OMB
Control # 0970 – 0481
Expiration Date: XX/XX/XXXX
STREAMS
Adult Second Follow Up Survey
CONTENTS
Section Page
A. CONSENT AND VERIFICATION 3
B. RELATIONSHIP ATTITUDES AND SKILLS 7
C. CURRENT RELATIONSHIPS 11
D. CHILDREN 34
E. EMPLOYMENT AND FINANCES 50
F. WELL BEING 53
All |
CAWI Intro. The STREAMS evaluation is a study sponsored by the Administration for Children and Families within the U.S. Department of Health and Human Services. The goal of the study is to identify and evaluate strategies for improving the delivery and effectiveness of healthy marriage and relationship education programs. This study will provide us with important information that will help create better programs.
The U.S. Department of Health and Human services has contracted with Mathematica Policy Research to work with STREAMS programs to run the study. As part of the study, we are asking you to complete a short survey, this survey is similar to the other surveys that you may have taken as part of the STREAMS evaluation over the last few years. It covers several topics, including your relationships with romantic partners, your living arrangements, how your children are doing, and how you are generally feeling about yourself.
Individual responses will not be matched with specific individuals. Responses to this data collection will be used only for the purposes of the study. The reports prepared from this survey will summarize findings across all study participants and individual information will not be available to anyone outside the study team, except as required by law.
The survey should take around 45 minutes to complete. To thank you, we will send you a gift card worth $50. The card can be used anywhere that a credit or debit card can be used.
If you have any questions, please contact us by phone at 1-844-673-0199 and ask for Sam Taylor or by e-mail at [email protected].
SI. SURVEY INSTRUCTIONS
CAWI ALL
How to complete the survey
Thank you for taking the time to complete this survey.
There are no right or wrong answers.
To answer a question, click the box to choose your response.
To continue to the next webpage, press the "Next" or "Continue" button.
To go back to the previous webpage, click the "Back" or "Previous" button. Please note that this command is only available in certain sections.
If you need to stop before you have finished, the "Suspend" button at the bottom of each page allows you to exit the survey. The data you provide prior to clicking "Suspend" will be securely stored and available when you return to complete the survey.
Please answer questions in the order they appear regardless of the question number. Questions will not always be numbered sequentially, and some may be skipped because they do not apply to you.
Select “next” to begin the survey.
ALL |
A1. CATI You may have received a letter recently to let you know that we would be calling you for a follow-up interview for our study. I’d like to interview you today.
The interview will take about 45 minutes and you will receive $50 for completing the interview. Your participation in the survey is voluntary. You do not have to answer any questions that make you uncomfortable.
We are conducting this survey for the U.S. Department of Health and Human Services. A federal agency may not conduct or sponsor a collection of information unless it has a currently valid OMB control number. The OMB number for this information collection is 0970-XXXX and the expiration date is [FILL WITH EXP DATE FOR NEW CLEARANCE].
To help us protect your privacy, we have obtained a Certificate of Confidentiality from the National Institutes of Health. With this Certificate, the researchers cannot be forced to disclose information that may identify you, even by a court subpoena, in any federal, state, local, civil, criminal, legislative, administrative, or other proceedings. The researchers will use the Certificate to resist any demands for information that would identify you, with one exception.
The Certificate of Confidentiality does not prevent the researchers from disclosing information that would identify you as a participant in the research project if you tell me anything that suggests you are very likely to harm yourself, that you are planning to hurt another person or child, or that someone is likely to harm you.
You should understand that a Certificate of Confidentiality does not prevent you, or a member of your family, from voluntarily releasing information about you or your involvement in this research. If an insurer, employer or other person obtains your written consent to receive research information, then the researchers may not use the Certificate to withhold that information.
Because we want to get your opinion, it is important that you answer the questions without help from anyone else. Of course, you can share what you said with others after we have completed the interview.
This interview may be recorded so my supervisor can monitor the interview and make sure that the questions are asked correctly. These recordings will be destroyed when the study is completed.
Is now a good time to start?
CAWI The interview will take about 45 minutes and you will receive $50 for completing the interview. Your participation in the survey is voluntary. You do not have to answer any questions that make you uncomfortable.
We are conducting this survey for the U.S. Department of Health and Human Services. A federal agency may not conduct or sponsor a collection of information unless it has a currently valid OMB control number. The OMB number for this information collection is 0970-XXXX and the expiration date is [FILL WITH EXP DATE FOR NEW CLEARANCE].
To help us protect your privacy, we have obtained a Certificate of Confidentiality from the National Institutes of Health. With this Certificate, the researchers cannot be forced to disclose information that may identify you, even by a court subpoena, in any federal, state, local, civil, criminal, legislative, administrative, or other proceedings. The researchers will use the Certificate to resist any demands for information that would identify you, with one exception.
The Certificate of Confidentiality does not prevent the researchers from disclosing information that would identify you as a participant in the research project if you tell me anything that suggests you are very likely to harm yourself, that you are planning to hurt another person or child, or that someone is likely to harm you.
You should understand that a Certificate of Confidentiality does not prevent you, or a member of your family, from voluntarily releasing information about you or your involvement in this research. If an insurer, employer or other person obtains your written consent to receive research information, then the researchers may not use the Certificate to withhold that information.
The information you provide will be kept private to the extent permitted by law.
Because we want to get your opinion, it is important that you answer the questions without help from anyone else. Of course, you can share what you said with others after we have completed the interview.
YES 1 GO TO A3
NO 0 GO TO A2
A1=0 |
A2. When would be a good time to do the interview?
INSTRUCTION: RECORD DATE ANVD TIME FOR CALL BACK.
INSTRUCTION: MAKE AN APPOINTMENT USING THE PARALLEL BLOCK.
INSTRUCTION: USE THE ‘APPOINTMENT’ TAB OR PRESS <CTRL-S> TO INVOKE THE APPOINTMENT MAKING DIALOG.
(STRING 20)
A1=1 |
BSF 15 month follow up
A3. First we’d like to verify that we are speaking with the correct person. We are going to ask you some questions that we asked when we last spoke with you.
When you were growing up—that is before you turned 18—did you live most of the time with . . .
PROBE: In which of these living situations did you spend most of your time before you turned 18?
Both your biological mother and your biological father, 1
Your biological mother only, 2
Your biological father only, or 3
Neither of your biological parents? 4
DON’T KNOW d
REFUSED r
CATI/CAWI HARD CHECK: AN ANSWER MUST BE PROVIDED FOR THIS QUESTION. |
IF A1=1 AND [BL F6 = A3] GO TO B1 |
A4. What is your date of birth?
| | | / | | | / | | | | |
MONTH DAY YEAR
(1-12) (1-31) (1900-1996)
DON’T KNOW d
REFUSED r
HARD CHECK: AN ANSWER MUST BE PROVIDED FOR THIS QUESTION. IF [BL F6 EQUALS A3] OR [BL A2 NE A5] GO TO A6 IF BL [BL F6 NE A3] OR [BL A2 EQUALS A5] GO TO A6 |
IF [BL F6 NE A 3] AND [BL A2 NE A 5]
|
A4a. CATI The information you provided does not match our records, we will contact you to shortly follow-up.
STATUS 1380 FOR SUP REVIEW
CAWI The information you provided does not match our records, we will contact you shortly to follow-up.
STATUS 1380 FOR SUP REVIEW
IF [BL F6 EQUALS A 3] AND [BL A2 NE A 5] [BL F6 NE A 3] AND [BL A2 EQUALS A 5]
|
A5. CATI Thank you for your response. I need to check our records before continuing the interview. Please hold on a moment while I get my supervisor.
CON’T 1 GO TO A6
CATI HARD CHECK: SUPERVISOR PLEASE ENTER YOUR ID TO CONTINUE
| | | | |
CAWI Thank you for your time. We need to check our records before continuining the interview. Please contact the SOC at 1-844-673-0199 and ask for Sam Taylor to complete the survey.
STATUS 1380 FOR SUP REVIEW
IF A1=1 AND [BL F6 EQUALS A3] AND [BL A2 NE A5] AND A5=1 A1=1 AND [BL F6 NE A3] AND [BL A2 EQUALS A5] AND A5=1
|
A6. CATI ONLY Can you tell me the name of the street that you lived on when you applied for the MotherWise program on [RA DATE]?
(STRING 20)
INSTRUCTION: Record address given by respondent
DON’T KNOW d GO TO A7
REFUSED r GO TO A7
CATI HARD CHECK: AN ANSWER MUST BE PROVIDED FOR THIS QUESTION. |
IF A1=1 AND [BL F6 EQUALS A3] AND [BL A2 NE A5] AND BL H1 EQUALS A7 A1=1 AND [BL F6 NE A3] AND [BL A2 EQUALS A5] AND BL H1 EQUALS A7 Thank you for your answer, I will hand the phone back to the interviewer to continue to the survey. GO TO B1 |
IF [BL F6 EQUALS A3] AND [BL A2 NE A5] OR [BL H1 NE A7] [BL F6 NE A3] AND [BL A2 EQUALS A5] OR [BL H1 NE A7] [BL F6 NE A3] AND [BL A2 NE A5] OR [BL H1 EQUALS A7] [BL F6 NE A3] AND [BL A2 NE A5] OR [BL A3 NE A4] AND [BL H1 EQUALS A7] |
A7. CATI ONLY I’m sorry. I need to check my records before I can interview you. Is this the best time to reach you in the future?
YES 1
NO, CALL BACK INFO 0
(STRING 20)
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
STATUS CASE 1380 FOR SUP REVIEW
IF [BL F6 EQUALS A3] AND [BL A2 NE A5] OR [BL H1 NE A7] AND A7=ANSWER [BL F6 NE A3] AND [BL A2 EQUALS A5] OR [BL H1 NE A7] AND A7=ANSWER [BL F6 NE A3] AND [BL A2 NE A5] OR [BL H1 EQUALS A7] AND A7=ANSWER PROGRAMMER NOTE: FOR CATI ONLY, RESET CASE TO A3 FOR SUPERVISORS FOR CAWI CASE NEEDS TO BE SCREENED OUT AND TRANSFERRED TO CATI MANUALLY
|
B. Relationship Attitudes and Skills
ALL |
B1. IF CATI: I’m going to read you some statements about relationships. For each, tell me whether you strongly agree, agree, disagree, or strongly disagree. [FILL A-M]. Do you strongly agree, agree, disagree, or strongly disagree?
IF CAWI: The next statements are about relationships. For each, tell me whether you strongly agree, agree, disagree, or strongly disagree. [FILL A-M]. Do you strongly agree, agree, disagree, or strongly disagree?
CATI ONLY: INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-M
Foshee
et al 1992
Foshee
et al 1992
Stanley
and Rhoades
Child
Trends 3M Project
Stanley
and Rhoades
Stanley
and Rhoades
Stanley
and Rhoades
Stanley
and Rhoades
PREP
PREP
|
|
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DON’T KNOW |
REF |
a. A good couple relationship is based on mutual respect. |
1 |
2 |
3 |
4 |
d |
r |
b. In a good couple relationship, you don’t always get your own way. |
1 |
2 |
3 |
4 |
d |
r |
c. Relationships go better if partners make decisions together. |
1 |
2 |
3 |
4 |
d |
r |
d. People are more likely to succeed in their relationships if they take things slowly. |
1 |
2 |
3 |
4 |
d |
r |
e. It is important to know a person well before having sex with them. |
1 |
2 |
3 |
4 |
d |
r |
f. Having a casual sexual relationship with someone is no big deal. |
1 |
2 |
3 |
4 |
d |
r |
g. If you are really in love, you can stop working on your relationship. |
1 |
2 |
3 |
4 |
d |
r |
h. Ending a bad romantic relationship is a good thing. |
1 |
2 |
3 |
4 |
d |
r |
i. There are times when hitting or pushing between people who are a couple is okay. |
1 |
2 |
3 |
4 |
d |
r |
j. Violence between partners can improve a couple’s relationship. |
1 |
2 |
3 |
4 |
d |
r |
k. Some couples need to use violence to solve their problems. |
1 |
2 |
3 |
4 |
d |
r |
l. Sometimes violence is the only way to express your feelings. |
1 |
2 |
3 |
4 |
d |
r |
m. Violence in a couple’s relationship is a personal matter and people should not interfere. |
1 |
2 |
3 |
4 |
d |
r |
Foshee
et al 1992
Foshee
et al 1992
Foshee
et al 1992
CATI/CAWI Next I’m going to read you some statements about how you think about romantic relationships.
ALL |
B2. CATI: For each statement, tell me whether you strongly agree, agree, disagree, or strongly disagree. [FILL A-G]. Do you strongly agree, agree, disagree, or strongly disagree?
CAWI: For each statement, please say whether you strongly agree, agree, disagree, or strongly disagree. [FILL A-G]. Do you strongly agree, agree, disagree, or strongly disagree?
CATI: INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-F
RESPONSE CATEGORIES A-G are to be used in CATI and CAWI
Venum
and Fincham, 2011
Venum
and Fincham, 2011
Venum
and Fincham, 2011
Venum
and Fincham, 2011
Baylor
evaluation of ARYA
Venum
and Fincham, 2011
Venum
and Fincham, 2011
|
|
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DON’T KNOW |
REF |
a. I believe I will be able to effectively deal with conflicts that arise in my relationships. |
1 |
2 |
3 |
4 |
d |
r |
b. I feel good about my ability to make a romantic relationship last. |
1 |
2 |
3 |
4 |
d |
r |
c. I can recognize the signs of a violent or unhealthy relationship. |
1 |
2 |
3 |
4 |
d |
r |
d. I am very confident when I think of having a stable, long term relationship. |
1 |
2 |
3 |
4 |
d |
r |
e. I have the skills needed for a lasting stable romantic relationship. |
1 |
2 |
3 |
4 |
d |
r |
f. I am able to recognize early on the warning signs in a bad relationship. |
1 |
2 |
3 |
4 |
d |
r |
g. I know what to do when I recognize the warning signs in a bad relationship. |
1 |
2 |
3 |
4 |
d |
r |
CATI/CAWI ALL |
FaMLE
|
|
|
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DON’T KNOW |
REF |
|
a. Living together is just the same as being married. |
1 |
2 |
3 |
4 |
d |
r |
|
b. It is better for children if their parents are married. |
1 |
2 |
3 |
4 |
d |
r |
ALL |
Buhrmester
et al. 1988
CATI ONLY INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-E
CAWI: The following questions are about how you might deal with different situations. For each situation, say whether you are extremely good at this, good at this, okay at this, or bad at this. [FILL A-E]. Would you say you are extremely good at this, good at this, okay at this, or bad at this?
RESPONSE CATEGORIES a-e are to be used in CATI and CAWI
|
|
|||||
|
EXTREMELY GOOD |
GOOD |
OKAY |
BAD |
DON’T KNOW |
REF |
a. Admitting that you might be wrong during an argument. |
1 |
2 |
3 |
4 |
d |
r |
b. Avoiding saying things that could turn a disagreement into a fight. |
1 |
2 |
3 |
4 |
d |
r |
c. Accepting another person’s point of view even if you don’t agree with it. . |
1 |
2 |
3 |
4 |
d |
r |
d. Listening to another person’s opinion during a disagreement. |
1 |
2 |
3 |
4 |
d |
r |
e. Working through problems without arguing. |
1 |
2 |
3 |
4 |
d |
r |
C.
Current Relationships
CATI Next, I’m going to ask you some questions about your relationships.
CAWI The next questions are about your relationships.
CATI/CAWI if FUP1 c1=m and ((BL c3 ne 1 or 2) and (BL c4 ne 1 or 2)) not in a relationship at baseline, go to c9. IF FUP1 C1=6 (PARTNER DIED), GO TO C9.
all other cases get c1
|
if FUP1 c1=m (did not collect bl partner status at fup1): FILL BL MONTH/YEAR fill [bl partner] from bl c5 if bl c3 = 1, fill engaged to if bl c3 = 2, fill married to if bl c4 = 1 or 2, fill in a romantic relationship with
IF FUP1 C1 NE M (COLLECTED BL PARTNER STATUS AT FUP1): FILL FUP1 MONTH/YEAR FILL [BL PARTNER] FROM BL C5 if FUP1 c1 = 1, fill engaged to if FUP1 c1 = 2, fill married to if FUP1 c3 = 1 or 2, fill in a romantic relationship with if fup1 c3 = 3, FILL not in a romantic relationship with |
STREAMS
Are you and [BL PARTNER] currently…
Engaged, 1 GO TO C2
Married, 2
Divorced, 3
Separated, or 4
Have you never been married to each other? 5
CATI: WIDOWED/PARTNER DIED 6 GO TO C9
CAWI: MY PARTNER PASSED AWAY 6 GO TO C9
DON’T KNOW d
REFUSED r
CATI ONLY IF C1=6 SAY: I’m very sorry to hear that. Our condolences for your loss.
CATI/CAWI c1=1 |
BSF
C2. When are you planning to get married?
CATI: INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR. IF NO MONTH GIVEN, MARK AS MISSING.
CAWI: RECORD ONLY MONTH AND YEAR. IF NO MONTH GIVEN, LEAVE AS BLANK.
CATI PROGRAMMER NOTE: ALLOW REFUSAL IN MM/YYYY
| | | / | | | | | DATE PLANNING TO MARRY
(01-12) (2014-2100)
MONTH
YEAR
CATI ONLY INTERVIEWER INSTRUCTION: IF NO DATE IS GIVEN, DO NOT PROBE
NO DATE HAS BEEN SET 0
DON’T KNOW d
REFUSED r
CATI/CAWI C1 ne 2 |
FaMLE
We are romantically involved on a steady basis, 1
We are involved in an on-again and off-again relationship, or 2
We are not in a romantic relationship 3
DON’T KNOW d
REFUSED r
PROGRAMMER SKIP BOX C3 IF ((FUP1C1=M OR FUP1 C3=M) or (FUP1 C1= 1 OR 2) or (FUP1 C3=1 OR 2)) AND C3=3, GO TO C4, ELSE SKIP TO C7 |
CATI/CAWI c3=3 |
BSF
C4. When did your relationship with [BL PARTNER] end?
| | | / | | | | | DATE RELATIONSHIP ENDED GO TO C5
(01-12) (2012-2021)
MONTH YEAR
CATI: WIDOWED/PARTNER DIED 6 GO TO C9
CAWI: MY PARTNER PASSED AWAY 6 GO TO C9
DON’T KNOW d GO TO C5
REFUSED r GO TO C5
CATI ONLY IF C4=6 SAY: I’m very sorry to hear that. Our condolences for your loss.
skip if c1=1 or 2 C4 NE 6 |
BSF
C5. CATI: I am going to read you a list of reasons that people give for why their relationships ended. For each reason, tell me if this is why your relationship with [BL PARTNER/ FUP1 PARTNER ] ended.
CAWI: Here is a list of reasons that people give for why their relationships ended. For each reason, tell me if this is why your relationship with [BL PARTNER] ended.
CATI/CAWI
Was it because…
IF C5a – C5f=1 ASK: Was that you, [BL PARTNER], or both of you?
|
CODE ONE PER ROW |
|||
RESPONSE CATEGORIES a-f are to be used in CATI and CAWI
|
|
|
Was that you, [BL PARTNER/ FUP1 PARTNER] or both of you? |
|
a. One of you cheated or was unfaithful? |
YES |
1 |
YOU |
1 |
[BL PARTNER/FUP1 PARTNER] |
2 |
|||
BOTH |
3 |
|||
NO |
0 |
|
|
|
b. One of you went to jail or prison? |
YES |
1 |
YOU |
1 |
[BL PARTNER/FUP1 PARTNER] |
2 |
|||
BOTH |
3 |
|||
NO |
0 |
|
|
|
c. One of you was abusive or violent? |
YES |
1 |
YOU |
1 |
[BL PARTNER/FUP1 PARTNER] |
2 |
|||
BOTH |
3 |
|||
NO |
0 |
|
|
|
d. One of you used drugs or alcohol? |
YES |
1 |
YOU |
1 |
[BL PARTNER/FUP1 PARTNER] |
2 |
|||
BOTH |
3 |
|||
NO |
0 |
|
|
|
e. One of you could not keep a job or contribute enough financially to the family? |
YES |
1 |
YOU |
1 |
[BL PARTNER/FUP1 PARTNER] |
2 |
|||
BOTH |
3 |
|||
NO |
0 |
|
|
|
f. One of you was not a good parent or role model? |
YES |
1 |
YOU |
1 |
[BL PARTNER/FUP1 PARTNER] |
2 |
|||
BOTH |
3 |
|||
NO |
0 |
|
|
|
g. The two of you were not communicating well or were arguing too much? |
YES
|
1 |
|
|
NO |
0 |
|
|
|
h. Of lack of support from family members? |
YES |
1 |
|
|
NO |
0 |
|
|
|
i. You and [BL PARTNER/FUP1 PARTNER] were living too far apart? |
YES |
1 |
|
|
NO |
0 |
|
|
CATI/CAWI skip if c1=1 or 2 C4 NE 6 |
BSF
C5j. Were there any other reasons why your romantic relationship ended?
YES 1 GO TO C5k
NO 0 GO TO C6
DON’T KNOW d GO TO C6
REFUSED r GO TO C6
CATI/CAWI skip if c1=1 or 2 C4 NE 6 and c5j=1 |
BSF
____________________________ STRING 100
REASONS RELATIONSHIP ENDED GO TO C6
CATI/CAWI c4 Ne 6 |
PACT
C6. Do you think it is a good thing for you that you and [BL PARTNER] broke up? Would you say…
Definitely yes, 1
Maybe yes, 2
Maybe no, or 3
Definitely no? 4
DON’T KNOW d
REFUSED r
CATI/CAWI C1 NE 6 and c4 ne 6 |
FaMLE
C7. Do you currently live with [BL PARTNER] in the same household …
All of the time, 1 GO TO C9
Most of the time, 2
Some of the time, or 3
None of the time? 4
DON’T KNOW d
REFUSED r
CATI/CAWI C7 NE 1 |
BSF
C8. How often do you and [BL PARTNER] see or talk to each other? Is it…
Every day or almost every day, 1
A few times a week, 2
A few times a month, 3
About once a month, 4
Only a few times in the past year, or 5
Hardly ever or never? 6
DON’T KNOW d
REFUSED r
CATI/CAWI skip if c1=2 (CURRENTLY MARRIED TO BL PARTNER) |
STREAMS
[Please include [BL PARTNER]
PROBE: Your best guess is fine.
| | | NUMBER OF PARTNERS
(0-99)
DON’T KNOW d
REFUSED r
PROGRAMMER SKIP BOX C9.1 If c9 = 0, go to C24. else, go to c9a. |
CATI/CAWI
if [FUP1 D6 NE1] OR [FUP1 D6=Missing and BL D22=1 and BL D24= NOT ASKED, 2, D or R] OR [FUP1 D6=MISSING AND [BL D22=0,D,R AND BL D16NE1]]
|
IF FUP1 D6A=NAME GIVEN fill [fup child parent] from fup1 D6a IF FUP1 D6A=MISSING AND BL_D18_1=NAME GIVEN, FILL [BL_CHILD_PARENT] FROM BL D18_1
IF BL D22=0,D,R and fup1 d6=missing Fill [BLCHILD NAME] from BL D8 IF BL D22=1 Fill [FUP1 CHILD NAME] from FUP1 D3
|
STREAMS
Are you currently involved in a romantic relationship with [BL CHILD PARENT/FUP1 CHILD PARENT]?
YES 1 GO TO C12
NO 0 GO TO C10
DON’T KNOW d GO TO C10
REFUSED r GO TO C10
CATI/CAWI IF C9A NE 1 AND (FUP1 C1 NE 1 OR 2) AND (FUP1 C3 NE 1 OR 2) AND (FUP1 C10=1) …. THEY COMPLETED THE FOLLOW-UP AND AT THAT TIME WERE NOT IN A RELATIONSHIP WITH THEIR BL PARTNER, BUT WERE IN A RELATIONSHIP AT FUP1 |
IF [NEW PARTNER] FROM fup1 C11 NE BLANK, FILL [fup1 PARTNER]. if fup1 c11= m, D or R, FILL A DIFFERENT PARTNER/that same partner |
STREAMS
Are you currently involved in a romantic relationship with [FUP1 PARTNER/that same partner]?
YES 1 GO TO C12
NO 0 GO TO C10a
DON’T KNOW d GO TO C10a
REFUSED r GO TO C10a
CATI/CAWI IF C9A NE 1 AND [[c1=6 or c3=3, dk or r] OR [C1 OR C3 = NOT ASKED] AND [C9 NE 0] AND C10 NE 1 |
C10a. Are you currently involved in a romantic relationship with someone?
BSF
YES 1 GO TO C11
NO 0 GO TO C23
DON’T KNOW d GO TO C23
REFUSED r GO TO C23
CATI/CAWI C10a=1 |
PACT
CATI INSTRUCTION: IF RESPONDENT INDICATES MORE THAN ONE CURRENT PARTNER, PROBE FOR NAME OF MAIN OR PRIMARY CURRENT PARTNER.
CATI INSTRUCTION: IF RESPONDENT DOES NOT GIVE FULL NAME PROBE FOR A NAME OR INITIALS
____________________________FIRST NAME OF PARTNER
STRING 20
CATI/CAWI c10a=1 |
fill [NEW partner] from c11. IF [NEW PARTNER] = m, D OR R, fill your new partner |
PACT
MAN 1
WOMAN 2
DON’T KNOW d
REFUSED r
CATI/CAWI if [FUP1 D6 NE1] OR [FUP1 D6=Missing and BL D22=1 and BL D24= NOT ASKED, 2, D or R] OR [FUP1 D6=MISSING AND [BL D22=0,D,R AND BL D16=1]] AND [C10=1 or C10a=1] |
if c10=1, fill [FUP1 PARTNER] FROM FUP1 C11, if fup1 c11= m, D or R, FILL that same partner if c10a=1, FILL [NEW PARTNER] from C11. IF C11= m, D OR R, fill your new partner
IF (C1=1 OR 2), OR (C3=1 OR 2) AND (FUP1 C1 NE 1 OR 2) AND (FUP1 C3 NE 1 OR 2) AND (C10=1), FILL [FUP1 PARTNER] FROM FUP1 C11
IF C9A=1 AND FUP1 D6A=NAME GIVEN, FILL [FUP CHILD PARENT] FROM FUP1 D6A
IF C9A=1 AND FUP1 D6A=MISSING AND BL_D18_1=NAME GIVEN, FILL [BL_CHILD_PARENT] FROM BL D18_1 |
BSF
Engaged, 1 GO TO C13
Married, 2 GO TO C13
Divorced, 3
Separated, or 4
Have you never been married to each other? 5
DON’T KNOW d
REFUSED r
CATI/CAWI C12 = 1 or 2 |
if c12 = 1 Fill did you IF c12 = 2 FILL are you planning to |
BSF
CATI INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR. IF NO MONTH GIVEN, MARK AS MISSING.
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/YYYY
| | |
/ | | | | | DATE OF
MARRIAGE/PLANNED DATE OF MARRIAGE
(01-12) (2014-2100)
MONTH YEAR
CATI INTERVIEWER INSTRUCTION: IF NO DATE IS GIVEN, DO NOT PROBE
NO DATE HAS BEEN SET 0
DON’T KNOW d
REFUSED r
CATI/CAWI if [FUP1 D6 NE1] OR [FUP1 D6=Missing and BL D22=1 and BL D24= NOT ASKED, 2, D or R] OR [FUP1 D6=MISSING AND [BL D22=0,D,R AND BL D16=1]] AND [C10=1 AND C12 NE 1 OR 2] |
C14. Which of the following best describes your relationship with [NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] ?
FaMLE
We are romantically involved on a steady basis, or 1
We are involved in an on-again and off-again relationship. 2
DON’T KNOW d
REFUSED r
CATI/CAWI if [FUP1 D6 NE1] OR [FUP1 D6=Missing and BL D22=1 and BL D24= NOT ASKED, 2, D or R] OR [FUP1 D6=MISSING AND [BL D22=0,D,R AND BL D16=1]] AND [C10=1] |
FaMLE
C15. Do you currently live with [NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] in the same household …
All of the time, 1
Most of the time, 2
Some of the time, or 3
None of the time? 4
DON’T KNOW d
REFUSED r
CATI/CAWI (C1=1 or 2) OR (C3=1 OR 2) OR c10 = 1 |
if [NEW PARtner] from c11 ne blank, fill [new partner]. If [NEW PARTNER] = M, D or R, fill your new partner
if (c1=1 or 2), or (c3=1 or 2) AND FUP1 c1=m: fill [bl partner] from bl c5
if (c1=1 or 2), or (c3=1 or 2) AND (FUP1 C1= 1 OR 2) or (FUP1 C3=1 OR 2), FILL [BL PARTNER] FROM BL C5
if C10=1, FILL [FUP1 PARTNER] FROM FUP1 C11
IF C9A=1 AND FUP1 D6A=NAME GIVEN, FILL [FUP CHILD PARENT] FROM FUP1 D6A
IF C9A=1 AND FUP1 D6A=MISSING AND BL_D18_1=NAME GIVEN, FILL [BL_CHILD_PARENT] FROM BL D18_1
|
BSF
C16. CATI: Now I would like to ask about how you feel about your relationship with [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT]. On a scale from 0 to 10, where 0 is not at all happy and 10 is completely happy, taking all things together, how happy would you say your relationship with [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] is?
CAWI: Now we would like to ask about how you feel about your relationship with [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] . On a scale from 0 to 10, where 0 is not at all happy and 10 is completely happy, taking all things together, how happy would you say your relationship with [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] is?
CATI/CAWI You can choose any number from 0 to 10.
| | |
(0-10)
DON’T KNOW d
REFUSED r
CATI/CAWI (C1=1 or 2) OR (C3=1 OR 2) OR c10 = 1 |
IF C12 = 1, FILL “marriage” ELSE FILL “relationship” if c1 = 2, fill “MARRIAGE” ELSE fill “relationship” |
PACT
C17. On a scale from 0 to 10, where 0 is not at all committed and 10 is completely committed, how committed are you to your [marriage/relationship] with [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] ?
| | |
(0-10)
DON’T KNOW d
REFUSED r
CATI/CAWI (C1=1 or 2) OR (C3=1 OR 2) OR c10 = 1 |
IF C12 = 1, FILL “marriage” ELSE FILL “relationship” if c1 = 2, fill “MARRIAGE” ELSE fill “relationship” |
PACT
C18. On a scale from 0 to 10, where 0 is not at all committed and 10 is completely committed, how committed would you say [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] is to your [marriage/relationship]?
| | |
(0-10)
DON’T KNOW d
REFUSED r
(C1=1 or 2) OR (C3=1 OR 2) OR C10 = 1 |
IF C12 = 1, FILL “marriage” ELSE FILL “relationship” if c1 = 2, fill “MARRIAGE” ELSE fill “relationship” |
I’m going to ask you some questions about [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] .
C19. CATI Tell me whether you strongly agree, agree, disagree, or strongly disagree with the following statements.
CAWI Please make below if you you strongly agree, agree, disagree, or strongly disagree with the following statements.
CATI/CAWI [FILL STATEMENT a-l] Do you strongly agree, agree, disagree, or strongly disagree?
CATI ONLY INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-I
BSF
PACT
FaMLE
BSF
BSF
FaMLE
FaMLE
|
CODE ONE PER ROW |
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DK |
REF |
a. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] is honest and truthful with me. |
1 |
2 |
3 |
4 |
d |
r |
b. I can trust [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] completely. |
1 |
2 |
3 |
4 |
d |
r |
c. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] can be counted on to help me. |
1 |
2 |
3 |
4 |
d |
r |
d. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] knows and understands me. |
1 |
2 |
3 |
4 |
d |
r |
![]() PACT e. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] listens to me when I need someone to talk to. |
1 |
2 |
3 |
4 |
d |
r |
f. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] respects me. |
1 |
2 |
3 |
4 |
d |
r |
g. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] shows love and affection. |
1 |
2 |
3 |
4 |
d |
r |
h. I feel appreciated by [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT]. |
1 |
2 |
3 |
4 |
d |
r |
i. I want my relationship with [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] to stay strong no matter what rough times we may have. |
1 |
2 |
3 |
4 |
d |
r |
j. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] supports me to do the things that are important to me. |
1 |
2 |
3 |
4 |
d |
r |
k. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] and I often talk about things that happen to each of us during the day. |
1 |
2 |
3 |
4 |
d |
r |
l. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] and I enjoy doing even ordinary, day-to-day things together. |
1 |
2 |
3 |
4 |
d |
r |
BSF
BSF
BSF
BSF
FaMLE
(C1=1 or 2) OR (C3=1 OR 2) OR C10 = 1 |
IF C12 = 1, FILL “marriage” ELSE FILL “relationship” if c1 = 2, fill “MARRIAGE” ELSE fill “relationship”
FOR BASELINE PARTNER IF BL C5a=1, FILL “he”; IF BL C5a=2, FILL “she” ELSE IF BL C5A= DK OR R FILL HE OR SHE
FOR FUP1 PARTNER, IF C11a=1, FILL “he”; IF C11a=2, FILL “she” ELSE IF C10A= DK OR R FILL HE OR SHE
FOR NEW PARTNER IF FUP1C11a=1, FILL “he”; IF FUP1C11a=2, FILL “she” ELSE IF FUP1C10A= DK OR R FILL HE OR SHE |
FAMLE
CAWI The next statements are about things you and [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] may experience when you are together. Please say if this never happens, hardly ever happens, sometimes happens, or often happens. [FILL STATEMENT A-O]…Does this happen never, hardly ever, sometimes, or often?
CATI INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-P
RESPONSE CATEGORIES a-o are to be used in CATI and CAWI
BSF
BSF
BSF
FAMLE
FAMLE
|
|
|||||
|
NEVER |
HARDLY EVER |
SOMETIMES |
OFTEN |
DK |
R |
a. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] and I are good at working out our differences. |
1 |
2 |
3 |
4 |
d |
r |
b. I feel respected even when [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] and I disagree. |
1 |
2 |
3 |
4 |
d |
r |
c. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] is rude or mean to me when we disagree. |
1 |
2 |
3 |
4 |
d |
r |
d. When [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] and I have a serious disagreement, we work on it together to find a solution. |
1 |
2 |
3 |
4 |
d |
r |
PACT
HM Baseline
BSF |
1 |
2 |
3 |
4 |
d |
r |
f. During arguments, [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] and I are good at taking breaks when we need them. |
1 |
2 |
3 |
4 |
d |
r |
g. When [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] and I argue, past hurts get brought up again. |
1 |
2 |
3 |
4 |
d |
r |
h. Our arguments become very heated. |
1 |
2 |
3 |
4 |
d |
r |
i. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] is good at calming me when I get upset. |
1 |
2 |
3 |
4 |
d |
r |
j. Small issues suddenly become big arguments. |
1 |
2 |
3 |
4 |
d |
r |
k. We are pretty good listeners, even when we have different positions on things. |
1 |
2 |
3 |
4 |
d |
r |
l. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] or I stay mad at one another after an argument. |
1 |
2 |
3 |
4 |
d |
r |
m. Even when arguing, we can keep a sense of humor. |
1 |
2 |
3 |
4 |
d |
r |
n. When we argue, one of us withdraws and refuses to talk about it anymore. |
1 |
2 |
3 |
4 |
d |
r |
o. When we argue I feel personally attacked. |
1 |
2 |
3 |
4 |
d |
r |
BSF
BSF
BSF
BSF
BSF
BSF
FAMLE
FAMLE
FAMLE
FAMLE
CATI/CAWI (C1=1 OR 2) OR (C3=1 OR 2) OR C10 = 1 |
|
PACT
C21. Since [RA DATE/FUP1 STATUS DATE], has [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] cheated on you with someone else? Would you say…
Definitely yes, 1
Maybe yes, 2
Maybe no, or 3
Definitely no? 4
DON’T KNOW d
REFUSED r
CATI/CAWI (C1=1 or 2) OR (C3=1 OR 2) OR C10 = 1 |
PACT
C22. Since [RA DATE/FUP1 STATUS DATE], have you cheated on [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] with someone else?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI Next I’m going to read a list of things that might have happened to you in the past year
CAWI. The following is a list of things that might have happened to you in the past year.
CATi/CAWI ALL |
C23. In the past year, did any romantic partner you’ve been involved with ever [FILL A-G]…
SHM
SHM
SHM
SHM
|
CODE ONE PER ROW |
||||
|
|
In the past year, did this happen… |
|
|
|
a. Try to keep you from seeing or talking with your friends? |
YES |
1 |
Once, |
1 |
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
b. Make you feel stupid? |
YES |
1 |
Once, |
1 |
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
SHM |
SHM |
SHM |
SHM |
SHM |
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
d. Make you feel afraid that they might hurt you?
|
YES |
1 |
Once, |
1 |
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
e. Push, shove, or slap you? |
YES |
1 |
Once, |
1 |
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
f. Punch or kick you or beat you up? |
YES |
1 |
Once, |
1 |
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
g. Use threats or force to make you have sex or do sexual things you didn’t want to do? |
YES
|
1 |
Once, |
1 |
|
|
|
Twice, |
2 |
|
|
|
|
3 to 5 times, |
3 |
|
|
|
|
6 to 10 times, |
4 |
|
|
|
|
11 to 20 times, or |
5 |
|
|
|
|
More than 20 times? |
6 |
|
|
|
NO |
0 |
|
|
|
|
DK |
d |
|
|
|
|
R |
r |
|
|
|
CTS2S
CTS2S
BSF
CATi/CAWI ALL where at least one item in C23 a-g=1 ONLY FILL ITEMS A-G WHERE CORRESPONDING ITEM IN C23=1 |
STREAMS
|
CODE ONE PER ROW
|
|||
|
YES |
NO |
DK |
R |
a. Tried to keep you from seeing or talking with your friends? |
1 |
0 |
D |
R |
b. Made you feel stupid? |
1 |
0 |
D |
R |
c. Kept money from you or took your money without asking? |
1 |
0 |
D |
R |
d. Made you feel afraid that they might hurt you?
|
1 |
0 |
D |
R |
e. Pushed, shoved, or slapped you? |
1 |
0 |
D |
R |
f. Punched or kicked you or beat you up? |
1 |
0 |
D |
R |
g. Used threats or force to make you have sex or do sexual things you didn’t want to do? |
1 |
0 |
D |
R |
CATI/CAWI ALL |
BSF
modified for STEAMS
YES 1 GO TO C26
NO 0 GO TO C27
DON’T KNOW d GO TO C27
REFUSED r GO TO C27
CATI/CAWI C25=1 |
PACT
C26. In the past year, did this happen…
Once, 1
Twice, 2
3 to 5 times, 3
6 to 10 times, 4
11 to 20 times, or 5
More than 20 times? 6
DON’T KNOW d
REFUSED r
CATI/CAWI ALL |
CTS2S
YES 1 GO TO C28
NO 0 GO TO C29
DON’T KNOW d GO TO C29
REFUSED r GO TO C29
CATI/CAWI C27=1 |
CTS2S
C28. In the past year, did you do this…
Once, 1
Twice, 2
3 to 5 times, 3
6 to 10 times, 4
11 to 20 times, or 5
More than 20 times? 6
DON’T KNOW d
REFUSED r
CATI/CAWI ALL |
CTS2S
YES 1 GO TO C30
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI C29=1 |
CTS2S
C30. In the past year, did you do this…
Once, 1
Twice, 2
3 to 5 times, 3
6 to 10 times, 4
11 to 20 times, or 5
More than 20 times? 6
DON’T KNOW d
REFUSED r
Programmer instruction: set qualified level to 4
IF FUP1 D1=M AND BL D22=1 (PREGNANT AT BASELINE), GO TO D1. IF FUP1 D1=M AND BL D22=0,D,R (NOT PREGNANT AT BASELINE) OR FUP1 D1 NE M, GO TO D5. |
CATI/CAWI IF BL D22=1 (pregnant at baseline) and FUP1 D1=M |
FILL [BL CHILD EXPECTED DATE] FROM BL D23 |
BSF
D1. CATI Now I have some questions about children you may have had since [RA DATE]. Our records indicate that you were expecting a baby around [BL CHILD EXPECTED DATE].
CAWI The next questions are about children you may have had since [RA DATE]. Our records indicate that you were expecting a baby around [BL CHILD EXPECTED DATE].
CATI/CAWI
Did you have a baby around that time?
CATI INSTRUCTION: IF RESPONDENT REPORTS DATE OF BIRTH, ANSWER “YES” AND ENTER DATE OF BIRTH ON NEXT SCREEN.
CATI INSTRUCTION: IF RESPONDENT REPORTS MULTIPLE BIRTHS, ENTER “YES.” YOU WILL ENTER NUMBER OF BABIES ON ANOTHER SCREEN.
CATI IF RESPONDENT ANSWERS NO, PROBE: I’m sorry. What happened?
YES 1
CATI YES, BUT BABY DIED 2 GO TO D11
CAWI YES, BUT BABY PASSED AWAY 2 GO TO D11
NO, MISCARRIAGE 3 GO TO D11
NO, ABORTION 4 GO TO D11
CATI NO, BABY DIED 5 GO TO D11
CAWI NO, BABY PASSED AWAY
NO, WAS NOT EXPECTING BABY AT BASELINE 6 GO TO D11
DON’T KNOW d GO TO D11
REFUSED r GO TO D11
CATI IF D1=2 or 5 SAY: I’m very sorry to hear that. Our condolences for your loss.
CATI/CAWI D1=1 |
BSF
modified for STREAMS
INSTRUCTION: ENTER RESPONSE WITHOUT ASKING IF KNOWN.
| | | / | | | / | | | | | BIRTHDATE
CATI BABY DIED 6 GO TO D11
CAWI BABY PASSED AWAY 6 GO TO D11
DON’T KNOW d
REFUSED r
CATI IF D1a=0 SAY: I’m very sorry to hear that. Our condolences for your loss.
DATE CHECK: DATE CANNOT BE BEFORE 1/1/2016 OR A DATE BEYOND INTERVIEW DATE
CATI/CAWI D1 = 1 |
BSF modified for STREAMS
D2. CATI ENTER WITHOUT ASKING IF KNOWN: OTHERWISE PROBE:
How many babies did you have on [BIRTHDATE]?
CATI INTERVIEWER INSTRUCTION: ENTER THE NUMBER OF BABIES BORN
CATI INTERVIEWER INSTRUCTION: IF D2=0 (BABY DIED), SAY: I am sorry for your loss.
| | | NUMBER OF BABIES BORN GO TO D3
(1-99)
BABY DIED 0 GO TO D11
CATI/CAWI D1=1 |
If D2>1, fill Thinking of the youngest baby you had on [BIRTHDATE], |
BSF
modified for STREAMS
CAWI If you do not feel comfortable providing your current baby’s name then you can write his or her initials. We are asking for this information so that the next questions can refer to your baby.
CATI INSTRUCTION: IF RESPONDENT DOES NOT GIVE FULL NAME PROBE FOR A NAME OR INITIALS
(STRING 25)
FIRST NAME
DON’T KNOW d
REFUSED r
CATI/CAWI D1=1 |
Fill [CHILD NAME] from D3 |
PACT
BOY 1
GIRL 2
DON’T KNOW d
REFUSED r
IF D3 = BLANK AND BL D8 = 4 THEN SKIP TO D11 |
CATI/CAWI D1=1 OR FUP1 D1=1 |
IF FUP1 D1 NE M AND BL D22=1 (Completed D1 at follow-up and was pregnant at baseline), Fill [FUP1 CHILD NAME] from FUP1 D3 IF FUP1 D1=M AND BL D22=1 (Didn’t complete FUP1, was pregnant at BL), FILL [FUP2 CHILD NAME] from D3
IF FUP1 D1 NE M AND BL D22=0,D,R (Completed D1 at follow-up and was not pregnant at baseline), Fill [BL CHILD NAME] from BL D8 IF FUP1 D1=M AND BL D22=0,D,R (Didn’t complete FUP1, was not pregnant at BL), Fill [BL CHILD NAME] from BL D8
|
IF FUP1 D1A NE M, FILL BIRTHDATE FROM FUP1 D1A, ELSE FILL FROM D1A |
FaMLE
CAWI [The next questions are about your child, [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME], who was born on [BIRTHDATE].] Does [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] live with you all of the time, most of the time, some of the time, or none of the time?
ALL OF THE TIME 1 GO TO D6
MOST OF THE TIME 2 GO TO D6
SOME OF THE TIME 3 GO TO D6
NONE OF THE TIME 4 GO TO D5a
DON’T KNOW d GO TO D6
REFUSED r GO TO D6
BABY DIED 0 GO TO D11
CATI/CAWI D5=4 |
STREAMS
YES 1 GO TO D6
NO 0 GO TO D8
DON’T KNOW d GO TO D7
REFUSED r GO TO D7
CATI/CAWI D1=1 OR FUP1 D1=1 |
BSF
|
CODE ONE PER ROW |
|||||||
In the past month, how often have you [STATEMENT a to d]? Was it more than once a day, about once a day, a few times a week, a few times a month, rarely, or not at all? |
MORE THAN ONCE A DAY |
ABOUT ONCE A DAY |
A FEW TIMES A WEEK |
A FEW TIMES A MONTH |
RARELY |
NOT AT ALL |
DK |
REF |
a. Sung songs with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
b. Read or looked at books with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
c. Played with games or toys with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
d. Played outside in the yard, a park, or a playground with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
CATI/CAWI D1=1 OR FUP1 D1=1 |
BSF
In the past month, how often would you say that [STATEMENT a to c]? Is that often, sometimes, rarely, or never?
|
CODE ONE PER ROW |
|||||
|
OFTEN |
SOMETIMES |
RARELY |
NEVER |
DK |
REF |
a. [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] and you had warm close times together |
1 |
2 |
3 |
4 |
d |
r |
b. You felt that [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] liked you and wanted to be near you |
1 |
2 |
3 |
4 |
d |
r |
c. When you were in a bad mood, you still showed [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] love |
1 |
2 |
3 |
4 |
d |
r |
CATI/CAWI D1=1 OR FUP1 D1=1 |
BSF
Excellent, 1
Very good, 2
Good, 3
Fair, or 4
Poor? 5
DK d
REF r
CATI/CAWI D1=1 OR FUP1 D1=1 |
BSF
YES 1
NO 0
DK d
REF r
CATI/CAWI D1=1 OR FUP1 D1=1 |
BITSEA
For each statement, please mark the answer that best describes your child in the past month.
How well does this describe [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] in the past month?
|
CODE ONE PER ROW |
||
|
NOT TRUE/ RARELY |
SOMEWHAT TRUE/ SOMETIMES |
VERY TRUE/ OFTEN |
a. Shows pleasure when she/he succeeds (for example, claps for self) |
1 |
2 |
3 |
b. Gets hurt so often that you can’t take your eyes off him/her |
1 |
2 |
3 |
c. Seems nervous, tense, or fearful |
1 |
2 |
3 |
d. Is restless and can’t sit still |
1 |
2 |
3 |
e. Follows rules |
1 |
2 |
3 |
f. Wakes up during naptime and needs help to fall asleep again |
1 |
2 |
3 |
g. Cries or tantrums until she/he is exhausted |
1 |
2 |
3 |
h. Is afraid of certain places, animals, or things |
1 |
2 |
3 |
i. Has less fun than other children |
1 |
2 |
3 |
j. Looks for you (or other parent) when upset |
1 |
2 |
3 |
k. Cries or hangs onto you when you try to leave |
1 |
2 |
3 |
l. Worries a lot or is very serious |
1 |
2 |
3 |
m. Looks right at you when you say his/her name |
1 |
2 |
3 |
n. Does not react when hurt |
1 |
2 |
3 |
o. Is affectionate with loved ones |
1 |
2 |
3 |
p. Won’t touch some objects because of how they feel |
1 |
2 |
3 |
q. Has trouble falling asleep or staying asleep |
1 |
2 |
3 |
r. Runs away in public places |
1 |
2 |
3 |
s. Plays well with other children (not including brother/sister) |
1 |
2 |
3 |
t. Can pay attention for a long time (not including TV) |
1 |
2 |
3 |
u. Has trouble adjusting to changes |
1 |
2 |
3 |
v. Tries to help when someone is hurt (for example, gives a toy). |
1 |
2 |
3 |
w. Often gets very upset |
1 |
2 |
3 |
x. Gags or chokes on food |
1 |
2 |
3 |
y. Imitates playful sounds when you ask him/her to (such as animal sounds) |
1 |
2 |
3 |
z. Refuses to eat |
1 |
2 |
3 |
aa. Hits, shoves, kicks, or bites children (not including brother/sister) |
1 |
2 |
3 |
bb. Is destructive (breaks or ruins things on purpose) |
1 |
2 |
3 |
cc. Points to show you something far away |
1 |
2 |
3 |
dd. Hits, bites, or kicks you (or other parent) |
1 |
2 |
3 |
ee. Hugs or feeds dolls or stuffed animals |
1 |
2 |
3 |
ff. Seems very unhappy, sad, depressed, or withdrawn |
1 |
2 |
3 |
gg. Purposely tries to hurt you (or other parent) |
1 |
2 |
3 |
hh. When upset, gets very still, freezes, or doesn’t move |
1 |
2 |
3 |
CATI/CAWI D1=1 OR FUP1 D1=1 |
BITSEA
For each statement, please mark the answer that best describes [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] in the past month.
|
CODE ONE PER ROW |
||
|
NOT TRUE/ RARELY |
SOMEWHAT TRUE/ SOMETIMES |
VERY TRUE/ OFTEN |
a. Puts things in a special order, over and over |
1 |
2 |
3 |
b. Repeats the same action or phrase, over and over |
1 |
2 |
3 |
c. Repeats a particular movement, over and over (like rocking, spinning, etc.) |
1 |
2 |
3 |
d. “Spaces out” (is totally unaware of what’s happening around him/her) |
1 |
2 |
3 |
e. Does not make eye contact |
1 |
2 |
3 |
f. Avoids physical contact |
1 |
2 |
3 |
g. Eats or drinks things that are not edible, like paper or paint |
1 |
2 |
3 |
h. Hurts him/herself on purpose (for example, bangs his/her head) |
1 |
2 |
3 |
CATI/CAWI
IF [FUP1 D6=M AND [BL D24=1 OR BL D16=1 OR [BL D16=0 AND BL D18=NAME GIVEN]]] OR [FUP1 D6=1] OR [FUP1 D6 NE 1 AND FUP1 D6A=NAME GIVEN] OR [IF FUP1 D6=1 AND [[BL D22=1 AND BL D24=1] OR [BL D22=0,D,R AND BL D16=1]]
|
IF FUP1 COMPLETE: IF [BL D22=1 AND BL D24=1] OR [BL D22=0,D,R AND BL D16=1] AND FUP1 D6=1, FILL [BL PARTNER NAME]
IF [BL D22=1 AND BL D24 = NOT ASKED, 2, D, OR R AND FUP1 D1=1] OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing] OR [BL D22=0, D or R AND FUP1 D6=0, D or R] OR [BL D22=1 AND FUP1 D6=0, D or R] AND FUP D6A=NAME GIVEN, FILL [FUP CHILD_PARENT]
IF BL ONLY COMPLETE: IF [BL D22=1 AND BL D24=1] OR IF [BL D22=0,D,R AND BL D16=1], FILL [BL PARTNER NAME] IF BL_D18_1=NAME GIVEN, FILL [BL_CHILD_PARENT] |
STREAMS
YES 1 GO TO D13
NO, DIFFERENT FATHER 0 GO TO D11a
DON’T KNOW d GO TO D11a
REFUSED r GO TO D11a
CATI/CAWI IF D11 NE 1 OR [C10=1 OR C10a=1] |
IF C10=1, FILL [FUP1 PARTNER] FROM FUP1 C11, IF FUP1 C11=M, FILL “THE PARTNER YOU TOLD US ABOUT ON [FUP1 STATUS DATE]”
IF C10A=1, FILL [NEW PARTNER] FROM C11, IF C11=M, FILL “YOUR NEW PARTNER” |
STREAMS
YES 1 GO TO D13
NO, DIFFERENT FATHER 0 GO TO D12
DON’T KNOW d GO TO D12
REFUSED r GO TO D12
CATI/CAWI IF FUP1 D6a=M AND [ [BL D22=1 AND BL D24 = 2, D, OR R AND D1=1] OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing] OR [BL D22=0, D or R AND D6=0, D or R] OR [BL D22=1 AND D6=0, D or R]] SKIP IF BL D22=0,d,r and BL D16 NE 1 AND BL D18 (BL_CHILDPARENTNAME IS DECEASED) |
Fill [FUP CHILD NAME] from D3 IF BL D22=0,D,R Fill [BL CHILD NAME] from BL D8 |
STREAMS
CAWI The next questions are about [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] ’s biological father. So I can ask a few questions about him, what is [[BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME]’s father’s name?
(STRING 25)
FATHER NAME
FATHER DECEASED 0 GO TO D17
DON’T KNOW d
REFUSED r
CATI ONLY IF D12=0 SAY: I’m very sorry to hear that. Our condolences for your loss.
CATI/CAWI FUP1 D1=1 OR FUP2 D1=1 OR BL D22=0,D,R SKIP IF D12=0, DK OR R SKIP IF BL D22=0,d,r and BL D16 NE 1 AND BL D18 (BL_CHILDPARENTNAME IS DECEASED) |
If [BL D22=1 AND BL D24 = 1 AND D6 = 1] OR [OR [BL D22=0,D,R AND BL D16=1 AND FUP1D6=1], fill [FATHER NAME] with [BL PARTNER]
IF [BL D22=1 AND BL D24 = 2, D, OR R] OR FUP1D6=0 OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing], FILL [FATHER NAME] from FUP1D6a (FUP1 CHILD PARENT NAME)
If [BL D22=1 AND BL D24 = 1 AND D6 = 1] OR [OR [BL D22=0,D,R AND BL D16=1 AND D6=1], fill [FATHER NAME] with [BL PARTNER]
IF [BL D22=1 AND BL D24 = 2, D, OR R] OR D6=0 OR [BL D22=0,d,r and BL D16 NE 1 AND BL D18=d,r or missing], FILL [FATHER NAME] from D12
If BL D22=0,D,R AND BL D16=0 then fill [FATHER NAME] with [BL_CHILDPARENTNAME] |
FaMLE
All of the time, 1
Most of the time, 2
Some of the time, or 3
None of the time? 4
DON’T KNOW d
REFUSED r
CATI/CAWI SKIP IF [D12=0, DK, R or M] AND [D1a NE 6] AND [D2 NE 0] AND [D1 NE 2,3,4,5,6,d,r,M] SKIP IF BL D22=0,d,r and BL D16 NE 1 AND BL D18 (BL_CHILDPARENTNAME IS DECEASED) |
BSF
Every day or almost every day, 1 GO TO D14b
A few times a week, 2 GO TO D14b
A few times in the past month, 3 GO TO D14b
Once or twice, or 4 GO TO D14b
Never? 5 GO TO D14a
DON’T KNOW d GO TO D14b
REFUSED r GO TO D14b
CATI/CAWI If D14=5 |
STREAMS
Yes 1 GO TO D14b
No 0 GO TO D15
CATI/CAWI If D14a NE 0 |
BSF
|
CODE ONE PER ROW |
|||||||
In the past month, how often have you [STATEMENT a to g]? Was it more than once a day, about once a day, a few times a week, a few times a month, rarely, or not at all? |
MORE THAN ONCE A DAY |
ABOUT ONCE A DAY |
A FEW TIMES A WEEK |
A FEW TIMES A MONTH |
RARELY |
NOT AT ALL |
DK |
REF |
a. played a game like “peek-a-boo” or “gotcha” with [CHILD] |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
b. sung songs with [CHILD] |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
c. read or looked at books with [CHILD] |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
d. played with games or toys with [CHILD] |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
e. helped [CHILD] to get dressed |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
f. Changed [CHILD]’s diapers or helped [him/her] use the toilet. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
g. Given [CHILD] a bottle or something to eat. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
CATI/CAWI SKIP IF [D12=0, DK, R or M] AND [D1a NE 6] AND [D2 NE 0] AND [D1 NE 2,3,4,5,6,d,r,M] SKIP IF BL D22=0,d,r and BL D16 NE 1 AND BL D18 (BL_CHILDPARENTNAME IS DECEASED) |
If FUP1D4 OR D4 = 1, fill his If FUP1D4 OR D4 = 2, fill her IF BL D22=1 and D4 = 1, fill his IF BL D22=1 and D4 = 2, fill her IF BL D22=0,d,r and BL D10 = 1, fill his IF BL D22=0,d,r and BL D10 = 1, fill his IF BL D22=1 Fill [FUP CHILD NAME] from D3 IF BL D22=0,D,R Fill [BL CHILD NAME] from BL D8 |
BSF
CAWI The next questions are about all the expenses associated with raising [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] ] such as [his/her] food, clothing, medical expenses, diapers, and any other costs of raising [him/her]. How much of the cost of raising [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] does [BL PARTNER]/[FATHER NAME]/[BL_CHILDPARENTNAME] cover? Would you say it’s…
All or almost all, 1
More than half, 2
About half, 3
Less than half, or 4
Little or none? 5
DON’T KNOW d
REFUSED r
CAti/cawi SKIP IF D12=0, DK OR R OR Not answered |
PAM
CAWI [The next questions are about parenting.] The following statements are about [BL PARTNER]/[FATHER NAME]/[BL_CHILDPARENTNAME]’s and your involvement in the care of your child/children. For each statement, please answer if overall you strongly agree, agree, disagree, or strongly disagree. In your answers, you should include all children that you have in common.
INTERVIEWER INSTRUCTION: IF CHILD OR PARENT IS DECEASED, GO TO D11
|
|
|||||
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DK |
R |
a. I believe [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME] is a good parent. |
1 |
2 |
3 |
4 |
d |
r |
b. [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME] and I communicate well about our children/child. |
1 |
2 |
3 |
4 |
d |
r |
c. I feel good about [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME]’s judgment about what is right for our children/child. |
1 |
2 |
3 |
4 |
d |
r |
d. [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME] makes my job of being a parent easier. |
1 |
2 |
3 |
4 |
d |
r |
e. [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME] and I are a good team. |
1 |
2 |
3 |
4 |
d |
r |
f. [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME] knows how to handle children well. |
1 |
2 |
3 |
4 |
d |
r |
g. When there is a problem with our children/child, we work out a good solution together. |
1 |
2 |
3 |
4 |
d |
r |
h. [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME] is willing to make personal sacrifices to help take care of our children/child. |
1 |
2 |
3 |
4 |
d |
r |
i. Talking to [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME] about our children/child is something I look forward to. |
1 |
2 |
3 |
4 |
d |
r |
j. [BL PARTNER/FATHER NAME/BL_CHILDPARENTNAME] pays a great deal of attention to our children/child. |
1 |
2 |
3 |
4 |
d |
r |
ALL |
If BL D22=0,d,r, fill After If FUP1D1 OR D1 NE 6, DK or R, fill again
FOR INTRO 2 OR 3 If BL A1c=2 , fill been
|
PPA
CAWI The next questions are about other pregnancies. [Besides/After] your pregnancy with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME], to the best of your knowledge, since [RA DATE], have you been pregnant [again], even if no child was born?
YES 1
NO 0 GO TO D21
DON’T KNOW d
REFUSED r
CATI/CAWI D17=1 |
If BL A1c=2 , fill been
|
D18. Since [RA DATE], how many times have you [been] pregnant?
PPA
| | | TIMES
(1-99)
DON’T KNOW d
REFUSED r
D17=1 |
IF D18 > 1 fill Let’s talk about the most recent pregnancy/For this question, think about the most recent pregnancy. |
PACT
CAWI [For this question, think about the most recent pregnancy.] Right before the pregnancy, did you want to have a baby? Would you say…
Definitely yes, 1
Probably yes, 2
Probably no, or 3
Definitely no? 4
DON’T KNOW d
REFUSED r
CATI/CAWI d17=1 AND D19 NE 4 |
PACT
SOONER 1
ABOUT RIGHT TIME 2
LATER 3
DIDN’T CARE 4
DIDN’T WANT TO HAVE A(NOTHER) BABY 5
DON’T KNOW d
REFUSED r
CATI/CAWI ALL |
STREAMS
YES 1 GO TO E1
NO 0
DK d
REF r
CATI/CAWI D21 NE 1 |
STREAMS
YES 1
NO 0 GO TO E1
DK d GO TO E1
REF r GO TO E1
CATI/CAWI D22=1 |
STREAMS
YES 1 GO TO E1
NO 0
DK d
REF r
CATI/CAWI D23=0 |
STREAMS
IUD: FOR EXAMPLE, PARAGARD, MIRENA, KYLEENA, LILETTA, AND SKYLA 1
IMPLANT: FOR EXAMPLE, NEXPLANON OR IMPLANON 2
THE SHOT: FOR EXAMPLE, DEPO-PROVERA 3
VAGINAL RING: NUVARING 4
THE PATCH 5
BIRTH CONTROL PILLS 6
CONDOM 7
WITHDRAWAL 8
BREASTFEEDING 9
FERTILITY AWARENESS/NATURAL FAMILY PLANNING/RHYTHM METHOD/CALENDAR METHOD, ETC 10
SPONGE 11
DIAPHRAGM 12
TUBES TIED 13
VASECTOMY 14
CERVICAL CAP 15
SPERMICIDE 16
NO BIRTH CONTROL 17
OTHER (SPECIFY) 99
(STRING 50)
DON’T KNOW d
REFUSED r
|
E.
Employment and Finances
CATi/CAWI ALL |
CSPED
E1. Are you currently working for pay?
Working for pay can include regular paid jobs, odd jobs, temporary jobs, work done in your own business, “under the table” work, “informal” work, or any other types of work you have done for pay.
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI ALL |
FaMLE
In the past month, have you or anyone in your household received any income from [fill statements a-c]?
|
CODE ONE RESPONSE PER ROW |
|||
|
YES |
NO |
DK |
REF |
a. Temporary Assistance for Needy Families, or TANF |
1 |
0 |
d |
r |
b. food stamps or SNAP |
1 |
0 |
d |
r |
c. Women, Infants, and Children, or WIC |
1 |
0 |
d |
r |
CATI/CAWI ALL |
CSPED
E3. Since [RA MONTH YEAR], did you do any of the following because you didn’t have enough money?
CODE ONE RESPONSE PER ROW
|
YES |
NO |
D |
R |
a. Cut the size of your meals or skip meals because you couldn’t afford enough food? |
1 |
0 |
d |
R |
b. Move in with other people, even for a little while, because of financial problems? |
1 |
0 |
d |
R |
c. Sold or pawned your belongings, or taken a payday loan or auto-title loan? |
1 |
0 |
d |
R |
d. Thought about going to the doctor, dentist or hospital, but decided not to because of the cost? |
1 |
0 |
d |
R |
F.
Well Being
CATI/CAWI These next questions are about how you.
CATI/CAWI ALL |
F1. In general, how would you describe your health? Would you say it is…
FaMLE
Excellent, 1
Very good, 2
Good, 3
Fair, or 4
Poor? 5
DON’T KNOW d
REFUSED r
CATI/CAWI ALL |
BSF
During the past month, how often have you…
[STATEMENT a to d] Was it all of the time, most of the time, some of the time, or none of the time? |
CODE ONE RESPONSE PER ROW |
|||||
|
ALL OF THE TIME |
MOST OF THE TIME |
SOME OF THE TIME |
NONE OF THE TIME |
DK |
REF |
a. Felt your (child/children) [is/are] much harder to care for than most? |
1 |
2 |
3 |
4 |
d |
r |
b. Felt your (child does/children do) things that really bother you? |
1 |
2 |
3 |
4 |
d |
r |
c. Felt you are giving up more of your life to meet your (child’s/children’s) needs than you ever expected? |
1 |
2 |
3 |
4 |
d |
r |
d. Felt angry with your (child/children)? |
1 |
2 |
3 |
4 |
d |
r |
CATI/CAWI all |
PHQ-8
F3. Over the last two weeks, how often have you been bothered by any of the following problems?
[PROGRAMMER: FILL a-h]
Would you say that the problem happened not at all, several days, more than half the days, or nearly every day in the last two weeks?
CATI INTERVIEWER INSTRUCTION: IF NEEDED READ RESPONSE CATEGORIES FOR B-H
|
CODE ONE RESPONSE PER ROW |
|||||
|
NOT AT ALL |
SEVERAL DAYS |
MORE THAN HALF THE DAYS |
NEARLY EVERY DAY |
DK |
REF |
a. Little interest or pleasure in doing things. |
0 |
1 |
2 |
3 |
d |
r |
b. Feeling down, depressed, or hopeless. |
0 |
1 |
2 |
3 |
d |
r |
c. Trouble falling or staying asleep, or sleeping too much. |
0 |
1 |
2 |
3 |
d |
r |
d. Feeling tired or having little energy. |
0 |
1 |
2 |
3 |
d |
r |
e. Poor appetite or overeating. |
0 |
1 |
2 |
3 |
d |
r |
f. Feeling bad about yourself—or that you are a failure or have let yourself or your family down. |
0 |
1 |
2 |
3 |
d |
r |
g. Trouble concentrating on things, such as reading or watching television. |
0 |
1 |
2 |
3 |
d |
r |
h. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual? |
0 |
1 |
2 |
3 |
d |
r |
CATI/CAWI all |
BSF
Modified for STREAMS
By a “drink” we mean either a bottle of beer, a wine cooler, a glass of wine, a shot of liquor, or a mixed drink
| | | NUMBER OF DRINKS
(0-99)
DON’T KNOW d
REFUSED r
END OF CALL
interview completed |
PACT
END. Thank you very much for your time. Those are all the questions we have right now. You will receive a $50 gift card as a token of our appreciation. Thank you for your participation in the STREAMS study.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | STREAMS CATI BILINGUAL |
Subject | CATI |
Author | MATHEMATICA STAFF |
File Modified | 0000-00-00 |
File Created | 2021-01-14 |