Second follow-up survey for adults (Instrument 13)

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

RESPONSE CATEGORIES A-M are to be used in CATI and CAWI

	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

B3. Do you strongly agree, agree, disagree, or strongly disagree with the following statements. [FILL a-b] Do you strongly agree, agree, disagree, or strongly disagree.

	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

B4. CATI: The following questions are about how you might deal with different situations. For each situation, tell me 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?

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

C1. When you completed your last survey around [FILL BL MONTH/YEAR/FILL FUP1 MONTH/YEAR], you told us you were [engaged to/married to/in a romantic relationship with/not in a romantic relationship with] [BL PARTNER].

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

C3. Which of the following best describes your relationship with [BL PARTNER]?

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

C5k. What were those other reasons?

____________________________ 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

C9. Since [RA DATE], how many romantic partners have you been involved with?

[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

C9a. During your last survey, you reported that [BL CHILD PARENT/FUP CHILD PARENT] was the biological father of [BL CHILD NAME/FUP1 CHILD NAME].

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

C10. On [FUP1 STATUS DATE], you reported that you were in a romantic relationship with [FUP1 PARTNER/a different partner].

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

C11. Just to be able to refer to [him/her] by name in this interview, what is your current partner’s first name?

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

C11a. Is [NEW PARTNER] a man or a woman?

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

C12. Are you and [NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] currently…

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

C13. When [did you/are you planning to] get married?

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

RESPONSE CATEGORIES a-l are to be used in CATI and CAWI

	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

C20. CATI Now I am going to read you some statements about things you and [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] may experience when you are together. Tell me 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?

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 e. [BL PARTNER/NEW PARTNER/FUP1 PARTNER/BL CHILD PARENT/FUP CHILD PARENT] seems to view my words or actions more negatively than I mean them to be.	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

[IF C23a – f=1] ASK: In the past year, did this happen once, twice, 3 to 5 times, 6 to 10 times, 11 to 20 times, or more than 20 times?

	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

C24. In the past year, have you ever sought professional help when your partner [FILL ITEMS A-G]…

	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

C25. In the past year, did you need to see a doctor because you were physically hurt in a fight with a romantic partner? Please include times when you needed to see a doctor, even if you didn’t go.

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

C27. In the past year, have you pushed, shoved, or slapped a romantic partner?

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

C29. In the past year, have you punched, kicked, or beat up a romantic partner?

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

D1a. For the baby you were expecting on [BL CHILD EXPECTED DATE], what date was the baby born?

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

D3. [Thinking of the youngest baby you had on [BIRTHDATE],] What is the baby’s first name?

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

D4. Is [FUP2 CHILD NAME] a boy or a girl?

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

D5. CATI [Now I’d like to ask you some questions 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?

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

D5a. Have you had in-person contact with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] in the past month.

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

D6. The next questions are about things you may have done with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] in the past month.

	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

D7. The next questions are about times you have spent with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] in the past month.

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

D8. In general, would you say [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME]’s health is...

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

D9. In the past month did [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] have a cold, flu or fever that limited [his/her] ability to participate in [his/her] usual activities?

YES 1

NO 0

DK d

REF r

CATI/CAWI

D1=1 OR FUP1 D1=1

BITSEA

D10. The first set of questions contains statements about 1- to 3-year-old children. Many statements describe normal feelings and behaviors, but some describe things that can be problems. Some may seem too young or too old for your child. Please do your best to answer every question.

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

D10a. The following questions are about feelings and behaviors that can be problems for young children. Some of the questions may be a bit hard to understand, especially if you have not seen them in a child. Please do your best to answer them anyway.

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

D11. When you completed your last survey, you told us that [BL PARTNER/FUP CHILD_PARENT/BL_CHILD_PARENT] was the biological father of [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] . Is that right?

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

D11a. Is [FUP1 PARTNER/NEW PARTNER] the biological father of [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME]?

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

D12. CATI I’d now like to ask some questions 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?

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

D13. Does [FATHER NAME] live in the same household with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME] …

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

D14. In the past month, how often has [FATHER NAME] spent one or more hours a day with [BL CHILD NAME/FUP1 CHILD NAME/FUP2 CHILD NAME]? Was it…

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

D14a. Has [FATHER NAME] seen [CHILD] in the past month?

Yes 1 GO TO D14b

No 0 GO TO D15

CATI/CAWI

If D14a NE 0

BSF

D14b. How many times in the past month would you say [FATHER NAME] has participated in the following activities?

	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

D15. CATI Now I’d like you to think 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 [FUP CHILD NAME]/[BL CHILD NAME] does [[BL PARTNER]/[FATHER NAME]/[BL_CHILDPARENTNAME] cover? Would you say it’s…

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

D16. CATI [Now I have some questions 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.

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

D17. CATI Now I have some questions about 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?

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

INTERVIEWER INSTRUCTION: COUNT THE BASELINE PREGNANCY

| | | 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

D19. CATI [Let’s talk about the most recent pregnancy.] Right before the pregnancy, did you want to have a baby? Would you say…

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

D20. Would you say this pregnancy came sooner than you wanted, at about the right time, or later than you wanted?

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

D21. Are you currently pregnant?

YES 1 GO TO E1

NO 0

DK d

REF r

CATI/CAWI

D21 NE 1

STREAMS

D22. Are you sexually active?

YES 1

NO 0 GO TO E1

DK d GO TO E1

REF r GO TO E1

CATI/CAWI

D22=1

STREAMS

D23. Are you currently trying to get pregnant?

YES 1 GO TO E1

NO 0

DK d

REF r

CATI/CAWI

D23=0

STREAMS

D24. What kind of birth control are you using?

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

E2. The next questions are about sources of income and other support that you and other members of your household may have received in the past month.

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

F2. Now, I am going to read you a list of ways you might have felt in the past month about being a parent.

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

F4. The next question is about drinking alcoholic beverages. In the past month, how many days have you had 4 or more drinks of alcohol in one day?

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