0920-0822 CATI Cognitive Testing Instrument, Round 1

The National Intimate Partner and Sexual Violence Survey (NISVS)

Att C. NISVS CATI Cognitive Testing Instrument

National Intimate Partner and Sexual Violence SCREEN - General Population

OMB: 0920-0822

What was your relationship to this person?

[RANGE 100-189]

DON’T KNOW

LEGIT SKIP

⚠️ Notice: This form may be outdated.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

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Attachment C:

National Intimate Partner and Sexual Violence Survey (NISVS) 4.0

CATI COGNITIVE TESTING INSTRUMENT, ROUND 1

Table of Contents

Section	Description	Pages
HC	Health Questions ……………………………………………………………………………	14
--	Victimization Introduction ……………………………………………………………..	15
ST	Stalking ………………………………………………………………………………………….	16
SC	Sexual Violence: Sexual Harassment, Unwanted Touching and Coerced Sex ……………………………………………………………………………………	22
AD	Sexual Violence: Completed Alcohol/Drug-Facilitated Rape and Made to Penetrate …………………………………………………..…………………….	32
FC	Sexual Violence: Completed Physically Forced Rape and Made to Penetrate Rape and Made to Penetrate …………………………………………	43
FA	Sexual Violence: Attempted Physically Forced Rape and Made to Penetrate (attempted) Rape and Made to Penetrate …………………….	52
OT	Sexual Violence: Outcomes of Rape and Made to Penetrate …………	61
PA	Psychological Aggression ……………………………………………………………….	62
PV	Physical Violence ……………………………………………………………………………	65
CQ	Consequences and Follow-up (IPV Impact) …………………………………….	68
W	Wrap-up ………………………………………………………………………………………..	73

General Notes:

The question numbers are the variable names. Question numbers in parentheses 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.

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. 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.

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.

The minimum number of relationships identified per respondent should equal the maximim number of perpetrators reported for that respondent across all violence victimization behaviors of a specific type endorsed?. If 996 is entered before the minimum number of relationships have been provided, a soft error check should appear. For example, If SC05=2 and SC06 = 4, then we should expect, at a minimum, 4 relationships to be provided. If 996 is entered for SC07_02 or SC07_03 or SC07_04, the soft check will appear.

The age at first occurrence of a victimization should be younger than the current age specified in RC1_CHK or calculated from RCMO and RCYR. If the age a victimization 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: RespAge}. Would you like me to go back and change your current age or the age I just entered?” Depending on the information provided, the interviewer will then either revise the current age, revise the age-at-first for the victimization behaviors in question, or suppress the check and keep the inconsistent responses. These occurances should be tracked in real time. Age-at-first is a critical variable and if these inconsistencies are present at a high rate, we will want to reconsider the idea of a “soft check”.). One note of caution: If the respondent age is changed, it is possible that this will cause inconsistencies with age-at-first collected in sections earlier in the survey, resulting in data quality (QA) errors in the data delivery - these QA failures will need to be documented and explained.

(HC_INTRO)

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

Do you have …

ITEM	QUESTION	YES	NO	DK	REF
HC01	… frequent headaches?	1	2	-1	-2
HC02	… chronic pain?	1	2	-1	-2
HC03	… difficulty sleeping?	1	2	-1	-2

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

ITEM	QUESTION	YES	NO	DK	REF
HC04	… Asthma?	1	2	-1	-2
HC05	… Irritable Bowel Syndrome or IBS?	1	2	-1	-2

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

ITEM	QUESTION	YES	NO	DK	REF
HC07	… any type of depression?	1	2	-1	-2

ITEM

QUESTION

YES

REF

HC06

Have you ever, even once, taken any prescription pain medicine (like OxyContin, Vicodin, Lortab, or Percocet) without a prescription or differently than how a doctor told you to use it?

-1

-2

ITEM	QUESTION	YES	NO	DK	REF
HC08	Have you ever attempted suicide?	1	2	-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.

(ST_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 …
ST01	… followed you around, watched, or spied on you when you did not want them to?	1	2	-1	-2
ST02	… 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
ST03	… used technology, such as hidden cameras, computer software, apps, or GPS to monitor or track your location without your permission. This includes GPS 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 …
ST04	… sneaked onto your property, such as your home or car, and did things to scare you by letting you know they had been there?	1	2	-1	-2
ST05	… made unwanted phone calls, sent emails, voice, or text messages?	1	2	-1	-2
Has anyone ever …
ST06	… sent you unwanted messages through social media, such as Facebook, Instagram, and chat rooms?	1	2	-1	-2
ST07	… 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 ST01-ST07 (INCLUDES RESPONSES OF DK AND REF), THEN SKIP TO SC_INTRO1; CODE ST08 – ST18_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”}.

ST08	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 SC_INTRO1}
	-1	DON’T KNOW	{SKIP TO SC_INTRO1}
	-2	REFUSED	{SKIP TO SC_INTRO1}
	-3	LEGIT SKIP

CATI:

IF “R” RESPONDS 0, DK OR REF TO ST08, SKIP TO SC_INTRO1; CODE ST09 – ST18_05 AS LEGIT SKIP.

ST09	Now, thinking ONLY about the {fill: “person” (ST08=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

ST10	Now, thinking ONLY about the {fill: “person” (ST08=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 ST09 AND ST010, SKIP TO SC_INTRO1; CODE ST11_01 – ST18_05 AS LEGIT SKIP.

MAXIMUM NUMBER OF RELATIONSHIPS IN ST11_ SHOULD EQUAL THE MINIMUM NUMBER ENTERED IN EITHER ST08 OR (ST09 + ST10).

ST11_01	Now I’d like you to only think about the {fill: “person” (ST08=1 or ST09 + ST10 = 1)/ “people”} who {FILL: LIST OF STALKING BEHAVIORS ENDORSED IN ST01 – ST07} 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

ST12	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF ST08=1 OR (ST09 + ST10=1) THEN SKIP TO ST13; CODE ST11_02 – ST11_10 AS LEGIT SKIP.

The first relationship has already been coded in ST11_01. Code additional relationships in the “ST11_” variables below using the Relationship/Sex template (Appendix I). Relationship categories may be repeated.

(ST11)

[IF MINIMUM VALUE BETWEEN ST08 or (ST09 + ST10) >1 ASK …]

ITEM			QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
ST11_02			Now I’m going to ask you about any additionnal 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
ST11_03			How did you know the 3^rd person who did any of these things to you?	_ _ _	996	-1	-2	-3
ST11_04			The 4^th person?	_ _ _	996	-1	-2	-3
ST11_05			The 5^th person?	_ _ _	996	-1	-2	-3
:			:
ST11_09			The 9^th person?	_ _ _	996	-1	-2	-3
ST11_10			The 10^th person?	_ _ _	996	-1	-2	-3
	CATI:	SHOW ONLY THE ST11_## THAT ARE < THE MINIMUM VALUE BETWEEN ST08 OR ST09 + ST10 ONCE CODE 996 IS USED, REMAINING “ST11_” VARIABLES SHOULD BE CODED AS LEGIT SKIP. CHECK: THE MAXIMUM NUMBER OF ST11_## THAT CAN BE ANSWERED MUST BE THE MINIMUM VALUE BETWEEN ST08 OR (ST09 + ST10). EXAMPLE: IF ST08=3, ST09_1=2 AND ST09_2=3, ST12_04 – ST12_10 MUST BE CODED LEGIT SKIP. NOTE: ITEMS ST11_02 – ST11_05 MAY NOT ALL HAVE RELATIONSHIP INFORMATION AS THE NUMBER IN ST08 IS FURTHER RESTRICTED TO THOSE WHO WERE COUNTED IN ST09 (fearful) AND/OR ST10 (threatened with physical harm).

CATI:

IF NONE OF “ST11_” ITEMS ARE AN INTIMATE PARTNER (ALL > 200), SKIP TO ST16; CODE ST13 – ST15 AS LEGIT SKIP.

ST13	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 ST11_01 – ST11_10}. Is this correct?
	1	YES	{SKIP TO ST15}
	2	NO	{GO TO ST14}
	-1	DON’T KNOW	{SKIP TO ST15}
	-2	REFUSED	{SKIP TO ST15}
	-3	LEGIT SKIP	{SKIP TO ST15}

CATI:

IF ST13=1, RECORD FIRST INTIMATE PARTNER RESPONSE FROM ST11_01 – ST11_10 IN ST14.

ST14	What was your relationship to this person?
	_ _ _	[RANGE 100-199]
	-3	LEGIT SKIP

(SC_INTRO1)

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.

SC_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	DK	REF	LEGIT SKIP
SC01	In your lifetime, how many people in your WORKPLACE made unwanted sexual remarks, sexual jokes, or offensive comments about your body or appearance? Please include people you work with or come into contact with through your job.	_ _	0 {SKIP	-1 TO	-2 SC03}	-3
SC02	How many people in your WORKPLACE have done this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?	_ _	0	-1	-2	-3
SC03	While you were in a PUBLIC place, how many people have ever verbally harassed you in a sexual way that made you feel uncomfortable?	_ _	0 {SKIP	-1 TO	-2 SC05}	-3
SC04	How many people have done this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?	_ _	0	-1	-2	-3

ITEM	QUESTION	RANGE [1-10]	NONE	DK	REF	LEGIT SKIP
How many people have ever …
SC05	… kissed you in a sexual way when you did not want it to happen?	_ _	0	-1	-2		-3
SC06	… 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 SC05 NOR SC06 ENDORSED, SKIP TO SC_INTRO2; CODE SC07_01 – SC14 AS LEGIT SKIP.

SC07_01	Think about the first time anyone EVER {FILL: LIST OF UNWANTED TOUCHING BEHAVIORS ENDORSED IN SC05 – SC06) – 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

SC08	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < SC08 THEN DISPLAY SOFT CHECK. (SEE GENERAL NOTES)

Note:

↓

The first relationship has already been coded in SC07_01. Code additional relationships in “SC07_” items below using the Relationship/Sex template (Appendix I). Note that relationship categories may be repeated.

(SC07)

[IF SC05+SC06>1, ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGITSKIP
SC07_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 SC05) / “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
SC07_03	How did you know the 3^rd person who did {FILL: “this” (JUST SC05) / “any of these things”} to you?	_ _ _	996	-1	-2	-3
SC07_04	The 4^th person?	_ _ _	996	-1	-2	-3
SC07_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
SC07_09	The 9^th person?	_ _ _	996	-1	-2	-3
SC07_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE SC07_## THAT ARE < THE SUM OF SC05+SC06 (THE MAXIMUM POSSIBLE).

ONCE CODE 996 IS USED, REMAINING “SC07_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “SC07_##” THAT CAN BE ANSWERED MUST BE < (SC05+SC06).

EXAMPLE: IF SC05=2 AND SC06=3, SC07_06 – SC07_10 MUST BE CODED LEGIT SKIP.

CATI:

IF NONE OF “SC07_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO SC12; CODE SC09 – SC11 AS LEGIT SKIP.

SC09	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 SC07_01 – SC07_10}. Is this correct?
	1	YES	{CODE RELATIONSHIP IN SC10}
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

SC10	What was your relationship to this person?
	_ _ _	[RANGE 100-199]
	-3	LEGIT SKIP

(SC_INTRO2)

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.

USER NOTE: ITEMS SC15 –SC22 ARE INCLUDED TO GET AT COERCED SEX

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
SC15	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
SC16	Wearing you down by repeatedly asking for sex, or showing they were unhappy?	_ _	0	-1	-2	-3
SC17	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 SC15 – SC17 ARE ENDORSED, SKIP TO AD_INTRO1; CODE SC18_01 – SC26_05 AS LEGIT SKIP.

SC18_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

SC19	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < SC19 THEN DISPLAY SOFT CHECK (SEE TEXT, GENERAL NOTES)

Note:

↓

The first relationship has already been coded in SC18_01. Code additional relationships in “SC18_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(SC18)

[IF SUM SC15+SC16+SC17 > 1), ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
SC18_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
SC18_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
SC18_04	The 4^th person?	_ _ _	996	-1	-2	-3
SC18_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
SC18_09	The 9^th person?	_ _ _	996	-1	-2	-3
SC18_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE SC18_## THAT ARE < THE SUM OF SC15+SC16+SC17 (THE MAXIMUM POSSIBLE).

ONCE CODE 996 IS USED, REMAINING “SC18_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “SC18_##” THAT CAN BE ANSWERED MUST BE < SUM (SC15+SC16+SC17).

EXAMPLE: IF SC15=2 AND SC16=1 AND SC17=2, SC18_06 – SC18_10 MUST BE CODED LEGIT SKIP.

CATI:

IF NONE OF “SC18_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO SC23; CODE SC20 – SC22 AS LEGIT SKIP.

SC20	I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {FILL: “this” (JUST SC17) / “any of these things“} to you was {FILL: (INTIMATE RELATIONSHIP CODES 107,157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM SC18_01 – SC18_10}. Is this correct?
	1	YES	{CODE RELATIONSHIP IN SC21}
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

SC21	What was your relationship to this person?
	_ _ _	[RANGE 100-199]
	-3	LEGIT SKIP

ALCOHOL/DRUG-FACILITATED RAPE AND MADE TO PENETRATE

AD_INTRO1

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.

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	{SKIP TO AD01}
7	R VOLUNTEERED NEVER DRUNK/HIGH	{SKIP TO AD_CHK1a}
-3	LEGIT SKIP

AD_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 VOLUNTEERED NEVER DRUNK/HIGH	{SKIP TO FC_INTRO1}
-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 AD_CHK1a AS 7 AND SKIP TO FC_INTRO1;

CODE AD01 – AD24 AS LEGIT SKIP.

CATI:

IF MALE RESPONDENT, SKIP TO AD05; CODE AD01 – AD04 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?
AD01	Put their mouth on your vagina?	_ _	0		-1		-2		-3
AD02	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 …
AD03	Put their penis in your vagina?	_ _	0		-1		-2		-3
AD04	Put their penis in your mouth or anus?	_ _	0		-1		-2		-3

CATI:

IF FEMALE RESPONDENT, SKIP TO AD09; CODE AD05 – AD08 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?
AD05	Put their fingers or an object in your anus?	_ _	0		-1		-2			-3
AD06	Put their mouth on your penis?	_ _	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 …
AD07	Made you put your penis in 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 …
AD08	Put their penis in your mouth or anus?	_ _	0		-1		-2			-3

↑

Note:

If at any point while answering AD01 – AD04 (FEMALE “R”) / AD05 – AD08 (MALE “R”), “R” volunteers that they have never been drunk, high, drugged, or passed out from alcohol or drugs, code AD_CHK1a as 7 and follow the appropriate skip pattern. If “R” volunteers this information AND has non-zero response to any of the AD01 – AD04 (FEMALE “R”) / AD05 – AD08 (MALE “R”) items already answered, probe as to whether or not that answer is correct BEFORE recoding AD_CHK1a to 7 and skipping out of this section.

CATI:

IF NONE OF AD01 – AD04 (FEMALE “R”) / AD05 – AD08 (MALE “R”) ARE ENDORSED, SKIP TO FC_INTRO1; CODE AD09 – AD24 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 AD_INTRO1 AND AD_CHK1a AS 7, SKIP TO FC_INTRO1; CODE AD09 – AD24 AS LEGIT SKIP. IF SOME OF THE AD01 – AD04 (FEMALE “R”) / AD05 – AD08 (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
AD09	… do you think you were ever given alcohol without your knowledge?	1	2	-1	-2	-3
AD10	… do you think you were ever given other drugs without your knowledge?	1	2	-1	-2	-3

CATI:

IF FEMALE “R” AND ANY OF AD01 – AD04 ENDORSED; OR IF MALE RESPONDENT AND EITHER AD05 OR AD08 IS ENDORSED, ASK AD11_01. ELSE SKIP TO AD_INTRO2; CODE AD11_01 – AD17 AS LEGIT SKIP.

USER NOTE: ITEMS AD11_01 – AD17 ARE INTENDED TO GET AT ALCOHOL/DRUG (A/D) FACILITATED RAPE.

AD11_01	Think about the first time anyone EVER {FILL: LIST OF A/D RAPE BEHAVIORS ENDORSED IN AD01 – AD04 (FEMALE “R”) / AD05, AD08 (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

AD12	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]
	-3	LEGIT SKIP
	-1	DON’T KNOW
	-2	REFUSED

CATI:

IF CURRENT AGE (RESPAGE) < AD12 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

Note:

↓

The first relationship has already been coded in AD11_01. Code additional relationships in “AD11_” items below using the Relationship/Sex template (Appendix I). Note that relationship categories may be repeated.

(AD11)

[IF SUM AD01 – AD04 (FEMALES) / AD05, AD08 (MALES) > 1, THEN ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
AD11_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
AD11_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
AD11_04	The 4^th person?	_ _ _	996	-1	-2	-3
AD11_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
AD11_09	The 9^th person?	_ _ _	996	-1	-2	-3
AD11_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE AD11_## THAT ARE < THE SUM OF AD01 – AD04 (FEMALES) / AD05, AD08 (MALES) (THE MAXIMUM POSSIBLE). ONCE CODE 996 IS USED, REMAINING “AD11_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “AD11_##” THAT CAN BE ANSWERED MUST BE < THE SUM OF

AD01 – AD04 (FEMALES) / AD05, AD08 (MALES).

EXAMPLE: IF AD05=2 AND AD08=1, AD11_06 – AD11_10 MUST BE CODED LEGIT SKIP.

CATI:

IF NONE OF “AD11_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO AD16; CODE AD13 – AD15 AS LEGIT SKIP.

AD13	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 AD11_01 – AD11_10}. Is this correct?
	1	YES	{CODE RELATIONSHIP IN AD13]
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

AD14	What was your relationship to this person?
	_ _ _	[RANGE 100-189]
	-3	LEGIT SKIP

CATI:

IF 100 < AD14 < 199 AND AD14 = AD11_01 THEN SKIP TO AD16; FILL AD15 = AD13.

AD15	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < AD14 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

AD16	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF A/D RAPE BEHAVIORS ENDORSED IN AD01 – AD04 (FEMALE “R”) / AD05, AD08 (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 AD_INTRO2}
	-2	REFUSED	{SKIP TO AD_INTRO2}
	-3	LEGIT SKIP

CATI:

IF AD16 IS CODED AS NONE, DK OR REF, SKIP TO AD_INTRO2; CODE AD17a, AD17_01 – AD17_05, AD18 AS LEGIT SKIP.

CHECK: AD16 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSHIPS LISTED

IN AD11_01 – AD11_10.

CATI:

IF ONE RELATIONSHIP EVER (AD11_01 ANSWERED, AD11_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (AD11_01 = 201 - 239, 251 - 289) CODE AD17_01 WITH VALUE FROM AD11_01, AND SKIP TO AD18; CODE AD17a, AD17_02 – AD17_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (AD11_01 ANSWERED, AD11_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (A16 = 1), READ AD17a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF AD16 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (AD17). CODE AD17a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (AD11_02 < 996) AND AD16=1, GO TO (AD17).

CODE AD17a AS LEGIT SKIP.

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

Note:

↓

Code Relationships in the “AD17_” 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 AD11_01 ANSWERED NOT 200-239, 250-289 AND AD11_02 = 996 or AD1_02=-3 LEGIT SKIP, READ …]

AD17a	I just want to confirm that this person was still {FILL: (RELATIONSHIP 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 AD11_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN AD17_01 AND SKIP TO AD18; CODE AD17_02 – AD17_05 AS LEGIT SKIP}
	1	YES	{SKIP TO AD18}
	2	NO	{GO TO AD17_01}
	-1	DON’T KNOW	{SKIP TO AD18}
	-2	REFUSED	{SKIP TO AD18}
	-3	LEGIT SKIP	{SKIP TO AD18}

CATI:

IF AD17a IS CODED AS 1, -1, -2, FILL AD17_01 WITH RELATIONSHIP FILL FROM AD17a AND SKIP TO AD18; CODE AD17_02 – AD17_05 AS LEGIT SKIP.

(AD17)

[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” (AD16=1)/ ”people” who did {FILL: ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months? [DO NOT READ AD17_01 – AD17_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
AD17_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
AD17_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
AD17_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
AD17_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
AD17_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE AD17_## THAT ARE < AD16. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF AD16 = 3, THEN AD117_01, AD17_02 AND AD17_03 MUST BE ANSWERED, AND AD17_04 – AD17_05 MUST BE CODED AS LEGIT SKIP.

AD18	Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months? 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.
	------	[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]
	999	TOO MANY TO COUNT
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

USER NOTE: ITEMS AD19 – AD26 ARE INTENDED TO GET AT ALCOHOL/DRUG-FACILITATED MADE TO PENETRATE (MTP)

CATI:

IF FEMALE “R” OR IF MALE “R” AND NEITHER AD06 NOR AD07 ENDORSED SKIP TO (FC_INTRO1); CODE AD19_01 – AD26 AS LEGIT SKIP.

IF MALE “R” AND AD06 OR AD07 IS ENDORSED ( > 1) AND ANY OF AD11_01 – AD18 ANSWERED, THEN DISPLAY (AD_INTRO2).

IF MALE “R” AND AD06 OR AD07 IS ENDORSED ( > 1) AND NONE OF AD11_01 – AD18 ANSWERED, THEN GO TO AD19_01.

(AD_INTRO2)

[IF MALE “R” AND EITHER OF AD06 OR AD07 IS ENDORSED AND ANY OF AD11_01 – AD18 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.

AD19_01	Think about the first time anyone EVER {FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES, AD06 OR AD07) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE 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 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

AD20	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < AD15 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

Note:

↓

The first relationship has already been coded in AD19_01. Code additional relationships in “AD19_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(AD19)

[IF SUM OF AD06 + AD07 (MALES) > 1, ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
AD19_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
AD19_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
AD19_04	The 4^th person?	_ _ _	996	-1	-2	-3
AD19_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
AD19_09	The 9^th person?	_ _ _	996	-1	-2	-3
AD19_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE AD19_ ## ITEMS THAT ARE < THE SUM (AD06 + AD07: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “AD19_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “AD19_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM (AD06 + AD07: MALES).

EXAMPLE: IF AD06=2 AND AD07=3, AD19_ 07 – AD19_10 MUST BE CODED LEGIT SKIP.

CATI:

IF NONE OF “AD19_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO AD24.

AD21	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 AD19_01 – AD19_10}. Is this correct?
	1	YES	{CODE RELATIONSHIP IN AD22}
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF 100 < AD22 < 199 AND AD22 = AD19_01 THEN SKIP TO AD24; FILL AD23 = AD21

AD23	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]
	-3	LEGIT SKIP
	-1	DON’T KNOW
	-2	REFUSED

CATI:

IF CURRENT AGE (RESPAGE) < AD23 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

AD24	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”)} who {FILL: LIST OF MTP BEHAVIORS ENDORSED IN AD06 OR AD07 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE 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 FC_INTRO1}
	-2	REFUSED	{SKIP TO FC_INTRO1}
	-3	LEGIT SKIP

CATI:

IF AD24 IS CODED AS NONE, DK OR REF, SKIP TO FC_INTRO1; CODE AD25a, AD25_01 –AD25_05, AD22 AS LEGIT SKIP.

CHECK: AD24 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN “AD19_”.

CATI:

IF ONE RELATIONSHIP EVER (AD19_01 ANSWERED, AD19_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (AD19_01 = 201 - 239, 251 - 289) CODE AD25_01 WITH VALUE FROM AD19_01, AND SKIP TO AD26; CODE AD25a, AD25_02 – AD25_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (AD19_01 ANSWERED, AD19_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (AD24 = 1), READ AD25a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF AD24 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (AD25). CODE AD23a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (AD19_02 < 996) AND AD24=1, GO TO (AD25).

CODE A25a AS LEGIT SKIP.

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

Note:

↓

Code Relationships in the “AD25_” 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 AD19_01 ANSWERED AND NOT 200-239, 250-289 AND AD19_02 = 996 or AD19_02=-3 LEGIT SKIP, READ …]

AD25a	I just want to confirm that this person was still {FILL: (RELATIONSHIP 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 AD19_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN AD25_01 AND SKIP TO AD26; CODE AD25_02 – AD25_05 AS LEGIT SKIP}
	1	YES	{SKIP TO AD26}
	2	NO	{GO TO AD25_01}
	-1	DON’T KNOW	{SKIP TO AD26}
	-2	REFUSED	{SKIP TO AD26}
	-3	LEGIT SKIP	{SKIP TO AD26}

CATI:

IF AD25a IS CODED AS 1, -1, -2, FILL AD25_01 WITH RELATIONSHIP FILL FROM AD25a AND SKIP TO AD26; CODE AD25_02 – AD25_05 AS LEGIT SKIP.

(AD25)

[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” (AD22=1)/”people”} who did ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months? [DO NOT READ AD25_01 – AD25_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
AD25_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
AD25_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
AD25_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
AD25_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
AD25_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE AD25_## THAT ARE < AD24. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF AD24 = 3, THEN AD25_01, AD25_02 AND AD25_03 MUST BE ANSWERED, AND AD25_04 – AD25_05 MUST BE CODED AS LEGIT SKIP.

AD26	Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months? 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.
	------	[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]
	999	TOO MANY TO COUNT
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

UNWANTED SEX DUE TO THREATS OF HARM/PHYSICAL FORCE

(FC_INTRO1)

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 FC05; CODE FC01 – FC04 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 …
FC01	… put their mouth on your vagina?	_ _	0	-1		-2			-3
FC02	… 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 …
FC03	… put their penis in your vagina?	_ _	0	-1		-2			-3
FC04	… put their penis in your mouth or anus?	_ _	0	-1		-2			-3

CATI:

IF FEMALE RESPONDENT, SKIP TO FC09; CODE FC05 – FC08 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 …
FC05	… put their fingers or an object in your anus?	_ _	0	-1		-2			-3
FC06	… put their mouth on your penis?	_ _	0	-1		-2			-3
How many FEMALES have ever used physical force or threats of physical harm to …
FC07	… make you put your penis in their vagina?	_ _	0	-1		-2			-3
How many MALES have ever used physical force or threats of physical harm to …
FC08	… put their penis in your mouth or anus?	_ _	0	-1		-2			-3

CATI:

IF NONE OF FC01 – FC04 (FEMALE “R”) / FC05 – FC08 (MALE “R”) ENDORSED, SKIP TO FA_INTRO1; CODE FC09_01 – FC24 AS LEGIT SKIP.

CATI:

IF FEMALE “R” AND ANY OF FC01 – FC04 ENDORSED; OR IF MALE RESPONDENT AND EITHER FC05 or FC08 IS ENDORSED, ASK FC09_01. ELSE SKIP TO (FC_INTRO2); CODE FC09_01 – FC16 AS LEGIT SKIP.

USER NOTE: ITEMS FC09_01 – FC16 ARE INTENDED TO GET AT FORCED RAPE

FC09_01	Think about the first time anyone EVER {FILL: LIST OF FORCED RAPE BEHAVIORS ENDORSED IN FC01 – FC04 (FEMALE “R”) / FC05, FC08 (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

FC10	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < FC10 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

Note:

↓

The first relationship has already been coded in FC09_01. Code additional relationships in “FC09_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(FC09)

[IF SUM FC01 – FC04 (FEMALES) / FC05, FC08 (MALES) > 1, THEN ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
FC09_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
FC09_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
FC09_04	The 4^th person?	_ _ _	996	-1	-2	-3
FC09_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
FC09_09	The 9^th person?	_ _ _	996	-1	-2	-3
FC09_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE FC09_## ITEMS THAT ARE < THE SUM (FC01 – FC04: FEMALES) OR SUM(FC05 + FC08: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “FC09_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “FC09_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM

(FC01 – FC04: FEMALES) OR < SUM (FC05 + FC08: MALES).

CATI:

IF NONE OF “FC09_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO FC14; CODE FC11 – FC13 AS LEGIT SKIP.

FC11	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 FC12}
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

FC12	What was your relationship to this person?
	_ _ _	[RANGE 100-189]
	-3	LEGIT SKIP

CATI:

IF 100 < FC12 < 199 AND FC12 = FC09_01 THEN SKIP TO FC14; FILL FC13 = FC10.

FC13	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]
	-3	LEGIT SKIP
	-1	DON’T KNOW
	-2	REFUSED

CATI:

IF CURRENT AGE (RESPAGE) < FC13 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

FC14	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF FORCED RAPE BEHAVIORS ENDORSED IN FC01 – FC04 (FEMALES) / FC05, FC08 (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}? INTERVIEWER: 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 FC14 IS CODED AS NONE, DK OR REF, SKIP TO (FA_INTRO2); CODE FC15a, FC15_01-FC15_05, FC16 AS LEGIT SKIP.

CHECK: FC14 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN FC09_01 – FC09_10.

CATI:

IF ONE RELATIONSHIP EVER (FC09_01 ANSWERED, FC09_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (FC09_01=201-239,251-289) CODE FC15_01 WITH VALUE FROM FC09_01, AND SKIP TO FC16; CODE FC15a, FC15_02 – FC15_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (FC09_01 ANSWERED, FC09_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (FC14=1), READ FC15a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF FC14 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (FC15). CODE FC15a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (FC09_02 < 996) AND FC14=1, GO TO (FC15).

CODE FC15a AS LEGIT SKIP.

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

Note:

↓

Code Relationships in the “FC15_” 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 FC09_01 ANSWERED AND FC09_01 NOT 200-239, 250-289 AND FC09_02 = 996 or FC09_02=-3 LEGIT SKIP, READ …]

FC15a	I just want to confirm that this person was still {FILL: (RELATIONSHIP 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 FC09_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN FC15_01 AND SKIP TO FC16; CODE FC15_02 – FC15_05 AS LEGIT SKIP}
	1	YES	{SKIP TO FC16}
	2	NO	{GO TO FC15_01}
	-1	DON’T KNOW	{SKIP TO FC16}
	-2	REFUSED	{SKIP TO FC16}
	-3	LEGIT SKIP	{SKIP TO FC16}

CATI:

IF FC15a IS CODED AS 1, -1, -2, FILL FC15_01 WITH RELATIONSHIP FILL FROM FC15a AND SKIP TO FC16; CODE FC15_02 – FC15_05 AS LEGIT SKIP.

(FC15)

[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 (FC14=1)/”people” who did ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months? [DO NOT READ FC15_01 – FC15_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
FC15_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
FC15_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
FC15_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
FC15_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
FC15_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE FC15_## THAT ARE < FC14. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF FC14 = 3, THEN FC15_01, FC15_02 AND FC15_03 MUST BE ANSWERED, AND FC15_04 – FC15_05 MUST BE CODED LEGIT SKIP.

FC16	Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months? 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.
	------	[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]
	999	TOO MANY TO COUNT
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

USER NOTE: ITEMS FC17_01 – FC24 ARE INTENDED TO GET AT FORCED MADE TO PENETRATE (MTP)

CATI:

IF FEMALE “R” OR IF MALE “R” AND NEITHER FC06 OR FC07 IS ENDORSED SKIP TO (FA_INTRO1); CODE FC17_01 – FC24 AS LEGIT SKIP.

IF MALE “R” AND EITHER FC06 OR FC07 IS ENDORSED ( > 1) AND EITHER FC05 OR, FC08 IS ENDORSED (> 1) ANSWERED, THEN DISPLAY (FC_INTRO2).

IF MALE “R” AND EITHER FC06 OR FC07 IS ENDORSED (> 1) AND NEITHER FC05 NOR FC08, ENDORSED, THEN GO TO FC17_01. NO NEED TO READ THE INTRODUCTION.

(FC_INTRO2b)

[IF MALE “R” AND EITHER FC06 OR FC07 IS ENDORSED (MTP) AND EITHER FC05 OR FC08 IS ENDORSED (MALE RAPE QUESTIONS), THEN READ …]

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

FC17_01	Think about the first time anyone EVER FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES, FC06 OR FC07) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”. 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

FC18	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < FC18 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

Note:

↓

The first relationship has already been coded in FC17_01. Code additional relationships in “FC17_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(FC17)

[IF MALE “R” AND SUM (FC06 + FC07) > 1, ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]	NO MORE	DK	REF	LEGIT SKIP
FC17_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
FC17_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
FC17_04	The 4^th person?	_ _ _	996	-1	-2	-3
FC17_05	The 5^th person?	_ _ _	996	-1	-2	-3
:	:
FC17_09	The 9^th person?	_ _ _	996	-1	-2	-3
FC17_10	The 10^th person?	_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE FC17_## ITEMS THAT ARE < THE SUM (FC06 + FC07: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “FC17_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “FC17_##” ITEMS THAT CAN BE ANSWERED MUST BE <

(FC06 + FC07: MALES)

CATI:

IF NONE OF “FC17_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO FC22; CODE FC19 – FC21 AS LEGIT SKIP.

FC19	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 FC17_01 – FC17_10}. Is this correct?
	1	YES	{CODE RELATIONSHIP IN FC20]
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

FC20	What was your relationship to this person?
	_ _ _	[RANGE 100-189]
	-3	LEGIT SKIP

CATI:

IF 100 < FC20 < 199 AND FC20 = FC17_01 THEN SKIP TO FC22; FILL FC21 = FC18.

FC21	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < FC21 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

FC22	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF MTP BEHAVIORS ENDORSED IN FC06 – FC07 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE 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 FA_INTRO1}
	-2	REFUSED	{SKIP TO FA_INTRO1}
	-3	LEGIT SKIP

CATI:

IF FC22 IS CODED AS ZERO, DK OR REF, SKIP TO FA_INTRO1; CODE FC23a, FC23_01 – FC23_05, FC24 AS LEGIT SKIP.

CHECK: FC22 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN FC17_01 – FC17_10.

CATI:

IF ONE RELATIONSHIP EVER (FC17_01 ANSWERED, FC17_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (FC17_01 = 201 - 239, 251 - 289) CODE FC23_01 WITH VALUE FROM FC17_01, AND SKIP TO FC24; CODE FC23a, FC23_02 – FC23_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (FC17_01 ANSWERED, FC17_02 = 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (FC22 = 1), READ FC23a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF FC22 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (E63). CODE FC23a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (FC17_02 < 996) AND FC22=1, GO TO (FC23).

CODE FC23a AS LEGIT SKIP.

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

Note:

↓

Code Relationships in the “FC23_” 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 FC17_01 ANSWERED NOT 200-239, 250-289 AND FC17_02= 996 or FC17_02=-3 LEGIT SKIP, READ …]

FC23a	I just want to confirm that this person was still {FILL: (RELATIONSHIP 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” RELATIONSHIP FC17_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN FC23_01 AND SKIP TO FC24; CODE FC23_02 – FC23_05 AS LEGIT SKIP}
	1	YES	{SKIP TO FC24}
	2	NO	{GO TO FC23_01}
	-1	DON’T KNOW	{SKIP TO FC24}
	-2	REFUSED	{SKIP TO FC24}
	-3	LEGIT SKIP	{SKIP TO FC24}

CATI:

IF FC23a IS CODED AS 1, -1, -2, FILL FC23_01 WITH RELATIONSHIP FILL FROM FC23a AND SKIP TO FC24; CODE FC23_02 – FC23_05 AS LEGIT SKIP.

(FC23)

[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” (FC22=1)/ ”people” who did ”this” (ONE BEHAVIOR) /”these things” to you in the past 12 months? [DO NOT READ FC23_01 – FC23_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT. IF NECESSARY: Was this person male or female?
FC23_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
FC23_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
FC23_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
FC23_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
FC23_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE FC23_## THAT ARE < FC22. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF FC22 = 3, THEN FC23_01, FC23_02 AND FC23_03 MUST BE ANSWERED,

AND FC23_04 – FC23_05 MUST BE CODED LEGIT SKIP.

FC24	Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months? 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.
	------	[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]
	999	TOO MANY TO COUNT
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

ATTEMPTED PHYSICALLY FORCED SEX

(FA_INTRO1)

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 FA02; CODE FA01 AS LEGIT SKIP.

[IF FEMALE “R” ASK …]

ITEM

QUESTION

RANGE:

[1-10]

NONE

REF

LEGIT SKIP

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

FA01

…TRY to put their penis in your vagina, mouth, or anus, but it did not happen?

_ _

-1

-2

-3

CATI:

IF FEMALE RESPONDENT, SKIP TO FA05_01; CODE FA02 – FA04 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 …
FA02	… 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 …
FA03	… TRY to make you put your penis in 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 …
FA04	… TRY to put their penis in your mouth or anus, but it did not happen?	_ _	0	-1		-2		-3

CATI:

IF NONE OF FA01 (FEMALE “R”) / FA02 – FA04 (MALE “R”) ARE ENDORSED, SKIP TO (OT_INTRO1); CODE FA05_01 – FA20 AS LEGIT SKIP.

CATI:

IF FEMALE “R” AND FA01 ENDORSED; OR IF MALE RESPONDENT AND FA04

ENDORSED, ASK FA05_01. ELSE SKIP TO (FA_INTRO2); CODE FA05 – FA12 AS LEGIT SKIP.

USER NOTE: ITEMS FA05_01– FA12 ARE INTENDED TO GET AT ATTEMPTED RAPE

FA05_01	Think about the first time anyone EVER {FILL: RAPE BEHAVIOR ENDORSED IN FA01 (FEMALES) / FA04 (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

FA06	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < FA06 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

Note:

↓

The first relationship has already been coded in FA05_01. Code additional relationships in “FA05_” below using the Relationship/Sex Template (Appendix I). Note that relationship categories may be repeated.

(FA05)

[IF FA01 (FEMALES) / FA04 (MALES) > 1, THEN ASK …]

ITEM	QUESTION	RELATIONSHIP [RANGE: 100-650]		NO MORE	DK	REF	LEGIT SKIP
FA05_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
FA05_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
FA05_04	The 4^th person?		_ _ _	996	-1	-2	-3
FA05_05	The 5^th person?		_ _ _	996	-1	-2	-3
:	:
FA05_09	The 9^th person?		_ _ _	996	-1	-2	-3
FA05_10	The 10^th person?		_ _ _	996	-1	-2	-3

CATI:

SHOW ONLY THE FA05_## ITEMS THAT ARE < THE SUM (FA01: FEMALES) / (FA04: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “FA05_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “FA05_##” ITEMS THAT CAN BE ANSWERED

MUST BE < (FA01: FEMALES) / SUM(FA04: MALES).

CATI:

IF NONE OF “FA05_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO FA10 ;

CODE FA07 – FA09 AS LEGIT SKIP.

FA07	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 FA07_01 – FA07_10}. Is this correct?
	1	YES	{CODE RELATIONSHIP IN FA08}
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

FA08	What was your relationship to this person?
	_ _ _	[RANGE 100-189]
	-3	LEGIT SKIP

CATI:

IF 100 < FA08 < 199 AND FA08 = FA05_01 THEN SKIP TO FA10; FILL FA09 = FA06.

FA09	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < FA09 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

FA10	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: ATTEMPTED RAPE BEHAVIORS ENDORSED IN FA01 (FEMALES) / FA04 (MALES) – USE THE ATTEMPTED RAPE BEHAVIORS (APPENDIX II); 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}? INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE. [A VALUE OF 0 = 5 OR MORE PEOPLE]
	_ _ _	[RANGE: 0 – 5]
	-1	DON’T KNOW	{SKIP TO FA_INTRO2}
	-2	REFUSED	{SKIP TO FA_INTRO2}
	-3	LEGIT SKIP

CATI:

IF FA10 IS CODED AS NONE, DK OR REF, SKIP TO FA_INTRO2; CODE FA11a, FA11_01 – FA11_05, FA12 AS LEGIT SKIP.

CHECK: FA10 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN FA05_01 – FA05_10.

CATI:

IF ONE RELATIONSHIP EVER (FA05_01 ANSWERED, FA05_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (FA05_01 = 201 - 239, 251 - 289) CODE FA11_01 WITH VALUE FROM FA05_01, AND SKIP TO FA12; CODE FA11a, FA11_02 – FA11_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (FA05_01 ANSWERED, FA05_02= 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (FA10=1), READ FA11a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF FA10 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (FA11). CODE FA11a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (FA05_02 < 996) AND FA10 = 1, GO TO (FA11).

CODE FA11a AS LEGIT SKIP.

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

Note:

↓

Code Relationships in the “FA11_” items below.

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

[IF FA05_01 ANSWERED AND NOT 200-239, 250-289 AND FA05_02_02= 996 or FA05_02=-3 LEGIT SKIP, READ …]

FA11a	I just want to confirm that this person was still {FILL: (RELATIONSHIP 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 FA05_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN FA11_01 AND SKIP TO FA12; CODE FA11_02 – FA11_05 AS LEGIT SKIP}
	1	YES	{SKIP TO FA12}
	2	NO	{GO TO FA11_01}
	-1	DON’T KNOW	{SKIP TO FA12}
	-2	REFUSED	{SKIP TO FA12}
	-3	LEGIT SKIP	{SKIP TO FA12}

CATI:

IF FA11a IS CODED AS 1, -1, -2, FILL FA11_01 WITH RELATIONSHIP FILL FROM FA11a AND SKIP TO FA12; CODE FA11_02 – FA11_05 AS LEGIT SKIP.

(FA11)

[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” (FA10=1)/” people” who did ”this” (ONE BEHAVIOR) /”these things” to you in the past 12 months? [DO NOT READ FA11_01-FA11_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
FA11_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
FA11_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
FA11_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
FA11_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
FA11_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE FA11_## THAT ARE < FA10. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF FA11 = 3, THEN FA11_01, FA11_02 AND FA11_03 MUST BE ANSWERED,

AND FA11_04 – FA11_05 MUST BE CODED AS LEGIT SKIP.

FA12	Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months? 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.
		[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]
	999	TOO MANY TO COUNT
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

USER NOTE: ITEMS FA13_01 - FA20 ARE INTENDED TO GET AT ATTEMPTED MADE TO PENETRATE (MTP) - MALES

CATI:

IF FEMALE “R” OR IF MALE “R” AND NEITHER FA02 – FA03 ENDORSED ( > 1) SKIP TO (OT_INTRO1). CODE FA13_01 – FA20 AS LEGIT SKIP.

IF MALE “R” AND EITHER FA02 OR FA03 IS ENDORSED ( > 1) AND ANY OF FA04, FA05_01 – FA12 ANSWERED (RAPE), THEN DISPLAY (FA_INTRO2).

IF MALE “R” AND EITHER OF FA02 OR FA03 IS ENDORSED ( > 1) AND NONE OF FA04, FA05_01 – FA12 ANSWERED, GO TO FA13_01.

(FA_INTRO2)

[IF MALE “R” AND EITHER FA02 OR FA03 (MTP) IS ENDORSED AND ANY OF FA05_01 – FA12 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.

FA13_01	Think about the first time anyone EVER {FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES: FA02 – FA03) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE 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

FA14	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < FA14 THEN DISPLAY SOFT CHECK. (SEE TEXT IN GENERAL NOTES)

Note:

↓

The first relationship has already been coded in FA13_01. Code additional relationships in “FA13_” below using the Relationship/Sex Template (Appendix I). Note that relationship categories may be repeated.

(FA13)

[IF SUM FA02 +– FA03 (MALES) > 1, ASK …]

ITEM		QUESTION	RELATIONSHIP	NO MORE		DK		REF			LEGIT SKIP
FA13_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
FA13_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
FA13_04	The 4^th person?				_ _ _		996		-1			-2	-3
FA13_05	The 5^th person?				_ _ _		996		-1			-2	-3
:	:
FA13_09	The 9^th person?				_ _ _		996		-1			-2	-3
FA13_10	The 10^th person?				_ _ _		996		-1			-2	-3

CATI:

SHOW ONLY THE FA13_## ITEMS THAT ARE < (FA02 + FA03: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “FA13_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “FA13_##” ITEMS THAT CAN BE ANSWERED

MUST BE < SUM (FA02 + FA03: MALES).

CATI:

IF NONE OF “FA13_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO FA18;

CODE FA15 – FA17 AS LEGIT SKIP.

FA15	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 FA12_02 – FA13_10}. Is this correct?
	1	YES	{CODE RELATIONSHIP IN FA16}
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

FA16	What was your relationship to this person?
	_ _ _	[RANGE 100-189]
	-3	LEGIT SKIP

CATI:

IF 100 < FA16 < 199 AND FA16 = FA13_01 THEN SKIP TO FA18; FILL FA17 = FA14.

FA17	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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < FA17 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

FA18	Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF MTP BEHAVIORS ENDORSED FA02 – FA03 (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 (PA_INTRO1)}
	-2	REFUSED	{SKIP TO (PA_INTRO1)}
	-3	LEGIT SKIP

CATI:

IF FA18 IS CODED AS NONE, DK OR REF, SKIP TO (PA_INTRO1); CODE FA19a, FA19_01 – FA19_05, FA20 AS LEGIT SKIP.

CHECK: FA18 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN FA13_01 – FA13_10.

CATI:

IF ONE RELATIONSHIP EVER (FA13_01 ANSWERED, FA13_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (FA13_01 = 201 - 239, 251 - 289) CODE FA19_01 WITH VALUE FROM FA12_01, AND SKIP TO FA20; CODE FA19a, FA19_02 – FA19_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (FA12_01 ANSWERED, FA12_02= 996) AND NOT A FAMILY MEMBER, AND ONE RELATIONSHIP PAST 12 MONTHS (FA18=1), READ FA19a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF FA18 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (FA19). CODE FA19a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (FA13_02 < 996) AND FA18 = 1, GO TO (FA19).

CODE FA19a AS LEGIT SKIP.

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

Note:

↓

Code Relationships in the “FA19_” items below.

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

[IF FA13_01 ANSWERED AND NOT 200-239, 250-289 AND FA13 _02= 996 or FA13_02=-3 LEGIT SKIP, READ …]

FA19a			I just want to confirm that this person was still {FILL: (RELATIONSHIP 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 FA11_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct? {IF YES, CODE RELATIONSHIP IN FA19_01 AND SKIP TO FA20; CODE FA19_02 – FA19_05 AS LEGIT SKIP}
			1	YES	{SKIP TO FA20}
			2	NO	{GO TO FA19_01}
			-1	DON’T KNOW	{SKIP TO FA20}
			-2	REFUSED	{SKIP TO FA20}
			-3	LEGIT SKIP	{SKIP TO FA20}
	CATI:	IF FA19a IS CODED AS 1, -1, -2, FILL FA19_01 WITH RELATIONSHIP FILL FROM FA19a AND SKIP TO FA20; CODE FA19_02 – FA19_05 AS LEGIT SKIP.

(FA19)

[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” (FA18=1) / “people” who did “this” (ONE BEHAVIOR) /”these things” to you in the past 12 months? [DO NOT READ FA19_01 – FA19_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT] IF NECESSARY: Was this person male or female?
FA19_01	PAST 12 MONTH RELATIONSHIP 1	_ _ _	-1	-2	-3
FA19_02	PAST 12 MONTH RELATIONSHIP 2	_ _ _	-1	-2	-3
FA19_03	PAST 12 MONTH RELATIONSHIP 3	_ _ _	-1	-2	-3
FA19_04	PAST 12 MONTH RELATIONSHIP 4	_ _ _	-1	-2	-3
FA19_05	PAST 12 MONTH RELATIONSHIP 5	_ _ _	-1	-2	-3

CATI:

SHOW ONLY THE FA19_## THAT ARE < FA18. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF FA19 = 3, THEN FA19_01, FA19_02 AND FA19_03 MUST BE ANSWERED,

AND FA19_04 – FA19_05 MUST BE CODED AS LEGIT SKIP.

FA20	Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months? 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.
	------	[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]
	999	TOO MANY TO COUNT
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

(PA_INTRO1)

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 partners have EVER ...
PA01	… insulted or humiliated you in front of others?	_ _	0	-1	-2
PA02	… kept you from having your own money?	_ _	0	-1	-2
PA03	… tried to keep you from seeing or talking to your family or friends?	_ _	0	-1	-2
PA04	… kept track of you by demanding to know where you were and what you were doing?	_ _	0	-1	-2
PA05	… made threats to physically harm you?	_ _	0	-1	-2
PA06	… threatened to hurt themselves or commit suicide because they were upset with you?	_ _	0	-1	-2
PA07	… made decisions that should have been yours to make?	_ _	0	-1	-2
PA08	… destroyed something that was important to you?	_ _	0	-1	-2

CATI:

IF NONE OF PA01 – PA08 ARE ENDORSED, SKIP TO PA_INTRO2; CODE PA09 – PA11 AS LEGIT SKIP.

PA09	How old were you the first time a current or ex 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]
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CATI:

IF CURRENT AGE (RESPAGE) < PA09 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

PA10	How many current or ex 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 (PA_INTRO2)}
	-2	REFUSED	{SKIP TO (PA_INTRO2)}
	-3	LEGIT SKIP

CATI:

IF PA10 = 0, DK OR REF, SKIP TO (PV_INTRO1); CODE PA11 AS LEGIT SKIP.

PA11	At the time that it was most frequent in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}, how often did a current or ex partner do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you? Would you say …” (READ RESPONSE OPTIONS 1-5 BELOW).
	1	ONCE
	2	A FEW TIMES A YEAR
	3	MONTHLY
	4	WEEKLY
	5	DAILY
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

(PV_INTRO1)

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

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

ITEM

QUESTION

RANGE

[1-10]

NONE

REF

How many of your current or ex partners have ever…

PV01

… slapped, pushed, or shoved you?

_ _

-1

-2

CATI:

IF PV01 NOT ENDORSED, SKIP TO PV_INTRO2; CODE PV02 – PV03 AS LEGIT SKIP.

PV02	How old were you the first time a current or ex partner did {FILL: “this” (JUST PV01) / ”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

CATI:

IF CURRENT AGE (RESPAGE) < PV02 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

PV03	How many current or ex partners have done {FILL: “this” / “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: PV03 MUST BE < PV01.

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 partners have ever …
PV04	… hit you with a fist or something hard?	_ _	0		-1		-2
PV05	… kicked you or stomped on you?	_ _	0		-1		-2
PV06	… hurt you by pulling your hair?	_ _	0		-1		-2
How many of your current or ex partners have ever …
PV07	… slammed you against something?	_ _	0		-1		-2
PV08	… tried to hurt you by choking or suffocating you?	_ _	0		-1		-2
How many of your current or ex partners have ever …
PV09	… used a knife on you?	_ _	0		-1		-2
PV10	… used a gun on you?	_ _	0		-1		-2

CATI:

IF NONE OF PV04 – PV10 ENDORSED, SKIP TO PV13; CODE PV11 – PV12 AS LEGIT SKIP. IF NONE OF PV01, PV04-PV10 ARE ENDORSED, SKIP TO CHK2; MARK PV11 – PV15 AS LEGIT SKIP.

PV11	How old were you the first time a current or ex partner {FILL: LIST OF SEVERE PHYSICAL ACT BEHAVIORS ENDORSED IN PV04 – PV10 – 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

CATI:

IF CURRENT AGE (RESPAGE) < PV11 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)

PV12	How many current or ex 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: PV12 MUST BE < SUM(PV04 THRU PV10).

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

ACTS OF VIOLENCE.

PV13	Think about {FILL: “the person” (ONLY ONE OF PV01, PV04 – PV10 ENDORSED AND ONLY 1 PERSON) / “all of the people”} who {FILL: ENDORSED BEHAVIORS PV01, PV04 – PV10 - 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 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 PV03 = 0 AND PV12 = 0 THEN SKIP TO CHK2; MARK PV14 – PV15 AS LEGIT SKIP.

PV14	What was your relationship with the {FILL: “first” (SUM PV03+PV12>1)} current or ex 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

PV15	At the time that it was most frequent in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}, how often did a current or ex partner do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you? Would you say …” READ RESPONSE OPTIONS 1-5 BELOW 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	ONCE
	2	A FEW TIMES A YEAR
	3	MONTHLY
	4	WEEKLY
	5	DAILY
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

CHK2

{If R endorses 3+ behaviors in Stalking, Psychological Aggression, Physical Violence – Sections ST, PA, PV }

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

1	YES {go to CQ_INTRO}
2	NO {BREAKOFF AND CODE AS DISTRESS}
-1	(VOL) DON’T KNOW {BREAKOFF AND CODE AS DISTRESS}
-2	(VOL) REFUSED {BREAKOFF AND CODE AS DISTRESS}

USER NOTE: The next section gets at the consequences of intimate partner violence. Intimate partner violence includes the following forms of victimization by an intimate partner: stalking, unwanted sexual contact, sexual coercion, and completed or attempted rape or those being made to penetrate someone else, and physical violence by an intimate partner. While questions are not asked of those who specifically endorsed psychological aggression by an intimate partner, respondents may be considering these experiences when responding to these questions.

(CQ_INTRO)

[IF ANY OF PV01, PV04-PV10 (PV BY AN INTIMATE PARTNER) AND/OR ANY OF ST09, ST10, SC05, SC06, SC15-SC17, AD01-AD04 (FEMALES)/AD05-AD08(MALES), FC01-FC04 (FEMALES)/FC05-FC08 (MALES), FA01(FEMALES)/

FA02-FA04(MALES) 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 CQ_INTRO above}.

CATI:

IF NONE OF PV01, PV04 THRU PV10 GE 1 AND ALL OF ST14, SC10,SC21,AD13,AD20, FC12,FC20,FA08,FA16 = 3 (LEGIT SKIP), THEN SKIP TO INTLANG; CODE CQ01 – CQ31 AS LEGIT SKIP.

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
CQ01	When any of those things happened, were you ever concerned for your safety?	1	2 {SKIP	-1 TO	-2 CQ03}	-3
CQ02	Were you concerned for your safety in the past 12 months?	1	2	-1	-2	-3
CQ03	When any of those things happened, were you ever fearful for yourself or someone close to you?	1	2 {SKIP	-1 TO	-2 CQ05}	-3
CQ04	Were you fearful in the past 12 months?	1	2	-1	-2	-3

CATI:

IF R RESPONDS NO, DK OR REF TO THE CQ01, SKIP TO CQ03; CODE CQ02 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO THE CQ03, SKIP TO CQ05; CODE CQ04 AS LEGIT SKIP.

USER NOTE: ITEMS CQ05 – CQ08 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
CQ05	… did you ever have nightmares?	1	2	-1	-2	-3
CQ06	… 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
CQ07	… did you ever feel like you were constantly on guard, watchful, or easily startled?	1	2	-1	-2	-3
CQ08	… did you ever feel numb or detached from others, your activities, or your surroundings?	1	2	-1	-2	-3

CATI:

IF NONE OF CQ05 – CQ08 ARE ENDORSED (INCLUDES RESPONSES OF DK AND REF), SKIP TO CQ10; CODE CQ09 AS LEGIT SKIP.

[IF ONE OR MORE OF CQ05-CQ08 ARE ENDORSED, READ …]

You told me that you {FILL: LIST PTSD SYMPTOMS ENDORSED IN CQ5 – CQ8 – 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 partner did to you.

CQ09	Did you ever feel this way in the past 12 months?
	1	YES
	2	NO
	-1	DON’T KNOW
	-2	REFUSED
	-3	LEGIT SKIP

I am going to read you a list of 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 partner.

Did you ever experience …

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
CQ10	… minor bruises or scratches?	1	2	-1	-2	-3
CQ11	… cuts, major bruises, or black eyes?	1	2	-1	-2	-3

ITEM	QUESTION	YES	NO	DK	REF	LEGIT SKIP
CQ12	Injury to any ligaments, muscles or tendons?	1	2	-1	-2	-3
CQ13	Broken bones or teeth?	1	2	-1	-2	-3
CQ14	Back or neck injury?	1	2	-1	-2	-3
CQ15	Being knocked out after getting hit, slammed against something or choked?	1	2	-1	-2	-3

ITEM

QUESTION

YES

REF

LEGIT SKIP

CQ16

A concussion is when a blow to the head caused you to have one or more symptoms such as blurred or double vision, sensitivity to light or noise, headaches, dizziness or balance problems, nausea, being dazed or confused, difficulty remembering, difficulty concentrating, or being knocked out.

Did you ever experience a concussion because of what a current or ex partner did to you?

{IF NECESSARY: Do not include situations where you were hurt accidentally.}

-1

-2

-3

If you have any questions or concerns about participating in the survey, please feel free to call the survey manager, {NAME at 1-###-###-####}. 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 National Sexual Assault Hotline at 1-800-656-HOPE (4673). You can reach the National Child Abuse Hotline at 1-800-4-A-Child (1-800-422-4453). You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

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

That completes the interview. Thank you for your participation.

IF R HEARD THE WHOLE SCRIPT, PRESS 1 AND ENTER TO CONTINUE.

*FOR THIS SCREEN ONLY* -> IF R REFUSED SCRIPT OR HUNG UP, CLICK ON REFUSAL ICON (!) AND THEN PRESS ENTER TO CONTINUE

1……………..CONTINUE

INTERVIEWER: DID THE respondent MENTION ANYTHING ABOUT A GROUP OF PERPETRATORS?

3………………..YES, THE RESPONDENT MENTIONED A GROUP OF PERPETRATORS

2………………..NO

(review.) PRESS “1” AND ENTER TO COMPLETE THIS PART OF THE INTERVIEW.

1……………..CONTINUE

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