Cognitive testing protocol

Attachment L:

NISVS Redesign Cognitive Testing Protocol

Form Approved
OMB No: 0920-0822
Exp. Date: xx/xx/xxxx

Public Reporting burden of this collection of information is estimated to average 1 hour per person, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-0822).

INTRODUCTION

Thank you for taking the time to help us today. The session will take approximately an hour. I’ll give you a little background on what we’ll be doing today.

Westat is working with the Centers for Disease Control and Prevention. We are developing a national survey about health and injuries that asks questions about physical injuries, harassing behaviors, and unwanted sexual activity and today we would like to test the questionnaire with you (on this laptop/using the device you brought with you). The survey asks about different types of experiences that you may have had. We are particularly interested in whether the questions make sense to you, and we might ask you to talk about what happened during these experiences and how you decided on your answers to the survey questions based on those experiences. We would also like your feedback on the online survey to make sure it is easy to understand and navigate.

Some of the language in the survey is explicit, but it is important that we ask the questions this way so that you are clear about what we mean. The questions we ask are detailed and some people may find them uncomfortable.

Today, I am going to ask you to go through the whole questionnaire as a survey respondent. I am going to observe you as you do this and will take a few notes as you go through the survey. Every now and then, I will stop you and we’ll talk about what you are seeing on the screen or how you decided on your answer to the question. If anything is confusing for you, or if you’re not sure how to answer a question or are unsure what to do next, just tell me. There are no right or wrong answers. Our purpose is not to compile information about you. Instead, your interview along with those of others will show us how to improve these questions for a later survey.

This is a research project and your participation is voluntary. You can skip any question and you can stop at any point. There are no known benefits for you to take part in this study, but your answers will help us improve the survey. There is a risk that some of the questions that we will ask you to talk about are about private and sensitive things that may bother you. If you become upset during the interview or want to stop the interview at any time, please let me know. I will provide you with a list of resources at the end of the interview that you can use to help you.

We would very much appreciate your permission to audio and video record this session. The recordings will be used for note-taking purposes only and may be used only by members of the project or the CDC staff. They will be destroyed as soon as we complete the questionnaire development process. You will receive $40 cash as a token of our appreciation at the end of the interview.

All information obtained during this study will be treated as confidential, as required by law, and will only be used to develop and improve the questionnaire. We will not share your answers with anyone outside of the research team. The one exception is that if you express that you are a danger to yourself or to others. If that happens, in order to help protect your safety and the safety of others, we would report this to the appropriate healthcare or law enforcement agencies.

Your answers to the questions will not be linked with your name and we will not use your name in any reports. We may use quotes in our report that you provide during the interview, but never in a way that would identify you.

[IF OBSERVERS ARE PRESENT OR ON WEBEX] {Finally, some of the researchers developing the questions are observing our interview to learn if there are things that might need to be changed.}

INFORMED CONSENT

ASK PARTICIPANT TO REVIEW THE CONSENT FORM, ANSWER ANY QUESTIONS, AND OBTAIN CONSENT BEFORE CONTINUING. This form contains more information about the research and your rights in this interview. Please read it over and let me know if you have any questions. (ANSWER QUESTIONS) If you are willing to take part in the study, please mark the Yes boxes. I will sign both copies. One copy is for you, and I will hold onto the other.

POINT TO THE LAST PARAGRAPH WITH CONTACT INFORMATION: Also, if you have any questions about this research study, you can contact David Cantor, the Principal Investigator. His phone number is provided here. If you have questions about your rights and welfare as a research participant, you can call the Westat Human Subjects Protections office. Their phone number is also provided on this form.

[START AUDIO RECORDER AND BEGIN RECORDING ON WEBEX AND GET ORAL PERMISSION TO RECORD.] It is [DATE AND TIME], do I have your permission to record this conversation? ~~~~Thank you.

Do you have any questions before we get started? I am going to start with a few questions and then will hand over control of the computer to you and will watch as you answer the questions. Every now and then we will stop to talk about the questions and the web screens Also, sometimes I will interrupt you before you click the next button to ask some questions. There are no right or wrong answers, we’re just interested in getting your feedback about the questions and how you came up with your answers.

PART A. ISSUE LOG

Any time the respondent has issues with navigation or questions, record the question number and a few words about the problem on the Issue Log. Use the “Usability Probes” to determine what probes to ask about the issue.

PART B: QUESTION-SPECIFIC PROBES

[Interviewers will ask concurrent probes on the items listed below.]

Health Characteristics

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

[HC01] The following questions are about health conditions that you may have. Remember, you don’t have to answer any question that you don’t want to.

Do you have …

… frequent headaches?

Yes 1

No 2

[HC02] … chronic pain?

Yes 1

No 2

[HC03] … difficulty sleeping?

Yes 1

No 2

[HC04]

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

… Asthma?

Yes 1

No 2

[HC05] … Irritable Bowel Syndrome or IBS?

Yes 1

No 2

[HC06] …any type of depression?

Yes 1

No 2

[HC07] 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?

Yes 1

No 2

[HC08] Have you ever attempted suicide?

Yes 1

No 2

Were any of these questions uncomfortable for you to answer? (If so, which ones and what made them uncomfortable?)
Were any of these questions unclear for you to answer? (If so, which ones and what made them unclear or confusing?)
If you were filling this out at home, how would you feel about continuing with the survey after being asked these questions?
What do you think is meant by “any type of depression”?
Let’s look at the question “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?.” What types of situations do you think this is asking about? IF YES: What made you say “yes” to this question?
The last question I asked was if you have ever attempted suicide. How did you feel about being asked that question? We’re trying to decide if we need to add a question before that which asks if you ever thought about suicide. Do you think we need to add that question?

Stalking

[ST01] Has anyone ever …

… followed you around, watched, or spied on you when you did not want them to?

Yes 1

No 2

[ST02] … approached you or showed up in places, such as your home, work, or school when you did not want them to?

Yes 1

No 2

[ST03] Has anyone ever …

… used technology, such as hidden cameras, computer software, apps, or GPS (Global Positioning System) to monitor or track your location without your permission? This includes GPS used in a phone or in social media, such as Facebook. (We are talking about times when you knew or you thought someone was using GPS technology to monitor you.)

Yes 1

No 2

[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?

Yes 1

No 2

[ST05] Has anyone ever …

… made unwanted phone calls, sent emails, voice, or text messages?

Yes 1

No 2

[ST06] … sent you unwanted messages through social media, such as Facebook, Instagram, and chat rooms?

Yes 1

No 2

[ST07] … sent you cards, letters, flowers, or presents when they knew you didn’t want them to?

Yes 1

No 2

(REVIEW EACH OF THESE 3 SCREENS AFTER ALL 3 HAVE BEEN ANSWERED) Let’s look back at each of these items. Were any of them confusing or unclear?
ASK FOR EACH YES RESPONSE: Can you tell me what made you say yes to this question?
ASK FOR UP TO 2 OR 3 ITEMS THAT WERE ANSWERED “NO” (STATE ITEM ALOUD FOR THE RECORDING): Can you tell me, in your own words, what types of situations you think this was asking about?

[ST08]

You answered earlier that someone had [FILLS]

How many people did any of these things to you on more than one occasion?

_____________

[IF ONLY ONE PERSON]

[ST09A] Now, thinking ONLY about that person who followed, contacted or harassed you on more than one occasion, did he/she ever make you feel fearful, threatened, or concerned for your safety or the safety of others?

Yes 1

No 2

[IF MORE THAN ONE PERSON]

[ST09]

Now, thinking ONLY about the {fill: ST08/IF ST08>1} people who followed, contacted or harassed you on more than one occasion, how many of those people ever made you fearful, threatened, or concerned for your safety or the safety of others?

_________

What do you think this question is asking you to count up?
What do you think is meant by “made you fearful or feel threatened or concerned for your safety or the safety of others?”
(IF YES OR >0) We’d like to understand what types of people are being counted in this question. Can you tell me a little more about what happened to you?

[IF ONLY ONE PERSON]

[ST10A] Still thinking about that person who followed, contacted or harassed you on more than one occasion, did he/she 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.

Yes 1

No 2

[IF MORE THAN ONE PERSON]

[ST10]

Now, thinking ONLY about the {fill: (ST08)} 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.

_______

What do you think this question is asking?
How is this different from the previous question you just answered about how many people ever made you feel fearful, feel threatened, or concerned for your safety or the safety of others? (IF NEEDED: Were you thinking about the same individuals as you did for the prior question, or did this make you think about different people?)
(IF YES OR >0) We’d like to understand what types of people are being counted in this question. Can you tell me a little more about what happened to you?

ST10_Review: Now, thinking about the {FILL: ST08} person/people who followed, contacted, or harassed you on

[ST10_REVIEW] You said that

-(IF ST09>0: [FILL IN ST09] people made you feel fearful, threatened, or concerned for your safety or the safety of others)

-(IF ST10>0: [FILL IN ST10] people made threats to physically harm you).

In total, how many DIFFERENT people did these things to you?

_____________

[IF SCREEN IS LEFT BLANK, IT WILL DISPLAY: You haven’t answered the question yet. If possible, please provide an answer to this question as this is one of the key questions in this study. Your answer will help CDC understand more about this topic.”]

What do you think this question was asking you to do?
How did you come up with your answer?
[IF R SAW ERROR MESSAGE] Why did you decide to leave this question blank? What did you think about the message that showed up on the screen? Was it helpful information? How effective was it to persuade you to answer the question?

[ST11_01] Only thinking about the 1st person who

followed, contacted, or harassed you on more than one occasion,

AND

[FILL: (IF ST09>=1: made you feel fearful, threatened, or concerned for your safety or the safety of others) (IF ST09>=1 AND ST10>=1: or) (IF ST10>=1: made threats to physically harm you)].

Was that person …?

Male 1

Female 2

[ST11_01B] The first time this happened, what was that person's relationship to you?

Someone I was involved romantically
or sexually at the time 1

Someone I previously had been
involved romantically or sexually 2

A family member/relative 3

A friend/neighbor/acquaintance 4

A person of authority (e.g., boss,
supervisor, teacher, doctor, police
officer, etc).) 5

A stranger 6

Someone else (Please specify: ) 7

IF ST11_01B=1,2, CODE ST11_INT=1;

IF ST11_01B=1,2,3,4,5 ASK ST11_01C. ELSE GO TO ST11_01E.

[ST11_01C] Specifically, was that person…?

ST11_01B: Which person were you thinking about when answering this question (ST11_01B)/these two questions (ST11_01B and ST11_01C)?
What do you think is meant by “the first person” who did these things to you?
What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
Were you deciding between any of the categories? If so, how did you decide which one to select?
What did you think was meant by the statement at the top of the screen that said “REPEATEDLY CONTACTED, FOLLOWED OR HARASSED YOU: PERSON 1”
ST11_01C: How easy or hard was it to find the answer you were looking for on this list?

[ST11_01F] Still thinking about the 1^st person who

• followed, contacted, or harassed you on more than one occasion,

AND

• [FILL: (IF ST09>=1: made you feel fearful, threatened, or concerned for your safety or the safety of others) (IF ST09>=1 AND ST10>=1: or) (IF ST10>=1: made threats to physically harm you)].

Did [FILL: he/she] do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?

Yes 1

No 2

IF ST11_01F=YES AND ST11_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK ST11_011G. ELSE GO TO SKIP INSTRUCTION BEFORE ST11_02.

[ST11_01G] Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

Yes 1

No 2

IF ST11_01G=NO OR (ST11_01F=YES AND ST11_01B=SOMEONE ELSE), ASK ST11_01H. ELSE GO TO ST11_02.

[PROGRAMMER NOTE: DISPLAY ST11_01H TO ST11_01I ON ONE SCREEN;

SHOW BURN LINE: Repeatedly contacted, followed, harassed you: : PERSON 1.

[ST11_01H] When [FILL: he/she] did these things to you in the past 12 months, what was [FILL: his/her] relationship to you?

Someone I was involved romantically
or sexually at the time 1

Someone I previously had been involved
romantically or sexually 2

A friend/neighbor/acquaintance 4

A person of authority (e.g., boss,
supervisor, teacher, doctor, police
officer, etc.) 5

A stranger 6

Someone else (Please specify:
7

IF ST11_01H=INTIMATE RELATIONSHIPS, ASK ST11_01I. ELSE GO TO SKIP INSTRUCTION BEFORE ST11_02.

[ST11_01I]. Specifically, was this person…?

[ADMINISTER PROBES AFTER ST11_01I]

ST11_01G: What do you think this question was asking?
What do you think is meant by the word “still” in this question?
IF NO: Tell me more about why you decided to answer No to this question.

END OF STALKING SECTION:

(IF R WAS ASKED MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions? Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?

Sexual Harassment, Unwanted Touching and Coerced Sex

SC01.

These first questions are about unwanted sexual situations, including verbal harassment and unwanted touching.

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.

_____

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}?

______

[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?

____

[SC04. ]

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

_______

[SC05]

How many people have ever …

… kissed you in a sexual way when you did not want it to happen?

______

[SC06]

… fondled, groped, grabbed, or touched you in a sexual way when you did not want it to happen?

______

(ADMINISTER PROBES AFTER SC06, RETURNING TO PRIOR SCREENS TO REMIND RESPONDENT OF THE QUESTION)
SC01: What do you think of when you see the word “workplace”?
SCO1: What do you think is meant by “Please include people you work with or come into contact with through your job.”
SC01: We’re hoping to understand how people interpret the idea of something happening in a workplace. So I’m going to ask you a few different situations to see what you think. In your opinion is this question asking about situations when someone from a workplace did or said something outside of the workplace? Like if you were at a happy hour with co-workers, or if you were at an offsite meeting or worksite?
SC01: Do you think this would include situations when someone who doesn’t work in your workplace did something while at your workplace? Like if a friend or boyfriend came to visit you and did something like this while at your place of work?
SC01: Do you think this would include situations when you were at work but the work place is a client’s residence or office (such as when you were fixing a client’s internet connection at the client’s office or home, or when you were providing a health care visit at the patient’s home)?
SC01: (IF ANSWER>=1) How did you decide on your answer to this question?
SC03: What types of situations do you think this is asking about? (IF NEEDED: What do you think is meant by “a public place”?)
SC03: (IF ANSWER>=1) How did you decide on your answer to this question?
SC04: What were you thinking about when you answered this question? (Probe to confirm that they were thinking about how many times in the past 12 months someone verbally harassed them in a public place.)
SC05/SC06: Was there anything confusing about either of these two questions?
SC05/SC06: (IF YES TO EITHER) You answered that one or more people did either of these things to you. What types of situations were you thinking about when you answered this?
IF “DON’T KNOW” TO ANY IN SC01-SC06: Tell me more about why you decided to answer “don’t know” to this question.

[SC06_REVIEW]

You just answered:

-(IF SC05>0: [FILL IN SC05] people kissed you in a sexual way when you did not want it to happen)

-(IF SC06>0: [FILL IN SC06] people fondled, groped, grabbed, or touched you in a sexual way when you did not want it to happen).

In total, how many DIFFERENT people did any of these things to you?

______

[IF SCREEN IS LEFT BLANK, IT WILL DISPLAY: You haven’t answered the question yet. If possible, please provide an answer to this question as this is one of the key questions in this study. Your answer will help CDC understand more about this topic.”]

(IF NOT ALREADY ASKED) What do you think this question was asking you to do?
How did you come up with your answer?
[IF R SAW ERROR MESSAGE] Why did you decide to leave this question blank? What did you think about the message that showed up on the screen? Was it helpful information? How effective was it to persuade you to answer the question?

SC07_01.

Think about the first time anyone EVER

-(IF SC05>0: kissed you in a sexual way when you did not want it to happen)

-(IF SC06>0: fondled, groped, grabbed, or touched you in a sexual way when you did not want it to happen),

was the person…?

1. Male

2. Female

[PROGRAMMER NOTE: DISPLAY SC07_01B AND SC07_01C ON ONE SCREEN; SHOW BURN LINE (Unwanted touching: PERSON 1)]

[SC07_01B]

The first time this happened, what was that person's relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

3. A family member/relative

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: __________________)

[SC07_01C]

Specifically, was that person…?

(ADMINISTER PROBES AFTER BOTH ITEMS HAVE BEEN ASKED, AS APPROPRIATE)

SC07_01B: Which person were you thinking about when answering this question (ST11_01B)/these two questions (ST11_01B and ST11_01C)?
(IF NOT ALREADY ASKED) What do you think is meant by “the first time” this happened to you?
(IF NOT ALREADY ASKED) What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
(IF NOT ALREADY ASKED) How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
Were you deciding between any of the categories? If so, how did you decide which one to select?
What did you think was meant by the statement at the top of the screen that said “UNWANTED TOUCHING: PERSON 1”
SC07_01C: How easy or hard was it to find the answer you were looking for on this list?

[SC07_01G]

Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

1. Yes

2. No

[PROGRAMMER NOTE: DISPLAY SC07_01H TO SC07_01I ON ONE SCREEN;

SHOW BURN LINE (Unwanted touching: PERSON 1)]

[SC07_01H]

When he/she did these things to you in the past 12 months, what was his/her relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: __________________)

Specifically, was this person…?

[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY]

SC07_01G: (IF NOT ALREADY ASKED) What do you think this question was asking?
IF NO: Tell me more about why you decided to answer No to this question.

END OF SEXUAL CONTACT SECTION:

(IF R WAS ASKED ABOUT MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions?
What were your reactions to being asked if these types of things have ever happened to you? (LISTEN FOR: embarrassed, upset, reluctant, etc.)
Did you feel like you changed your answers in any way to make it less embarrassing or so that you wouldn’t be asked so many questions?
Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?

Coerced Sex

[SC15] How many people have you had vaginal, oral, or anal sex with after they pressured you by doing any of the following….?

Telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you?

________

[SC16] Wearing you down by repeatedly asking for sex, or showing they were unhappy?

________

[SC17] Using their influence or authority over you, for example, your boss or your teacher? (We are asking about people other than parents or other family members.)

______

SC15-SC17: Was there anything confusing about any of these questions?

[SC17_REVIEW]

You just answered that you have had vaginal, oral, or anal sex with people after they pressured you-

-(IF SC15>0: [FILL IN SC15] by telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you)

-(IF SC16>0: [FILL IN SC16] by wearing you down by repeatedly asking for sex, or showing they were unhappy)

-(IF SC17>0: [FILL IN SC17] by using their influence or authority over you).

In total, how many DIFFERENT people did any of these things to you?

________

[IF SCREEN IS LEFT BLANK, IT WILL DISPLAY: You haven’t answered the question yet. If possible, please provide an answer to this question as this is one of the key questions in this study. Your answer will help CDC understand more about this topic.”]

(IF NOT ALREADY ASKED) What do you think this question was asking you to do?
How did you come up with your answer?
[IF R SAW ERROR MESSAGE] Why did you decide to leave this question blank? What did you think about the message that showed up on the screen? Was it helpful information? How effective was it to persuade you to answer the question?

[SC18_01] Think about the first time these things happened to you. Was the person…?

1. Male

2. Female

[PROGRAMMER NOTE: DISPLAY SC18_01B AND SC18_01C ON ONE SCREEN; SHOW BURN LINE (Unwanted sex you were pressured into: Person 1)]

[SC18_01B] The first time this happened, what was that person's relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

3. A family member/relative

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: _____________________)

[SC18_01C] Specifically, was that person…?

(ADMINISTER PROBES AFTER BOTH ITEMS HAVE BEEN ASKED, AS APPROPRIATE)

SC18_01B: Which person were you thinking about when answering this question (ST11_01B)/these two questions (ST11_01B and ST11_01C)?
(IF NOT ALREADY ASKED) What do you think is meant by “the first time” this happened to you?
(IF NOT ALREADY ASKED) What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
(IF NOT ALREADY ASKED) How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
Were you deciding between any of the categories? If so, how did you decide which one to select?
What did you think was meant by the statement at the top of the screen that said “UNWANTED SEX YOU WERE PRESSURED INTO: PERSON 1”
SC18_01C: How easy or hard was it to find the answer you were looking for on this list?

[SC18_01G] Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

1. Yes

2. No

[PROGRAMMER NOTE: DISPLAY SC18_01H TO SC18_01I ON ONE SCREEN;

SHOW BURN LINE (Unwanted sex you were pressured into: Person 1)]

[SC18_01H] When he/she did these things to you in the past 12 months, what was his/her relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[SC18_01I] Specifically, was this person…?

SC18_01G: (IF NOT ALREADY ASKED) What do you think this question was asking?
IF NO: Tell me more about why you decided to answer No to this question.

END OF SEXUAL PRESSURE SECTION:

(IF R WAS ASKED ABOUT MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions?
Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?

Alcohol/Drug Facilitated

[FEMALES]

[AD01] 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?

Put their mouth on your vagina?

_____________

[AD02] Put their fingers or an object in your vagina or anus?

_________

[AD03] 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…?

Put their penis in your vagina?

_________

[AD04] Put their penis in your mouth or anus?

_________

[MALES]

[AD05] 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…?

Put their fingers or an object in your anus?

________

[AD06] Put their mouth on your penis?

________

[AD07] 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…

Made you put your penis in their vagina?

_______

[AD08] 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 …

Put their penis in your mouth or anus?

______

[ALL]

[AD09] 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 …

… do you think you were ever given alcohol without your knowledge?

1. Yes

2. No

[AD10] … do you think you were ever given other drugs without your knowledge?

1. Yes

2. No

AD01-AD10: Was there anything confusing about any of these questions?
AD01: Let’s look at the introduction before this question. (“Thinking about situations 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…”) What types of situations do you think this is asking about?

[AD11_REVIEW]

(IF FEMALE RESPONDENTS: )

You answered earlier that, 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,

-(IF AD01>=1: [FILL: AD01] people put their mouth on your vagina,)

-(IF AD02>=1: [FILL: AD02] people put their fingers or an object in your vagina or anus,)

-(IF AD03>=1: [FILL: AD03] males put their penis in your vagina,)

-(IF AD04>=1: [FILL: AD04] males put their penis in your mouth or anus.)

(IF MALE RESPONDENTS: )

You answered earlier that, 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,

-(IF AD05>=1: [FILL: AD05] people put their fingers or an object in your anus,)

-(IF AD08>=1: [FILL: AD08] males put their penis in your mouth or anus.)

In total, how many DIFFERENT people did any of these things to you?

______________

[IF SCREEN IS LEFT BLANK, IT WILL DISPLAY: You haven’t answered the question yet. If possible, please provide an answer to this question as this is one of the key questions in this study. Your answer will help CDC understand more about this topic.”]

(IF NOT ALREADY ASKED) What do you think this question was asking you to do?
How did you come up with your answer?
[IF R SAW ERROR MESSAGE] Why did you decide to leave this question blank? What did you think about the message that showed up on the screen? Was it helpful information? How effective was it to persuade you to answer the question?

[AD11_01]

[PROGRAMMER NOTE: DISPLAY BURNLINE (Unwanted sex while drunk, high, drugged, or passed out: Person 1)]

Think about the first time anyone EVER:

(IF FEMALE RESPONDENTS: )

-(IF AD01>=1: put their mouth on your vagina,)

-(IF AD02>=1: put their fingers or an object in your vagina or anus,)

-(IF AD03>=1: put his penis in your vagina,)

-(IF AD04>=1: put his penis in your mouth or anus.)

(IF MALE RESPONDENTS: )

-(IF AD05>=1: put their fingers or an object in your anus,)

-(IF AD08>=1: put his penis in your mouth or anus.)

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.

Was this person…?

1. Male

2. Female

[PROGRAMMER NOTE:

-DISPLAY AD11_01B AND AD11_01C ON ONE SCREEN;

-SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 1)]

[AD11_01B]

The first time this happened, what was that person's relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

3. A family member/relative

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF AD11_01B=1,2, CODE AD11_INT=1.

IF AD11_01B=1,2,3, 4,5 ASK AD11_01C. ELSE GO TO AD11_01E]

[AD11_01C] Specifically, was that person…?

(ADMINISTER PROBES AFTER BOTH ITEMS HAVE BEEN ASKED, AS APPROPRIATE)

AD11_01B: Which person were you thinking about when answering this question (ST11_01B)/these two questions (ST11_01B and ST11_01C)?
(IF NOT ALREADY ASKED) What do you think is meant by “the first time” these things happened to you?
(IF NOT ALREADY ASKED) What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
(IF NOT ALREADY ASKED) How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
Were you deciding between any of the categories? If so, how did you decide which one to select?
What did you think was meant by the statement at the top of the screen that said “UNWANTED SEX WHILE DRUNK, HIGH, DRUGGED, OR PASSED OUT: PERSON 1”
AD11_01C: How easy or hard was it to find the answer you were looking for on this list?

[AD11_01G] Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

1. Yes

2. No

[PROGRAMMER NOTE: DISPLAY AD11_01H TO AD11_01I ON ONE SCREEN; SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: PERSON 1)]

AD11_01H: When he/she did these things to you in the past 12 months, what was his/her relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF AD11_01H=INTIMATE RELATIONSHIPS, ASK AD11_01I. ELSE GO TO AD11_02]

AD11_01I: Specifically, was this person…?

AD11_01G: (IF NOT ALREADY ASKED) What do you think this question was asking?
IF NO: Tell me more about why you decided to answer No to this question.

AD18. Think about the {AD12_CNT=1: person / (FILL: AD12_CNT) people} who

(IF FEMALE RESPONDENTS: )

-(IF AD01>=1: put {his/her} mouth on your vagina,)

-(IF AD02>=1: put {his/her}their fingers or an object in your vagina or anus,)

-(IF AD03>=1: put his penis in your vagina,)

-(IF AD04>=1: put his penis in your mouth or anus.)

(IF MALE RESPONDENTS: )

-(IF AD05>=1: put {his/her} fingers or an object in your anus,)

-(IF AD08>=1: his penis in your mouth or anus.)

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 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?

(“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.)

__________________

IF >0: How did you come up with your answer to this? (IF NEEDED: Which types of incidents were you thinking about?)
How easy or difficult was it to count up the number of different times this happened in the past 12 months?
How certain are you that you’ve only counted up the incidents that happened in the past 12 months?
IF TOO MANY TO COUNT: How did you decide to select this answer?

END OF ALCOHOL/DRUG FACILITATED SECTION:

(IF R WAS ASKED ABOUT MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions?
Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?
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?

Alcohol/Drug Facilitated Made to Penetrate (MALES ONLY)

[IF MALE “R” ASK …]

[AD19_REVIEW]

You answered earlier that

-(IF AD06>=1: [FILL IN AD06] people put their mouth on your penis,)

-(IF AD07>=1: [FILL IN AD07] females made you put your penis in their vagina)

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.

In total, how many DIFFERENT people did any of these things to you?

(IF NOT ALREADY ASKED) What do you think this question was asking you to do?
How did you come up with your answer?

[AD19_01]

[PROGRAMMER NOTE:. DISPLAY BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 1)]

Think about the first time anyone EVER

-(IF AD06>=1: put their mouth on your penis,)

-(IF AD07>=1: made you put your penis in their vagina)

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, was the person…?

1. Male

2. Female

[PROGRAMMER NOTE:

-DISPLAY AD19_01B AND AD19_01C ON ONE SCREEN;

-SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: PERSON 1)]

[AD19_01B]

The first time this happened, what was that person's relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

3. A family member/relative

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF AD19_01B=1,2, CODE AD19_INT=1.

IF AD19_01B=1,2,3, 4,5 ASK SAD19_01C. ELSE GO TO AD19_01E]

[AD19_01C]

Specifically, was that person…?

(ADMINISTER PROBES AFTER BOTH ITEMS HAVE BEEN ASKED, AS APPROPRIATE)

AD19_01B: Which person were you thinking about when answering this question/these two questions?
(IF NOT ALREADY ASKED) What do you think is meant by “the first time” these things happened to you?
(IF NOT ALREADY ASKED) What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
(IF NOT ALREADY ASKED) How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
IF NEEDED: Were you deciding between any of the categories? If so, how did you decide which one to select?
What did you think was meant by the statement at the top of the screen that said “Made to penetrate while drunk, high, drugged, or passed out: PERSON 1” (IF NEEDED) What does this phrase “made to penetrate” mean?
AD19_01C: How easy or hard was it to find the answer you were looking for on this list?

[AD19_01G]

Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

1. Yes

2. No

[PROGRAMMER NOTE: DISPLAY AD19_01H TO AD19_01I ON ONE SCREEN;

SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: PERSON 1)]

[AD19_01H]

When he/she did these things to you in the past 12 months, what was his/her relationship to you?

1. Someone I was involved romantically or sexually or intimate

2. Someone I previously had been involved romantically or sexually

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF AD19_01H=INTIMATE RELATIONSHIPS, ASK AD19_01I. ELSE GO TO AD19_02]

[AD19_01I] Specifically, was this person…?

AD19G: (IF NOT ALREADY ASKED) What do you think this question was asking?
IF NO: Tell me more about why you decided to answer No to this question.

[AD26]

Think about the {(IF AD19_CNT=1: person)/(FILL: AD19_CNT) people} who

-(IF AD06>=1: put their mouth on your penis,)

-(IF AD07>=1: made you put your penis in their vagina)

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 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?

(“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).

_____________________

IF >0: How did you come up with your answer to this? (IF NEEDED: Which types of incidents were you thinking about?)
How easy or difficult was it to count up the number of different times this happened in the past 12 months?
How certain are you that you’ve only counted up the incidents that happened in the past 12 months?
IF TOO MANY TO COUNT: How did you decide to select this answer?

END OF ALCOHOL/DRUG FACILITATED MADE TO PENETRATE SECTION:

(IF R WAS ASKED ABOUT MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions?
Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?
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?

Unwanted Sex by Force

[FEMALES]

[FC01]

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

….put their mouth on your vagina?

(Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no.)

___________

[FC02] … put their fingers or an object in your vagina or anus?

___________

[FC03]

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

… put their penis in your vagina?

(Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no.)

___________

[FC04]… put their penis in your mouth or anus?

___________

[MALES]

[FC05]

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

… put their fingers or an object in your anus?

(Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no.)

___________

[FC06] … put their mouth on your penis?

___________

[FC07] How many FEMALES have ever used physical force or threats of physical harm to make you put your penis in their vagina?

(Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no.)

___________

[FC08] How many MALES have ever used physical force or threats of physical harm to put their penis in your mouth or anus?

___________

FC01-FC08: Was there anything confusing about any of these questions?

[FC09_REVIEW]

(IF FEMALE RESPONDENTS: )

You answered earlier that, using physical force or threats of harm…

-(IF FC01>=1: [FILL: FC01] people put their mouth on your vagina)

-(IF FC02>=1: [FILL: FC02] people put their fingers or an object in your vagina or anus)

-(IF FC03>=1: [FILL: FC03] males put their penis in your vagina)

-(IF FC04>=1: [FILL: FC04] males put their penis in your mouth or anus)

(IF MALE RESPONDENTS: )

You answered earlier that,

-(IF FC05>=1: [FILL: FC05] people put their fingers or an object in your anus)

-(IF FC06>=1: [FILL: FC08] males put their penis in your mouth or anus).

In total, how many DIFFERENT people did any of these things to you?

______________

(IF NOT ALREADY ASKED) What do you think this question was asking you to do?
How did you come up with your answer?

[FC09_01]

Think about the first time anyone EVER

(IF FEMALE RESPONDENTS: )

-(IF FC01>=1: put their mouth on your vagina)

-(IF FC02>=1: put their fingers or an object in your vagina or anus)

-(IF FC03>=1: put their penis in your vagina)

-(IF FC04>=1: [put their penis in your mouth or anus)

(IF MALE RESPONDENTS: )

-(IF FC05>=1: put their fingers or an object in your anus)

-(IF FC06>=1: put their penis in your mouth or anus).

using physical force or threats of harm.

The first time these things happened to you, was this person…?

1. Male

2. Female

[PROGRAMMER NOTE: DISPLAY FC09_01B AND FC09_01C ON ONE SCREEN; SHOW BURN LINE (Unwanted sex by force: Person 1)]

[FC09_01B] The first time this happened, what was that person's relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

3. A family member/relative

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF FC09_01B=1,2,CODE FC09_INT=1.

IF FC09_01B=1,2,3, 4,5 ASK FC09_01C. ELSE GO TO FC09_01E]

[FC09_01C] Specifically, was that person…?

(ADMINISTER PROBES AFTER BOTH ITEMS HAVE BEEN ASKED, AS APPROPRIATE)

FC09_01B: Which person were you thinking about when answering this question (ST11_01B)/these two questions (ST11_01B and ST11_01C)?
(IF NOT ALREADY ASKED) What do you think is meant by “the first time” these things happened to you?
(IF NOT ALREADY ASKED) What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
(IF NOT ALREADY ASKED) How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
Were you deciding between any of the categories? If so, how did you decide which one to select?
What did you think was meant by the statement at the top of the screen that said “UNWANTED SEX BY FORCE: PERSON 1”
FC09_01C: How easy or hard was it to find the answer you were looking for on this list?

[FC09_01G] Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

1. Yes

2. No

[PROGRAMMER NOTE:

-DISPLAY FC09_01H TO FC09_01I ON ONE SCREEN;

-SHOW BURN LINE (Unwanted sex by force: PERSON 1)]

[FC09_01H] When he/she did these things to you in the past 12 months, what was his/her relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF FC09_01H=INTIMATE RELATIONSHIPS, ASK FC09_01I. ELSE GO TO FC09_02]

[FC09_01I] Specifically, was this person…?

FC09_01G (IF NOT ALREADY ASKED) What do you think this question was asking?
IF NO: Tell me more about why you decided to answer No to this question.

[FC16]

Think about the {(IF FC09_CNT=1: person) / (FILL: FC09_CNT) people} who

(IF FEMALE RESPONDENTS: )

-(IF FC01>=1: put {his/her} mouth on your vagina)

-(IF FC02>=1: put {his/her} fingers or an object in your vagina or anus)

-(IF FC03>=1: put his penis in your vagina)

-(IF FC04>=1: put his penis in your mouth or anus)

(IF MALE RESPONDENTS: )

-(IF FC05>=1: put {his/her? fingers or an object in your anus)

-(IF FC06>=1: put his penis in your mouth or anus)

using physical force or threats of harm 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?

(“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.)

_____________

IF >0: How did you come up with your answer to this? (IF NEEDED: Which types of incidents were you thinking about?)
How easy or difficult was it to count up the number of different times this happened in the past 12 months?
How certain are you that you’ve only counted up the incidents that happened in the past 12 months?
IF TOO MANY TO COUNT: How did you decide to select this answer.

END OF UNWANTED SEX BY FORCE SECTION:

(IF R WAS ASKED ABOUT MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions?
What were your reactions to being asked if these types of things have ever happened to you? (LISTEN FOR: embarrassed, upset, reluctant, etc.)
Did you feel like you changed your answers in any way to make it less embarrassing or so that you wouldn’t be asked so many questions?
Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?
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?

Made to Penetrate by Force (MALES ONLY)

[FC17_REVIEW]

You answered earlier that

-[FILL IN FC06] people put their mouth on your penis,

-[FILL IN FC07] females made you put your penis in their vagina

…….using physical force or threats of harm.

In total, how many DIFFERENT people did any of these things to you?

________

(IF NOT ALREADY ASKED) What do you think this question was asking you to do?
How did you come up with your answer?

[FC17_01]

[PROGRAMMER NOTE:. DISPLAY BURN LINE (Made to penetrate by force: Person 1)]

Think about the first time anyone EVER

-(IF FC06>=1: put their mouth on your penis)

-(IF FC07>=1: made you put your penis in their vagina)

using physical force or threats of harm.

The first time these things happened to you, was the person…?

1. Male

2. Female

[PROGRAMMER NOTE: DISPLAY FC17_01B AND FC17_01C ON ONE SCREEN; SHOW BURN LINE (Made to penetrate by force: PERSON 1)]

[FC17_01B] The first time this happened, what was that person's relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

3. A family member/relative

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF FC17_01B=1,2, CODE FC17_INT=1.

IF FC17_01B=1,2,3,4,5 ASK FC17_01C. ELSE GO TO FC17_01E]

[FC17_01C] Specifically, was that person…?

(ADMINISTER PROBES AFTER BOTH ITEMS HAVE BEEN ASKED, AS APPROPRIATE)

FC17_01B: Which person were you thinking about when answering this question (ST11_01B)/these two questions (ST11_01B and ST11_01C)?
(IF NOT ALREADY ASKED) What do you think is meant by “the first time” these things happened to you?
(IF NOT ALREADY ASKED) What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
(IF NOT ALREADY ASKED) How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
Were you deciding between any of the categories? If so, how did you decide which one to select?
(IF NOT ALREADY ASKED) What did you think was meant by the statement at the top of the screen that said “MADE TO PENETRATE BY FORCE: PERSON 1”
FC17_01C: How easy or hard was it to find the answer you were looking for on this list?

[FC17_01G] Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

1. Yes

2. No

[IF FC17_01G=NO OR (FC17_01F=YES AND FC17_01B=SOMEONE ELSE), ASK FC17_01H. ELSE GO TO FC17_02]

[PROGRAMMER NOTE: DISPLAY FC17_01H TO FC17_01I ON ONE SCREEN;

SHOW BURN LINE (Made to penetrate by force: PERSON 1)]

[FC17_01H] When he/she did these things to you in the past 12 months, what was his/her relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF FC17_01H=INTIMATE RELATIONSHIPS, ASK FC17_01I. ELSE GO TO FC17_02]

[FC17_01I] Specifically, was this person…?

FC17_01G: (IF NOT ALREADY ASKED) What do you think this question was asking?
IF NO: Tell me more about why you decided to answer No to this question.

[FC24]

Think about {(IF FC17_CNT=0: person)/(FILL: FC17_CNT) people)} who

-(IF FC06>=1: put their mouth on your penis)

-(IF FC07>=1: made you put your penis in their vagina)

using physical force or threats of harm 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?

(“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.)

____

IF >0: How did you come up with your answer to this? (IF NEEDED: Which types of incidents were you thinking about?)
How easy or difficult was it to count up the number of different times this happened in the past 12 months?
How certain are you that you’ve only counted up the incidents that happened in the past 12 months?
IF TOO MANY TO COUNT: How did you decide to select this answer.

END OF MADE TO PENETRATE BY FORCE SECTION:

(IF R WAS ASKED ABOUT MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions?
What were your reactions to being asked if these types of things have ever happened to you? (LISTEN FOR: embarrassed, upset, reluctant, etc.)
Did you feel like you changed your answers in any way to make it less embarrassing or so that you wouldn’t be asked so many questions?
Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?

Attempted Physically Forced Sex

[FEMALES]

[FA01]

[PROGRAMMER NOTE: DROP-DOWN BOX]

How many MALES have ever used physical force or threats of physical harm to TRY to put their penis in your vagina, mouth, or anus, but it did not happen?

______

[MALES]

[FA02]

[PROGRAMMER NOTE: DROP-DOWN BOX]

How many PEOPLE have ever used physical force or threats of physical harm to TRY to put their mouth on your penis, but it did not happen?

__________

[FA03]

[PROGRAMMER NOTE: DROP-DOWN BOX]

How many FEMALES have ever used physical force or threats of physical harm to TRY to make you put your penis in their vagina, but it did not happen?

__________

[FA04]

[PROGRAMMER NOTE: DROP-DOWN BOX]

How many MALES have ever used physical force or threats of physical harm to TRY to put their penis in your mouth or anus, but it did not happen?

__________

FA01-FA04: Was there anything confusing about any of these questions?

[FA05_01B]

(IF FEMALE RESPONDENTS: Think about the first time anyone EVER tried to put their penis in your vagina, mouth or anus using physical force or threats of harm, but sex DID NOT happen. )

(IF MALE RESPONDENTS: Think about the first time anyone EVER tried to put their penis in your mouth or anus using physical force or threats of harm, but sex DID NOT happen. )

The first time this happened, what was that person's relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

3. A family member/relative

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF FA05_01B=1,2,CODE FA05_INT=1.

IF FA05_01B=1,2,3,4,5 ASK SFA05_01C. ELSE GO TO FA05_01E]

[FA05_01C]. Specifically, was that person…?

(ADMINISTER PROBES AFTER BOTH ITEMS HAVE BEEN ASKED, AS APPROPRIATE)

FA05_01B: Which person were you thinking about when answering this question (ST11_01B)/these two questions (ST11_01B and ST11_01C)?
(IF NOT ALREADY ASKED) What do you think is meant by “the first time” these things happened to you?
(IF NOT ALREADY ASKED) What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
(IF NOT ALREADY ASKED) How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
Were you deciding between any of the categories? If so, how did you decide which one to select?
What did you think was meant by the statement at the top of the screen that said “ATTEMPTED UNWANTED SEX BY FORCE: PERSON 1”
FA05_01C: How easy or hard was it to find the answer you were looking for on this list?

[FA05_01G] Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

1. YES

2. NO

[PROGRAMMER NOTE: DISPLAY FA05_01H TO FA05_01I ON ONE SCREEN;

SHOW BURN LINE (Attempted Unwanted Sex By Force: Person 1)]

[FA05_01H] When he/she did these things to you in the past 12 months, what was his/her relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: ________________________)

[IF FA05_01H=INTIMATE RELATIONSHIPS, ASK FA05_01I. ELSE GO TO FA05_02]

FA05_01I: Specifically, was this person…?

What do you think this question was asking?
IF NO: Tell me more about why you decided to answer No to this question.

FA12

Think about the {(IF FA05_CNT=1: person) / (FILL: FA05_CNT 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?

(“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.)

_______

IF >0: How did you come up with your answer to this? (IF NEEDED: Which types of incidents were you thinking about?)
How easy or difficult was it to count up the number of different times this happened in the past 12 months?
How certain are you that you’ve only counted up the incidents that happened in the past 12 months?
IF TOO MANY TO COUNT: How did you decide to select this answer.

END OF ATTEMPTED UNWANTED SEX BY FORCE SECTION:

(IF R WAS ASKED ABOUT MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions?
Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?

Attempted Made to Penetrate (MALES ONLY)

[FA13_REVIEW]

You answered earlier that

-(IF FA02>=1: [FILL IN FA02] people tried to put their mouth on your penis, )

-(IF FA03>=1: [FILL IN FA03] females tried to make you put your penis in their vagina,)

…………………….but it didn’t happen.

In total, how many DIFFERENT people did any of these things to you?

(IF NOT ALREADY ASKED) What do you think this question was asking you to do?
How did you come up with your answer?

FA13_01:

[FA13_01] Think about the first time anyone ever

-(IF FA02>=1: tried to put their mouth on your penis)

-(IF FA03>=1: tried to make you put your penis in their vagina)

but it didn’t happen.

The first time these things happened to you, was the person…?

1. Male

2. Female

[PROGRAMMER NOTE: DISPLAY FA13_01B AND FA13_01C ON ONE SCREEN; SHOW BURN LINE (Attempted made to penetrate: PERSON 1)]

[FA13_01B] The first time this happened, what was that person's relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

3. A family member/relative

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: _______________________)

[IF FA13_01B=1,2, CODE FA13_INT=1.

IF FA13_01B=1,2,3,4,5 ASK FA13_01C. ELSE GO TO FA13_01E]

[FA13_01C] Specifically, was that person…?

(ADMINISTER PROBES AFTER BOTH ITEMS HAVE BEEN ASKED, AS APPROPRIATE)

FA13_01B: Which person were you thinking about when answering this question (ST11_01B)/these two questions (ST11_01B and ST11_01C)?
(IF NOT ALREADY ASKED) What do you think is meant by “the first time” these things happened to you?
(IF NOT ALREADY ASKED) What do you think is meant by “person of authority”? Could you give me a few examples of what you think that means?
(IF NOT ALREADY ASKED) How about “acquaintance”? Could you give me a few examples of what you think that means?
In your own words, how would you describe what this person’s connection to you was at that time?
How well does the answer you chose describe your connection to that person?
Were you deciding between any of the categories? If so, how did you decide which one to select?
(IF NOT ALREADY ASKED) What did you think was meant by the statement at the top of the screen that said “Attempted made to penetrate: PERSON 1”
FA13_01C: How easy or hard was it to find the answer you were looking for on this list?

[FA13_01G] Just to confirm, this person was still [FILL RELATIONSHIP] when [FILL: he/she] did [this/any of these things] to you in the past 12 months. Is that correct?

1. Yes

2. No

[IF FA13_01G=NO OR (FA13_01F=YES AND FA13_01B=SOMEONE ELSE), ASK FA13_01H. ELSE GO TO FA13_02]

[PROGRAMMER NOTE: DISPLAY FA13_01H AND FA13_01I ON ONE SCREEN;

SHOW BURN LINE (Attempted made to penetrate: PERSON 1)]

[FA13_01H] When he/she did these things to you in the past 12 months, what was his/her relationship to you?

1. Someone I was involved romantically or sexually at the time

2. Someone I previously had been involved romantically or sexually

4. A friend/neighbor/acquaintance

5. A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc)

6. A stranger

7. Someone else (Please specify: _______________________)

[IF FA13_01H=INTIMATE RELATIONSHIPS, ASK FA13_01I. ELSE GO TO FA13_02]

[FA13_01I] Specifically, was this person…?

FA13_01G: (IF NOT ALREADY ASKED) What do you think this question was asking?
IF NO: Tell me more about why you decided to answer No to this question.

[FA20]

Think about the {(IF FA13_CNT=1: person) / (FILL: FA13_CNT 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?

(“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.)

IF >0: How did you come up with your answer to this? (IF NEEDED: Which types of incidents were you thinking about?)
How easy or difficult was it to count up the number of different times this happened in the past 12 months?
How certain are you that you’ve only counted up the incidents that happened in the past 12 months?
IF TOO MANY TO COUNT: How did you decide to select this answer.

END OF ATTEMPTED MADE TO PENETRATE SECTION:

(IF R WAS ASKED ABOUT MORE THAN ONE PERSON IN THIS SECTION) How easy or difficult was it to keep track of the different people who did this to you when you were answering these questions?
Before we move on to the next set of questions, do you have any final comments or reactions you can share with me about this set of questions?

Psychological Aggression

[PA01]

How many of your current or ex partners have EVER ...

… insulted or humiliated you in front of others?

_____

[PA02]

… kept you from having your own money?

_____

[PA03]

… tried to keep you from seeing or talking to your family or friends?

_____

[PA04]

How many of your current or ex partners have EVER ...

… kept track of you by demanding to know where you were and what you were doing?

[PA05]

… made threats to physically harm you?

[PA06]

… threatened to hurt themselves or commit suicide because they were upset with you?

[PA07]

How many of your current or ex partners have EVER ...

… made decisions that should have been yours to make?

[PA08]

… destroyed something that was important to you?

PA01-PA08: Was there anything confusing about any of these questions?

[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”} in the past 12 months?

1. Once

2. A few times a year

3. Monthly

4. Weekly

5. Daily

How did you decide on your answer to this question?
What do you think is meant by “At the time that it was most frequent in the past 12 months”?

Physical Violence

[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?

1. Once

2. A few times a year

3. Monthly

4. Weekly

5. Daily

How did you decide on your answer to this question?
What do you think is meant by “At the time that it was most frequent in the past 12 months”?
We are just about finished with the interview, but I’d like to check in with you to make sure you’re feeling alright and would like to wrap up the interview. Shall we continue?

Consequences

[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?

(Do not include situations where you were hurt accidentally.)

1. Yes

2. No

How closely did you read the definition of “concussion”?
Did you consider this definition when you were answering the question?

Part C: Scenarios

Now I’d like to present you with some different scenarios to see how you might describe that person’s relationship to you.

I’m going to read you the description and then will ask you to share how you would answer the question that I’m going to hand to you. In each of these scenarios, please imagine that you had experienced some form of sexual harassment or unwanted sexual contact by this person.

(PROBE: Please tell me how you decided on your answer. IF NECESSARY: Were you deciding between any of the categories?)

At the time, what was that person's relationship to you?

Someone I was involved romantically or sexually at the time 1

Someone I previously had been involved romantically or sexually 2

A family member/relative 3

A friend/neighbor/acquaintance 4

A person of authority (e.g., boss, supervisor, teacher, doctor, police officer, etc).) 5

A stranger 6

Someone else (Please specify: ) 7

1. A distant cousin

2. Your pastor

3. Someone you met at a bar

4. Neighbor down the block but you don’t know her name

5. Your Godfather

6. Your landlord

7. The bus driver

8. A nurse

9. Your therapist

10. Someone with whom you went out on one date

Part D: Debriefing

General – ASK PROBES AS NEEDED (IF THEY HAVE NOT ALREADY BEEN ADDRESSED)

Now that you’ve worked through the questionnaire, what are your overall thoughts on it?
We are interested in whether any of the questions might be too sensitive to ask people. Were there any that you felt particularly uncomfortable answering? IF YES: What make you uncomfortable? (PROBE to find out if it was the explicit language, vs. recalling your memories, vs something else?)
Were there any features or things about the web survey design that you particularly liked?
Were there any features or things about the web survey design that you didn’t like?
What did you think about the way the questions looked on the screens, in terms of the font, the font size, and being able to find the buttons to click for your answers?
How about the background color?
Were there any web design features that you felt were missing that would have helped you in completing the questionnaire?
Did you have any problems with going from screen to screen?
Do you have any feedback for me on the amount of scrolling up and down that you had to do on screens?
Do you have any feedback for me on the amount of clicking you had to do on the screens?

Do you have any other thoughts for me on your experiences completing the survey?

Part E. Browser Clearing Process

The last thing I would like to do is to show you a document that we are considering having on the web survey in case respondents would like to clear this survey URL out of their browser history so that no one else with access to the device would know that they participated in this. (HAND INSTRUCTIONS TO RESPONDENT)

First, what do you think of this idea of providing these instructions?

[SHOW INSTRUCTIONS TO R AND ASK R TO FOLLOW THEM. IF R BROUGHT THEIR OWN DEVICE TO THE INTERVIEW, HAVE THEM FOLLOW THE INSTRUCTIONS TO CLEAR THEIR BROWSER ON THEIR DEVICE.]

What are your reactions to these instructions?

How easy or difficult were they to follow?

Do you have any ideas for how we could make them easier to follow?

How likely would you be to do this step if you filled out this survey at home?

Closing and Incentive

Those are all the questions I have for you. Is there anything we haven't discussed that you would like to mention?

DISCUSS ANY RESPONDENT COMMENTS.

STOP RECORDER.

Before we finish, I just want to make sure you’re doing ok. (REFER TO DISTRESS PROTOCOL IF NEEDED).

IN-PERSON

Here is some contact information for local and national organizations that you can call if you want to talk about any feelings or emotions you experience. (HAND RESOURCE LIST TO R)

REMOTE

I’d like to give you some contact information for local and national organizations that you can call if you want to talk about any feelings or emotions you experience. I can either read those numbers to you now, or I can put them in the mail with your incentive payment. Which would you prefer?

1. IF READ ALOUD: Let me know when you have a pen and paper ready and I will start reading them to you.

2. IF MAIL: Ok, we will include the list with your incentive payment.

You will receive a thank you letter and $40 for your participation soon. Can you provide me with your mailing address? [READ BACK TO CONFIRM]

Thank you for your time.

GIVE INCENTIVE AND HAVE RESPONDENT SIGN RECEIPT.

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