
		-3	LEGIT SKIP

CATI:

IF 100 < E86 < 199 AND E86 = E82_01 THEN SKIP TO E89; FILL E87 = E83, E88a = E84a, E88b = E84b.

E87	How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110] …………………………	{IF AGE > 18, SKIP TO E89}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < E87 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF E87 (AGE AT FIRST) > 18 YEARS, SKIP TO E89; CODE E88a, E88b AS LEGIT SKIP.

E88a	Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} did any of these things to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110 YEARS] …. {SKIP TP E89}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF E88a NE DK/REF, SKIP TO E89; CODE E88b AS LEGIT SKIP.

E88b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

E89	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF MTP BEHAVIORS ENDORSED E67 – E69 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of violence, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 = 5 OR MORE PEOPLE]
	_	[RANGE: 0 – 5]
	-1	DON’T KNOW ...……………............	{SKIP TO (F_INTRO)}
	-2	REFUSED ………………………………….	{SKIP TO (F_INTRO)}
	-3	LEGIT SKIP

CATI:

IF E89 IS CODED AS NONE, DK OR REF, SKIP TO (F_INTRO); CODE E90a, E90_01-E90_05, E91 AS LEGIT SKIP.

CHECK: E89 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN E82_01 – E82_10.

CATI:

IF ONE RELATIONSHIP EVER (E82_01 ANSWERED, E82_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (E82_01 = 201 - 239, 251 - 289) CODE E90_01 WITH VALUE FROM E81_01, AND SKIP TO E91; CODE E90a, E90_02-E90_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (E81_01 ANSWERED, E81_02= 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (E89=1), READ E90a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF E89 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (E90).

IF MORE THAN ONE RELATIONSHIP EVER (E82_02 < 996) AND E89 = 1, GO TO (E90)

PAST 12 MONTH RELTIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “E90_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

[IF E82_01 ANSWERED AND E82_01 NOT 200-239, 250-289 AND E82 _02= 996 or E82_02=-3 LEGIT SKIP, READ …]

E90a	I just want to confirm that this person was still {FILL: (REALTIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556)/ “your” ANY OTHER RELATIONSHIP CODES AT E80_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN E90_01 AND SKIP TO E91; CODE E90_02 – E90_05 AS LEGIT SKIP}
	1	YES …………………………….	{SKIP TO E91}
	2	NO	{GO TO E90_01}
	-1	DON’T KNOW	{SKIP TO E91}
	-2	REFUSED	{SKIP TO E91}
	-3	LEGIT SKIP	{SKIP TO E91}

CATI:

IF E90a IS CODED AS 1, -1, -2, FILL E90_01 WITH RELATIONSHIP FILL FROM E90a AND SKIP TO E91;

CODE E90_02 – E90_05 AS LEGIT SKIP.

(E90)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-1-2]	DK	REF	LEGIT SKIP

How did you know the “person” (E89=1) / “people” who did “this” (ONE BEHAVIOR) /”these things” to you in the past 12 months? [DO NOT READ E90_01-E90_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
E90_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
E90_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
E90_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
E90_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
E90_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE E90_## THAT ARE < E89. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF E90 = 3, THEN E90_01, 90_02 AND E90_03 MUST BE ANSWERED, AND E90_04 – E90_05 MUST BE

CODED LEGIT SKIP.

CATI:

QUESTION E91 IS ASKED AS OPEN-ENDED, HOWEVER THE CLOSED FORM DISPLAY OPTIONS SHOULD BE PRESENTED ON THE SCREEN. THE INTERVIEWER WILL CLASSIFY THE OPEN-ENDED RESPONSE INTO ONE OF THE AVAILABLE CLOSED FORM CATEGORIES.

E91		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer”; IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW; IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

(E_INTRO4)

I have a few follow-up questions about the times in your life {FILL: “this person” (ONE BEHAVIOR, ONE PERSON) / “anyone”} ever {FILL: “made you” (E33 – E44) } have sex using physical force or threats of violence, {FILL: “tried to make you” (E65 – E71)} have sex using physical force or threats of violence; {FILL: made you have unwanted sex when you were unable to consent or refuse because you were too drunk, high, drugged, or passed out from alcohol or drugs” (E01 – E12)} – SEPARATE THE LAST TWO PHRASES WITH THE WORD “or”.

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
E92	Thinking about these experiences in your entire lifetime, were you ever physically injured when {FILL: “this” (IF JUST ONE BEHAVIOR ENDORESED FROM E01-E12, E33-44, E65-71 / “any of these things”} happened? For example, did you have bruises, {FILL: “vaginal” or (FEMALES)} anal tears, or other internal or external injuries?	1	2	-1	-2	-3
[IF ANY OF E01 – E12, E33 – E44 ENDORSED, ASK …]
E93	Did you ever get an STD or other infection when {FILL: “this” (IF JUST ONE BEHAVIOR ENDORESED FROM E01-E12, E33-44, E65-71 / “any of these things} happened? For example, did you get Chlamydia, Gonorrhea, HIV, or some other STD?	1	2	-1	-2	-3
[IF FEMALE AND EITHER E03 OR E35 ENDORSED, ASK …]
E94	Did you ever get pregnant when {FILL: “this” (IF JUST E03 OR E35 ENDORSED/ “any of these things”} happened?	1	2	-1	-2	-3

CATI:

IF MALE OR, IF FEMALE AND NEITHER E03 NOR E35 ARE ENDORSED, SKIP TO E95; CODE E94 AS LEGIT SKIP.

ITEM

QUESTION

YES

REF

LEGIT SKIP

E95

Were you ever concerned for your safety?

-1

-2

-3

E96

Were you ever fearful for yourself or someone

close to you?

-1

-2

-3

CHK1

{If R endorses 1 or more behaviors in Sexual Violence -Section D or E}

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

YES {go to F_INTRO}
NO {BREAKOFF AND CODE AS DISTRESS}

-1 DON’T KNOW {BREAKOFF AND CODE AS DISTRESS}

-2 REFUSED {BREAKOFF AND CODE AS DISTRESS}

(F_INTRO)

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

INTERVIEWER: IF R ASKS IF THEY SHOULD INCLUDE, OR IF R INDICATES INCLUDING PHYSICAL VIOLENCE, TELL R PHYSICAL VIOLENCE DOES NOT COUNT HERE.

ITEM	QUESTION	RANGE: [1-10]		NONE		DK		REF
How many of your current or ex-romantic or sexual partners have EVER ... INTERVIEWER: THE LEAD-IN PHRASE (“HOW MANY OF YOUR…HAVE EVER”) MUST BE READ AT LEAST TWICE IN EACH SECTION. READ AS NECESSARY FOR THE REMAINING ITEMS.
F01	… insulted, humiliated, or made fun of you in front of others?	_ _	0		-1		-2
F02	… kept you from having your own money?	_ _	0		-1		-2
F03	… tried to keep you from seeing or talking to your family or friends?	_ _	0		-1		-2
F04	… kept track of you by demanding to know where you were and what you were doing?	_ _	0		-1		-2
How many of your current or ex-romantic or sexual partners have ever ...
F05	… made threats to physically harm you?	_ _	0		-1		-2
F06	… threatened to hurt themselves or commit suicide because they were upset with you?	_ _	0		-1		-2
F07	… made decisions that should have been yours to make?	_ _	0		-1		-2
F08	… destroyed something that was important to you?	_ _	0		-1		-2

CATI:

IF NONE OF F01-F08 ARE ENDORSED, SKIP TO G_INTRO1a; CODE F09 –F12 AS LEGIT SKIP.

F09	How old were you the first time a current or ex-romantic or sexual partner did {FILL: “this” (ONE BEHAVIOR, ONE PERSON) / “any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110 YEARS] ……….	{IF AGE > 18 YEARS, SKIP TO F11}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:	IF CURRENT AGE (A1_CHK) < F09 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

CATI:

IF F09 (AGE AT FIRST) > 18 YEARS, SKIP TO F11; CODE F10a AND F10b AS LEGIT SKIP.

F10a	Approximately how old was “this person” the first time he or she did {FILL: “this” (ONE BEHAVAIOR) / ”any of these things”} to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
		_ _ _	[RANGE 0-110 YEARS] ………. {SKIP TO F11}
		-1	DON’T KNOW
		-2	REFUSED
		-3	LEGIT SKIP

CATI:

IF F10a NE DK/REF, SKIP TO F11; CODE F10b AS LEGIT SKIP.

F10b	Was this person less than 5 years older than you or 5 or more years older than you the first time he or she did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

F11	How many current or ex-romantic or sexual partners have done {FILL: “this” (JUST ONE OF F01-F08) / “any of these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 = 5 OR MORE PEOPLE]
	_	[RANGE: 0-5]
	-1	DON’T KNOW ...……………..................	{SKIP TO (G_INTRO1a)}
	-2	REFUSED ……………………………………….	{SKIP TO (G_INTRO1a)}
	-3	LEGIT SKIP

CATI:

IF F11 = 0, DK OR REF, SKIP TO (G_INTRO1a); CODE F12 AS LEGIT SKIP.

F12		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer” IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW IF NECESSARY: “In total” refers to your combined experiences across all current or ex-romantic sexual partners in the past 12 months.
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

(G_INTRO1a)

The next questions are related to physical acts you may have experienced with your romantic or sexual partners.

USER NOTE: THESE NEXT FEW QUESTIONS REFER TO MINOR PHYSICAL ACTS OF VIOLENCE.

ITEM	QUESTION	RANGE [1-10]		NONE		DK		REF
How many of your current or ex-romantic or sexual partners have ever…
G01	… slapped you?	_ _	0		-1		-2
G02	…Pushed or shoved you?	_ _	0		-1		-2

CATI:

IF NEITHER OR G01 – G02 ARE ENDORSED, SKIP TO G_INTRO1b; CODE G03 – G04 AS LEGIT SKIP.

CATI:	IF CURRENT AGE (A1_CHK) < C13 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

G03	How old were you the first time a current or ex-romantic or sexual partner did {FILL: “this” (JUST G01) / ”any of these things”} to you? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
	_ _ _	[RANGE 0-110]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

G04	How many current or ex-romantic or sexual partners have done {FILL: “this” (JUST G01)/ “any of these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 =5 OR MORE PEOPLE]
	__	[RANGE: 0 - 5]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

CHECK: G04 MUST BE < SUM(G01,G02).

(G_INTRO1b)

I want to continue to ask you about other physical acts you might have ever experienced by a current or ex-romantic or sexual partner in your lifetime.

USER NOTE: THESE NEXT FEW QUESTIONS REFER TO MORE SEVERE PHYSICAL ACTS OF VIOLENCE.

ITEM	QUESTION	RANGE [1-10]		NONE		DK		REF
How many of your current or ex-romantic or sexual partners have ever … INTERVIEWER: THE LEAD-IN PHRASE (“HOW MANY OF YOUR…HAVE EVER”) MUST BE READ AT LEAST TWICE IN EACH SECTION. READ AS NECESSARY FOR THE REMAINING ITEMS.
G05	… hit you with a fist or something hard?	_ _	0		-1		-2
G06	… kicked you?	_ _	0		-1		-2
G07	… hurt you by pulling your hair?	_ _	0		-1		-2
How many of your current or ex-romantic or sexual partners have ever …
G08	… slammed you against something?	_ _	0		-1		-2
G09	… tried to hurt you by choking or suffocating you?	_ _	0		-1		-2
How many of your current or ex-romantic or sexual partners have ever …
G10	… beaten you?	_ _	0		-1		-2
G11	… burned you on purpose?	_ _	0		-1		-2
G12	… used a knife on you?	_ _	0		-1		-2
G13	… used a gun on you?	_ _	0		-1		-2

CATI:

IF NONE OF G05 – G13 ENDORSED, SKIP TO G16; CODE G14 –G15 AS LEGIT SKIP.

CATI:	IF CURRENT AGE (A1_CHK) < C13 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)

G14		How old were you the first time a current or ex-romantic or sexual partner {FILL: LIST OF SEVERE PHYSICAL ACT BEHAVIORS ENDORSED IN G05-G13 – USE THE SEVERE PHYSICAL VIOLENCE BEHAVIOR FILLS (APPENDIX II) - SEPARATE THE LAST TWO BEHAVIORS ENDORSED WITH “or”}? [RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]
		_ _ _		[RANGE 0-110]
		-1		DON’T KNOW
		-2		REFUSED
		-3		LEGIT SKIP

G15	How many current or ex-romantic or sexual partners have done {FILL: “this” (ONE BEHAVIOR, ONE PERSON)/ “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 5 = 5 OR MORE PEOPLE]
	__		[RANGE: 0 – 5]
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

CHECK: G15 MUST BE < SUM(G05 THRU G13).

USER NOTE: THESE NEXT FEW QUESTIONS COMBINE THE MINOR AND MORE SEVERE BEHAVIORS PHYSICAL

ACTS OF VIOLENCE.

G16		Think about {FILL: “the person” (ONLY ONE OF G01, G02, G05 – G13 ENDORSED AND ONLY 1 PERSON) / “all of the people”} who {FILL: ENDORSED BEHAVIORS G01, G02, G05-G13 - USE THE PHYSICAL VIOLENCE BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} in your lifetime. What was your relationship with the first current or ex-romantic or sexual partner who did {FILL: “this” (ONE BEHAVIOR)/ “any of these things”} to you the FIRST time? IF NECESSARY: “Was this person male or female?” [CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]
	_ _ _		[RANGE 100-199]
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CATI:

IF BOTH PHYSICAL VIOLENCE AGE AT FIRST VARIABLES (G03, G14) > 18, SKIP TO G18; CODE G17A AS LEGIT SKIP.
IF EITHER G03 > 18 and G14=LEGIT SKIP CODE G17A AS LEGIT SKIP
IF EITHER G14 > 18 and G=LEGIT SKIP CODE G17A AS LEGIT SKIP

G17a	Approximately how old was this person the first time {FILL: “he” (RELATIONSHIP CODES 100-139) / “she” (RELATIONSHIP CODES 150-189)} “he” or “she” did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you? IF NECESSARY: IF “R” PROVIDES A RANGE OR “R” DOES NOT KNOW, ASK THEM TO APPROXIMATE [RECORD AGE IN YEARS]
	_ _ _	[RANGE 0-110] …… {SIP TO G18}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF G17a NE DK/REF, SKIP TO G18; CODE G17b AS LEGIT SKIP.

G17b	Was this person less than 5 years older than you or 5 or more years older than you the first time {FILL: he/she} did any of these things to you?
	1	LT 5 YEARS OLDER
	2	5+ YEARS OLDER
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

G18	What was your relationship with the {FILL: “first” (SUM G04+G15>1)} current or ex-romantic or sexual partner who did {FILL: “this” (ONE BEHAVIOR)/ “any of these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “Was this person male or female?” [CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]
	_ _ _	[RANGE 100-139, 150-189]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

G19		Approximately how many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}? IF NECESSARY: “I just need an approximate answer” IF “R” GIVES A RESPONSE THAT SPANS CATEGORIES: “Would you say …” READ AFFECTED RESPONSE OPTIONS BELOW IF “R” DOES NOT KNOW: “Would you say …” READ RESPONSE OPTIONS 1-5 BELOW. IF NECESSARY: “In total” refers to your combined experiences across all of the people who did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.]
	1		ONE TIME
	2		TWO TO FIVE TIMES
	3		SIX TO TEN TIMES
	4		ELEVEN TO TWENTY TIMES
	5		MORE THAN TWENTY TIMES
	-1		DON’T KNOW
	-2		REFUSED
	-3		LEGIT SKIP

CHK2

{If R endorses 3+ behaviors in Stalking, Psychological Aggression, Physical Violence- Section C, F, G}

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

YES {go to H_INTRO}
NO {BREAKOFF AND CODE AS DISTRESS}

-1 (VOL) DON’T KNOW {BREAKOFF AND CODE AS DISTRESS}

-2 (VOL) REFUSED {BREAKOFF AND CODE AS DISTRESS}

(H_INTRO)

[IF ANY OF G01-G02, G05-G13 GE 1 (PV BY AN INTIMATE PARTNER) AND/OR ANY OF C10, D03, D04, D15-D17, E01 – E12, E33 – E44, E65-E71 GE 1 AND ONE OR MORE RELATIONSHIP WAS AN INTIMATE PARTNER (CODES 100-139, 150-189) (VIOLENCE BY AN INTIMATE PARTNER), READ …]

We want to talk now about the consequences of the different experiences that you have shared with us involving a current or ex-romantic or sexual partner. These could be physical acts, unwanted sexual situations, or repeated unwanted attempts to contact, follow, or harass you. We are interested in understanding the consequence of these experiences for you.

You told me previously that current or ex romantic or sexual partners have {fill: all endorsed behaviors/conditions from those mentioned in H_INTRO above}.

CATI:

IF NONE OF G01, G02, G05-G13 GE 1 AND EITHER NONE OF C10,

D03-D04, D15-D17, E01-E12, E33–E44, E65-E71 GE 1 OR AT LEAST ONE OF D03-D04, D15-D17, E01-E12, E33-E44, E65-E71 GE 1 BUT NONE OF THE RELATIONSHIPS LISTED WAS AN INITMATE PARTNER (C16, D09, D22, E19, E27, E49, E59, E76, AND E86 ALL LEGIT SKIP) SKIP TO H33; CODE H01 – H32 AS LEGIT SKIP.

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
H01	When any of those things happened, … were you ever concerned for your safety?	1	2 {SKIP	-1 TO	-2 H03}	-3
H02	Were you concerned for your safety in the past 12 months?	1	2	-1	-2	-3
H03	… were you ever fearful for yourself or someone close to you?	1	2 {SKIP	-1 TO	-2 H05}	-3
H04	Were you fearful in the past 12 months?	1	2	-1	-2	-3

CATI:

IF R RESPONDS NO, DK OR REF TO THE H01, SKIP TO H03; CODE H02 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO THE H03, SKIP TO H05; CODE H04 AS LEGIT SKIP.

USER NOTE: ITEMS H05-H08 ARE INTENDED TO GET AT SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER.

Thinking back to the physical acts, unwanted sexual situations, or repeated unwanted attempts to contact, follow, or harass you by a current or ex romantic or sexual partner …

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
H05	… did you ever have nightmares?	1	2	-1	-2	-3
H06	… did you ever try hard not to think about or go out of your way to avoid being reminded of the things that were done to you?	1	2	-1	-2	-3
H07	… did you ever feel like you were constantly on guard, watchful, or easily startled?	1	2	-1	-2	-3
H08	… did you ever feel numb or detached from others, your activities, or your surroundings?	1	2	-1	-2	-3

CATI:

IF NONE OF H05-H08 ARE ENDORSED (INCLUDES RESPONSES OF DK AND REF), SKIP TO H10; CODE H09 AS LEGIT SKIP.

[IF ONE OR MORE OF H05-H08 ARE ENDORSED, READ …]

You told me that you {FILL: LIST PTSD SYMPTOMS ENDORSED IN H05-H08 – USE THE SYMPTOMS OF PTSD BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO SYMPTOMS WITH THE WORD “or”} because of what a current or ex-romantic or sexual partner did to you.

H09	Did you ever feel this way in the past 12 months?
	1	YES
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

Because of what a current or ex-romantic or sexual partner did to you, did you ever experience …

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
H10	… minor bruises or scratches?	1	2	-1	-2	-3
H11	… cuts, major bruises, or black eyes?	1	2	-1	-2	-3
H12	… any other physical injuries?	1	2 {SKIP	-1 TO	-2 H18}	-3

CATI:

IF R RESPONDS NO, DK OR REF TO H12, SKIP TO H18; CODE H13-H17 AS LEGIT SKIP.

I am going to read you a list of other possible injuries. Please tell me which of these you have experienced because of the physical acts, unwanted sexual situations, or repeated unwanted attempts to contact, follow, or harass you by a current or ex romantic or sexual partner.

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
H13	Injury to any ligaments, muscles or tendons?	1	2	-1	-2	-3
H14	Broken bones or teeth?	1	2	-1	-2	-3
H15	Back or neck injury?	1	2	-1	-2	-3
H16	Being knocked out after getting hit, slammed against something or choked?	1	2	-1	-2	-3
H17	A head injury?	1	2	-1	-2	-3

ITEM	QUESTION		YES			NO			DK			REF		LEGIT SKIP
H18	Did you ever experience mental or emotional harm (for example, anxiety or depression) because of what a current or ex-romantic or sexual partner did to you?		1	2			-1			-2			-3
[IF ANY OF H10-H12 OR H18 IS YES, ASK H19]
H19	Did you ever need medical care because of what a current or ex-romantic or sexual partner did to you?		1	2 {SKIP			-1 TO			-2 H21}			-3
H20	Were you able to get the medical care you needed?	1			2			-1			-2				-3
H21	Were you injured in the past 12 months because of any of the things a current or ex-romantic or sexual partner did to you?	1			2 {SKIP			-1 TO			-2 H23}				-3
[IF H19=YES AND H21=YES, ASK…]
H22	Did you need medical care for any of these injuries in the past 12 months?	1			2			-1			-2				-3

CATI:

IF R RESPONDS NO, DK OR REF TO ALL OF H10-H12, H18, GO TO H23; CODE H19-H22 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO H19, SKIP TO H21; CODE H20 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO H21, SKIP TO H23; CODE H22 AS LEGIT SKIP.

IF R RESPONDS YES TO H21 AND DOES NOT RESPOND YES TO H19, SKIP TO H23; CODE H22 AS LEGIT SKIP.

Now I am going to read you a list of services and other types of assistance you might have needed.

ITEM	QUESTION	YES		NO		DK		REF		LEGIT SKIP
H23	Have you ever talked to a crisis hotline operator about what a current or ex-romantic or sexual partner did to you?	1	2		-1		-2		-3
H24	Did you ever need housing services because of the things a current or ex-romantic or sexual partner did to you?	1	2		-1		-2		-3
H25	Did you ever need victim’s advocate services?	1	2		-1		-2		-3
H26	Did you ever need help from law enforcement because of the things a current or ex-romantic or sexual partner did to you?	1	2 {SKIP		-1 TO		-2 H28}		-3
H27	Did you need help from law enforcement in the past 12 months?	1	2		-1		-2		-3
H28	Did you ever need legal services or the advice of an attorney?	1	2		-1		-2		-3

CATI:

IF R RESPONDS NO, DK OR REF TO H26, SKIP TO H28; CODE H27 AS LEGIT SKIP.

ITEM	QUESTION	RANGE: [1-365 DAYS]		NO DAYS		DK		REF		NA
H29	About how many days of work did you ever have to miss when a current or ex-romantic or sexual partner did these things to you?	_ _ _	0 {SKIP		-1 TO		-2 H31}		-3
H30	In the past 12 months how many days of work did you have to miss when a current or ex-romantic or sexual partner did these things to you?	_ _ _	0		-1		-2		-3
H31	About how many days of school did you ever have to miss when a current or ex-romantic or sexual partner did these things to you?	_ _ _	0 -1 -2 -3 {SKIP TO H33}
H32	In the past 12 months how many days of school did you have to miss when a current or ex-romantic or sexual partner did these things to you?	_ _ _	0		-1		-2		-3

CATI:

IF R RESPONDS NO, DK OR REF TO H29, SKIP TO H31; CODE H30 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO H31, SKIP TO H33; CODE H32 AS LEGIT SKIP.

H33	Are there any children under the age of 18 currently living in your household all or most of the year?
	1	YES
	2	NO …………………………	{SKIP TO J_Intro}
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

[IF H33=1 (CHILDREN UNDER 18 CURRENTLY LIVING IN THE HOUSEHOL), READ …]

These next two questions are about children under the age of 18.

H34	Did a child under the age of 18 currently living in your household ever see or hear their parent or guardian being pushed, slapped, hit, punched, or beat up by that person’s current or ex romantic or sexual partner?
	1	YES
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

H35	Did a child under the age of 18 currently living in your household ever see or hear their parent or guardian being insulted, humiliated, or threatened with physical harm by that person’s current or ex romantic or sexual partner?
	1	YES
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

(J_INTRO)

We have asked you about your experiences related to health and injuries. The next section is going to ask you about your thoughts about some of the topics we discussed. I want your honest opinion about each of these statements. There are no right or wrong answers. Remember, your information will be combined with the answers from all of the other people who are in the survey.

For each of the following statements, please tell me whether you: Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, or Strongly Disagree.

ITEM	STATEMENT	Strongly Agree	Agree	Neither	Disagree	Strongly Disagree	DK	REF


J05	It is not necessary to get consent before sexual activity if you are married to the person.	1	2	3	4	5	-1	-2
J06	When a friend makes disrespectful comments about their romantic or sexual partner, I indicate my disapproval to that friend.	1	2	3	4	5	-1	-2
J07	When someone makes sexual comments, jokes, or gestures, I say something to try to get them to stop.	1	2	3	4	5	-1	-2

Next, we want to know more about your opinions about helping others who are at risk of intimate partner violence. Intimate partner violence includes physical, sexual, or psychological aggression or stalking of a romantic or sexual partner.

For each of the following statements, please tell me whether you: Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, or Strongly Disagree.

ITEM	STATEMENT		Strongly Agree	Agree	Neither	Disagree	Strongly Disagree	DK	REF
J08	I feel that intimate partner violence between other people is a private matter and is not my concern.		1	2	3	4	5	-1	-2
J09		I have doubts that I could recognize situations that might result in someone else being a victim of intimate partner violence.	1	2	3	4	5	-1	-2
J10		I have doubts that I would know what to say or do to stop intimate partner violence among others if I were to see a situation that could turn violent.	1	2	3	4	5	-1	-2
J11		Even when I’m not involved and it’s not about me, I can make a difference in helping to prevent violence by intimate partners.	1	2	3	4	5	-1	-2

Now we would like to know your opinions about helping others when they are at risk for sexual violence. Sexual violence includes sex or sexual contact without the person’s consent or against someone who is unable to consent. Sexual violence can be committed by anyone, such as a romantic or sexual partner, family member, acquaintance, or stranger. Examples of sexual violence include physically forced sex, attempted forced sex, having sex with someone when they are too drunk, high, drugged or passed out to consent, or unwanted sexual touching.

For each of the following statements, please tell me whether you: Strongly agree, Agree, Neither agree nor disagree, Disagree, or Strongly disagree.

ITEM	STATEMENT	Strongly Agree	Agree	Neither	Disagree	Strongly Disagree	DK	REF
J13	I feel that sexual violence between other people is a private matter and is not my concern	1	2	3	4	5	-1	-2
J14	I have doubts that I could recognize situations that might result in someone else being a victim of sexual violence.	1	2	3	4	5	-1	-2
J15	I have doubts that I would know what to say or do to stop sexual violence if I were to see a situation that could result in someone else being a victim.	1	2	3	4	5	-1	-2
J16	Even when I’m not involved and it’s not about me, I can make a difference in helping to prevent sexual violence.	1	2	3	4	5	-1	-2

INTLANGUAGE

WAS THIS INTERVIEW COMPLETED IN ENGLISH OR SPANISH?

1=English

2 = Spanish

W1	That’s my last question in this survey. To thank you for your participation, we would like to mail you a check for {FILL: $10 / $40 (INTERVIEWED IN NON-RESPONSE FOLLOW-UP PHASE}
	1	RECEIVE INCENTIVE
	2	REFUSED

W2_FName

In order to mail you your check, I need to collect your full name and mailing address. This information will never be connected with your answers in the survey.

[RECORD FIRST NAME]

W2_LNAME

[RECORD FIRST NAME]

W2_Address

[RECORD STREET ADDRESS]

W2_City

[RECORD CITY]

W2_State

[RECORD STATE FROM LIST]

W2_ZIP

[RECORD ZIP]

If you have any questions or concerns about participating in the survey, please feel free to call the survey manager, Jessica Williams at 1-866-800-9181. You will hear an option to speak with a project staff member.

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

You can reach the National Domestic Violence Hotline at 1-800-799-SAFE (7233). You can reach the Rape, Abuse and Incest National Network at 1-800-656-HOPE (4673). You can reach the National Child Abuse Hotline at 1-800-4-A-Child (1-800-422-4453).

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

That completes the interview. Thank you for your participation.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified	0000-00-00
File Created	0000-00-00