ABS, web screener
The National Intimate Partner and Sexual Violence Survey (NISVS)
AttE.2A_Web Survey_12.13.19
Phase 3 - ABS, web screener
OMB: 0920-0822
Attachment
E.2A
NISVS Web Survey
Form
Approved
OMB No: 0920-0822
Exp. Date: xx/xx/xxxx
Public
Reporting burden of this collection
of information varies from 3 to 25 minutes with an estimated
average of 14 minutes 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).
National
Intimate Partner and Sexual Violence Survey (NISVS) Redesign
Task
3.2 Draft Web-Based Questionnaire
Contract Number GS00F009DA
December 13, 2019
Prepared for:
Centers for Disease Control and Prevention
Prepared by:
Westat
An Employee-Owned Research Corporation®
1600 Research Boulevard
Rockville, Maryland 20850-3129
(301) 251-1500
Notes for Draft
1. Unless otherwise noted, there will be one question per screen.
2. Screens that have multiple questions (e.g., grids) are noted in the instructions prior the question.
3. Each screen will include links to ‘resources’ (help lines) and study contact information.
4. All of the victimization sections are intended to document up to 10 perpetrators. To save space on this draft, the different sections only carry out the pattern for 3-5 perpetrators.
5. Once a victimization is reported, the screen will include a reference to the particular victimization being reported. The text for this is indicated by the instruction “BURN LINE”.
6. Words in uppercase are skip instructions, programming instructions for programmers, or general notes for readers of the document. Programming notes are also in boxes to distinguish from skip instructions and notes. Words in bold are displayed on screen for respondents to see. Question numbers are in brackets “[ ]”.
7. The respondent selection method assumes an experiment with two different methods. The ‘youngest male, oldest female’ (YMOF) and the Rizzo-Brick-Park (RBP) Method. The YMOF will be used to directly select an individual in the letter sent to the household. For this method, the household will be asked to select the respondent before they sign onto the computer. For the RBP method, the respondent will be selected once signing onto the computer.
8. Respondents will be allowed to skip any question, except for items that are considered critical. When a critical item is skipped, the next screen will display the question again with a message in red: “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.”
9. The following abbreviations are used within the instrument: BLANK is for when an item is skipped without respondents providing an answer, DK is for “I truly don’t know”, REF is for “I’d rather not answer”, MTP is Made to Penetrate, and PTSD is Posttraumatic Stress Disorder.
10. This survey will be administered both in English and in Spanish (following translation).
Table of Contents
SC. SEXUAL HARASSMENT, UNWANTED TOUCHING 2
AD. COMPLETED ALCOHOL/DRUG-FACILITATED RAPE AND MADE TO PENETRATE 2
FC. UNWANTED SEX DUE TO THREATS OF HARM/PHYSICAL FORCE 2
FA. ATTEMPTED PHYSICALLY FORCED SEX 2
OT. SEXUAL VIOLENCE: OUTCOMES OF RAPE AND MADE TO PENETRATE 2
PA. PSYCHOLOGICAL AGGRESSION 2
GENERAL NOTES TO PROGRAMMER: DISPLAY ONE QUESTION PER SCREEN UNLESS SPECIFIED OTHERWISE. |
CF. SCREENER
PROGRAMMER NOTE: -SAMPLE_FLAG IS A SAMPLE FRAME VARIABLE TO BE LOADED TOGETHER WITH THE SAMPLE
[SAMPLE_FLAG] 1=ABS_RBP 2=ABS_YOUNGEST MALE 3=ABS_YOUNGEST FEMALE 4=ABS_OLDEST MALE 5=ABS_OLDEST FEMALE 6=ONLINE PANELS |
|
[CF_INTRO] Thank you for participating in this important research study on health and injuries for the Centers for Disease Control and Prevention, the CDC. In addition to preventing diseases, the CDC also focuses on a range of health topics, including injuries. (IF SAMPLE_FLAG=1,2,3,4,5: Your household has been/IF SAMPLE_FLAG=6: You have been) chosen randomly to represent thousands of others in the country. Here are a few questions about your household (IF SAMPLE_FLAG=1: and whether there is an adult in your household who is eligible to participate). (IF SAMPLE_FLAG=1,2,3,4,5: You will receive an Amazon gift card for {FILL: $10/$20} for completing this short survey.)
[NUM_ADULTS]
PROGRAMMER NOTE:
-IF R ENTERED ANY NUMBER OUTSIDE 0 TO 10, SHOW THE QUESTION AGAIN AND DISPLAY A MESSAGE IN RED BELOW THE QUESTION: “Please enter a number from 0 to 10. If there are more than 10 people aged 18 or more, enter 10.”
-IF R GOES TO NEXT SCREEN WITHOUT ENTERING A NUMBER, BRING RESPONDENTS BACK TO THE QUESTION AND DISPLAY A MESSAGE IN RED SAYING: “We need to know the number of people living in your household in order to determine the eligibility of an adult in your household. Please provide an answer.”) |
Including yourself, how many people living in this household are 18 years of age or older? Please enter a number from 0 to 10. If there are more than 10 people aged 18 or more, enter 10.
__________
IF NUM_ADULTS=0, ASK CF6SELF. ELSE GO TO CF7_1
[CF6SELF] Did you include yourself when you said that no one is 18 years old?
Yes 1
No 2
IF CF6SELF=1, GO TO CF6_1. ELSE GO TO NUM_ADULTS.
[CF6_1] We are only interviewing adults aged 18 or older, so those are all the questions we have for you. Thank you for your time.
END INTERVIEW; SCREEN OUT, INELIGIBLE AGE.
PROGRAMMER NOTE FOR CF7_1: -IF R ENTERED OUT-OF-RANGE VALUE (<0 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 0 and 110.” |
[CF7_1] These next questions are about you and the other members living in the household who are at least 18 years old.
How old are you?
__________
If CF7_1 <18 then ask CF7_2. Otherwise go to CF7_3.
[CF7_2] We are only interviewing adults aged 18 and older. Please ask an adult in your household to log in the survey using the same information that you used. Thank you for your time.
END SURVEY AND RESET THIS CASE TO ALLOW R TO START ALL OVER AGAIN.
PROGRAMMER NOTE FOR NUM_MALES AND NUM_FEMALES: -DISPLAY NUM_ADULTS (WITH ANSWERS FILELD IN), NUM_MALES, AND NUM_FEMALES ON ONE SCREEN
-IF R ENTERED ANY NUMBER OUTSIDE 0 TO 10, SHOW ERROR MESSAGE: “Please enter a number from 0 to 10. If there are more than 10 male adults, enter 10.”
-IF R ENTERED ANY NUMBER LARGER THAN NUM_ADULTS, SHOW THE QUESTION AGAIN AND DISPLAY A MESSAGE IN RED BELOW THE QUESTION: “You have entered a number larger than the number of adults living in your household. Please change your answer.”
-IF R GOES TO NEXT SCREEN WITHOUT ENTERING A NUMBER, BRING RESPONDENTS BACK TO THE QUESTION AND DISPLAY A MESSAGE IN RED SAYING: “We need to know the number of people living in your household in order to determine the eligibility of an adult in your household. Please provide an answer.”) |
[NUM_ADULTS] You said that [NUM_ADULTS] adults live in your household.
The number of adults is pre-populated using your answer. Please change if necessary.
___________Total number of adults living in your household
[NUM_MALES] How many of them are male?
__________The number of male adults
[NUM_FEMALES] How many of them are female?
The number of females is pre-populated using the number of adults and number of males. Please change if necessary.
__________
PROGRAMMER NOTE FOR CF7_3:
-RANDOMLY FILL IN ONE INJURY EXAMPLE FROM THE LIST BELOW: 1 Cut or wound, dislocation, bruise or sprain 2 Bruise, cut or wound, sprain or head injury 3 Head injury, sprain, broken bone or cut or wound 4 Sprain, bruise, cut or wound or scrape 5 Cut or wound, broken bone, sprain or burn 6 Cut or wound, bruise, broken bone or sprain 7 Cut or wound, sprain, scrape, or broken bone 8 Head injury, bruise, cur or wound or sprain 9 Bruise, insect bite, sprain, or cut or wound 10 Cut or wound, sprain, broken bone or bruise |
[CF7_3] DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], did any person 18 years and older in this household] have an injury where any part of the body was hurt, for example, with a {FILL ONE RANDOM INJURY EXAMPLE})?
Yes 1
No 2
[CF7_4] Does a physical, mental, or emotional problem NOW keep any person 18 years and older in this household from working at a job or business?
Yes 1
No 2
[CF7_5] Has any person 18 years and older in this household been hospitalized OVERNIGHT in the past 12 months? Do not include an overnight stay in the emergency room.
Yes 1
No 2
PROGRAMMER NOTE FOR CF7_6:
-DISPLAY CF7_6a TO CF7_6e ON ONE SCREEN IN A GRID |
[CF7_6] The following questions are to classify your household.
Do you or any member of this household have access to the Internet using a –
Yes No
a. cellular
data plan for a smartphone or other mobile
device? 1 2
b. broadband
(high speed) Internet service such as
cable, fiber optic, or
DSL service installed in this
household? 1 2
c. satellite Internet service installed in this household? 1 2
d. dial-up Internet service installed in this household? 1 2
e. some other Internet service? 1 2
[CF7_7] Is this house, apartment, or mobile home….
Owned by you or someone in this household with a mortgage or loan? Include home equity loans……………………………………………1
Owned by you or someone in this household free and clear (without a mortgage or loan)………………………………………………………2
Rented…………………………………………………………………..3
Occupied without payment of rent……………………………………4
IF SAMPLE_FLAG=6 (ONLINE PANELS), GO TO LANDING_PAGE (OF MAIN INTERVIEW).
IF NUM_ADULTS=1 AND SAMPLE_FLAG^=6, GO TO CF12B (DISPLAY AMAZON CODE, AND END SCREENER).
IF NUM_ADULTS>1 AND SAMPLE_FLAG=2 (ABS_YOUNGEST MALE), ASK CF_CHECK1. ELSE GO TO SKIP INSTRUCTIONS BEFORE CF_CHECK2.
PROGRAMMER NOTE FOR CF_CHECK1 -SHOW OPTION 3 WHEN NUM_MALES>0 -IF R LEAVES CF_CHECK1 BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “You haven’t answered the question yet. Please provide an answer to this question.” |
[CF_CHECK1] We would like the youngest male adult (at least 18 years old) in the household to complete the rest of the survey. Are you that person?
(IF NUM_MALES>0, SHOW: ) Yes, I’m the youngest male ………… 1
(IF NUM_MALES>1, SHOW: ) No, but I will get the youngest male …..2
(IF NUM_MALES=0, SHOW: ) No, there are no male adults in the household …………………3
IF CF_CHECK1=1, GO TO CF12B.
ELSE IF CF_CHECK1=2, 3, GO TO
CF11_FIRST (NAME OF R SELECTED FOR MAIN INTERVIEW) AND CF12A (AMAZON CODE SCREEN, END SCREENER).
IF NUM_ADULTS>1 AND SAMPLE_FLAG=3 (ABS_YOUNGEST FEMALE), ASK CF_CHECK2. ELSE GO TO SKIP INSTRUCTIONS BEFORE CF_CHECK3.
PROGRAMMER NOTE FOR CF_CHECK2 IF R LEAVES CF_CHECK1 BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “You haven’t answered the question yet. Please provide an answer to this question.” |
[CF_CHECK2] We would like the youngest female adult (at least 18 years old) in the household to complete the rest of the survey. Are you that person?
(IF NUM_FEMALES>0, SHOW: ) Yes, I’m the youngest female adult …………1
(IF NUM_FEMALES>1, SHOW: ) No, but I will get the youngest female adult …..2
(IF NUM_FEMALES=0, SHOW: ) No, there are no female adults in the household …………………3
IF CF_CHECK2=1, GO TO CF12B.
ELSE IF CF_CHECK2=2, 3,
GO TO CF11_FIRST AND CF12A.
IF NUM_ADULTS>1 AND SAMPLE_FLAG=4 (ABS_OLDEST MALE), ASK CF_CHECK3. ELSE GO TO SKIP INSTRUCTIONS BEFORE CF_CHECK4.
PROGRAMMER NOTE FOR CF_CHECK3 -show option 3 "No, there are no male adults in the household" only when NUM_MALES>0 IF R LEAVES CF_CHECK1 BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “You haven’t answered the question yet. Please provide an answer to this question.” |
[CF_CHECK3] We would like the oldest male adult (at least 18 years old) in the household to complete the rest of the survey. Are you that person?
(IF NUM_MALES>0, SHOW: )Yes, I’m the oldest male adult ………… 1
(IF NUM_MALES>1, SHOW: )No, but I will get the oldest male adult …..2
(IF NUM_MALES=0, SHOW: ) No, there are no male adults in the household …………………3
IF CF_CHECK3=1, GO TO CF12B.
ELSE IF CF_CHECK3=2, 3,
GO TO CF11_FIRST AND CF12A.
IF NUM_ADULTS>1 AND SAMPLE_FLAG=5 (ABS_OLDEST FEMALE), ASK CF_CHECK4. ELSE GO TO SKIP INSTRUCTIONS BEFORE CFSELECT.
PROGRAMMER NOTE FOR CF_CHECK4 IF R LEAVES CF_CHECK1 BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “You haven’t answered the question yet. Please provide an answer to this question.” |
[CF_CHECK4] We would like the oldest female adult (at least 18 years old) in the household to complete the rest of the survey. Are you that person?
(IF NUM_FEMALES>0, SHOW: ) Yes, I’m the oldest female adult …………1
(IF NUM_FEMALES>1, SHOW: ) No, but I will get the oldest female adult …..2
(IF NUM_FEMALES=0, SHOW: ) No, there are no female adults in the household …………………3
IF CF_CHECK4=1, GO TO CF12B.
ELSE IF CF_CHECK4=2, 3,
GO TO CF11_FIRST AND CF12A.
IF NUM_ADULTS>=2 AND SAMPLE_FLAG=1 (ABS_RBP), GENERATE A RANDOM NUMBER BETWEEN 1 AND NUM_ADULTS. IF THE GENERATED RANDOM NUMBER=1 THEN SCREENER RESPONDENT IS SELECTED. IF THE GENRATED RANDOM NUMBER>1, THEN SCREENER RESPONDENT IS NOT SELECTED.
IF NUM_ADULTS=2 AND SAMPLE_FLAG=1 (ABS_RBP), THEN GO TO CFSELECT. ELSE GO TO SKIP INSTRUCTIONS BEFORE CFSELECT2.
[CFSELECT] The computer will randomly select one adult from your household to participate in the rest of this study.
The person in your household that is selected for this study is {FILL: “you” (IF “R” SELECTED)/“the other household adult” (IF “R” NOT SELECTED)}.
IF R SELECTED, GO TO CF12b. ELSE IF R NOT SELECTED, GO TO CF11_FIRST AND CF12A.
IF NUM_ADULTS>=3 AND SAMPLE_FLAG=1 (ABS_RBP), IF SCREENER RESPONDENT IS SELECTED GO TO CFSELECT2. ELSE IF SCREENER R IS NOT SELECTED, GO TO CF9.
[CFSELECT2] The computer will randomly select one adult from your household to participate in this study.
The person in your household that is selected for this study is you.
GO TO CF12b.
[CF9] The computer will randomly select one adult from your household to participate in this study. To do this, we need to collect the age and gender of each person 18 years and older in the household besides yourself Please start with the oldest and move to the youngest.
PROGRAMMER NOTE FOR HH_ROSTER2 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER2] Not including yourself, how old is the oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER2/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the oldest person….?
Male 1
Female 2
Transgender 3
PROGRAMMER NOTE FOR HH_ROSTER3 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER3] Not including yourself, how old is the 2nd oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER3/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the 2nd oldest person….?
Male 1
Female 2
Transgender 3
IF NUM_ADULTS>=4, ASK HH_ROSTER4; ELSE GO TO SKP INSTRUCTION BEFORE HH_ROSTER5.
PROGRAMMER NOTE FOR HH_ROSTER4 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER4] How old is the 3rd oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER4/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the 3rd oldest person….?
Male 1
Female 2
Transgender 3
IF NUM_ADULTS>=5, ASK HH_ROSTER5; ELSE GO TO SKP INSTRUCTION BEFORE HH_ROSTER6.
PROGRAMMER NOTE FOR HH_ROSTER5 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER5] How old is the 4th oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER5/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the 4th oldest person….?
Male 1
Female 2
Transgender 3
IF NUM_ADULTS>=6, ASK HH_ROSTER6; ELSE GO TO SKP INSTRUCTION BEFORE HH_ROSTER7.
PROGRAMMER NOTE FOR HH_ROSTER6 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER6] How old is the 5th oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER6/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the 5th oldest person….?
Male 1
Female 2
Transgender 3
IF NUM_ADULTS>=7, ASK HH_ROSTER7; ELSE GO TO SKP INSTRUCTION BEFORE HH_ROSTER8.
PROGRAMMER NOTE FOR HH_ROSTER7 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER7] How old is the 6th oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER7/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the 6th oldest person….?
Male 1
Female 2
Transgender 3
IF NUM_ADULTS>=8, ASK HH_ROSTER8; ELSE GO TO SKP INSTRUCTION BEFORE HH_ROSTER9.
PROGRAMMER NOTE FOR HH_ROSTER8 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER8] How old is the 7th oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER8/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the 7th oldest person….?
Male 1
Female 2
Transgender 3
IF NUM_ADULTS>=9, ASK HH_ROSTER9; ELSE GO TO SKP INSTRUCTION BEFORE HH_ROSTER10.
PROGRAMMER NOTE FOR HH_ROSTER9 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER9] How old is the 8th oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER9/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the 8th oldest person….?
Male 1
Female 2
Transgender 3
IF NUM_ADULTS>=10, ASK HH_ROSTER10; ELSE GO TO CFSLECT3.
PROGRAMMER NOTE FOR HH_ROSTER10 -IF R LEAVES AGE BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s age in order to determine their eligibility. Please provide an answer.” -IF R PROVIDED A NUMBER<18 OR >110, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “Please enter a number between 18 and 110.” -IF R LEAVES SEX BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know the household member’s sex in order to determine their eligibility. Please provide an answer.” |
[HH_ROSTER10] How old is the 9th oldest person who is at least 18 years old?
__________
PROGRAMMER NOTE FOR HH_ROSTER10/GENDER -IF NUM_MALES=0, DO NOT SHOW THIS QUESTION AND RECORD “FEMALE” IN THE SYSTEM FOR THIS PERSON. -IF NUM_FEMALES=0, DO NOT SHOW THIS QUESTION AND RECORD “MALE” IN THE SYSTEM FOR THIS PERSON. -SHOW THIS QUESTION ONLY WHEN NUM_MALES>0 AND NUM_FEMALES>0 |
Is the 9th oldest person…?
Male 1
Female 2
Transgender 3
IF THERE ARE TWO OR MORE PEOPLE WHO HAVE THE SAME AGE AND GENDER IN THE HOUSEHOLD ROSTER, ASK HH_ROSTER11. ELSE GO TO CFSELECT3.
[PROGRAMMER NOTE: SHOW TABLE FOR HH_ROSTER 11 THAT DISPLAYS AGE AND GENDER AND THAT ALLOWS R TO ENTER A NAME OR INITIAL]
PROGRAMMER NOTE FOR HH_ROSTER11 -IF R LEAVES NAME BLANK, BRING BACK TO QUESTION AND SHOW MESSAGE IN RED: “We need to know their names to tell them apart. Please provide an answer.” |
[HH_ROSTER11] It seems that there are [NUMBER] people who are (GENDER) and (AGE). Can
you provide their first name or initials so that we can tell them apart?
GENDER |
AGE |
FIRST NAME OR INITIAL |
|
|
|
|
|
|
GENERATE A RANDOM NUMBER BETWEEN 2 AND NUM_ADULTS TO RANDOMLY SELECT ONE PERSON.
[CFSELECT3] The computer will randomly select one adult from your household to participate in this study.
(IF PERSON SELECTED DOES NOT HAVE THE SAME AGE AND GENER WITH ANOTHER PERSON IN HOUSEHOLD, SHOW: The person selected is the (GENDER) who is (AGE)./IF PERSON SELECTED HAS THE SAME AGE AND GENDER WITH ANOTHER PERSON IN HOUSEHOLD, SHOW: The person selected is (FIRST NAME OR INITIAL). )
PROGRAMMER NOTE FOR CF11_FIRST: IF R MOVES FORWARD WITHOUT PROVIDING A NAME, BRING R BACK TO THE SCREEN WITH A MESSAGE IN RED: “We really need that person’s name so that we can get in touch about this important study. Could you provide the first name or first initial?” |
[CF11_FIRST] Thank you for providing the information about your household. We are almost done with this screening survey and your Amazon gift card will be shown on the next screen.
Before you ask
(IF SAMPLE_FLAG =1 AND NUM_ADULTS=2: the other household member/
IF SAMPLE_FLAG=1 AND NUM_ADULTS>2 AND NO ONE HAS THE SAME AGE AND GENDER: the (AGE) year old (GENDER)/
IF SAMPLE_FLAG=1 AND NUM_ADULTS>2 AND TWO OR MORE PEOPLE HAVE THE SAME AGE AND GENDER: (FIRST NAME OR INITIAL FROM HH_ROSTER11)/
IF CF_CHECK1=2: the youngest male adult/
IF CF_CHECK1=3: the youngest female adult/
IF CF_CHECK2=2: the youngest female adult/
IF CF_CHECK2=3: the youngest male adult/
IF CF_CHECK3=2: the oldest male adult/
IF CF_CHECK3=3: the oldest female adult/
IF CF_CHECK4=2: the oldest female adult/
IF CF_CHECK4=3: the oldest male adult) to take the main survey, we would like to get
(IF SAMPLE_FLAG =1 AND NUM_ADULTS=2: his/her/
IF SAMPLE_FLAG=1 AND NUM_ADULTS>2 AND IF GENDR=MALE: his/IF GENER=FEMALE: her/
IF CF_CHECK1=2: his/
IF CF_CHECK1=3: her/
IF CF_CHECK2=2: her/
IF CF_CHECK2=3: his/
IF CF_CHECK3=2: his/
IF CF_CHECK3=3: her/
IF CF_CHECK4=2: her/
IF CF_CHECK4=3: his)
name or initials and contact information in case we need to get in touch with
(IF SAMPLE_FLAG =1 AND NUM_ADULTS=2: him/her/
IF SAMPLE_FLAG=1 AND NUM_ADULTS>2 AND IF GENDR=MALE: him/IF GENER=FEMALE: her/
IF CF_CHECK1=2: him/
IF CF_CHECK1=3: her/
IF CF_CHECK2=2: her/
IF CF_CHECK2=3: him/
IF CF_CHECK3=2: him/
IF CF_CHECK3=3: her/
IF CF_CHECK4=2: her/
IF CF_CHECK4=3: him)?
First name or initial:
Last name:
Email address:
Cell phone number:
[CF12a] Thank you for completing this first step. Please ask (CF11_FIRST)
to log in to the survey using the same information that you used. Let them know that we are conducting a study on health and safety and we would like for them to participate in the second step. We will provide them {FILL: $15/$25} if they complete the second step survey.
As a token of appreciation, below is the code for an Amazon gift card worth (FILL: $10/$20) for your completion of this short screening survey.
CODE
This is the only notice you will get with this number, so please write it down before you close the survey web site.
If you would like the code to be sent to you by e-mail, please provide your e-mail address here:
END SURVEY.
[CF12b] Thank you for providing this information about your household.
As a token of appreciation, below is the code for an Amazon gift card worth (FILL: $10/$20). Please click “Next” to continue with the second step.
CODE
This is the only notice you will get with this number, so please write it down before you close the survey web site.
If you would like the code to be sent to you by e-mail, please provide your e-mail address here:
Please continue on to the rest of the survey.
MAIN STUDY
HC. HEALTH CHARACTERISTICS
[LANDING PAGE] Thank you for participating in this important research study on health and injuries for the Centers for Disease Control and Prevention, the CDC.
On each screen, you will be asked about experience that have happened to you. Click on your answer or type in an answer, and then click the Next button to continue to the next screen. You can skip any question you don’t know the answer to or prefer not to answer by leaving the question blank and clicking the Next button. You can double click a radio button to unselect your answer.
If you need to review or change an answer, you can click the Previous button to go back to an earlier screen. Do not click the “Back” button in your browser.
For security purposes, please create a new password to continue. Select a password that you will remember. If you forget your password, you will need to restart the survey for security purposes.
[CF_INTRO1b] You have been randomly chosen to participate in an important study conducted by the Centers for Disease Control and Prevention (CDC). Men and women age 18 and older will be asked questions about their health and injuries they may have experienced. Your answers are very important and will be combined with the answers from other people to inform prevention efforts.
The survey will take approximately 25 minutes, on average. Since some of the questions are personal, we suggest that you be in a private setting during the survey.
Participation is voluntary, and you can stop or quit the survey at any time. With a few exceptions, you can skip any question. The questions that are required are used to determine which questions you will receive.
If you complete the survey, as a token of our appreciation we will give you an Amazon gift card for {FILL: $15 / $25}.
No information that could personally identify you will be given to the CDC or anyone else. Your survey responses are safe. If you have questions or concerns about participating in the study, you may call the Survey Helpdesk at ###-###-####. If you have any questions about your rights as a research participant, please Call the Westat Human Subjects Protections office at 1-888-920-7631.
[RCMO/RCYR]
PROGRAMMER NOTE:
-TWO DROP-DOWN BOXES WITH ONE FOR BIRTH MONTH (SHOWING OPTIONS FROM 01 TO 12 AND ONE FOR BIRTH YEAR (SHOWING OPTIONS FROM 1909 TO 2001). |
First, some questions about you for survey analysis purposes. In what month and year were you born?
____/_______
IF RCYR IS SKIPPED, SHOW MESSAGE: “We have to know your age in order to determine your eligibility. Please provide an answer.”
IF R IS THE SAME AS SCREENER R AND R PROVIDED SEX, PASS GENDER TO ‘RESPSEX’ AND THEN GO TO CF16. ELSE ASK CF 14.
[CF14] What sex were you assigned at birth, on your original birth certificate?
Male 1
Female 2
IF CF14=MALE OR FEMALE, PASS TO ‘RESPSEX’ AND THEN GO TO RC16. ELSE ASK CF15.
[CF15]
How do you describe your gender identity?
Male 1
Female 2
Male-to-female transgender 3
Female-to-male transgender 4
Other gender identity, specify 5
___________________________________
PROGRAMMER NOTE:
-IF R LEAVES CF15 BLANK GO TO AD00a.
-ELSE IF CF15=MALE OR FEMALE, PASS VALUE TO ‘RESPSEX’ THEN GO TO CF16 -ELSE IF CF15=MALE-TO-FEMALE TRANSGENDER, USE ‘FEMALE’ AS ‘RESPSEX’ THEN GO TO CF16. -ELSE IF CF15=FEMALE-TO-MALE TRANSGENDER, USE ‘MALE’ AS ‘RESPSEX’ THEN GO TO CF16. -ELSE IF CF15=OTHER GENDER IDENTITY AND CF14=MALE OR FEMALE, USE RESPONSE FROM CF14 AS ‘RESPSEX’ THEN GO TO CF16. -ELSE IF CF15= OTHER GENDER IDENTITY AND CF14 BLANK GO TO AD00a. |
[AD00a] We have to know your sex in order to direct you to the right questions. If you choose not to answer, we will have to terminate the survey. What would you like to do?
Answer the sex question 1
Terminate the survey 2
IF AD00a=1, GO BACK TO CF15. ELSE IF AD00a=2, GO TO AD00b.
[AD00b] Thank you very much for your time.
END SURVEY.
[RESPEX] PROGRAMMER NOTE: WEB SYSTEM VARIABLE USED FOR WEB FILL IN DISPLAY. DO NOT SHOW TO RESPONDENTS.
MALE 1 FEMALE 2 |
[CF16] Which of the following best represents how you think of yourself?
Lesbian or gay 1
Straight, that is, not lesbian or gay 2
Bisexual 3
Something else 4
I don’t know the answer 5
[CF17] What is the highest level of education you have completed?
No schooling 1
1st-8th grade 2
Some high school 3
High school graduate/GED 4
Technical
or vocational school
(Attended/graduated) 5
Some college 6
Associates (2-year) degree 7
Bachelor’s (4-year) degree 8
Postgraduate degree (Master’s degree, Doctorate degree, M.D., J.D.) 9
[CF18] Are
you of Hispanic or {FILL: “Latina” (FEMALE) / “Latino”
{MALE)} origin?
Yes 1
No 2
[CF19]
PROGRAMMER:
-CHECK BOXES TO ALLOW R TO SELECT MORE THAN ONE.
-PROVIDE A TEXT FIELD THAT TAKES UP TO 40 CHARACTERS FOR ‘OTHER (PLEASE SPECIFY)’ OPTION. |
What is your race? You may identify more than one category.
White 1
Black or African American 2
Asian 3
Native Hawaiian or Pacific Islander 4
American Indian or Alaska Native 5
Other (Please specify ______) 6
[CF20] Are you now…?
Married 1
Divorced 2
Separated 3
Widowed 4
Not married but living with a partner 5
Never married 6
IF CF19=5 (NATIVE AMERICAN/ALASKA NATIVE), SKIP TO CF22. ELSE GO TO CF21.
[CF21] Were
you born in the United States, including U.S. territories and U.S.
military bases?
Yes 1
No 2
IF CF21=NO, ASK CF21A. ELSE GO TO CF22.
[CF21A]
PROGRAMMER:
-IF NUMBER ENTERED HERE IS MORE THAN RESPONDENT AGE, BRING R BACK TO QUESTION, SHOWING MESSAGE UNDER QUESTION IN RED: “You entered a number greater than your age. Please check your answer” |
How many years have you lived in the United States?
If it is less than 1 year, enter 0.
________ YEARS
[CF22] What was the total income from ALL household members during <fill previous year>, before taxes?
Include income from all sources such as work, investments, child support, and public assistance.
If you are a student, you should NOT include your parents’ income.
Less than $10,000 1
$10,000 to Less than $15,000 2
$15,000 to Less than $20,000 3
$20,000 to Less than $25,000 4
$25,000 to Less than $35,000 5
$35,000 to Less than $50,000 6
$50,000 to Less than $75,000 7
$75,000 or more 8
PROGRAMMER NOTE: PLACE HC01-HC03 IN A GRID. |
[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
PROGRAMMER NOTE: PLACE HC04-HC05 IN A GRID. |
[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] Have you ever, even once, taken any prescription pain medicine without a prescription or differently than how a doctor told you to use it (for example, OxyContin, Vicodin, Lortab, or Percocet)?
Yes 1
No 2
|
[HC07] Have you ever been told by a doctor, nurse, or other health professional that you had any type of depression?
Yes 1
No 2
[HC08a] The next questions are about thoughts of suicide. Please remember that your answers are confidential.
Have you ever seriously thought about trying to kill yourself?
Yes 1
No 2
Don’t know……………………………. 3
IF HC08a=YES, ASK HC08. ELSE GO TO V_INTRO.
[HC08] Have you ever tried to kill yourself?
Yes 1
No 2
ST. STALKING
[V_INTRO]
PROGRAMMER NOTE: SHOW V_INTRO ON ONE SCREEN. |
The next set of questions asks about experiences that can directly impact your health or may have resulted in injury. The questions ask about physical injuries, harassing behaviors, and unwanted sexual activity.
Remember, you don’t have to answer any question that you don’t want to. We suggest that you be in a private setting during the remainder of the survey. If, at any time, you do not feel physically or emotionally safe, you can just quit the survey by closing the browser. You can come back to the survey whenever you want. If at any point, the questions are making you upset and you would like to speak with a trained professional please click on the Resources button on the right side of your screen.
[ST_INTRO]
PROGRAMMER NOTE: SHOW ST_INTRO ON ONE SCREEN. |
First are 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; for example, a romantic or sexual partner, a family member, a friend, a teacher, a supervisor or a co-worker, a neighbor, someone you just met, or a stranger.
Please DO NOT include someone following or contacting you as part of their job, such as bill collectors or sales people.
PROGRAMMER NOTE: PLACE ST01-ST02 IN A GRID. |
[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
PROGRAMMER NOTE: PLACE ST03-ST04 IN A GRID. |
[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
PROGRAMMER NOTE: PLACE ST05-ST07 IN A GRID. |
[ST05] Has anyone ever …
… made unwanted phone calls to you, sent you emails, voice, or text messages?
Please do not include bill collectors or telephone solicitors.
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
IF R DIDN’T ANSWER “YES” TO ANY OF ST01 TO ST07, SKIP TO SC_INTRO1. ELSE GO TO ST08_01.
[ST08_01] You answered earlier that someone had…
-(IF ST01=1: Followed you around or watched you)
-(IF ST02=1: Approached you or showed up in places)
-(IF ST03=1: Used technology to monitor or track your location)
-(IF ST04=1: Sneaked onto your property)
-(IF ST05=1: Made unwanted phone calls, emails, text messages)
-(IF ST06=1: Sent unwanted messages through social media)
-(IF ST07=1: Left unwanted presents)
Has the same person done any of these things to you on more than one occasion?
Yes 1
No 2
IF ST08_01=1 (YES), ASK ST08. ELSE GO TO SC_INTRO1.
[ST08]
PROGRAMMER NOTE:
DISPLAY A DROP-DOWN BOX SHOWING 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE PEOPLE. |
How many people did any of these things to you on more than one occasion?
__________
ONLY ONE PERSON WHO FOLLOWED/CONTACTED/HARASSED R ON MORE THAN ONE OCCASION.
IF ST08=1, ASK ST09A AND ST10A. ELSE GO TO SKIP INSTRUCTION BEFORE ST09.
[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
[ST10A] Still thinking about that person who followed, contacted or harassed you on more than one occasion, did he/she ever make 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 ST09A=NO AND ST10A=NO, GO TO SC_INTRO1.
ELSE:
-IF ST09A=YES, THEN CODE ST09=1.
-IF ST10A=YES, THEN CODE ST10=1.
-GO TO ST10_REVIEW.
IF ST08>1, ASK ST09. ELSE GO TO SC_INTRO1.
[ST09]
PROGRAMMER NOTE: -DISPLAY A DROP-DOWN BOX SHOWING NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE PEOPLE. -IF ST08>1 AND ST09>ST08, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than ST08. Please check your answer.” |
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?
__________
[ST10]
PROGRAMMER NOTE: -DISPLAY A DROP-DOWN BOX SHOWING NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE PEOPLE. -IF ST08>1 AND ST10>ST08, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than ST08. Please check your answer.” |
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.
__________
IF ST09=0 AND ST10=0 THEN GO TO NEXT SECTION (SC_INTRO1).
ELSE IF ST09>=1 AND ST10=0 THEN ST10_REVIEW=ST09 AND GO TO ST11_01.
ELSE IF ST09=0 AND ST10>=1 THEN ST10_REVIEW=ST10 AND GO TO ST11_01.
ELSE IF ST09>=1 and ST10>=1, THEN ASK ST10_REVIEW.
PROGRAMMER NOTE: -USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE -IF ST10_REVIEW>(ST09+ST10), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (ST09+ST10). Please check your answer.” -LOOP UP TO 10 PERPETRATORS USING SAME WORDING AND LOGIC. INSTRUMENT ONLY SHOWS QUESTIONS FOR 5 PERPETRATORS |
[ST10_REVIEW] You said that…
-(IF ST09>0: {fill: ST09} {IF ST09>1: people/IF ST09=1: person} made you feel fearful, threatened, or concerned for your safety or the safety of others)
-(IF ST10>0: [FILL IN ST10] {IF ST10>1: people/IF ST10=1: person} made threats to physically harm you).
In total, how many DIFFERENT people did these things to you?
__________
STALKING: Person 1
IF ST10_REVIEW>=1, ASK ST11_01. ELSE GO TO INSTRUCTION BEFORE ST11_02.
PROGRAMMER NOTE: DISPLAY A BURN LINE (Repeatedly contacted, followed, harassed you: Person 1). |
[ST11_01] Only thinking about the (IF ST10_REVIEW=1: person/IF ST10_REVIEW>1: people) 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)]
(IF ST10_REVIEW>1: The FIRST time any one did any of these things to you, was/IF ST10_REVIEW=1: Was)that person …?
Male 1
Female 2
PROGRAMMER NOTE: DISPLAY BURNLINE (Repeatedly contacted, followed, harassed you: Person 1). |
[ST11_01B] The first time this happened, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance (e.g., neighbor, roommate, classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g., taxi driver, someone met at party/bar……………………..8
A complete stranger 6
Someone
else (Please specify:
) 7
IF ST11_01B=1,2, CODE ST11_INT=1;
IF ST11_01B=1,2,3,4,5,8,9 ASK ST11_01C. ELSE GO TO ST11_01E.
[ST11_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON ANSWERS TO ST11_01 AND ST11_01B IN APPENDIX II. |
[ST11_01E]
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 1). |
How old were you the first time this person did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE: Repeatedly contacted, followed, harassed you: Person 1. |
[ST11_01F] Still thinking about this person. Did [FILL: he/she] do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
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 made threats to physically harm you)(IF ST09=0 AND IF ST10>=1: Made threats to physically harm you)]
Yes 1
No 2
IF ST11_01F=YES AND ST11_01B IS NOT (FAMILY MEMBER OR SOMEONE ELSE), ASK ST11_011G. ELSE GO TO SKIP INSTRUCTION BEFORE ST11_01H.
[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 OR ST11_01B IS LEFT BLANK)), ASK ST11_01H. ELSE GO TO ST11_02.
[PROGRAMMER NOTE: SHOW BURN LINE: Repeatedly contacted, followed, harassed you: Person 1. |
[ST11_01H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance (e.g., neighbor, roommate, classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…..9
A
person of authority (e.g.,
teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete 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…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON PERSON1’S SEX. |
STALKING: Person 2
IF ST10_REVIEW>1, ASK ST11_02. ELSE GO TO INSTRUCTION BEFORE ST11_03.
PROGRAMMER NOTE: DISPLAY A BURN LINE (Repeatedly contacted, followed, harassed you: Person 2). |
[ST11_02] Only thinking about the 2nd 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
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 2). |
[ST11_02B] How did you know Person 2? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance (e.g., neighbor, roommate, classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)….9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF ST11_02B=1,2,3,4,5, 8,9 ASK ST11_02C. ELSE GO TO ST11_02D.
[ST11_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF ST11_INT^=1 AND ST11_02B=(INTIMATE RELATIONSHIP), ASK ST11_02D AND ST11_02E.
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 2). |
[ST11_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF ST11_02D=YES, CODE ST11_INT=1 AND ASK ST11_02E. ELSE GO TO ST11_02F.
[ST11_02E] How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
PROGRAMMER NOTE: SHOW BURN LINE: Repeatedly contacted, followed, harassed you: Person 2. |
[ST11_02F] Still thinking about the 2nd 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 this person 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_02F=YES AND ST11_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK ST11_02G. ELSE GO TO ST11_02H.
[ST11_02G] Just to confirm, Person 2 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_02G=NO OR (ST11_02F=1 AND (ST11_02B=SOMEONE ELSE OR ST11_02B IS LEFT BLANK)), ASK ST11_02H. ELSE GO TO ST11_03.
PROGRAMMER NOTE: SHOW BURN LINE: Repeatedly contacted, followed, harassed you: Person 2. |
[ST11_02H]
How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance (e.g., neighbor, roommate, classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc)….9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF ST11_02H=INTIMATE RELATIONSHIPS, ASK ST11_02I. ELSE GO TO ST11_03.
[ST11_02I]. Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
STALKING: Person 3
IF ST10_REVIEW>2, ASK ST11_03. ELSE GO TO INSTRUCTION BEFORE ST11_04.
PROGRAMMER NOTE: DISPLAY A BURN LINE (Repeatedly contacted, followed, harassed you: Person 3). |
[ST11_03] Only thinking about the 3rd 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
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 3). |
[ST11_03B] How did you know Person 3? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance (e.g., neigbhor, roommate, classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)….9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF ST11_03b=1,2,3,4,5, 8,9 ASK ST11_03C. ELSE GO TO ST11_03C.
[ST11_03C] Specifically, was Person 3…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF ST11_INT^=1 AND ST11_03B=(INTIMATE RELATIONSHIP), ASK ST11_03D AND ST11_03E. ELSE GO TO SKIP INSTRUCTIONS BEFORE ST11_03F.
PROGRAMMER NOTE: BURN LINE (Repeatedly contacted, followed, harassed you: Person 3). |
[ST11_03D] Is Person 3 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF ST11_03D=YES, CODE ST11_INT=1 AND ASK ST11_03E. ELSE GO TO ST11_03F.
[ST11_03E] How old were you the first time Person 3 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 3). |
[ST11_03F] Still thinking about the 3rd 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 this person 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_03F=YES AND ST11_03B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK ST11_03G. ELSE GO TO ST11_03H.
[ST11_03G] Just to confirm, Person 3 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
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
IF ST11_03G=NO OR (ST11_03F=YES AND (ST11_03B=SOMEONE ELSE OR ST11_03B IS LEFT BLANK)), ASK ST11_03H. ELSE GO TO ST11_04.
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 3). |
[ST11_03H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance (e.g., neighbor, roommate, classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF ST11_03H=INTIMATE RELATIONSHIPS, ASK ST11_03I. ELSE GO TO ST11_04.
[ST11_03I] Specifically, was Person 3…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
STALKING: Person 4
IF ST10_REVIEW>3, ASK ST11_04. ELSE GO TO INSTRUCTION BEFORE ST11_05.
PROGRAMMER NOTE: DISPLAY A BURN LINE (Repeatedly contacted, followed, harassed you: Person 4). |
[ST11_04] Only thinking about the 4th 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
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 4). |
[ST11_04B] How did you know Person 4? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance (e.g., neighbor, roommate, classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF ST11_04b=1,2,3,4,5,8,9 ASK ST11_04C. ELSE GO TO ST11_04D.
[ST11_04C] Specifically, was Person 4…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF ST11_INT^=1 AND ST11_04B =INTIMATE RELATIONSHIP ASK ST11_04D AND ST11_04E. ELSE GO TO SKIP INSTRUCTIONS BEFORE ST11_04F.
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: : Person 4). |
[ST11_04D] Is Person 4 the FIRST romantic or sexual partner who ever did any of these things to you?
YES 1
NO 2
IF ST11_04D=YES, CODE ST11_INT=1 AND ASK ST11_04E. ELSE GO TO ST11_04F.
[ST11_04E] How old were you the first time Person 4 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 4). |
[ST11_04F] Still thinking about the 4th 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 this person 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_04F=YES AND ST11_04B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK ST11_04G. ELSE GO TO ST11_04H.
[ST11_04G] Just to confirm, Person 4 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_04G=NO OR (ST11_04F=YES AND (ST11_04B=SOMEONE ELSE OR ST11_04B IS LEFT BLANK)), ASK ST11_04H. ELSE GO TO ST11_05.
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 4). |
[ST11_04H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance (e.g., neighbor, roommate, classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF ST11_04H=INTIMATE RELATIONSHIPS, ASK ST11_04I. ELSE GO TO ST11_05.
[ST11_04I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
STALKING: Person 5
IF ST10_REVIEW>4, ASK ST11_05. ELSE GO TONEXT PERSON.
PROGRAMMER NOTE: DISPLAY A BURN LINE (Repeatedly contacted, followed, harassed you: Person 5). |
[ST11_05] Only thinking about the 5th 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
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 5). |
05B] How did you know Person 5? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate, classmate, etc). 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone else 7
IF ST11_05b=1,2,3,4,5, 8,9 ASK ST11_05C. ELSE GO TO ST11_05D.
[ST11_05C] Specifically, was Person 5…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF ST11_INT^=1 AND ST11_05B=INTIMATE RELATIONSHIP, ASK ST11_05D AND ST11_05E. ELSE GO TO SKIP INSTRUCTIONS BEFORE ST11_05F.
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 5). |
[ST11_05D] Is Person 5 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF ST11_05D=YES, CODE ST11_INT=1 AND ASK ST11_05E. ELSE GO TO ST11_05F.
[ST11_05E] How old were you the first time Person 5 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 5). |
[ST11_05F] Still thinking about the 5th 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 this person 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_05F=YES AND ST11_05B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK ST11_05G. ELSE GO TO ST11_05H.
[ST11_05G] Just to confirm, Person 5 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_05G=NO OR (ST11_05F=1 AND (ST11_05B=SOMEONE ELSE OR ST11_05B IS LEFT BLANK)), ASK ST11_05H. ELSE GO TO ST11_06.
PROGRAMMER NOTE: SHOW BURN LINE (Repeatedly contacted, followed, harassed you: Person 5). |
[ST11_05H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or sexually 2
A friend or acquaintance(e.g., neighbor, roommate, classmate, etc.). 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF ST11_05H=INTIMATE RELATIONSHIPS, ASK ST11_05I. ELSE GO TO ST11_06.
[ST11_05I] Specifically, was Person 5 …?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY.
SC. SEXUAL HARASSMENT, UNWANTED TOUCHING
[SC_INTRO1]
PROGRAMMER NOTE: DISPLAY SC_INTRO1 ON ONE SCREEN. |
Next are 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 well, 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 the questions are asked this way so that you understand what we mean. Your answers will help us learn how often these things happen. You can skip questions you don’t want to answer and you can stop at any time.
PROGRAMMER NOTE: FOR EACH ITEM, SHOW A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[SC01] These first questions are about unwanted sexual situations, including verbal harassment and unwanted touching.
In your lifetime, how many people from your WORKPLACE made unwanted sexual remarks or sexual jokes in your presence, or sexually offensive comments about your body or appearance? Please include people you work with or come into contact with through your job. This may have happened at work, or elsewhere with people connected to your workplace.
__________
IF SC01>=1 THEN ASK SC02. ELSE GO TO SC03.
[SC02] How many people from your WORKPLACE have done this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?
__________
IF SC02>SC01: SHOW PROMPT: “You have enetered a number larger than [SC01]. Please change your answer.”
PROGRAMMER NOTE: FOR EACH ITEM, SHOW A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[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?
__________
IF SC03>=1 THEN ASK SC04. ELSE GO TO PROGRAMMER NOTE BEFORE SC05.
[SC04] How many people have done this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?
__________
IF SC04>SC03: SHOW PROMPT: “You have enetered a number larger than [SC03]. Please change your answer.”
PROGRAMMER NOTE: DISPLAY SC05 AND 06 ON ONE SCREEN; SHOW A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[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?
__________
IF SC05=0 AND SC06=0 THEN GO TO NEXT SECTION.
IF SC05>=1 AND SC06=0 THEN SC06_REVIEW=SC05 AND GO TO SC07_01.
IF SC05=0 AND SC06>=1 THEN SC06_REVIEW=SC06 AND GO TO SC07_01.
IF SC05>=1 and SC06>=1, THEN ASK SC06_REVIEW. ELSE GO TO SC07_01.
[SC06_REVIEW]
PROGRAMMER NOTE: -SHOW A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. -IF SC06_REVIEW>(SC05+SC06), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (SC05+SC06). Please check your answer.” |
You just answered…
-(IF SC05>0: [FILL IN SC05] {IF SC05>1: people/IF SC05=1: person} kissed you in a sexual way when you did not want it to happen).
-(IF SC06>0: [FILL IN SC06] {IF SC06>1: people/IF SC06=1: person} 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?
__________
UNWANTED TOUCHING: Person 1
IF SC06_REVIEW>=1, ASK SC07_01. ELSE GO TO SKIP INSTRUCTION BEFORE SC07_02.
PROGRAMMER NOTE: DISPLAY BURN LINE (Unwanted touching: Person 1) ON THE SAME SCREEN WITH SC07_01; SHOW A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[SC07_01] Think about the FIRST time anyone EVER did any of the following to you…
-(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…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted touching: Person 1). |
[SC07_01B] The first time this happened, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate, classmate, etc.). 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF SC07_01B=1,2 CODE SC07_INT=1;
IF SC07_01B=1,2,3,4,5,8,9 ASK SC07_01C. ELSE GO TO SC07_01E.
[SC07_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted touching: Person 1). |
[SC07_01E] How old were you the first time this person did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted touching: Person 1). |
[SC07_01F] Still thinking about this person. Did [he/she] do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
[FILL: Kissed you in a sexual way (SC05>=1)]
[FILL: Fondled, groped, grabbed, or touched you in a sexual way (SC06>=1)]
when you did not want [him/her] to.
Yes 1
No 2
IF SC07_01F=YES AND SC07_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK SC07_01G. ELSE GO TO SC07_01H.
[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?
Yes 1
No 2
IF SC07_01G=NO OR (SC07_01F=YES AND (SC07_01B=SOMEONE ELSE OR SC07_01B IS LEFT BLANK)), ASK SC07_01H. ELSE GO TO SC07_02.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted touching: Person 1). |
[SC07_01H]
How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate, classmate, etc.). 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF SC07_01H=INTIMATE RELATIONSHIPS, ASK SC07_01I. ELSE GO TO SC07_02.
[SC07_01I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
UNWANTED TOUCHING: Person 2
IF SC06_REVIEW>1, ASK SC07_02. ELSE GO TO SKIP INSTRUCTION BEFORE SC07_03.
PROGRAMMER NOTE: DISPLAY BURN LINE (Unwanted touching: Person 2) ON THE SAME SCREEN WITH SC07_02. |
[SC07_02] Only thinking about the 2nd person who…
(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 2nd person…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted touching: Person 2). |
[SC07_02B] How did you know Person 2? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A firend or acquaintance(e.g., neigbhor, roommate, classmate, etc.). 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)….9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF SC07_02B=1,2,3,4,5,8,9 ASK SC07_02C. ELSE GO TO SC07_02D.
[SC07_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF SC07_INT^=1 AND SC07_02B=INTIMATE RELATIONSHIP, ASK SC07_02D AND SC07_02E. ELSE GO TO SKIP INSTRUCTIONS BEFORE SC07_02G.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted touching: Person 2); |
[SC07_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF SC07_02D=YES, CODE SC07_INT=1 AND ASK SC07_02E. ELSE GO TO SC07_02F.
[SC07_02E] How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted touching: Person 2). |
[SC07_02F] Still thinking about the 2nd person. Did [he/she] do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
[FILL: Kissed you in a sexual way when you did not want it to happen (SC05>=1)]
[FILL: Fondled, groped, grabbed, or touched you in a sexual way when you did not want it to happen (SC06>=1)]
Yes 1
No 2
IF SC07_02F=YES AND SC07_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK SC07_02G. ELSE GO TO SC07_02H.
[SC07_02G] Just to confirm, Person 2 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 SC07_02G=NO OR (SC07_02F=YES AND (SC07_02B=SOMEONE ELSE OR SC07_02B IS LEFT BLANK)), ASK SC07_02H. ELSE GO TO SC07_03.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted touching: Person 2). |
[SC07_02H]
How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate, classmate, etc.). 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)….9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF SC07_02H=INTIMATE RELATIONSHIPS, ASK SC07_02I. ELSE GO TO SC07_03.
[SC07_02I] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
SC. COERCED SEX
[SC_INTRO2]
PROGRAMMER NOTE: DISPLAY SC_INTRO2 ON ONE SCREEN. |
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.
PROGRAMMER NOTE: DISPLAY SC15-SC17 ON ONE SCREEN; USE DROP-DOWN BOX FOR EACH ITEM WITH THE OPTIONS BEING NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[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.)
__________
IF SC15=0 AND SC16=0 AND SC17=0 THEN GO TO NEXT SECTION (AD_INTRO1).
ELSE IF SC15>=1 AND SC16=0 AND SC17=0 THEN SC17_REVIEW=SC15 AND GO TO SC18_01.
ELSE IF SC15=0 AND SC16>=1 AND SC17=0 THEN SC17_REVIEW=SC16 AND GO TO SC18_01.
ELSE IF SC15=0 AND SC16=0 AND SC17>=1 THEN SC17_REVIEW=SC17 AND GO TO SC18_01.
ELSE ASK SC17_REVIEW.
PROGRAMMER NOTE: -SHOW A DROP DOWN BOX WITH THE FOLLOWING OPTIONS:1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. - IF SC17_REVIEW>(SC15+SC16+SC17), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (SC15+SC16+SC17). Please check your answer.” |
[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?
__________
COERCED SEX: Person 1
IF SC17_REVIEW>=1, ASK SC18_01. ELSE GO TO SKIP INSTRUCTION BEFORE SC18_02.
PROGRAMMER NOTE: DISPLAY BURN LINE (Unwanted sex you were pressured into: Person 1) ON THE SAME SCREEN WITH SC18_01. |
[SC18_01] Think about the FIRST time anyone EVER pressured you into having (IF RESPSEX=FEMALE: vaginal,) oral, or anal sex with them by…
-(IF SC15>0: 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: wearing you down by repeatedly asking for sex, or showing they were unhappy)
-(IF SC17>0: using their influence or authority over you)
Was the person…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 1). |
[SC18_01B] The first time this happened, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate, classmate, etc.). 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF SC18_01B=1,2, CODE SC18_INT=1;
IF SC18_01B=1,2,3,4,5,8,9 ASK SC18_01C. ELSE GO TO SC18_01D.
[SC18_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 1). |
[SC18_01E] How old were you the first time this person did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 1). |
[SC18_01F] Still thinking about this person. Did [he/she] pressure you into having (RESPSEX=FEMALE: vaginal,) oral, or anal sex with {him/her} by any of these things within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
-(SC15>0: 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>0: Wearing you down by repeatedly asking for sex, or showing they were unhappy)
-(SC17>0: Using their influence or authority over you).
Yes 1
No 2
IF SC18_01F=YES AND SC18_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK SC18_01G. ELSE GO TO SC18_01H.
[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?
Yes 1
No 2
IF SC18_01G=NO OR (SC18_01F=YES AND (SC18_01B=SOMEONE ELSE OR SC18_01B IS LEFT BLANK)), ASK SC18_01H. ELSE GO TO SC18_02.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 1). |
[SC18_01H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate, classmate, etc.). 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF SC18_01H=INTIMATE RELATIONSHIPS, ASK SC18_01I. ELSE GO TO SC18_02.
[SC18_01I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
COERCED SEX: Person 2
IF SC17_REVIEW>1, ASK SC18_02. ELSE GO TO SKIP INSTRUCTION BEFORE SC18_03.
PROGRAMMER NOTE: DISPLAY BURN LINE (Unwanted sex you were pressured into: Person 2) ON THE SAME SCREEN WITH SC18_02. |
[SC18_02] Think about the 2nd person who ever did this/these things to you. Was the 2nd person…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 2). |
[SC18_02B] How did you know Person 2? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
Classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient etc.)….9
A
person of authority (e.g.,
teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF SC18_02B=1,2,3,4,5,8,9 ASK SC18_02C. ELSE GO TO SC18_02D.
[SC18_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF SC18_INT^=1 AND SC18_02B=INTIMATE RELATIONSHIPS, ASK SC18_02D AND SC18_02E. ELSE GO TO S18_02F.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 2). |
[SC18_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF SC18_02D=YES, CODE SC18_INT=1 AND ASK SC18_02E. ELSE GO TO SC18_02F.
[SC18_02E] How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 2). |
[SC18_02F] Still thinking about Person 2 who pressured you into having (RESPSEX=FEMALE: vaginal,) oral, or anal sex with {him/her}. Did Person 2 do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
IF SC18_02F=YES AND SC18_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK SC18_02G. ELSE GO TO SC18_02H.
[SC18_02G] Just to confirm, Person 2 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 SC18_02G=NO OR (SC18_02F=1 AND (SC18_02B=SOMEONE ELSE OR SC18_02B IS LEFT BLANK)), ASK SC18_02H. ELSE GO TO SC18_03.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 2). |
[SC18_02H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
Classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF SC18_02H=INTIMATE RELATIONSHIPS, ASK SC18_02I. ELSE GO TO SC18_03.
[SC18_02I] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
PROGRAMMER NOTE: DISPLAY SC23 AND SC24 ON ONE SCREEN IN A GRID. |
[SC23] Did you EVER get a sexually transmitted disease or other infection when {FILL: “this” (JUST SC17) / “any of these things”} happened? For example, did you get Chlamydia, Gonorrhea, HIV, or some other STD?
Yes 1
No 2
IF RESPSEX=FEMALE, ASK SC24. ELSE GO TO NEXT SECTION.
[SC24] Did you EVERget pregnant when FILL: “this” (JUST SC17) / “any of these things”} happened?
Yes 1
No 2
AD. COMPLETED ALCOHOL/DRUG-FACILITATED RAPE AND MADE TO PENETRATE
PROGRAMMER NOTE: DISPLAY AD_INTRO ON ONE SCREEN |
[AD_INTRO1] This next section is about unwanted sex or sexual contact, that is, 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. You might or might not have ever been in this type of situation. Please remember that even if someone uses alcohol or drugs, what happens to them is not their fault.
These questions use detailed and explicit language so that everyone is clear about what the questions are asking.
IF RESPSEX= “FEMALE”, ASK AD01 TO AD04. ELSE SKIP TO AD05.
PROGRAMMER NOTE -USE DROP-DOWN BOX WITH OPTIONS: NONE/NOT APPLICABLE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE;
|
[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?
(If this has never happened or you have never been drunk or drugged, choose None/Not Applicable.)
__________
[AD02] Put their fingers or an object in your vagina or anus?
__________
PROGRAMMER NOTE: -USE DROP-DOWN BOX WITH OPTIONS: NONE/NOT APPLICABLE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[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?
__________
IF RESPSEX= ‘MALE’, ASK AD05 TO AD08. ELSE GO TO AD09.
PROGRAMMER NOTE: -USE DROP-DOWN BOX WITH OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE.
|
[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?
(If this has never happened or you have never been drunk or drugged, choose None/Not Applicable.)
__________
[AD06] Put their mouth on your penis?
__________
PROGRAMMER NOTE:
-USE DROP-DOWN BOX WITH OPTIONS: NONE/NOT APPLICABLE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[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?
__________
PROGRAMMER NOTE: USE DROP-DOWN BOX WITH OPTIONS: NONE/NOT APPLICABLE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[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?
__________
IF FEMALE RESPONDENT:
IF AD01>0 OR AD02>0 OR AD03>0 OR AD04>0, THEN ASK AD09 AND AD10. ELSE SKIP TO INSTRUCTION BEFORE AD11_REVIEW.
IF MALE RESPONDENT:
IF AD05>0 OR AD06>0 OR AD07>0 OR AD08>0, THEN ASK AD09 AND AD10. ELSE SKIP TO INSTRUCTION BEFORE AD11_REVIEW.
PROGRAMMER NOTE: DISPLAY AD09 AND AD10 ON ONE SCREEN. |
[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?
Yes 1
No 2
[AD10] … do you think you were ever given other drugs without your knowledge?
Yes 1
No 2
FOR FEMALE RESPONDENTS:
IF AD01=0 AND AD02=0 AND AD03=0 AND AD04=0 THEN GO TO NEXT SECTION.
ELSE IF AD01>=1 AND AD02=0 AND AD03=0 AND AD04=0 THEN CODE AD11_REVIEW=AD01 AND GO TO AD11_01.
ELSE IF AD01=0 AND AD02>=1 AND AD03=0 AND AD04=0 THEN CODE AD11_REVIEW=AD02 AND GO TO AD11_01.
ELSE IF AD01=0 AND AD02=0 AND AD03>=1 AND AD04=0 THEN CODE AD11_REVIEW=AD03 AND GO TO AD11_01.
ELSE IF AD01=0 AND AD02=0 AND AD03=0 AND AD04>=1 THEN CODE AD11_REVIEW=AD04 AND GO TO AD11_01.
ELSE GO TO AD11_REVIEW.
IF MALE RESPONDENTS:
IF AD05=0 AND AD08=0 THEN GO TO NEXT SECTION (INSTRUCTIONS BEFORE AD_INTRO2).
ELSE IF AD05=0 AND AD08>=1 THEN CODE AD11_REVIEW=AD08 AND GO TO AD11_01.
ELSE IF AD05>=1 AND AD08=0 THEN CODE AD11_REVIEW=AD05 AND GO TO AD11_01.
ELSE GO TO AD11_REVIEW.
PROGRAMMER NOTE: --USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE -IF FEMALE RESPONDENT AND AD11_REVIEW>(AD01+AD02+AD03+AD04), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (AD01+AD02+AD03+AD04). Please check your answer.”
-IF MALE RESPONDET AND AD11_REVIEW>(AD05+AD08), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (AD05+AD08). Please check your answer.” |
[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] {IF AD01>1: people/IF AD01=1: person} put [their/his or her] mouth on your vagina)
-(IF AD02>=1: [FILL: AD02] {IF AD02>1: people/IF AD02=1: person} put [their/his or her] fingers or an object in your vagina or anus)
-(IF AD03>=1: [FILL: AD03] {IF AD03>1: males/IF AD03=1: male} put [their/his] penis in your vagina)
-(IF AD04>=1: [FILL: AD04] {IF AD04>1: males/IF AD04=1: male} put [their/his] 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] {IF AD05>1: people/IF AD05=1: person} put [their/his or her] fingers or an object in your anus)
-(IF AD08>=1: [FILL: AD08] {IF AD08>1: males/IF AD08=1: male} put [their/his] penis in your mouth or anus)
In total, how many DIFFERENT people did any of these things to you?
__________
ALCOHOL/DRUG FACILITATED SEX: Person 1
IF AD11_REVIEW>=1, ASK AD11_01. ELSE GO TO AD11_02.
IF RESPSEX=FEMALE AND AD01=0 AND AD02=0 AND AD11_REVIEW>=1, CODE AD11_01=MALE, AND GO TO AD11_01B. ELSE ASK AD11_01;
IF RESPSEX=MALE AND AD05=0 AND AD11_REVIEW>=1, CODE AD11_01=MALE AND GO TO AD11_01B. ELSE ASK AD11_01.
[AD11_01]
PROGRAMMER NOTE: DISPLAY BURNLINE (Unwanted sex while drunk, high, drugged, or passed out: Person 1). |
Think about the FIRST time anyone EVER did any of the following to you 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 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)
Was this person…?
Male 1
Female 2
PROGRAMMER NOTE: -SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 1). |
[AD11_01B]
IF (RESPSEX=FEMALE AND AD01=0 AND AD02=0 AND AD11_REVIEW>=1), THEN SHOW:
Think about the FIRST time anyone EVER did any of the following to you 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 AD03>=1: Put his penis in your vagina,)
-(IF AD04>=1: Put his penis in your mouth or anus.)
IF (RESPSEX=MALE AND AD05=0 AND AD11_REVIEW>=1), THEN SHOW:
Think about the FIRST time anyone EVER 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.
The first time this happened, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
Classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF AD11_01B=1,2, CODE AD11_INT=1.
IF AD11_01B=1,2,3,4,5,8,9 ASK AD11_01C. ELSE GO TO AD11_01E.
[AD11_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
[AD11_01E]
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 1). |
How old were you the first time this person did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 1). |
[AD11_01F] Still thinking about this person. Did [he/she] do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
(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 AND AD11_01=MALE: Put his penis in your vagina,
-(IF AD04>=1 AND AD11_01=MALE: 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 AND AD11_01=MALE: 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
Yes 1
No 2
IF AD11_01F=YES AND AD11_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK AD11_01G. ELSE GO TO AD11_01H.
[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?
Yes 1
No 2
IF AD11_01G=NO OR (AD11_01F=YES AND (AD11_01B=SOMEONE ELSE OR AD11_01B IS LEFT BLANK)), ASK AD11_01H. ELSE GO TO AD11_02.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 1). |
[AD11_01H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)….9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF AD11_01H=INTIMATE RELATIONSHIPS, ASK AD11_01I. ELSE GO TO AD11_02.
[AD11_01I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
ALCOHOL/DRUG FACILITATED SEX: Person 2
IF AD11_REVIEW>1, ASK AD11_02. ELSE GO TO AD11_03.
IF RESPSEX=FEMALE AND AD01=0 AND AD02=0 AND AD11_REVIEW>1, CODE AD11_02=MALE AND GO TO AD11_02B. ELSE ASK AD11_02;
IF RESPSEX=MALE AND AD05=0 AND AD11_REVIEW>1, CODE AD11_02=MALE AND GO TO AD11_02B. ELSE ASK AD11_02.
[AD11_02]
PROGRAMMER NOTE: DISPLAY BURNLINE (Unwanted sex while drunk, high, drugged, or passed out: Person 2). |
Think about the 2nd person who did this/any of these things to you. Was Person 2…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 2). |
[AD11_02B] IF (RESPSEX=FEMALE AND AD01=0 AND AD02=0 AND AD11_REVIEW>1), THEN SHOW:
Think about the 2nd person who…
-(IF AD03>=1: Put his penis in your vagina)
-(IF AD04>=1: Put his penis in your mouth or anus)
IF (RESPSEX=MALE AND AD05=0 AND AD11_REVIEW>1), THEN SHOW:
Think about the 2nd person who put his penis in your mouth or anus.
How did you know Person 2? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member………………………..3
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8A complete stranger 6
Someone
else (Please specify:
) 7
IF AD11_02B=1,2,3,4,5,8,9 ASK AD11_02C. ELSE GO TO AD11_02D.
[AD11_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF AD11_INT^=1 AND AD11_02B=INTIMATE RELATIONSHIP, ASK AD11_02D AND AD11_02E. ELSE GO TO AD11_02F.
PROGRAMMER NOTE:
-SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 2). |
[AD11_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF AD11_02D=YES, CODE AD11_INT=1 AND ASK AD11_02E. ELSE GO TO AD11_02F.
[AD11_02E] How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 2). |
[AD11_02F] Still thinking about Person 2, did 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 AD11_02F=YES AND AD11_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK AD11_02G. ELSE GO TO AD11_02H.
[AD11_02G] Just to confirm, Person 2 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 AD11_02G=NO OR (AD11_02F=YES AND (AD11_02B=SOMEONE ELSE OR AD11_02B IS LEFT BLANK)), ASK AD11_02H. ELSE GO TO AD11_03.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex while drunk, high, drugged, or passed out: Person 2). |
[AD11_02H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF AD11_02H=INTIMATE RELATIONSHIPS, ASK AD11_02I. ELSE GO TO AD11_03.
[AD11_02I] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF AD11_01F=1 OR AD11_02F=1 OR AD11_03F=1 OR AD11_04F=1 OR AD11_05F=1 OR AD11_06F=1 OR AD11_07F=1 OR AD11_08F=1 OR AD11_09F=1 OR AD11_10F=1, ASK AD18. ELSE GO TO SKIP INSTRUCTIONS BEFORE AD_INTRO2.
[AD18]
[PROGRAMMER NOTE:
-CREATE A VARIABLE AD12_CNT AND MAKE AD12_CNT EQUAL TO THE NUMBER OF YES ANSWERS TO AD11_01F, AD11_02F, AD11_03F, AD11_04F, AD11_05F, AD11_06F, AD11_07F, AD11_08F, AD11_09F, AD11_10F.
-SHOW A TEXT FIELD ALLOWING FOR NUMBERS FROM 1 TO 99.
-SHOW TWO RADIO BUTTONS BELOW THE TEXT FIELD; ONE IS LABELED AS “More than 100 times” AND THE SECOND “Too many to count”. |
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: 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 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.)
__________
MADE TO PENETRATE: ANSWERED BY ONLY MALE RESPONDENTS
IF FEMALE RESPONDENTS, GO TO NEXT SECTION (FC_INTRO1).
IF MALE RESPONDENTS:
-IF AD06=0 AND AD07=0 THEN SKIP TO NEXT SECTION (FC_INTRO1);
-ELSE GO TO SKIP INSTRUCTIONS BEFORE AD_INTRO2.
IF AD11_REVIEW>=1, GO TO AD_INTRO2. ELSE GO TO SKIP INSTRUCTIONS BEFORE AD19_REVIEW.
[AD_INTRO2] The next questions are about some of the other things that have happened to you.
IF AD06=0 AND AD07>=1 THEN AD19_REVIEW=AD07 AND GO TO SKIP INSTRUCTION BEFORE AD19_01;
ELSE IF AD06>=1 AND AD07=0 THEN AD19_REVIEW=AD06 AND GO TO SKIP INSTRUCTION BEFORE AD19_01;
ELSE GO TO AD19_REVIEW.
PROGRAMMER NOTE: -USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE -IF AD19_REVIEW>(AD06+AD07), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (AD06+AD07). Please check your answer.” |
[AD19_REVIEW] You answered earlier that…
-(IF AD06>=1: [FILL IN AD06] {IF AD06>1: people/IF AD06=1: person} put [their/his or her] mouth on your penis)
-(IF AD07>=1: [FILL IN AD07] {IF AD07>1: females/IF AD07=1: female} made you put your penis in [their/her] 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?
__________
ALCOHOL/DRUG FACILITATED MADE TO PENETRATE: Person 1
IF AD19_REVIEW>=1 AND AD06=0, CODE AD19_01=FEMALE AND GO TO AD19_01B.
ELSE IF AD19_REVIEW>=1 AND AD06>0, ASK AD19_01.
ELSE GO TO SKIP INSTRUCTION BEFORE AD19_02.
[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 did any of the following to you 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 AD06>=1: Put his or her mouth on your penis)
-(IF AD07>=1: Made you put your penis in her vagina)
Was the person…?
Male 1
Female 2
PROGRAMMER NOTE:
-SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 1). |
[AD19_01B] IF AD19_REVIEW>=1 AND AD06=0, THEN SHOW:
Think about the first time anyone EVER 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 this happened, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF AD19_01B=1,2, CODE AD19_INT=1.
IF AD19_01B=1,2,3,4,5,8,9 ASK AD19_01C. ELSE GO TO AD19_01E.
[AD19_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
[AD19_01E]
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 1). |
How old were you the first time this person did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 1). |
[AD19_01F] Still thinking about this person. Did {he/she} do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
-(IF AD06>=1: Put [his/her} mouth on your penis)
-(IF AD07>=1 AND AD19_01=FEMALE: Made you put your penis in her 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.
Yes 1
No 2
IF AD19_01F=YES AND AD19_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK AD19_01G. ELSE GO TO AD19_01H.
[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?
Yes 1
No 2
IF AD19_01G=NO OR (AD19_01F=YES AND (AD19_01B=SOMEONE ELSE OR AD19_01B IS LEFT BLANK)), ASK AD19_01H. ELSE GO TO AD19_02.
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 1). |
[AD19_01H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF AD19_01H=INTIMATE RELATIONSHIPS, ASK AD19_01I. ELSE GO TO AD19_02.
[AD19_01I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
ALCOHOL/DRUG FACILITATED MADE TO PENETRATE: Person 2
IF AD19_REVIEW>1 AND AD06=0, CODE AD19_02=FEMALE AND GO TO AD19_02B. ELSE IF AD19_REVIEW>1 AND AD06>0, ASK AD19_02. ELSE GO TO AD19_03.
[AD19_02]
PROGRAMMER NOTE: DISPLAY BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 12). |
Was the 2nd person who did this/any of these to you…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 2). |
[AD19_02B] IF AD19_REVIEW>1 AND AD06=0, THEN SHOW:
Think about the 2ND person who 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.
How did you know Person 2? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF AD19_02B=1,2,3,4,5,8,9 ASK AD19_02C. ELSE GO TO AD19_02D.
[AD19_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF AD19_INT^=1 AND AD19_02B=INTIMATE RELATIONSHIP, ASK AD19_02D AND AD19_02E.
PROGRAMMER NOTE:; SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 2).
[AD19_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF AD19_02D=YES, CODE AD19_INT=1 AND ASK AD19_02E. ELSE GO TO AD19_02F.
AD19_02E How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 2). |
[AD19_02F] Did Person 2 do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
IF AD19_02F=YES AND AD19_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK AD19_02G. ELSE GO TO AD19_02H.
[AD19_02G] Just to confirm, Person 2 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 AD19_02G=NO OR (AD19_02F=YES AND (AD19_02B=SOMEONE ELSE OR AD19_02B IS LEFT BLANK)), ASK AD19_02H. ELSE GO TO AD19_03.
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate while drunk, high, drugged, or passed out: Person 2). |
[AD19_02H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF AD19_02H=INTIMATE RELATIONSHIPS, ASK AD19_02I. ELSE GO TO AD19_03.
[AD19_02I] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF AD19_01F=1 OR AD19_02F=1 OR AD19_03F=1 OR AD19_04F=1 OR AD19_05F=1 OR AD19_06F=1 OR AD19_07F=1 OR AD19_08F=1 OR AD19_09F=1 OR AD19_10F=1, ASK AD26. ELSE GO TO FC_INTRO1.
[AD26]
PROGRAMMER NOTE:
-CREATE A VARIABLE AD19_CNT AND MAKE AD19_CNT EQUAL TO THE NUMBER OF YES ANSWERS TO AD19_01F, AD19_02F, AD19_03F, AD19_04F, AD19_05F, AD19_06F, AD19_07F, AD19_08F, AD19_09F, AD19_10F.
-SHOW A TEXT FIELD ALLOWING FOR NUMBERS FROM 1 TO 99.
-SHOW TWO RADIO BUTTONS BELOW THE TEXT FIELD; ONE IS LABELED AS “More than 100 times” AND THE SECOND “Too many to count”. |
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/her] 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).
__________
FC. UNWANTED SEX DUE TO THREATS OF HARM/PHYSICAL FORCE
[FC_INTRO1]
PROGRAMMER NOTE: DISPLAY FC_INTRO1 ON ONE SCREEN. |
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, the next questions are asking only about times in your life when sex was unwanted and you did not give consent.
IF RESPSEX=FEMALE, ASK FC01 TO FC04. ELSE GO TO SKIP INSTRUCTIONS BEFORE FC05.
PROGRAMMER NOTE: DISPLAY FC01 AND FC02 ON ONE SCREEN; USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[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?
__________
PROGRAMMER NOTE: DISPLAY FC03 AND FC04 ON ONE SCREEN; USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE |
[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?
__________
IF RESPSEX=MALE, ASK FC05 TO FC08. ELSE GO TO SKIP INSTRUCTIONS BEFORE FC09.
PROGRAMMER NOTE: DISPLAY FC05 TO FC06 ON ONE SCREEN; USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE DROP-DOWN BOX. |
[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, or make you put your penis in their mouth?
__________
PROGRAMMER NOTE: DISPLAY FC07 TO FC08 ON ONE SCREEN; USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE |
[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?
__________
IF FEMALE RESPONDENTS:
IF FC01=0 AND FC02=0 AND FC03=0 AND FC04=0 THEN GO TO NEXT SECTION.
ELSE IF FC01>=1 AND FC02=0 AND FC03=0 AND FC04=0 THEN CODE FC09_REVIEW=FC01 AND GO TO FC09_01.
ELSE IF FC01=0 AND FC02>=1 AND FC03=0 AND FC04=0 THEN CODE FC09_REVIEW=FC02 AND GO TO FC09_01.
ELSE IF FC01=0 AND FC02=0 AND FC03>=1 AND FC04=0 THEN CODE FC09_REVIEW=FC03 AND GO TO FC09_01.
ELSE IF FC01=0 AND FC02=0 AND FC03=0 AND FC04>=1 THEN CODE FC09_REVIEW=FC04 AND GO TO FC09_01.
ELSE GO TO FC09_REVIEW.
IF MALE RESPONDENTS:
IF FC05=0 AND FC08=0 THEN GO TO NEXT SECTION.
ELSE IF FC05=0 AND FC08>=1 THEN CODE FC09_REVIEW=FC08 AND GO TO FC09_01.
ELSE IF FC05>=1 AND FC08=0 THEN CODE FC09_REVIEW=FC05 AND GO TO FC09_01.
ELSE GO TO FC09_REVIEW.
[FC09_REVIEW]
PROGRAMMER NOTE: -USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE - IF FEMAL RESPONDENT AND FC09_REVIEW>(FC01+FC02+FC03+FC04), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (FC01+FC02+FC03+FC04). Please check your answer.” -IF MALE RESPONDENT AND FC09_REVIEW>(FC05+FC08), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (FC05+FC08). Please check your answer.” |
(IF FEMALE RESPONDENTS: )
You answered earlier that, using physical force or threats of harm…
-(IF FC01>=1: [FILL: FC01] {IF FC01>1: people/IF FC01=1: person} put [their mouth/his or her] on your vagina)
-(IF FC02>=1: [FILL: FC02] {IF FC02>1: people/IF FC02=1: person} put [their/his or her] fingers or an object in your vagina or anus)
-(IF FC03>=1: [FILL: FC03] {IF FC03>1: males/IF FC03=1: male} put [their/his] penis in your vagina)
-(IF FC04>=1: [FILL: FC04] {IF FC04>1: males/IF FC04=1: male} put [their/his] penis in your mouth or anus)
(IF MALE RESPONDENTS: )
You answered earlier that, using physical force or threats of harm…
-(IF FC05>=1: [FILL: FC05] {IF FC05>1: people/IF FC05=1: person} put [their/his or her] fingers or an object in your anus)
-(IF FC08>=1: [FILL: FC08] {IF FC08>1: males/IF FC08=1: male} put [their/his] penis in your mouth or anus)
In total, how many DIFFERENT people did any of these things to you?
__________
UNWANTED SEX BY FORCE: Person 1
IF FC09_REVIEW>=1 AND (RESPSEX=FEMALE AND FC01=0 AND FC02=0), CODE FC09_01=MALE AND GO TO FC09_01B.
ELSE IF FC09_REVIEW>=1 AND (RESPSEX=MALE AND FC05=0), CODE FC09_01=MALE AND GO TO FC09_01B.
ELSE IF FC09_REVIEW>=1 GO TO FC09_01.
ELSE GO TO SKIP INSTRUCTIONS BEFORE FC09_02.
PROGRAMMER NOTE: DISPLAY BURNLINE (Unwanted sex by force: Person 1). |
[FC09_01] Think about the FIRST time anyone EVER did any of the following to you using physical force or threats of harm...
(IF FEMALE RESPONDENTS: )
-(IF FC01>=1: put his or her mouth on your vagina)
-(IF FC02>=1: put his or 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 FC08>=1: put his penis in your mouth or anus)
Was this person…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex by force: Person 1). |
[FC09_01B] IF FC09_REVIEW>=1 AND (RESPSEX=FEMALE AND FC01=0 AND FC02=0), SHOW:
Think about the first time anyone EVER did any of the following to you using physical force or threats of harm...
-(IF FC03>=1: put his penis in your vagina)
-(IF FC04>=1: put his penis in your mouth or anus)
IF FC09_REVIEW>=1 AND (RESPSEX=MALE AND FC05=0),
SHOW:
Think about the first time anyone EVER put their penis in your mouth or anus using physical force or threats of harm.
The first time this happened, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FC09_01B=1,2,CODE FC09_INT=1.
IF FC09_01B=1,2,3,4,5,8,9 ASK FC09_01C. ELSE GO TO FC09_01E.
[FC09_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex by force: Person 1). |
[FC09_01E] How old were you the first time this person did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE:
-SHOW BURN LINE (Unwanted sex by force: Person 1). |
[FC09_01F] Still thinking about this person. Did [he/she] [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
(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 AND FC09_01=MALE: Put his penis in your vagina)
-(IF FC04>=1 AND FC09_01=MALE: 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 FC08>=1 AND FC09_01=MALE: Put his penis in your mouth or anus)
using physical force or threats of harm
Yes 1
No 2
IF FC09_01F=YES AND FC09_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK FC09_01G. ELSE GO TO FC09_01H.
[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?
Yes 1
No 2
IF FC09_01G=NO OR (FC09_01F=YES AND (FC09_01B=SOMEONE ELSE OR FC09_01B IS LEFT BLANK)), ASK FC09_01H. ELSE GO TO FC09_02.
PROGRAMMER NOTE:
-SHOW BURN LINE (Unwanted sex by force: Person 1). |
[FC09_01H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., boss,
supervisor, teacher, doctor,
police
officer, etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FC09_01H=INTIMATE RELATIONSHIPS, ASK FC09_01I. ELSE GO TO FC09_02.
[FC09_01I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
UNWANTED SEX BY FORCE: Person 2
IF FC09_REVIEW>1 AND (RESPSEX=FEMALE AND FC01=0 AND FC02=0), CODE FC09_02=MALE AND GO TO FC09_02B.
ELSE IF FC09_REVIEW>1 AND (RESPSEX=MALE AND FC05=0), CODE FC09_02=MALE AND GO TO FC09_02B.
ELSE IF FC09_REVIEW>1 ASK FC09_02.
ELSE GO TO SKIP INSTRUCTION BEFORE FC09_03.
PROGRAMMER NOTE: DISPLAY BURNLINE (Unwanted sex by force: Person 2). |
[FC09_02] Think about the 2nd person who did this/any of these things to you. Was Person 2…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex by force: Person 2). |
[FC09_02B]
IF FC09_REVIEW>=1 AND (RESPSEX=FEMALE AND FC01=0 AND FC02=0), SHOW:
Think about the 2nd person who…
-(IF FC03>=1: put his penis in your vagina)
-(IF FC04>=1: put his penis in your mouth or anus)
using physical force or threats of harm
IF FC09_REVIEW>=1 AND (RESPSEX=MALE AND FC05=0),
SHOW:
Think about the 2nd person who put his penis in your mouth or anus using physical force or threats of harm.
How did you know Person 2 ? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FC09_02B=1,2,3,4,5,8,9 ASK FC09_02C. ELSE GO TO FC09_02D.
[FC09_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF FC09_INT^=1 AND FC09_02B=INTIMATE RELATIONSHIP, ASK FC09_02D AND FC09_02E. ELSE GO TO FC09_02F.
PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex by force: Person 2). |
[FC09_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF FC09_02D=YES, CODE FC09_INT=1 AND ASK FC09_02E. ELSE GO TO FC09_02F.
[FC09_02E] How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE:
-SHOW BURN LINE (Unwanted sex by force: Person 2). |
[FC09_02F] Still thinking about Person 2, did 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 FC09_02F=YES AND FC09_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK FC09_02G. ELSE GO TO FC09_02H.
[FC09_02G] Just to confirm, Person 2 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 FC09_02G=NO OR (FC09_02=YES AND (FC09_02B=SOMEONE ELSE OR FC09_01B IS LEFT BLANK)), ASK FC09_02H. ELSE GO TO FC09_03.
PROGRAMMER NOTE:
-SHOW BURN LINE (Unwanted sex by force: Person 2). |
[FC09_02H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FC09_02H=INTIMATE RELATIONSHIPS, ASK FC09_02I. ELSE GO TO FC09_03.
[FC09_02I] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF FC09_01F=1 OR FC09_02F=1 OR FC09_03F=1 OR FC09_04F=1 OR FC09_05F=1 OR FC09_06F=1 OR FC09_07F=1 OR FC09_08F=1 OR FC09_09F=1 OR FC09_10F=1, ASK FC16. ELSE GO TO SKIP INSTRUCTIONS BEFORE FC_INTRO2.
[FC16]
PROGRAMMER NOTE:
-CREATE A VARIABLE FC09_CNT AND MAKE FC09_CNT EQUAL TO THE NUMBER OF YES ANSWERS TO FC09_01F, FC09_02F, FC09_03F, FC09_04F, FC09_05F, FC09_06F, FC09_07F, FC09_08F, FC09_09F, FC09_10F
-SHOW A TEXT FIELD ALLOWING FOR NUMBERS FROM 1 TO 99.
-SHOW TWO RADIO BUTTONS BELOW THE TEXT FIELD; ONE IS LABELED AS “More than 100 times” AND THE SECOND “Too many to count”. |
Think about the {(IF FC09_CNT=1: person) / (FILL: FC09_CNT) people} who…
(IF FEMALE RESPONDENTS:)
-(IF FC01>=1: Put {his or her/their} mouth on your vagina)
-(IF FC02>=1: Put {his or her/their} fingers or an object in your vagina or anus)
-(IF FC03>=1: Put [his/their] penis in your vagina)
-(IF FC04>=1: Put [his/their] penis in your mouth or anus)
(IF MALE RESPONDENTS:)
-(IF FC05>=1: put {his or her/their} fingers or an object in your anus)
-(IF FC08>=1: put [his/their] 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 RESPSEX=FEMALE, GO TO NEXT SECTION (FA_INTRO1).
IF REPSEX= MALE AND:
-IF FC06=0 AND FC07=0 THEN SKIP TO NEXT SECTION (FA_INTRO1);
ELSE GO TO SKIP INSTRUCTION BEFORE FC_INTRO2.
IF (FC06>=1 AND FC07>=1) AND FC09_REVIEW>=1 THEN GO TO FC_INTRO2. ELSE GO TO INSTRUCTION BEFORE FC17_REVIEW.
MADE TO PENETRATE BY FORCE: ANSWERED ONLY BY MALES
[FC_INTRO2] The next questions are about some of the other things that have happened to you.
IF FC06=0 AND FC07>=1 THEN FC17_REVIEW=FC07 AND GO TO SKIP INSTRUCTION BEFORE FC17_01;
ELSE IF FC06>=1 AND FC07=0 THEN FC17_REVIEW=FC06 AND GO TO SKIP INSTRUCTION BEFORE FC17_01;
ELSE GO TO FC17_REVIEW.
[FC17_REVIEW]
PROGRAMMER NOTE: -USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS:1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE -IF FC17_REVIEW>(FC06+FC07), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (FC06+FC07). Please check your answer.” |
You answered earlier that…
-[FILL IN FC06] {IF FC06>1: people/IF FC06=1: person} put [their/his or her] mouth on your penis, or made you put your penis in [their/his or her] mouth,
-[FILL IN FC07] {IF FC07>1: females/IF FC07=1: female} made you put your penis in [their/his or her] vagina
…….using physical force or threats of harm.
In total, how many DIFFERENT people did any of these things to you?
________
MADE TO PENETRATE BY FORCE: Person 1
IF FC17_REVIEW>=1 AND FC06=0, CODE FC17_01=FEMALE AND GO TO FC17_01B.
ELSE IF FC17_REVIEW>=1 AND FC06>=1 THEN ASK FC17_01.
ELSE GO TO SKIP INSTRUCTIONS BEFORE FC17_02.
[FC17_01]
PROGRAMMER NOTE: DISPLAY BURN LINE (Made to penetrate by force: Person 1). |
Think about the FIRST time anyone EVER did any of the following using physical force or threats of harm…
-(IF FC06>=1: Put his/her mouth on your penis, or made you put your penis in his/her mouth)
-(IF FC07>=1: Made you put your penis in her vagina)
Was the person…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate by force: Person 1). |
[FC17_01B] IF FC17_REVIEW>=1 AND FC06=0, THEN SHOW:
Think about the first time anyone EVER made you put your penis in their vagina
using physical force or threats of harm.
The first time this happened, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FC17_01B=1,2, CODE FC17_INT=1.
IF FC17_01B=1,2,3,4,5,8,9 ASK FC17_01C. ELSE GO TO FC17_01E.
[FC17_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate by force: Person 1). |
[FC17_01E] How old were you the first time this person did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate by force: Person 1). |
[FC17_01F] Still thinking about this person. Did {he/she} do {this/any of these things} within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
-(IF FC06>=1: Put {his/her} mouth on your penis, or made you put your penis in {his/her} mouth)
-(IF FC07>=1 AND FC17_01=FEMALE: Make you put your penis in her vagina)
using physical force or threats of harm
Yes 1
No 2
IF FC17_01F=YES AND FC17_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK FC17_01G. ELSE GO TO FC17_01H.
[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?
Yes 1
No 2
IF FC17_01G=NO OR (FC17_01F=YES AND (FC17_01B=SOMEONE ELSE OR FC17_01B IS LEFT BLANK)), ASK FC17_01H. ELSE GO TO FC17_02.
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate by force: Person 1). |
[FC17_01H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FC17_01H=INTIMATE RELATIONSHIPS, ASK FC17_01I. ELSE GO TO FC17_02.
[FC17_01I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
MADE TO PENETRATE BY FORCE: Person 2
IF FC17_REVIEW>1 AND FC06=0, CODE FC17_02=FEMALE AND GO TO FC17_02B.
ELSE IF FC17_REVIEW>1, ASK FC17_02.
ELSE GO TO SKIP INSTRUCTIONS BEFORE FC17_03.
PROGRAMMER NOTE: DISPLAY BURN LINE (Made to penetrate by force: Person 2). |
[FC17_02] Was the 2nd person who did this/any of these to you…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate by force: Person 2). |
[FC17_02B] IF FC17_REVIEW>1 AND FC06=0, THEN SHOW:
Think about the 2nd person who made you put your penis in their vagina
using physical force or threats of harm.
How did you know Person 2? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FC17_02B=1,2,3,4,5,8,9 ASK FC17_02C. ELSE GO TO FC17_02D.
[FC17_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF FC17_INT^=1 AND FC17_02B=INTIMATE RELATIONSHIP, ASK FC17_02D AND FC17_02E.
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate by force: Person 2). |
[FC17_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF FC17_02D=YES, CODE FC17_INT=1 AND ASK FC17_02E. ELSE GO TO FC17_02F.
[FC17_02E] How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate by force: Person 2). |
[FC17_02F] Did Person 2 do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
IF FC17_02F=YES AND FC17_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK FC17_02G. ELSE GO TO FC17_02H.
[FC17_02G] Just to confirm, Person 2 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 FC17_02G=NO OR (FC17_02F=YES AND (FC17_02B=SOMEONE ELSE OR FC17_02B IS LEFT BLANK)), ASK FC17_02H. ELSE GO TO FC17_03.
PROGRAMMER NOTE: SHOW BURN LINE (Made to penetrate by force: Person 2). |
[FC17_02H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone
I knew through work (e.g., co-worker, boss/supervisor,
client/customer/patient, etc.)…9A person of authority (e.g.,
teacher, doctor, police
officer, etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FC17_02H=INTIMATE RELATIONSHIPS, ASK FC17_02I. ELSE GO TO FC17_03.
[FC17_02I] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF FC17_01F=1 OR FC17_02F=1 OR FC17_03F=1 OR FC17_04F=1 OR FC17_05F=1 OR FC17_06F=1 OR FC17_07F=1 OR FC17_08F=1 OR FC17_09F=1 OR FC17_10F=1, ASK FC24. ELSE GO TO SKIP INSTRUCTIONS BEFORE FA_INTRO1.
[FC24]
PROGRAMMER NOTE: -CREATE A VARIABLE FC17_CNT AND MAKE FC17_CNT EQUAL TO THE NUMBER OF YES ANSWERS TO FC17_01F, FC17_02F, FC17_03F, FC17_04F, FC17_05F, FC17_06F, FC17_07F, FC17_08F, FC17_09F, FC17_10F -SHOW A TEXT FIELD ALLOWING FOR NUMBERS FROM 1 TO 99. -SHOW TWO RADIO BUTTONS BELOW THE TEXT FIELD; ONE IS LABELED AS “More than 100 times” AND THE SECOND “Too many to count”] |
Think about the {(IF FC17_CNT=1: person)/(FILL: FC17_CNT) people)} who…
-(IF FC06>=1: put [his or her/their] mouth on your penis, or made you put your penis in [his or her/their] mouth)
-(IF FC07>=1: made you put your penis in [her/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.)
__________
FA. ATTEMPTED PHYSICALLY FORCED SEX
PROGRAMMER NOTE: DISPLAY FA_INTRO1 ON ONE SCREEN. |
[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.
IF RESPSEX=FEMALE, ASK FA01. ELSE GO TO SKIP INSTRUCTIONS BEFORE FA02.
[FA01]
PROGRAMMER NOTE: USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE |
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?
__________
IF RESPSEX=MALE, ASK FA02 TO FA04. ELSE GO TO SKIP INSTRUCTIONS BEFORE FA05_01.
[FA02]
PROGRAMMER NOTE: USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE |
How many PEOPLE have ever used physical force or threats of physical harm to TRY to put their mouth on your penis, or TRY to make you put your penis in their mouth, but it did not happen?
__________
[FA03]
PROGRAMMER NOTE: USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE |
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: USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE |
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?
__________
IF FEMALE RESPONDENTS:
IF FA01=0, SKIP TO NEXT SECTION (OT_INTRO1). ELSE GO TO FA05_01.
IF MALE RESPONDENTS:
IF FA02=0 AND FA03=0 AND FA04=0, SKIP TO NEXT SECTION (OT_INTRO1);
ELSE IF FA04>=1 THEN GO TO FA05_1;
ELSE IF FA04=0 AND (FA02>=1 OR FA03>=1), GO TO SKIP INSTRUCTIONS BEFORE FA_INRO2.
IF FA01>=1 OR FA04>=1, CODE FA05_01=MALE AND ASK FA05_01B. ELSE GO TO SKIP INSTRUCTIONS BEFORE FA05_02.
ATTEMPTED SEX BY FORCE: Person 1
[FA05_01]
PROGRAMMER: CODE THIS TO MALE AND DO NOT SHOW THE ITEM TO RESPONDENTS. |
Was this person…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex By Force: Person 1). |
[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, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance(e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FA05_01B=1,2,CODE FA05_INT=1.
IF FA05_01B=1,2,3,4,5,8,9 ASK FA05_01C. ELSE GO TO FA05_01E.
[FA05_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex By Force: Person 1). |
[FA05_01E] How old were you the first time this person did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex By Force: Person 1). |
[FA05_01F] Still thinking about this person. Did he
(FOR FEMALE RESPONDENTS: try to put his penis in your vagina, mouth, or anus)
(FOR MALE RESPONDENTS: tried to put his penis in your mouth or anus)
using physical force or threats of harm, but sex DID NOT happen
within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
YES 1
NO 2
IF FA05_01F=YES AND FA05_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK FA05_01G. ELSE GO TO FA05_01H.
[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?
YES 1
NO 2
IF FA05_01G=NO OR (FA05_01F=YES AND (FA05_01B=SOMEONE ELSE OR FA05_01B IS LEFT BLANK)), ASK FA05_01H. ELSE GO TO FA05_02.
PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex By Force: Person 1). |
[FA05_01H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance (e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FA05_01H=INTIMATE RELATIONSHIPS, ASK FA05_01I. ELSE GO TO FA05_02.
[FA05_01I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
ATTEMPTED SEX BY FORCE: Person 2
IF FA01_>1 OR FA04>1, CODE FA05_02 AS MALE AND GO TO FA05_02B. ELSE GO TO SKIP INSTRUCTIONS BEFORE FA05_03.
PROGRAMMER NOTE: DO NOT SHOW FA05_02. |
[FA05_02] Think about the 2nd person who did this/any of these things to you. Was Person 2…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex by Force: Person 2). |
[FA05_02B] Think about the 2nd person who tried to put his penis in your (FOR FEMALE RESPONDENTS: vagina, mouth, or anus) (FOR MALE RESPONDENTS: mouth or anus) using physical force or threats of harm, but sex DID NOT happen.
How did you know Person 2? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance (e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g.,
teacher, doctor,
police
officer, etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FA05_02B=1,2,3,4,5,8,9 ASK FA05_02C. ELSE GO TO FA05_02D.
[FA05_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF FA05_INT^=1 AND FA05_02B=INTIMATE RELATIONSHIP, ASK FA05_02D AND FA05_02E. ELSE GO TO FA05_02F.
PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex by Force: Person 2). |
[FA05_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF FA05_02D=YES, CODE FA05_INT=1 AND ASK FA05_02E. ELSE GO TO FA05_02F.
[FA05_02E] How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex by Force: Person 2). |
[FA05_02F] Still thinking about Person 2, did 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 FA05_02F=YES AND FA05_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK FA05_02G. ELSE GO TO FA05_02H.
[FA05_02G] Just to confirm, Person 2 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
PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex by Force: Person 2). |
IF FA05_02G=NO OR (FA05_02F=YES AND (FA05_02B=SOMEONE ELSE OR FA05_02B IS LEFT BLANK)), ASK FA05_02H. ELSE GO TO FA05_03.
[FA05_02H]
How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance (e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g.,
teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FA05_02H=INTIMATE RELATIONSHIPS, ASK FA05_02I. ELSE GO TO FA05_03.
[FA05_02I] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF FA05_01F=1 OR FA05_02F=1 OR FA05_03F=1 OR FA05_04F=1 OR FA05_05F=1 OR FA05_06F=1 OR FA05_07F=1 OR FA05_08F=1 OR FA05_09F=1 OR FA05_10F=1, ASK FA12. ELSE GO TO SKIP INSTRUCTIONS BEFORE FA_INTRO2.
[FA12]
PROGRAMMER NOTE:
-CREATE A VARIABLE FA05_CNT AND MAKE FA05_CNT EQUAL TO THE NUMBER OF YES ANSWERS TO FA05_01F, FA05_02F, FA05_03F, FA05_04F, FA05_05F, FA05_06F, FA05_07F, FA05_08F, FA05_09F, FA05_10F
-SHOW A TEXT FIELD ALLOWING FOR NUMBERS FROM 1 TO 99.
-SHOW TWO RADIO BUTTONS BELOW THE TEXT FIELD; ONE IS LABELED AS “More than 100 times” AND THE SECOND “Too many to count”. |
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.)
__________
ATTEMPTED MADE TO PENETRATE BY FORCE: ANSWERED ONLY BY MALE RESPONDENTS
IF FEMALE RESPONDENTS, GO TO NEXT SECTION (OT_INTRO1).
IF MALE RESPONDENTS:
IF FA02=0 AND FA03=0 THEN SKIP TO NEXT SECTION (OT_INTRO1);
ELSE IF FA02=0 AND FA03>=1 THEN FA13_REVIEW=FA03. GO TO SKIP INSTRUCTION BEFORE FA13_01;
ELSE IF FA02>=1 AND FA03=0 THEN FA13_REVIEW=FA02. GO TO SKIP INSTRUCTION BEFORE FA13_01;
ELSE IF FA02>=1 AND FA03>=1 THEN GO TO FA13_REVIEW.
[FA13_REVIEW]
PROGRAMMER NOTE: -USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS:1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE -IF FA13_REVIEW>(FA02+FA03), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than (FA02+FA03). Please check your answer.” |
You answered earlier that…
-(IF FA02>=1: [FILL IN FA02] {IF FA02>1: people/IF FA02=1: person} tried to put [their/his or her] mouth on your penis, or tried to make you put your penis in [their/his or her] mouth)
-(IF FA03>=1: [FILL IN FA03] {IF FA03>1: females/IF FA03=1: female} tried to make you put your penis in [their/her vagina)
using physical force or threats of harm, but sex DID NOT happen.
In total, how many DIFFERENT people did any of these things to you?
__________
ATTEMPTED MADE TO PENETRATE BY FORCE: Person 1
IF FA13_REVIEW>=1 AND FA02=0 THEN CODE FA13_01=FEMALE AND GO TO FA13_01B.
ELSE IF FA13_REVIEW>=1 AND FA02>0, ASK FA13_01.
ELSE GO TO FA13_02.
PROGRAMMER NOTE: DISPLAY BURN LINE (Attempted made to penetrate by force: Person 1). |
[FA13_01] Think about the FIRST time anyone EVER did any of the following to you using physical force or threats of harm, but sex DID NOT happen…
-(IF FA02>=1: Tried to put their mouth on your penis, or tried to make you put your penis in their mouth)
-(IF FA03>=1: Tried to make you put your penis in their vagina)
Was the person…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Attempted made to penetrate by force: Person 1). |
[FA13_01B] IF FA13_REVIEW>=1 AND FA02=0, THEN SHOW:
Think about the FIRST time anyone EVER tried to make you put your penis in their vagina using physical force or threats of harm, but sex DID NOT happen.
The first time this happened, how did you know this person? Please choose a category that best describes how you knew the person.
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance (e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g.,
teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FA13_01B=1,2, CODE FA13_INT=1.
IF FA13_01B=1,2,3,4,5,8,9 ASK FA13_01C. ELSE GO TO FA13_01E.
[FA13_01C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
PROGRAMMER NOTE: SHOW BURN LINE (Attempted made to penetrate by force: Person 1). |
[FA13_01E] How old were you the first time this person did any of these things to you?
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Attempted made to penetrate by force: Person 1). |
[FA13_01F] Still thinking about this person. Did {he/she} do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
-(IF FA02>=1: Tried to put {his/her} mouth on your penis, or tried to make you put your penis in {his/her} mouth)
-(IF FA03>=1 AND FA13_01=2 (FEMALE)): Tried to make you put your penis in her vagina)
but sex DID NOT happen
Yes 1
No 2
IF FA13_01F=YES AND FA13_01B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK FA13_01G. ELSE GO TO FA13_01H.
[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?
Yes 1
No 2
IF FA13_01G=NO OR (FA13_01F=YES AND (FA13_01B=SOMEONE ELSE OR FA13_01B IS LEFT BLANK)), ASK FA13_01H. ELSE GO TO FA13_02.
PROGRAMMER NOTE: SHOW BURN LINE (Attempted made to penetrate by force: Person 1). |
[FA13_01H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance (e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FA13_01H=INTIMATE RELATIONSHIPS, ASK FA13_01I. ELSE GO TO FA13_02.
[FA13_01I] Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
ATTEMPTED MADE TO PENETRATE BY FORCE: Person 2
IF FA13_REVIEW>1 AND FA02=0, CODE FA13_02 AS FEMALE AND GO TO FA13_02B.
ELSE IF FA13_REVIE>1 AND FA02>0, ASK FA13_02.
ELSE GO TO SKIP INSTRUCTIONS BEFORE FA13_03.
PROGRAMMER NOTE:. DISPLAY BURN LINE (Attempted made to penetrate by force: Person 2). |
[FA13_02] Was the 2nd person who did this/any of these to you…?
Male 1
Female 2
PROGRAMMER NOTE: SHOW BURN LINE (Attempted made to penetrate by force: Person 2). |
[FA13_02B]
IF FA13_REVIEW>=1 AND FA02=0, THEN SHOW:
Think about the 2nd person who tried to make you put your penis in their vagina
using physical force or threats of harm, but sex DID NOT happen.
How did you know Person 2? Please choose a category that best describes how you knew the person.
Someone
I was involved withromantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or
sexually 2
A family member 3
A friend or acquaintance (e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g.,
teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FA13_02B=1,2,3,4,5,8,9 ASK FA13_02C. ELSE GO TO FA13_02D.
[FA13_02C] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF FA13_INT^=1 AND FA13_02B=INTIMATE RELATIONSHIP, ASK FA13_02D AND FA13_02E.
PROGRAMMER NOTE: SHOW Attempted made to penetrate by force: Person 2). |
[FA13_02D] Is Person 2 the FIRST romantic or sexual partner who ever did any of these things to you?
Yes 1
No 2
IF FA13_02D=YES, CODE FA13_INT=1 AND ASK FA13_02E. ELSE GO TO FA13_02F.
[FA13_02E] How old were you the first time Person 2 did any of these things to you?
__________
PROGRAMMER NOTE: -IF R ENTERED OUT-OF-RANGE VALUE (<1 OR >110), BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “Please enter a number between 1 and 110.” - IF R ENTERED A NUMBER OLDER THAN AGE, BRING R BACK TO THE QUESTION AND SHOW THE MESSAGE IN RED: “You entered a number greater than your age. Please check your answer”. |
|
PROGRAMMER NOTE: SHOW BURN LINE (Attempted made to penetrate by force: Person 2). |
[FA13_02F] Did Person 2 do [this/any of these things] within the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
IF FA13_02F=YES AND FA13_02B IS NOT (FAMILY MEMBER/RELATIVE OR SOMEONE ELSE), ASK FA13_02G. ELSE GO TO FA13_02H.
[FA13_02G] 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 FA13_02G=NO OR (FA13_02F=YES AND (FA13_02B=SOMEONE ELSE OR FA13_02B IS LEFT BLANK)), ASK FA13_02H. ELSE GO TO FA13_03.
PROGRAMMER NOTE: SHOW BURN LINE (Attempted made to penetrate by force: Person 2)] |
[FA13_02H] How did you know [him/her] when [FILL: he/she] did these things to you in the past 12 months?
Someone
I was involved with romantically
or sexually with at the
time 1
Someone
I previously had been
involved with romantically or
sexually 2
A friend or acquaintance (e.g., neighbor, roommate,
classmate, etc.) 4
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/patient, etc.)…9
A
person of authority (e.g., teacher, doctor, police
officer,
etc.) 5
Someone I knew less than 24 hours (e.g.,
taxi driver, someone met at party/bar)…. 8
A complete stranger 6
Someone
else (Please specify:
) 7
IF FA13_02H=INTIMATE RELATIONSHIPS, ASK FA13_02I. ELSE GO TO FA13_03.
[FA12_02I] Specifically, was Person 2…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF FA13_01F=1 OR FA13_02F=1 OR FA13_03F=1 OR FA13_04F=1 OR FA13_05F=1 OR FA13_06F=1 OR FA13_07F=1 OR FA13_08F=1 OR FA13_09F=1 OR FA13_10F=1, ASK FA20. ELSE GO TO SKIP INSTRUCTIONS BEFORE OT_INTRO1.
[FA20]
PROGRAMMER NOTE:
-CREATE A VARIABLE FA13_CNT AND MAKE FA13_CNT EQUAL TO THE NUMBER OF YES ANSWERS TO FA13_01F, FA13_02F, FA13_03F, FA13_04F, FA13_05F, FA13_06F, FA13_07F, FA13_08F, FA13_09F, FA13_10F
-SHOW A TEXT FIELD ALLOWING FOR NUMBERS FROM 1 TO 99.
-SHOW TWO RADIO BUTTONS BELOW THE TEXT FIELD; ONE IS LABELED AS “More than 100 times” AND THE SECOND “Too many to count”. |
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 FEMALE RESPONDENTS:
IF AD11_REVIEW>=1 OR FC09_REVIEW>=1 OR FA01>=1 THEN ASK OT_INTRO1. ELSE SKIP TO NEXT SECTION (PA_INTRO1)
IF MALE RESPONDENTS:
IF AD11_REVIEW>=1 OR AD19_REVIEW>=1 OR FC09_REVIEW>=0 OR FC17_REVIEW>=1 OR FA04>=1 OR FA13_REVIEW>=1 THEN ASK OT_INTRO1. ELSE SKIP TO NEXT SECTION (PA_INTRO1).
OT. SEXUAL VIOLENCE: OUTCOMES OF RAPE AND MADE TO PENETRATE
[OT_INTRO1] Next are a few follow-up questions about the times in your life anyone ever…
-(IF AD11_REVIEW>=1 OR AD19_REVIEW>=1: Made you have unwanted sex when you were unable to consent or refuse because you were too drunk, high, drugged, or passed out from alcohol or drugs)
-(IF FC09_REVIEW>=1 OR FC17_REVIEW>=1: Made you have sex using physical force or threats of violence)
-(IF FA01>=1 OR FA04>=1 OR FA13_REVIEW>=1: Tried to make you have sex using physical force or threats of violence, but sex did not happen)
[OT1] Thinking about these experiences in your entire lifetime, when {FILL: “this” (IF JUST ONE BEHAVIOR ENDORSED FROM AD01 – AD04, FC01-FC04,FA01 (FEMALE)/AD05 – AD08, FC05-FC08,FA02-FA04 (MALE), / “any of these things”} happened, did you file a police report?
-(IF AD11_REVIEW>=1 OR AD19_REVIEW>=1: Made you have unwanted sex when you were unable to consent or refuse because you were too drunk, high, drugged, or passed out from alcohol or drugs)
-(IF FC09_REVIEW>=1 OR FC17_REVIEW>=1: Made you have sex using physical force or threats of violence)
-(IF FA01>=1 OR FA04>=1 OR FA13_REVIEW>=1: Tried to make you have sex using physical force or threats of violence, but sex did not happen)
Yes 1
No 2
[OT2] Were you ever physically injured when {FILL: “this” (IF JUST ONE BEHAVIOR ENDORSED FROM AD01 – AD04,FC01-FC04,FA01 (FEMALE)/AD05 – AD08, FC05-FC08, FA02-FA04 (MALE) / “any of these things”} happened? For example, did you have bruises, {IF FEMALE: FILL “vaginal or anal tears”/IF MALE: FILL “anal tears”}, or other internal or external injuries?
Yes 1
No 2
IF RESPSEX=FEMALE AND (AD01>0 OR AD02>0 OR AD03>0 OR AD04>0 OR FC01>0 OR FC02>0 OR FC03>0 OR FC04>0), ASK OT03. ELSE GO TO SKIP INSTRUCTION BEFORE OT04.
IF RESPSEX=MALE AND (AD05>0 OR AD06>0 OR AD07>0 OR AD08>0 OR FC05>0 OR FC06>0 OR FC07>0 OR FC08>0), ASK OT03. ELSE GO TO SKIP INSTRUCTION BEFORE OT04.
[OT03] Did you EVER get an STD or other infection when {FILL: “this” (IF JUST ONE BEHAVIOR ENDORSED FROM AD01 – AD04, FC01-FC04 (FEMALE)/AD05 – AD08, FC05-FC08 (MALE) / “any of these things} happened? For example, did you get Chlamydia, Gonorrhea, HIV, or some other STD?
Yes 1
No 2
IF RESPSEX=FEMALE AND (AD03>0 OR FC03>0) ASK OT04. ELSE GO TO OT05.
IF RESPSEX=MALE GO TO OT05.
[OT04] Did you EVER get pregnant when {FILL: “this” (IF ONLY AD03 OR FC03 ENDORSED/ “any of these things”} happened?
Yes 1
No 2
PROGRAMMER NOTE: DISPLAY OT05 AND OT06 ON ONE SCREEN IN A GRID. |
[OT05] Were you ever concerned for your safety?
Yes 1
No 2
[OT06] Were you ever fearful for yourself or someone close to you?
Yes 1
No 2
PA. PSYCHOLOGICAL AGGRESSION
[PA_INTRO1] The next questions ask more generally about experiences you may have had in your life with your romantic or sexual partners. Examples of romantic or sexual partners include: spouses, boyfriends, girlfriends, people you have dated, or people you were seeing. Do not include first dates or one-time hook-up situations.
PROGRAMMER NOTE: DISPLAY PA02-PA03 ON ONE SCREEN, USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE . |
How many of your current or ex partners have EVER ...
[PA01] … kept you from having your own money?
__________
[PA02] … tried to keep you from seeing or talking to your family or friends?
__________
PROGRAMMER NOTE: DISPLAY PA04-PA06 ON ONE SCREEN, USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[PA03] 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?
[PA04] … made threats to physically harm you?
[PA05] … threatened to hurt themselves or commit suicide because they were upset with you?
PROGRAMMER NOTE: DISPLAY PA07,PA08, PA01 ON ONE SCREEN, USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[PA06] How many of your current or ex partners have EVER ...
… made decisions that should have been yours to make?
[PA07] … destroyed something on purpose that was important to you?
[PA08] … insulted or humiliated you in front of others?
IF PA01>0 OR PA02>0 OR PA03>0 OR PA04>0 OR PA05>0 OR PA06>0 OR PA07>0 OR PA08>0, ASK P09. ELSE SKIP TO PA_INTRO2.
[PA09] How old were you the first time a current or ex partner did any of the following…?
-(IF PA01>=1:Kept you from having your own money)
-(IF PA02>=1: Tried to keep you from seeing or talking to your family or friends)
-(IF PA03>=1: Kept track of you by demanding to know where you were and what you were doing)
-(IF PA04>=1: Made threats to physically harm you)
-(IF PA05>=1: Threatened to hurt themselves or commit suicide because they were upset with you)
-(IF PA06>=1: Made decisions that should have been yours to make)
-(IF PA07>=1: Destroyed something that was important to you)
-(IF PA08>=1: Insulted or humiliated you in front of others)
__________
PROGRAMMER NOTE: USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE |
[PA10] How many current or ex partners have done {FILL: “this” (JUST ONE OF PA01 – PA08) / “any of these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?
__________
IF PA10>SUM(PA01 TO PA08): SHOW PROMPT: “You have entered a number larger than [SUM OF PA01 TO PA08]. Please change your answer.”
IF PA10=0, SKIP TO NEXT SECTION (PV_INTRO1). ELSE ASK PA11.
[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?
Once 1
A few times a year 2
Monthly 3
Weekly 4
Daily 5
[PA_INTRO2] The next few questions are related to other experiences you may have had with a current or ex-romantic or sexual partner.
PROGRAMMER NOTE: USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
IF RESPSEX=FEMALE, ASK PA12. ELSE GO TO SKIP INSTRUCTIONS BEFORE PA13.
[PA12] How many of your current or ex partners have EVER tried to get you pregnant when you did not want to become pregnant or tried to stop you from using birth control?
__________
IF RESPSEX=MALE, ASK PA13. ELSE GO TO SKIP INSTRUCTIONS BEFORE PA14.
[PA13] How many of your current or ex partners have EVER tried to get pregnant when you didn’t want them to get pregnant or tried to stop you from using birth control?
__________
IF PA12>=1 OR PA13>=1, ASK PA14. ELSE GO TO SKIP INSTRUCTIONS BEFORE PA15.
[PA14] How many current or ex partners have done this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?
__________
IF RESPSEX=FEMALE AND PA14>PA12: SHOW PROMPT: “You have enetered a number larger than [PA12]. Please change your answer.”
IF RESPSEX=MALE AND PA14>PA13: SHOW PROMPT: “You have enetered a number larger than [PA13]. Please change your answer.”
PROGRAMMER NOTE: USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
[PA15] How many of your current or ex partners have EVER refused to use a condom when you wanted them to use one?
__________
IF PA15>0, ASK PA16. ELSE GO TO PV_INTRO1.
[PA16] How many current or ex partners have done this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?
__________
IF PA16>PA15: SHOW PROMPT: “You have enetered a number larger than [PA15]. Please change your answer.”
PV. PHYSICAL VIOLENCE
PROGRAMMER NOTE: DISPLAY PV_INTRO1, PV01 ON ONE SCREEN. USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE FOR PV01 AND PV03. |
[PV_INTRO1] The next questions are related to physical acts you may have experienced with your current or ex-romantic or sexual partners.
[PV01] How many of your current or ex partners have ever slapped, pushed, or shoved you?
__________
IF PV01>0, ASK PV02 AND PV03. ELSE GO TO PV04.
[PV02] How old were you the first time a current or ex partner slapped, pushed, or shoved you?
__________
[PV03] How many current or ex partners have slapped, pushed, or shoved you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?
__________
PROGRAMMER NOTE: IF PV03>PV01, BRING R BACK TO PV03 AND SHOW A WARNING MESSAGE: You entered a number bigger than (FILL PV01). |
PROGRAMMER NOTE: DISPLAY PV04-PV06 ON ONE SCREEN, USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE FOR ALL THREE. |
[PV04] How many of your current or ex partners have ever …
… hit you with a fist or something hard?
__________
[PV05] … kicked you or stomped on you?
__________
[PV06] … hurt you by pulling your hair?
PROGRAMMER NOTE: DISPLAY PV07-PV08 ON ONE SCREEN, USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE FOR BOTH. |
[PV07] How many of your current or ex partners have ever …
… slammed you against something?
__________
[PV08] … tried to hurt you by choking or suffocating you?
PROGRAMMER NOTE: DISPLAY PV09-PV10 ON ONE SCREEN, USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE FOR BOTH. |
[PV09] How many of your current or ex partners have ever …
… used a knife on you?
__________
[PV10] … used a gun on you?
__________
IF PV04=0 AND PV05=0 AND PV06=0 AND PV07=0 AND PV08=0 AND PV09=0 AND PV10=0, GO TO SKIP INSTRUCTIONS BEFORE PV13. ELSE ASK PV11.
[PV11] How old were you the first time a current or ex partner did any of these things to you…?
-(IF PV04>0: Hit you with a fist or something hard)
-(IF PV05>0: Kicked you or stomped on you)
-(IF PV06>0: Hhurt you by pulling your hair)
-(IF PV07>0: Slammed you against something)
-(IF PV08>0: Tried to hurt you by choking or suffocating you)
-(IF PV09>0: Used a knife on you)
-(IF PV10>0: Used a gun on you)
__________
[PV12]
PROGRAMMER NOTE: USE A DROP DOWN BOX WITH THE FOLLOWING OPTIONS: NONE, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 OR MORE. |
How many current or ex partners have…
-(IF PV04>0: hit you with a fist or something hard)
-(IF PV05>0: kicked you or stomped on you)
-(IF PV06>0: hurt you by pulling your hair)
-(IF PV07>0: slammed you against something)
-(IF PV08>0: tried to hurt you by choking or suffocating you)
-(IF PV09>0: used a knife on you)
-(IF PV10>0: used a gun on you)
in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?
__________
PROGRAMMER NOTE: IF PV12>SUM(PV04 THROUGH PV10), BRING R BACK TO PV12 AND DISPLAY A WARNING MESSAGE: “You entered a number that is bigger than the number of current or ex partners in life time that ever hurt you.”. |
IF PV01=0 AND PV04=0 AND PV05=0 AND PV06=0 AND PV07=0 AND PV08=0 AND PV09=0 AND PV10=0, GO TO NEXT SECTION (CQ_INTRO1). ELSE ASK PV13.
[PV13] Think about {FILL: “the person” (IF SUM OF PV01, PV04 THROUGH PV10=1) / “all of the people”} who…
-(IF PV01>0: slapped, pushed, or shoved you)
-(IF PV04>0: hit you with a fist or something hard )
-(IF PV05>0: kicked you or stomped on you )
-(IF PV06>0: hurt you by pulling your hair )
-(IF PV07>0: slammed you against something )
-(IF PV08>0: tried to hurt you by choking or suffocating you)
-(IF PV09>0: used a knife on you)
-(IF PV10>0: used a gun on you)
in your lifetime.
The FIRST time {this/any of these things} happened to you, was that person…?
Male 1
Female 2
[PV13_B] The first time {this/any of these things} happened to you, what was the person's relationship to you?
Someone
I was involved with romantically
or sexually at the time 1
Someone
I previously had been
involved with romantically or sexually 2
[PV13_C] Specifically, was that person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
IF PV03 = 0 AND PV12 = 0 THEN GO TO NEXT SECTION (CQ_INTRO1). ELSE ASK PV14A.
[PV14A] For 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, was this person male or female?
Male 1
Female 2
[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}?
Someone
I was involved romantically
or sexually at the time 1
Someone
I previously had been
involved romantically or
sexually 2
[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?
Once 1
A few times a year 2
Monthly 3
Weekly 4
Daily 5
CQ. CONSEQUENCES AND FOLLOW-UP
IF PV01>=1 OR
SUM OF (PV04 THROUGH PV10)>=1 OR
(ST10_REVIEW>=1 AND ST10_INT=1) OR
(SC06_REVIEW>=1 AND SC07_INT=1) OR
(SC17_REVIEW>=1 AND SC18_INT=1) OR
(AD11_REVIEW>=1 AND AD11_INT=1) OR
(AD19_REVIEW>=1 AND AD19_INT=1) OR
(FC09_REVIEW>=1 AND FC09_INT=1) OR
(FC17_REVIEW>=1 AND FC17_INT=1) OR
((FA01>=1 OR FA04>=1) AND FA05_INT=1) OR
(FA13_REVIEW>=1 AND FA13_INT=1), GO TO CQ_INTRO. ELSE GO TO DEBRIEFING.
[CQ_INTRO] The next questions ask about the consequences of the different experiences that you have shared with us involving a current or ex-romantic or sexual partner.
[CQ01] You said previously that current or ex romantic or sexual partners have…
-(IF ST11_REVIEW>0 AND ST11_INT=1: Followed, contacted, or harassed you on more than one occasion AND) (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)
-(IF SC05>0 AND SC07_INT=1: Kissed you in a sexual way when you did not want it to happen)
-(IF SC06>0 AND SC07_INT=1: Fondled or touched you when you did not want it to happen)
-(IF SC17_REVIEW>0 AND SC18_INT=1: Verbally pressured you into unwanted sex)
-(IF (AD11_REVIEW>0 AND AD11_INT=1) or (AD19_REVIEW>=1 AND AD19_INT=1): Had unwanted sex or sexual contact with you when you were too drunk, high, drugged, or passed out from alcohol or drugs and unable to consent)
-(IF (FC09_REVIEW>0 AND FC09_INT=1) or (FC17_REVIEW>0 AND FC17_INT=1): Threatened you with harm or physically forced you to have sex or sexual contact when you didn’t want to)
-(IF (FA01>0 AND FA05_INT=1) OR (FA04>0 AND FA05_INT=1) or ( FA13_REVIEW>0 AND FA13_INT=1): Attempted to have sex or sexual contact with you by using physical force or threats of harm but sex did NOT Happen)
-(IF PV01>0: Slapped, pushed, or shoved you)
-(IF PV04>0: Hit you with a fist or something hard )
-(IF PV05>0: Kicked you or stomped on you )
-(IF PV06>0: Hurt you by pulling your hair )
-(IF PV07>0: Slammed you against something )
-(IF PV08>0: Tried to hurt you by choking or suffocating you)
-(IF PV09>0: Used a knife on you)
-(IF PV10>0: Used a gun on you)
When any of those things happened, were you ever concerned for your safety?
Yes 1
No 2
IF CQ01=YES, ASK CQ02. ELSE GO TO CQ03.
[CQ02] When any of those things happened, were you concerned for your safety in the past 12 months?
Yes 1
No 2
[CQ03] When any of those things happened, were you ever fearful for yourself or someone close to you?
Yes 1
No 2
IF CQ03=YES, ASK CQ04. ELSE GO TO CQ05.
[CQ04] When any of those things happened, ere you fearful in the past 12 months?
Yes 1
No 2
PROGRAMMER NOTE: DISPLAY CQ05-CQ08 IN A GRID. |
[CQ05] 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 …
… did you ever have nightmares?
Yes 1
No 2
[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?
Yes 1
No 2
[CQ07] … did you ever feel like you were constantly on guard, watchful, or easily startled?
Yes 1
No 2
[CQ08] … did you ever feel numb or detached from others, your activities, or your surroundings?
Yes 1
No 2
IF CQ05=YES OR CQ06=YES OR CQ07=YES OR CQ08=YES, ASK CQ09. ELSE GO TO CQ10.
[CQ09] You said earlier that you…
-(IF CQ05=YES: had nightmares)
-(IF CQ06=YES: tried not to think about things done to you)
-(IF CQ07=YES: felt constantly on guard or easily startled)
-(IF CQ08=YES: felt numb or detached)
because of what a current or ex partner did to you.
Did you ever feel this way in the past 12 months?
Yes 1
No 2
PROGRAMMER NOTE: DISPLAY CQ10-CQ15 IN ONE GRID. |
[CQ10] Here is a list of possible injuries. Please indicate 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 …
… minor bruises or scratches?
Yes 1
No 2
[CQ11] … cuts, major bruises, or black eyes?
Yes 1
No 2
[CQ12] … injury to any ligaments, muscles or tendons?
Yes 1
No 2
[CQ13] … broken bones or teeth?
Yes 1
No 2
[CQ14] … back or neck injury?
Yes 1
No 2
[CQ15] … being knocked out after getting hit, slammed against something or choked?
Yes 1
No 2
[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.)
Yes 1
No 2
[CQ17] Did you ever experience mental or emotional harm (for example, anxiety or depression) because of what a current or ex partner did to you?
Yes 1
No 2
IF CQ10=YES OR CQ11=YES OR CQ12=YES OR CQ13=YES OR CQ14=YES OR CQ15=YES OR CQ16=YES, ASK CQ17. ELSE GO TO CQ22.
[CQ18] Did you ever need medical care because of what a current or ex partner did to you?
Yes 1
No 2
IF CQ18=YES, ASK C19. ELSE GO TO CQ20.
[CQ19] Were you able to get the medical care you needed?
Yes 1
No 2
|
[CQ20] In the past 12 months were you injured because of the things a current or ex partner did to you?
Yes 1
No 2
IF CQ18=YES AND CQ20=YES, ASK CQ21. ELSE GO TO CQ22.
[CQ21] In the past 12 months did you need medical care for any of these injuries?
Yes 1
No 2
PROGRAMMER NOTE: DISPLAY CQ22 TO CQ25 IN A GRID. |
[CQ22] Here is a list of services and assistance you might have needed because of what a current or ex-romantic or sexual partner did to you.
Have you ever talked to a crisis hotline operator?
Yes 1
No 2
[CQ23] Did you ever need housing services?
Yes 1
No 2
[CQ24] Did you ever need victim’s advocate services?
Yes 1
No 2
[CQ25] Did you ever need legal services or the advice of an attorney?
Yes 1
No 2
[CQ26] Did you ever file a police report because of the things that a current or ex partner did to you?
Yes 1
No 2
IF CQ26=YES, ASK CQ27. ELSE GO TO CQ28.
[CQ27] In the past 12 months did you file a police report because of the things that a current or ex partner did to you?
Yes 1
No 2
PROGRAMMER NOTE: DISPLAY TEXT FIELD TO TAKE WHOLE NUMBER FROM 0 TO 365. |
[CQ28] About how many days of work did you ever have to miss when a current or ex partner did these things to you?
__________
IF CQ28>=1, ASK CQ29. ELSE GO TO CQ30.
[CQ29] In the past 12 months how many days of work did you have to miss when a current or ex partner did these things to you?
__________
PROGRAMMER NOTE: DISPLAY TEXT FIELD TO TAKE WHOLE NUMBER FROM 0 TO 365. |
[CQ30] About how many days of school did you ever have to miss when a current or ex partner did these things to you?
__________
IF CQ30>=1, ASK CQ31. ELSE GO TO DEBRIEFING.
[CQ31] In the past 12 months how many days of school did you have to miss when a current or ex partner did these things to you?
__________
IC. DEBRIEFING QUESTIONS
ITEM COUNT
PROGRAMMER NOTE: -RANDOMLY ASSIGN RESPONDENTS INTO TWO GROUPS: GROUP A GET IC1 AND GROUP 2 GET IC2. |
[IC1] Next is a list of three things that may happen to some people. How many of them happened to you in the past 12 months?
DROP-DOWN BOX SHOWING (None, 1, 2, 3)
Had something stolen or taken away from your porch, lawn, or other parts of your property
Had something you carry (such as cell phone, money, wallet etc.) stolen or taken away from you
Had a traffic ticket
[IC2] Next is a list of four things that may happen to some people. How many of them happened to you in the past 12 months?
DROP-DOWN BOX SHOWING (None, 1, 2, 3, 4)
Had something stolen or taken away from your porch, lawn, or other parts of your property
Had something you carry (such as cell phone, money, wallet, etc.) stolen or taken away from you
Had been kissed, fondled, groped, grabbed or touched in a sexual way when you didn’t want it to happen
Had a traffic ticket
ST11_REVIEW>0 OR SC05>0 OR SC06>0 OR SC17_REVIEW>0 OR AD11_REVIEW>0 OR AD19_REVIEW > 0 OR FC09_REVIEW>0 OR FC17_REVIEW>0 OR FA01>0 OR FA04>0 OR FA13_REVIEW>0 THEN ASK NARRATIVE. ELSE GO TO DQ_INTRO.
NARRATIVE. Thanks for sharing your experience. To make sure that the survey captures everything needed, would you describe, in your own words, an incident of someone doing any of these to you…?
- (IF ST11_REVIEW>0: Following you)
-(IF SC05>0 or SC06>0: Kissing you in a sexual way)
-(IF SC17_REVIEW>0: Verbally pressuring you into unwanted sex)
-(IF AD11_REVIEW>0 or AD19_REVIEW>=1: Having sex or sexual contact with you when you were unable to consent)
-(IF FC09_REVIEW>0 or FC17_REVIEW>0: Using threats or physical force to have sex or sexual contact with you)
-(IF FA01>0 OR FA04>0 or FA13_REVIEW>0: Attempting to have sex through threats or physical force)
____________________________
[DQ_INTRO] Thank you for answering these questions. We appreciate that you were willing to share your personal experiences and answer questions about some very private and sensitive issues in this survey.
The following questions are about your reactions to this survey. Please indicate how strongly you agree or disagree with each statement.
[D1] You experienced intense emotions while completing the survey.
Strongly Disagree 1
Disagree 2
Neutral 3
Agree 4
Strongly Agree 5
[D2] The survey made you think about things you didn’t want to think about.
Strongly Disagree 1
Disagree 2
Neutral 3
Agree 4
Strongly Agree 5
[D3] You believe you have been able to help others by participating in this study.
Strongly Disagree 1
Disagree 2
Neutral 3
Agree 4
Strongly Agree 5
[D5] Now that you know what the survey is about, you would have made the same choice to participate.
Strongly Disagree 1
Disagree 2
Neutral 3
Agree 4
Strongly Agree 5
DEBRIEFING ON ENVIRONMENT
[D6] Where were you when completing the survey?
At
home, in a room with all doors
closed 1
At
home, in a room with doors, but
at least one door was not
closed 2
At home, in a room without any doors 3
On
public transportation (e.g., bus,
train) 4
In
another public place (specify
) 5
Other
setting (specify
) 6
IF D6 = 1, 2, 3, ASK D7. ELSE GO TO D10.
[D7] Was anyone else in the room while you were completing the survey?
Yes 1
No 2
IF D7 = 1, ASK D8 AND D9. ELSE GO TO D10.
[D8] When someone was in the room, was this because…?
The person walked through the area 1
The
person was sitting or standing
in the room for less than 5
minutes 2
The
person was sitting or standing
in the room for at least 5
minutes 3
[D9] Who else was in the room while you were completing the survey?
Your spouse or partner 1
Some other adult 2
A child/children 3
[D10] Do you think anyone in your household knows what this survey is about?
Yes, someone in my household knows 1
No, no one in my household knows 2
I am not sure if anyone knows 3
[D11] Overall, how burdensome was this survey to you?
Very burdensome 1
Somewhat burdensome 2
A little burdensome 3
Not at all burdensome 4
[D12] How sensitive did you feel the questions asked in this survey were?
Very sensitive 1
Somewhat sensitive 2
A little sensitive 3
Not at all sensitive 4
[D13] Do you feel that the length of this interview was too long, too short, or about right?
Too long 1
Too short 2
About right 3
[D14] How would you rate your understanding of the questions asked in this survey?
Excellent 1
Very good 2
Good 3
Fair 4
Poor 5
[D15] How sure are you that you’ve reported all of the things that happened to you?
Very sure 1
Somewhat sure 2
Somewhat unsure 3
Very unsure 4
[INCENTIVE] That completes the interview. Thank you for your participation. Below is the code for an Amazon gift card worth ($15/$25) as a token of appreciation for completing this survey:
CODE
This is the only notice you will get with this number, so please write it down before you close the survey web site.
If you would like the code to be sent to you by e-mail, please provide your e-mail address here:
[FINAL SCREEN]
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.
Below are some 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 (422-4453).
You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
You may now close your browser.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Westat |
| File Modified | 0000-00-00 |
| File Created | 2021-01-14 |
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