Youth participant questionnaire
Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US
AttachmentJ_VACS Youth Participant Questionnaire_EFtracked
Youth participant questionnaire
OMB: 0920-1356
Attachment
J: VACS Youth Participant Questionnaire
Form Approved
OMB
No: 0920-xxxx
Exp. Date: xx-xx-xxxx
Public Reporting burden of this collection of information is estimated at 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-xxxx).
CORE VIOLENCE AGAINST CHILDREN SURVEY
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HEAD OF HOUSEHOLD QUESTIONNAIRE COMPLETED FOR THIS HOUSEHOLD |
YES NO |
1 2 |
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Q1 |
RECORD THE TIME THE INTERVIEW BEGAN (00:00):
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Q2
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I would like to start by asking you questions about yourself:
How old are you? |
years old:
don’T know declined |
-98 -99 |
Q3
Q2A
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Q2A |
Would you say that you were:
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0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q3
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Are you Hispanic or Latino? |
YES, HISPANIC OR LATINO NO, NOT HISPANIC OR LATINO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q4
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What is your race?
(Choose all responses that apply) |
American indian or alaska native.................... asian....................................................................................... black or african american...................................... native hawaiian or other pacific islander... WHITE...................................................................................... don’t know......................................................................... declined............................................................................... |
1 2 3 4 5 -98 -99
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Q5
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Which of the following best represents how you think of yourself? Lesbian or gay? Straight, that is, not lesbian or gay? Bisexual? Or something else? |
gay (LESbian or gay)...................................................... straight, that is, not gay (or lesbian or gay)......................................................................................... bisexual............................................................................... something else................................................................ don’t know........................................................................ declined............................................................................... |
1 2 3 4 -97 -98 -99 |
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Q6
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What sex were you assigned at birth, on your original birth certificate? |
Male....................................................................................... Female................................................................................... don’t know........................................................................ declined...............................................................................
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1 2 -98 -99
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Q7 |
Do you currently describe yourself as male, female or transgender? |
Male........................................................................................ Female................................................................................... I AM TRANSGENDER AND IDENTIFY AS A BOY OR MAN.......................................................................................... I AM TRANSGENDER AND IDENTIFY AS A GIRL OR WOMAN................................................................................... I AM TRANSGENDER AND IDENTIFY IN SOME OTHER WAY........................................................................... NONE OF THESE.................................................................... DON’T KNOW......................................................................... DECLINED...............................................................................
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1 2
3
4
5 6 -98 -99 |
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Q8 |
Just to confirm, you were assigned [FILL TEXT] at birth and now you describe yourself as [FILL TEXT], is that correct? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q9 |
Are you deaf or do you have serious difficulty hearing?
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YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q10 |
Are you blind or do you have serious difficulty seeing, even when wearing glasses? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q11 |
Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q12 |
Do you have serious difficulty walking or climbing stairs? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q13 |
Do you have difficulty dressing or bathing? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q14 |
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping? (15 years old or older) |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q15
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Are you currently in school? |
YES NO don’t know DECLINED |
2 -98 -99 |
Q17
Q16 |
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Q16
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What is the highest grade or year of school you completed?
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Elementary (grades 1-8).............................................. some high school (Grades 9-11)................................ High school graduate (Grade 12 or ged)........... some college or technical school...................... college graduate (college 4 years or more)...................................................................................... DON’T KNOW......................................................................... DECLINED............................................................................... |
2 3 4
5 -98 -99 |
Q20 |
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Q17
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What is your current grade or level of school? |
6th grade or lower....................................................... 7th grade ............................................................ 8th grade ...................................................................... 9th grade ............................................................................. 10th grade ...................................................................... 11th grade........................................................................... 12th grade........................................................................... some college or technical school..................... college graduate (college 4 years or more)...................................................................................... DON’T KNOW ................................................................. DECLINED ............................................................................... |
1 2 3 4 5 6
8
9 -98 -99 |
Q20
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Q18 |
(For 12th grade and lower from Q17) When you were in {Q17-1 grade level} grade, how many times did you skip a full day of school (count only non-excused absences)? |
0 DAYS ....................................................... 1-5 DAYS ......................................................................... 6-10 DAYS ............................................................................ 10 OR MORE DAYS ....................................................... DON’T KNOW ......................................................................... DECLINED ............................................................................... |
0 1 2 3 -98 -99 |
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Q19
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During this school year, were you taught any of the the following in school:
A. How to manage anger B. How to avoid physical fights and violence C. How to avoid bullying D. How to avoid dating violence and sexual assault |
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Q20
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WORK: In the past 12 months, were you ever employed or working any job for which you were paid? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q21
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FRIENDSHIPS: For each of the following statements please tell me if this is true for you or not:
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Q22
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COMMUNITY CONNECTEDNESS: For each of the following statements please tell me if this is true for you or not:
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Q23
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For each of the following statements, please tell me if this is true for you or not.
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Q24 |
FAMILY: (For 13-17yo) What grown-ups live in your house?
(For 18-24yo) Before you turned 18, what adults lived in your house? (Choose all that apply)
(Choose all responses that apply) |
MOTHER FATHER STEPMOTHER/FATHERS GIRLFRIEND STEPFATHER/MOTHERS BOYFRIEND FOSTER mOTHER/female GUARDIAN FOSTER FATHER/male GUARDIAN GRANDMOTHER GRANDFATHER AUNT UNCLE OTHER RELATIVES OR FRIENDS YOUR boyfriend/girlfriend FAMILY OF YOUR BOYFRIEND/GIRLFRIEND dON’T KNOW DECLINED |
1 2 3 4 5 6 7 8 9 10 11 12 13 -98 -99 |
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Q25 |
ACES: (For 13-17) The next questions are about events that may have happened during your life. (use present tense)
(For 18-24) The next questions are about events that may have happened in your childhood, before you turned 18. Before you were 18 years old ---(use past tense in the below questions)
Did your mother, father, or guardian die?
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YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q26 |
Did one or both of your parents ever live in a different place than you for more than half a year?
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YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q27 |
Have you ever been in foster care?
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YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q28 |
How often does/did your family cut the size of meals or skip meals because there was not enough money for food?
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never rarely sometimes most of the time always don’t know declined |
1 2 3 4 5 -98 -99 |
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Q29 |
How often is/was there an adult living with you who tries/tried hard to make sure your basic needs are/were met, such as looking after your safety and making sure you had clean clothes and enough to eat?
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never rarely sometimes most of the time always don’t know declined |
1 2 3 4 5 -98 -99 |
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Q30 |
How often is/was there an adult living with you who makes/made you feel safe and protected?
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never rarely sometimes most of the time always don’t know declined |
1 2 3 4 5 -98 -99 |
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Q31 |
Have you ever lived/did you live with someone who was having a problem with alcohol or drug use?
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YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q32 |
Have you ever lived/did you live with someone who was depressed, mentally ill, or suicidal?
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YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q33 |
Have you ever been/were you ever separated from a parent or guardian because they went to jail, prison, or a detention center?
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YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q34 |
If your birth parents were married to each other at one point, did they ever separate or divorce?
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YES NO parents never married to each other don’t know DECLINED |
1 2 3 -98 -99 |
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Q35 |
How often have you felt/ did you feel that you were treated badly or unfairly because of your race or ethnicity?
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never rarely sometimes most of the time always don’t know declined |
1 2 3 4 5 -98 -99 |
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Q36 |
How often have you felt/did you feel that you were treated badly or unfairly because of your sexual orientation? |
never rarely sometimes most of the time always don’t know declined |
1 2 3 4 5 -98 -99 |
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Q37 |
How often have you felt/did you feel that you were treated unfairly by the police? |
never HAD CONTACT WITH THE POLICE nEVER TREATED UNFAIRLY BY THE POLICE rarely TREATED UNFAIRLY BY THE POLICE sometimes TREATED UNFAIRLY BY THE POLICE most of the time TREATED UNFAIRLY BY THE POLICE..................................................................................... always TREATED UNFAIRLY BY THE POLICE don’t know declined |
1 2 3 4
5 6 -98 -99 |
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Q38
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For 13-17 year olds dependents: use present tense For 18-24 year olds/13-17 year old non-dependents and if parents are deceased: use past tense
Thinking of the parent or guardian with whom you have the closest relationship, how easy or difficult is/was it to talk to that person about things that really bother you? Would you say very easy, easy, difficult, very difficult, or do not have/never had a relationship with your parents/guardians? |
VERY EASY EASY DIFFICULT VERY DIFFICULT nO RELATIONSHIP DON’T KNOW DECLINED |
1 2 3 4
-98 -99 |
Q41 |
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Q39
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For 13-17 year olds dependents: use present tense For 18-24 year olds/13-17 year old non-dependents and if parents are deceased: use past tense
Thinking of the parent or guardian with whom you have the closest relationship, how close do/did you feel to that person? Would you say very close, close, not close, or do not have/never had a relationship with your parents/guardians? |
VERY close close Not Close nO RELATIONSHIP DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q40
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For 13-17 year old dependents: use present tense For 18-24 year olds/13-17 year old non-dependents: use past tense
Thinking of the parent or guardian with whom you have the closest relationship, how much does/did this person really know about the following things – do/did they know a lot, a little, or nothing?
A. Who your friends are/were B. How you spend/spent your money C. Where you go/went after school D. Where you go/went at night E. What you do/did with your free time F. What you do/did on the internet |
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Q41
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For 13-17 year old dependents: use present tense For 18-24 year olds and 13-17 year old non-dependents: use past tense
Including your parents or guardians and any other family members, would you say that you have/had an adult family member who cares about you? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q42
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For 13-17 year old dependents: use present tense For 18-24 year olds and 13-17 year old non-dependents: use past tense
Including your parents or guardians and any other adult family members, would you say that you have/had an adult family member who is willing to help you make decisions? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
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Q43 |
MARRIAGE AND PARTNERSHIP: The next questions ask about marriage and dating partners. Dating partners are people you have been involved with romantically or sexually, which might include husbands, wives, boyfriends, girlfriends, people you have dated, people you were seeing, or people you hooked up with.
Have you ever had a dating partner?
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YES NO don’t know DECLINED |
1
-98 -99 |
Q48
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Q44
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Have you ever lived with a dating partner or been married? |
YES, ever lived with a partner YES, ever married NO, never married or lived with a partner DON’T KNOW DECLINED |
1
3 -98 -99 |
Q47 |
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Q45
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How old were you when you first started living with any dating partner or got married? |
YEARS OLD:
DON’T KNOW DECLINED |
-98 -99 |
Q46
Q45A |
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Q45A |
Would you say that you were:
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0-5 years old 6-11 years old 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q46
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How old was this dating partner when you first started living together or got married? Please give us your best guess. |
DON’T KNOW DECLINED |
-98 -99 |
Q47
Q46A
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Q46A |
Would you say this person was:
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YOUNGER……………………………………........................ ABOUT THE SAME AGE……………………....................... MORE THAN 5 YEARS OLDER……………........................ MORE THAN 10 YEARS OLDER………………………….. DON’T KNOW………………………………………………. DECLINED…………………………………………………... |
1 2 3 4 -98 -99 |
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Q47 |
What is your marital status now? Are you living with a dating partner, married, widowed, divorced, or separated? |
LIVING WITH a dating partner married widowed divorced separated DON’T KNOW DECLINED |
1 2 3 4 5 -98 -99 |
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Q48 |
GENDER ATTITUDES:
How strongly do you agree or disagree with the following statements?
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Q49
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ATTITUDES ABOUT CORPORAL PUNISHMENT:
Do you believe that in order to bring up a child properly, a parent or caregiver needs to physically punish the child, for example by spanking or hitting the child?
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YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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1
1
7
5
2
|
IF Q2=13-17, CONTINUE TO Q50 (DISCIPLINE) IF Q2=18-24, SKIP TO Q51 (SAFETY) |
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Q50
|
DISCIPLINE:
In the past 12 months, has a parent or adult caregiver punished or corrected you by:
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Q51
|
SAFETY: During the past 12 months, were there times you did not go to school or did not leave home because you felt it would be unsafe for any reason? |
YES........................................................................................................ No......................................................................................................... DON’T KNOW..................................................................................... DECLINED........................................................................................... |
1 2 -98 -99 |
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Q52 |
SURVIVORSHIP:
At any time in your life was anyone you felt close to murdered? |
YES........................................................................................................ No......................................................................................................... DON’T KNOW..................................................................................... DECLINED........................................................................................... |
1 2 -98 -99 |
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Q53 |
CARRYING WEAPONS:
Now I am going to ask questions about weapons. For these questions, please do not include times you carried a gun or knife only for hunting or for a sport, such as target shooting. Remember you can skip questions if you don’t want to answer
Have you ever carried a weapon such as a gun, knife, or club? |
YES........................................................................................................ No......................................................................................................... DON’T KNOW..................................................................................... DECLINED........................................................................................... |
2 -98 -99 |
Q54
Q62
|
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Q54 |
What type of weapon have you carried? (Select all that apply) |
GUN....................................................................................................... KNIFE...................................................................................................Club..................................................................................................... OTHER WEAPON................................................................................ DON’T KNOW..................................................................................... DECLINED........................................................................................... |
1 2 3 -97 -98 -99 |
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Q55 |
During the past 12 months, how often did you carry a weapon such as a gun, knife, or club? |
NEVER.................................................................................................. RARELY............................................................................................... SOMETIMES........................................................................................ MOST OF THE TIME ......................................................................... ALL OF THE TIME............................................................................. DON’T KNOW..................................................................................... DECLINED........................................................................................... |
1 2 3 4 5 -98 -99 |
Q62 |
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Q56 |
What is the main reason that you carried a weapon such as a gun, knife, or club, during the past 12 months? |
FOR PROTECTION AGAINST ATTACKS BY OTHER PEOPLE... BECAUSE MY FRIENDS CARRY WEAPONS................................ BECAUSE IT MAKES ME FEEL IMPORTANT............................... TO “SHOW OFF” AND IMPRESS MY FRIENDS............................ BECAUSE I WANTED TO HURT SOMEONE................................. OTHER................................................................................................. DON’T KNOW.................................................................................... DECLINED.......................................................................................... |
1 2 3 4 5 -97 -98 -99 |
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Q57 |
During the past 12 months, did you use a weapon to threaten or injure another person? |
YES....................................................................................................... NO......................................................................................................... DON’T KNOW..................................................................................... DECLINED........................................................................................... |
1 2 -98 -99 |
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Q58 |
During the past 12 months, how many times did you use a weapon to threaten or injure another person? |
0 TIMES................................................................................................ 1 TIME ............................................................................................... 2 – 4 TIMES ................ 5 OR MORE TIMES............................................................................ DON’T KNOW.................................................................................... DECLINED.......................................................................................... |
0 1 2 3 -98 -99 |
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Q59 |
GUNS:
Now I would like to specifically ask you about guns. For these questions, do not count any times when you may have carried a gun only for hunting or for a sport, such as target shooting.
During the past 12 months, how often did you carry a gun onto school property? |
NEVER................................................................................................. RARELY.............................................................................................. SOMETIMES....................................................................................... MOST OF THE TIME ......................................................................... ALL OF THE TIME.............................................................................. DON’T KNOW..................................................................................... DECLINED........................................................................................... |
2 3 4 5 -98 -99 |
Q62 |
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Q60 |
During the past 12 months, how often did you carry a gun in your neighborhood? |
NEVER................................................................................................. RARELY.............................................................................................. SOMETIMES....................................................................................... MOST OF THE TIME ......................................................................... ALL OF THE TIME.............................................................................. DON’T KNOW..................................................................................... DECLINED........................................................................................... |
2 3 4 5 -98 -99 |
Q62 |
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Q61 |
Where did you get the gun(s) that you carried during the past 12 months? SELECT ALL THAT APPLY
|
PARENT OR OTHER FAMILY MEMBER’S GUN TAKEN FROM HOME................................................................................................... I PURCHASED FROM A STORE THAT SELLS GUNS.................. ADULT PURCHASED FOR ME........................................................ PURCHASED “ON THE STREET”.................................................... BORROWED FROM A FRIEND OR SOMEONE I KNOW............. STOLEN............................................................................................... PURCHASED FROM A GUN SHOW................................................ DON’T KNOW..................................................................................... DECLINED........................................................................................... |
1 2 3 4 5 6 7 -98 -99 |
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Q62 |
(For 13-17) How long would it take you to get and be ready to fire a loaded gun without a parent’s or adult’s permission? This gun could be yours or someone else’s and it could be located anywhere.
(For 18-24) How long would it take you to get and be ready to fire a loaded gun? This gun could be yours or someone else’s and it could be located anywhere. |
I COULD NOT GET A LOADED GUN.............................................. LESS THAN 10 MINUTES.................................................................. 10 OR MORE MINUTES, BUT LESS THAN 1 HOUR..................... 1 OR MORE HOURS, BUT LESS THAN 4 HOURS......................... 4 HOURS OR MORE, BUT LESS THAN 24 HOURS....................... 24 HOURS OR MORE......................................................................... don’t know..................................................................................... declined........................................................................................... |
1 2 3 4 5 6 -98 -99 |
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Q63 |
Now I have a few questions about gangs.
Is there gang activity in your school? |
YES NO DON’T KNOW DECLINED............................................................................ |
1 2 -98 -99 |
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Q64 |
Is there gang activity in your neighborhood? |
YES NO DON’T KNOW DECLINED............................................................................ |
1 2 -98 -99 |
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if q63=2 and q64=2, skip to q67 (juvenile and peer delinquency) |
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Q65 |
During the past 12 months, how many times did you feel threatened as a result of gang activity? |
0 TIMES 1 TIME 2 – 4 TIMES 5 OR MORE TIMES DON’T KNOW DECLINED |
0 1 2 3 -98 -99 |
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Q66 |
During the past 12 months, have you ever been a member of a gang? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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1
1
1
Q67 |
JUVENILE AND PEER DELINQUENCY
(For 13-17) The next questions are about events that may have happened during your life. Did you ever:
(For 18-24) The next questions are about events that may have happened in your childhood, before you turned 18. Thinking back before you were 18 years old, did you ever:
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Q68 |
(For 13-17) The next questions are about your friends. Please think of your closest friends
(For 18-24) The next questions are about your friends growing up before you turned 18. Now, thinking back before you were 18 years old …
Did your closest friends ever:
IF PARTICIPANT SAYS THEY DID NOT HAVE ANY FRIENDS THEN SELECT OPTION AA/NO FRIENDS |
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Q100
|
PV: PHYSICAL VIOLENCE
PV1: INTIMATE PARTNER VIOLENCE
The next questions ask about experiences you may have had in your life with your dating or sexual partners. When we ask about your dating or sexual partners, please think about people you have been involved with romantically or sexually, which might include boyfriends, girlfriends, people you have dated, people you were seeing, people you hooked up with, or your husband or wife. Remember, you can skip any question you do not want to answer.
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IF Q100A =1 OR Q100B=1 OR Q100C=1 OR Q100D=1, GO TO Q101 if Q100a=2/-98/-99 and Q100b=2/-98/-99 and Q100c=2/-98/-99 and Q100D=2/-98/-99, GO TO Q110 (Peers) |
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Q101
|
PV1: Has your current or ex dating or sexual partner injured you in any of these ways more than once? |
YES NO ................................................................ Don’t know declined |
2 -98 -99 |
Q106 |
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Q102 |
PV1: MOST RECENT TIME
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED .................................................. |
1 2 -98 -99 |
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Q103 |
How old were you the last time this happened? |
DON’T KNOW DECLINED |
-98 -99 |
Q104
Q103A |
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Q103A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q104
|
Was this current or ex-partner someone you were married to or living with at the time? |
YES.................................................................. NO.................................................................... Don’t KNow................................................ Declined...................................................... |
1 2 3 -98 -99 |
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Q104A |
Were you married or living with this current or ex-partner at the time? |
MARRIED....................................................... LIVING WITH................................................ DON’t KNOW................................................ Declined...................................................... |
1 2 -98 -99 |
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Q105
|
How old was this current or ex-partner? Please give your best guess. |
YEARS OLD:
don’t know DECLINED |
-98
|
Q106
Q105A |
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Q105A |
Would you say this person was:
|
YOUNGER ABOUT THE SAME AGE MORE THAN 5 YEARS OLDER MORE THAN 10 YEARS OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q106 |
PV1: FIRST TIME
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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IF Q101=1, CONTINUE WITH Q107 AS WRITTEN IF Q101=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED” FOR Q107 |
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Q107
|
How old were you the first time this happened?
|
YEARS OLD:
DON’T KNOW DECLINED |
-98 -99 |
Q108
Q107A |
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Q107A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q108 |
Was this current or ex-partner someone you were married to or living with at the time? |
YES, MARRIED.............................................. YES, LIVING WITH....................................... NO.................................................................... Don’t KNow................................................ Declined...................................................... |
1 2 3 -98 -99 |
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Q109
|
How old was your partner at that time? Please give your best guess. |
YEARS OLD:
don’t know DECLINED |
-98 -99 |
Q110
q109a |
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Q109A |
Would you say this person was:
|
YOUNGER ABOUT THE SAME AGE MORE THAN 5 YEARS OLDER MORE THAN 10 YEARS OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q110
|
Has a current or ex-partner ever hurt you so that you were injured in any of the following ways:
A. bruises, cuts, scrapes, or scratches B. black eyes or other eye injuries C. gashes, deep wounds such as from a knife, gun or other object D. broken bones or teeth E. burns such as from a cigarette, hot liquid, open flame F. other injuries
|
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Q110G |
(If yes to any from Q110) Did you ever need medical care because of any of these injuries? |
YES NO DON’t KNOW DECLINED...................................................... |
1 2 -98 -99 |
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|
IF Q110A=1 OR Q110B=1 OR Q110C=1 OR Q110D=1 OR Q110E=1 or q110f =1, CONTINUE WITH Q111 IF Q110A=2/-98/-99 AND Q108B=2/-98/-99 AND Q110C=2/-98/-99 AND Q110D=2/-98/-99 AND Q110E=2/-98/-99 and q110f=2/-98/-99, GO TO Q112 |
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Q111
|
How old were you the first time a current or ex-partner injured you in any of these ways? |
YEARS OLD:
don’t know DECLINED |
-98
|
Q112
Q111A |
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Q111A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q112
|
PV2: PEER VIOLENCE
The next questions are about people about your own age not including a current or ex-partner or siblings. These may include people who you may or may not know such as schoolmates, neighbors, or strangers. Remember, you can skip any question you do not want to answer.
|
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|
IF Q112A =1 OR Q112B=1 OR Q112C=1 OR Q112D=1, GO TO Q113 if Q112A=2/-98/-99 and Q112b=2/-98/-99 and Q112c=2/-98/-99 AND Q112D=2/-98/-99, GO TO Q124 (PARENTS, ADULT CARETAKERS, ADULT RELATIVES) |
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Q113 |
PV2: Has someone about your own age injured you in any of these ways more than once? |
YES NO........................................................................ Don’t know declined |
1 2 -98 -99 |
Q118 |
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Q114 |
PV2: MOST RECENT TIME
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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Q115
|
How old were you the last time this happened? |
YEARS OLD:
don’t know DECLINED |
-98 -99 |
Q116
Q115A |
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Q115A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q116 |
Of the people who hurt you the last time this happened, think of the person who hurt you the most for the following questions. What was this person’s relationship to you? |
FrIEND CLASSMATE/SCHOOLMATE NEIGHBOR OTHER PERSON that you know ABOUT YOUR AGE STRANGER |
1 2 3
4 5 |
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Q117 |
Was this person male or female? |
MALE……………………………………........... fEMALE……………………………………….. DON’T KNOW……………………………….... DECLINED…………………………….............. |
1 2 -98 -99 |
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Q118
|
PV2: FIRST TIME Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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IF Q113=1, CONTINUE WITH Q119 AS WRITTEN IF Q113=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED” FOR Q119 |
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Q119
|
How old were you the first time this happened?
|
don’t know DECLINED |
-98
|
Q120
Q119A
|
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Q119A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q120 |
What was this person’s relationship to you? |
FrIEND CLASSMATE/SCHOOLMATE NEIGHBOR OTHER PERSON That you know ABOUT YOUR AGE STRANGER Other ……………………………………. DON’T KNOW DECLINED |
1 2 3 4 5 6 -97 -98 -99 |
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Q121 |
Was this person male or female? |
MALE……………………………………........... fEMALE……………………………………….. DON’T KNOW……………………………….... DECLINED…………………………….............. |
1 2 -98 -99 |
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Q122
|
Has anyone about your own age ever hurt you so that you were injured in any of the following ways:
A. bruises, cuts, scrapes or scratches B. black eyes or other eye injuries C. gashes, deep wounds such as from a knife, gun or other object D. broken bones or teeth E. burns such as from a cigarette, hot liquid, open flame F. other injuries
|
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|
IF Q122A=1 OR Q122B=1 OR Q122C=1 OR Q122D=1 OR Q122E=1 or 122f=1, CONTINUE WITH Q123 IF Q122A=2/-98/-99 AND Q122B=2/-98/-99 AND Q122C=2/-98/-99 AND Q122D=2/-98/-99 AND Q122E=2/-98/-99 and Q122f=2/-98/-99, GO TO Q124 |
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Q123
|
How old were you the first time someone about your own age injured you in any of these ways?
|
don’t know DECLINED |
-98 -99 |
Q124
Q123A |
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Q123A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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|
Q124
|
pV3: PARENTS, adult caregivers AND OTHER ADULT RELATIVES
The next set of questions are about parents, adult caregivers, or other adult relatives. This means only adults related to you, responsible for your care or that you have lived with. We will ask about other adults in the next section, so please do not include them here. Remember, you can skip any question you do not want to answer.
|
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|
|
IF Q124A =1 OR Q124B=1 OR Q124C=1 OR Q124D=1, CONTINUE TO Q125 if Q125a=2/-98/-99 and Q125b=2/-98/-99 and Q125c=2/-98/-99 and Q125D=2/-98/-99, MOVE TO Q137 (Adults IN THE COMMUNITY) |
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|
Q125
|
PV3: Has a parent, adult caregiver or adult relative injured you in any of these ways more than once? |
YES NO Don’t know declined |
2 -98 -99 |
Q129 |
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|
Q126
|
PV3: MOST RECENT TIME
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
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|
Q127
|
How old were you the last time this happened? |
YEARS OLD:
don’t know . DECLINED |
-98 -99 |
Q127A |
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|
Q127A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER.......................................... DON’T KNOW....................................................... DECLINED............................................................. |
1 2 3 4 -98 -99 |
|
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|
Q127B |
What was this person’s relationship to you? |
Parent stepparent OTHER adult RELATIVE oR CAREGIVER don’t know DECLINED |
1 2 -97 -98 -99 |
|
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|
Q127C |
Was this person male or female? |
MALE fEMALE DON’T KNOW DECLINED |
1 2 -98 -99 |
|
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|
Q128
|
When this last happened, was this adult living in the same house as you? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
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|
|
|
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|
Q129
|
PV3: FIRST TIME
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
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IF Q125=1, CONTINUE WITH Q130 AS WRITTEN IF Q125=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED” FOR Q130 |
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|
Q130
|
How old were you the first time this happened? |
YEARS OLD:
don’t know DECLINED |
-98 -99 |
Q132
Q131A
|
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|
Q131A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
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|
Q132 |
What was this person’s relationship to you? |
Parent stepparent OTHER adult RELATIVE oR CAREGIVER don’t know DECLINED |
1 2 -97 -98 -99 |
|
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|
Q133 |
Was this person male or female? |
MALE fEMALE DON’T KNOW DECLINED |
1 2 -98 -99 |
|
|||||||||||||||||||||||||
IF Q125=1, CONTINUE WITH Q134 AS WRITTEN IF Q125=2/98/99, READ “WHEN THIS HAPPENED, WAS THIS ADULT LIVING IN THE SAME HOME AS YOU?” FOR Q134 |
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Q134
|
When this first happened, was this adult living in the same home as you? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
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Q135
|
Has a parent, adult caregiver, or adult relative ever hurt you so that you were injured in any of the following ways:
A. bruises, cuts, scrapes, or scratches B. black eyes or other eye injuries C. gashes, deep wounds such as from a knife, gun, or other object D. broken bones or teeth E. burns such as from a cigarette, hot liquid, open flame F. other injuries |
|
|||||||||||||||||||||||||||||||||||||
IF Q135A=1 OR Q135B=1 OR Q135C=1 OR Q135D=1 OR Q135E=1 orQ135f=1, CONTINUE WITH Q136 IF Q135A=2/-98/-99 AND Q135B=2/-98/-99 AND Q135C=2/-98/-99 AND Q135D=2/-98/-99 AND Q135E=2/-98/-99 and Q135f=2/-98/-99, MOVE TO Q137 |
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Q136
|
How old were you the first time a parent, adult caregiver or adult relative injured you in any of these ways? |
don’t know DECLINED |
-98 -99 |
Q137
Q136A |
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Q136A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED ... |
1 2 3 4 -98 -99 |
|
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Q137
|
pv4: Adults IN THE COMMUNITY/NEIGHBORHOOD
The next set of questions are about adults in your community who are not related to you or responsible for your care and who does not live with you. This includes adults such as teachers, police, employers, religious or community leaders, neighbors, or even adults you don’t know personally. Remember, you can skip any question that you do not want to answer.
|
||||||||||||||||||||||||||||||||||||||
|
IF Q137A =1 OR Q137B=1 OR Q137C=1 OR Q137D=1, GO TO Q138 if Q137a=2/-98/-99 and Q137b=2/-98/-99 and Q137c=2/-98/-99 and Q137D=2/-98/-99: CHECK THE FOLLOWING: iF Q100A/B/C/D=1 OR Q112A/B/C/D =1 OR Q124A/B/C/D =1, GO TO Q149 (PV SERVICES) IF Q100A/B/C/D =2/-98/-99 AND Q112A/B/C/D =2/-98/-99 AND Q124A/B/C/D =2/-98/-99, GO TO Q200 (PV PERPETRATION)
|
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Q138
|
PV4: Has an adult in your community who is not related to you or responsible for your care and who does not live with you injured you in any of these ways more than once? |
YES NO Don’t know declined |
2 -98 -99 |
Q143 |
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Q139
|
PV4: MOST RECENT TIME Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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Q140
|
How old were you the last time this happened?
|
don’t know DECLINED |
-98 -99 |
Q141
Q140A |
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Q140A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q141
|
Of these people who hurt you the last time this happened, think of the person who hurt you the most for the following questions.
What was this person’s primary relationship to you? |
TEACHER ... POLICE OFFICER COACH NEIGHBOR EMPLOYER OTHER ADULT DON’T KNOW DECLINED |
1 2 3 4 5 6 -98 -99 |
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Q142 |
Was this person male or female? |
MALE FEMALE DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q143
|
PV4: FIRST TIME
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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IF Q138=1, CONTINUE WITH Q144 AS WRITTEN IF Q138=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED?” FOR Q144 |
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Q144
|
How old were you the first time this happened |
YEARS OLD:
DON’t KNOW DECLINED............................................................... |
-98 -99 |
Q145
Q144A |
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Q144A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINEd............................................................... |
1 2 3 4 -98 -99 |
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Q145 |
What was this person’s primary relationship to you? |
TEACHER ... POLICE OFFICER COACH NEIGHBOR EMPLOYER OTHER ADULT DON’T KNOW DECLINED............................................................... |
1 2 3 4 5 6 -98 -99 |
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Q146 |
Was this person male or female? |
MALE FEMALE DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q147 |
Has an adult in your neighborhoor or community who is not related to you or responsible for your care and who does not live with you ever hurt you so that you were injured in any of the following ways?
A. bruises, cuts, scrapes, or scratches B. black eyes or other eye injuries C. gashes, deep wounds such as from a knife, gun, or other object D. broken bones or teeth E. burns such as from a cigarette, hot liquid, open flame F. other injuries
|
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|
IF Q147A=1 OR Q147B=1 OR Q147C=1 OR Q147D=1 OR Q147E=1 OR Q147F=1, CONTINUE WITH Q148 IF Q147A=2/-98/-99 AND Q147B=2/-98/-99 AND Q147C=2/-98/-99 AND Q147D=2/-98/-99 AND Q147E=2/-98/-99 AND 147F=1, GO TO Q149 |
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Q148
|
How old were you the first time an adult in your neighborhoor or community who is not related to you or responsible for your care and who does not live with you injured you in any of these ways?
|
YEARS OLD:
DON’t KNOW DECLINED............................................................... |
-98 -99 |
Q149
Q148A |
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Q148A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED............................................................... |
1 2 3 4 -98 -99 |
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-98-99 |
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Q149 |
PV SERVICES:
Did you ever have to miss school because you had been hurt by anyone we just asked about, including parents, other adults, dating partners, people about your own age, or others in the community? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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Q150
|
Did you know of a place to go for help when you had been hurt by anyone we just asked about, including parents, other adults, dating partners, people about your own age, or others in the community? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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Q151
|
Did you try to seek professional help or services because you had been physically hurt by anyone we just asked about, including parents, other adults, dating partners, people about your own age, or others in the community? |
YES NO DON’t KNOW DECLINED |
2 -98 -99 |
Q153
Q152 |
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Q152 |
There are many reasons why people do not seek professional help or services when they have been hurt. Do you agree or disagree with each of the following as reasons you did not seek help?
I did not seek help because…
|
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|
if 151=2/-98/-99, SKIP TO Q154B |
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Q153 |
From whom did you receive professional help or services? |
HEALTHCARE PROFESSIONAL.......................................... POLICE..................................................................................... LAWYER OR LEGAL PROFESSIONAL............................... SOCIAL WORKER, COUNSELOR OR CHILD PROTECTIVE SERVICES....................................................... 911............................................................................................. OTHER...................................................................................... DON’T KNOW......................................................................... DECLINED............................................................................... |
1 2 3
4 5 -97 -98 -99 |
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Q154A
|
Besides the professional people or service providers you just selected, did you tell anyone else about any of these experiences? |
YES NO DON’t KNOW DECLINED |
2 -98 -99 |
Q155
q156
|
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Q154B
|
Did you tell anyone about any of these experiences? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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Q155 |
Whom did you tell? (SELECT ALL THAT APPLY)
|
CURRENT OR EX DATING PARTNER................................ RELATIVE............................................................................... FRIEND OR NEIGHBOR........................................................ SERVICE PROVIDER (like a doctor or counselor)......................................................................... AUTHORITY FIGURE (like a teacher or police officer).................................................................................. oTHER...................................................................................... DON’T KNOW......................................................................... DECLINED............................................................................... |
1 2 3
4
5 -97 -98 -99 |
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IF 154A=1 OR 154B=1, SKIP TO Q200 |
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Q156
|
There are many reasons why people do not tell anyone when they have been hurt. Do you agree or disagree with each of the following as reasons you did not tell anyone?
I did not tell anyone because…
|
|
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|
|
IF Q44=3/-98/-99 (NEVER MARRIED/NEVER LIVED W/ SOMEONE AS MARRIED/DK/DTA) AND Q43=2/-98/-99 (NEVER HAD A PARTNER), GO TO Q203
IF Q44=1/2 (EVER MARRIED OR LIVED WITH SOMEONE AS MARRIED) OR Q43=1 (EVER PARTNER), CONTINUE WITH Q200 |
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Q200
|
PV PERPETRATION:
|
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|
IF q200A=1 OR Q200B=1 OR Q200C=1 OR Q200D=1, CONTINUE TO q201 IF q200A=2/-98/-99 AND Q200B=2/-98/-99, AND Q200C=2/-98/-99 AND Q200D=2/-98/-99, SKIP TO q203 |
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Q201
|
Did you do any of these things to a current or ex-partner in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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Q202 |
How old were you the first time this happened? |
don’T know declined |
-98 -99 |
Q203
Q202A |
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Q202A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED................................................................................ |
1 2 3 4 -98 -99 |
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Q203
|
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|
IF q203A=1 OR Q203B=1 OR Q203C=1 OR Q203D=1, CONTINUE TO q204 IF q203A=2/-98/-99 AND Q203B=2/-98/-99, AND Q203C=2/-98/-99 AND Q203D=2/-98/-99, SKIP TO q206 |
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Q204
|
Did you do any of these things to anyone who was not a dating partner in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
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Q205 |
How old were you the first time this happened? |
years old:
don’T know declined |
-98 -99 |
Q206
Q205A |
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Q205A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q206
|
PHYSICAL FIGHTING:
During the past 12 months, were you in a physical fight with anyone? |
YES NO DON’t KNOW DECLINED................................................................................. |
1 2 -98 -99 |
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Q300
|
EMOTIONAL VIOLENCE
EV1: PARENT, ADULT CAREGIVER, OR OTHER ADULT RELATIVE
The next questions ask about what a parent, adult caregiver, or other adult relative may have said to you.
|
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|
IF Q300A=1 OR Q300B=1 OR Q300C=1, CONTINUE WITH Q301 IF Q300A=2/-98/-99 AND Q300B=2/-98/-99 AND Q300C=2/-98/-99, GO TO Q310 |
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Q301
|
Has a parent, adult caregiver, or other adult relative ever said these things to you more than once?
|
YES NO Don’t know declined |
1
-98 -99 |
Q307 |
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Q302
|
EV1: MOST RECENT TIME
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
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Q303
|
How old were you the last time this happened? |
years old:
don’T know declined .... |
-98 -99 |
Q304
Q303A |
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Q303A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
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Q304 |
What was this person’s relationship to you? |
Parent ... stepparent OTHER adult RELATIVE oR CAREGIVER….. don’t know DECLINED |
1 2 -97 -98 -99 |
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Q305 |
Was this person male or female? |
MALE ... fEMALE DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q306
|
When this last happened, was this adult living in the same home as you? |
YES............................................................................. NO............................................................................... DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q307 |
EV1: FIRST TIME
Did this happen in the past 12 months? |
YES............................................................................. NO............................................................................... DON’T KNOW DECLINED |
1 2 -98 -99 |
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IF Q301=1, CONTINUE WITH 308 AS WRITTEN IF Q301=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED?” FOR Q308 AND “WHEN THIS HAPPENED, WAS THE ADULT LIVING IN THE SAME HOME AS YOU?” FOR Q311 |
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Q308 |
How old were you the first time this happened? |
years old:
don’T know declined. |
-98 -99 |
Q309
|
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Q308A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
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Q309 |
What was this person’s relationship to you? |
Parent……………………………………………. stepparent…………………………………….... OTHER adult RELATIVE oR CAREGIVER………….............................................. don’t know DECLINED................................................................. |
1 2
-97 -98 -99 |
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Q310 |
Was this person male or female? |
MALE fEMALE DON’T KNOW DECLINED |
1 2 -98 -99 |
|
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Q311
|
When this first happened, was this adult living in the same home as you? |
YES............................................................................. NO............................................................................... DON’T KNOW DECLINEd…………………………………………. |
1 2 -98 -99 |
|
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|
IF Q44=3/-98/-99 (NEVER MARRIED/NEVER LIVED W/ SOMEONE AS MARRIED/DK/DTA) AND Q43=2/-98/-99 (NEVER PARTNER), GO TO Q319 (PEER EV)
IF Q44=1/2 (EVER MARRIED OR LIVED WITH SOMEONE AS MARRIED) OR Q43=1 (EVER PARTNER), CONTINUE WITH Q312 (INTIMATE PARTNER EV) |
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Q312
|
EV2: INTIMATE PARTNER The next questions ask about experiences you may have had in your life with your dating or sexual partners. When we ask about your dating or sexual partners, please think about people you have been involved with romantically or sexually, which might include boyfriends, girlfriends, people you have dated, people you were seeing, people you hooked up with, or your husband or wife.
|
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IF Q312A=1 OR Q312B=1 OR Q312C=1 OR Q312D=1 OR Q312E=1 OR 312F=1, CONTINUE WITH Q313 IF Q312A=2/-98/-99 AND Q312B=2/-98/-99 AND Q312C=2/-98/-99 AND Q312D=2/-98/-99 AND Q312E=2/-98/-99 AND 312F=2/-98/-99, GO TO Q319 |
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Q313
|
Has a current or ex dating or sexual partner ever said these things to you more than once? |
YES NO Don’t know declined |
2 -98 -99 |
Q316 |
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Q314
|
EV 2: MOST RECENT TIME
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
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Q315
|
How old were you the last time this happened? |
don’T know declined |
-98 -99 |
Q316
Q315A |
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Q315A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
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Q316
|
EV2: FIRST TIME
Did this happen in the last 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
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IF Q313=1, CONTINUE WITH Q318 AS WRITTEN IF Q313=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED?” FOR Q318 |
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Q317
|
Was this current or ex-partner someone you were married to or living with at the time? |
YES, MARRIED......................................................... YES, LIVING WITH.................................................. NO............................................................................... Don’t KNow........................................................... Declined................................................................. |
1 2 3 -98 -99 |
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Q318
|
How old were you the first time this happened? |
years old:
don’T know declined ..... |
-98 -99 |
Q319
|
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Q318A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED................................................................. |
1 2 3 4 -98 -99 |
|
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Q319
|
EV3: PEER EMOTIONAL VIOLENCE The next questions are about people your own age not including a current or ex-partner. This could be a schoolmate, a neighbor, or a stranger. It could have happened in person or virtually through things like text messages, instant/direct messages, calls, videos, emails, social media, apps, online gaming etc.
|
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IF Q319A=1 OR Q319B=1 OR Q319C=1, CONTINUE WITH Q320 IF Q319A=2/-98/-99 AND Q319B=2/-98/-99 AND Q319C=2/-98/-99, GO TO Q400 |
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Q320
|
Has a person your own age ever said these things to you more than once? |
YES NO Don’t know declined |
2 -98 -99 |
Q325 |
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Q321
|
EV3: MOST RECENT TIME
Did this happen in the past 12 months? |
YES NO Don’t know declined................................................................. |
1 2 -98 -99 |
|
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Q322
|
How old were you the last time this happened? |
years old:
don’T know declined................................................................. |
-98 -99 |
Q323
|
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Q322A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED................................................................. |
1 2 3 4 -98 -99 |
|
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Q323 |
The last time this happened, did one person or more than one person do this to you? |
1 person……………………………………… more than one person…………………. don’t know…………………………………. declined……………………………………... |
1 2 -98 -99 |
|
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Q324 |
Did this happen in person or virtually through things like text messages, instant/direct messages, calls, videos, emails, social media, apps, etc.? |
in person….....................….......….......…...... virtually........................................................ DON’t KNOW………………………………. DECLINED……..…………………………... |
1 2 -98 -99 |
|
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|
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Q325
|
EV3: FIRST TIME
Did this happen in the past 12 months? |
YES NO Don’t know declined................................................................. |
1 2 -98 -99 |
|
|||||||||||||||||||||||||||||||||||
IF Q320=1, CONTINUE WITH q326 and 327 AS WRITTEN IF Q320=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED?” FOR Q326 AND “WHEN THIS HAPPENED, did one person or more than one person do this to YOU?” FOR Q327 |
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Q326
|
How old were you the first time this happened? |
don’T know declined |
-98 -99 |
Q327
Q326A |
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Q326A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED................................................................. |
1 2 3 4 -98 -99 |
|
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Q327 |
The first time this happened, did one person or more than one person do this to you? |
1 person……………………………………… more than one person…………………. don’t know…………………………………. declined……………………………………... |
1 2 -98 -99 |
|
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Q328 |
Did this happen in person or virtually through things like text messages, instant/direct messages, calls, videos, emails, social media, apps, etc.? |
in person….....................….......….......…............. virtually.............................................................. DON’t KNOW……………………………………... DECLINED……..…………………………............... |
1 2 -98 -99 |
|
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Q400
|
SEXUAL BEHAVIOR: The next questions are about sexual activity. By sex we mean vaginal, oral, or anal sex or the insertion of hands, fingers, or other objects into your vagina or anus by someone else.
Have you ever had sex? |
YES NO Don’t know declined................................................................. |
2 -98 -99 |
Q600 |
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Q401 |
During your life, with whom have you had sexual contact, males, females, or both? |
MALES....................................................................... FEMALES.................................................................. BOTH MALES and females.............................. don’t know.......................................................... declined................................................................ |
1 2 3 -98 -99 |
|
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Q402
|
How old were you when you had sex for the very first time? |
YEARS OLD:
Don’t know declined................................................................. |
-98 -99 |
Q403
Q402A |
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Q402A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
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Q403
|
The first time you had sex, would you say that you wanted to have sex, you did not want to have sex but it happened anyway, or were you forced to have sex? |
wanted to............................................................. DID NOT WANT TO BUT IT HAPPENED ANYWAY.................................................................. forced to ................................................ Don’t know declined................................................................. |
2 3 -98 -99 |
Q405
|
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Q404 |
The first time you had sex, were you verbally persuaded, pressured (through harassment or threats), too drunk or drugged to say no, or physically forced? |
VERBALLY PERSUADED ... pressured/THREATENED too drunk to say no PHYSICALLY FORCED OTHER....................................................................... don’t know declined |
1 2 3 4 -97 -98 -99 |
|
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Q405 |
What was the person’s relationship to you the first time you had sex? |
CURRENT OR EX-DATING PARTNER relative Friend/Classmate/schoolmate adult in my community (Teacher, POlice/ SECURITY PERSON, neighbor, Employer, COMMUNITY/ Religious LEADER) OTHER DON’T KNOW DECLINED |
1 2 3 4
5 -97 -98 -99 |
|
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Q406 |
Was this person male or female? |
MALE ... fEMALE DON’T KNOW DECLINED................................................................. |
1 2 -98 -99 |
|
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Q406A
|
How old was this person the first time you had sex? Please give your best guess. |
YEARS OLD:
Don’t know declined................................................................. |
-98 -99 |
Q407
Q406A |
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Q406 B |
Would you say this person was:
|
YOUNGER…………………………………………. ABOUT THE SAME AGE…………………………. MORE THAN 5 YEARS OLDER………………….. MORE THAN 10 YEARS OLDER………………… DON’T KNOW……………………………………... DECLINED…………………………………….…… |
1 2 3 4 -98 -99 |
|
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Q407
|
PREGNANCY (FEMALES ONLY): The next questions are about pregnancy.
Have you ever been pregnant? |
YES............................................................................. NO ......... DON’t KNOW .. declined |
2 -98 -99 |
Q409 |
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Q408
|
How old were you the first time that you got pregnant? |
Don’t know declined................................................................. |
-98 -99 |
Q409
Q408A |
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Q408A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
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Q409
|
SEX HISTORY AND RISK TAKING:
In your life, how many people have you had sex with? |
NUMBER of Persons:
Too MANY TO RECALL........................................ Don’t know declined................................................................. |
66 -98 -99 |
|
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Q410 |
Have you had sex within the past 12 months? |
YES NO DON’T KNOW DECLINED |
2 -98 -99 |
Q500 |
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Q411
|
How many people have you had sex within the past 12 months? |
NUMBER of Persons:
Too MANY TO RECALL........................................ Don’t know declined................................................................. |
-98 -99 |
Q500 |
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Q412
|
The last time you had sex, what method did you or your partner use to prevent pregnancy?
(Choose all responses that apply) |
an iud (such as Mirena or paragard) or implant (such as implanon or nexplanon) A shot (such as depo-proera), patch (such as ortho evra), or a birth control ring (such as Nuvaring) birth control pills CONDOM withdrawal OR PULL-OUT NO METHOD OTHer....................................................................... don’t know declined |
1
2
3 4
6 7 -97 -98 -99
|
Q414 |
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Q413
|
The last time you had sex, did you or your partner use a condom? |
YES............................................................................. NO............................................................................... DON’T KNOW........................................................... DECLINED................................................................. |
1 2 -98 -99 |
|
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Q414
|
Has a current or ex-partner ever refused to use a condom when you wanted them to? |
YES............................................................................. NO............................................................................... DON’T KNOW........................................................... DECLINED................................................................. |
1 2 -98 -99 |
|
|||||||||||||||||||||||||||||||||||
Q415 |
Has a current or ex-partner ever tried to get you pregnant when you did not want to become pregnant (F) / tried to get pregnant when you did not want them to get pregnant (M), or tried to stop you from using birth control? |
YES............................................................................. NO............................................................................... DON’T KNOW........................................................... DECLINED................................................................. |
1 2 -98 -99 |
|
|||||||||||||||||||||||||||||||||||
Q500
|
TRANSACTIONAL SEX
Have you ever started a relationship with someone mainly in order to get things that you need such as money, gifts, favors, or housing, etc.? |
YES............................................................................. NO............................................................................... DON’T KNOW........................................................... DECLINED................................................................. |
2 -98 -99 |
Q600 |
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Q501
|
Did this happen in the past 12 months? |
YES............................................................................. NO............................................................................... DON’T KNOW........................................................... DECLINED................................................................. |
1 2 -98 -99 |
|
|||||||||||||||||||||||||||||||||||
Q502
|
Including all your experiences having sex with someone because they gave you things that you need, what did they give you?
(Choose all responses that apply) |
mONEY Food gifts/favors HOUSING OTHER....................................................................... don’t know declined |
1 2 3 4 -97 -98 -99 |
|
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1
66
5
1SeXUAL VIOLENCE:
Young people may experience unwanted sexual contact by people they know well, such as a current or ex-partner, family member or friend, or by strangers. Your answers are confidential and you can skip any questions that you don’t feel comfortable answering. |
||||||
Q600
|
Has anyone ever touched you in a sexual way against your will, but did not try and force you to have sex? This could include fondling, pinching, or grabbing in a sexual way. It could also include touching you on or around your sexual body parts. |
YES NO DON’T KNOW DECLINED |
2 -98 -99 |
|
||
Q601
|
SV1: TOUCHING WITHOUT PERMISSION- LIFETIME
Has this happened to you more than once? |
YES NO......................................................................... don’t know DECLINED |
2 -98 -99 |
Q610 |
||
Q602
|
SV1A: TOUCHING – MOST RECENT
Was the last time this happened within the past 12 months |
YES NO don’t know DECLINED |
1 2 -98 -99 |
|
||
Q603
|
How old were you the last time this happened? |
YEARS OLD:
DON’T KNOW DECLINED |
-98 -99 |
Q604
Q603A |
||
Q603A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
||
Q604
|
The last time this happened, did one person or more than one person do this to you?
|
1 PERSON............................................................ MORE THAN 1 PERSON.................................... DON’T KNOW DECLINED |
1 2
-98 -99 |
|
||
|
IF Q604>1, PROVIDE TEXT BELOW IF Q604=2/-98/-99, GO TO Q605
Of these people who touched you in a sexual way against your will the last time, think of the person who hurt you the most for the following questions: |
|||||
Q605 |
What was this person’s relationship to you? |
CURRENT OR EX dating partner……... relative……………………………………... classmate/schoolmate……………….. authority figure (like a teacher of police officer)………………………… friend………………………………………… stranger……………………………………. other…………………………………………. DON’T KNOW…………………………………. DECLINED……………………………………... |
1 2 3 4
5 6 -97 -98 -99 |
|
||
Q606 |
Was this person male or female? |
MALE…………………………………………... fEMALE……………………………………….. DON’T KNOW……………………………….. DECLINED…………………………………….. |
1 2 -98 -99 |
|
||
Q607 |
How old was this person at the time? Please give your best guess. |
DON’T KNOW DECLINED |
-98 -99 |
Q608
Q607A |
||
Q607A |
Would you say this person was:
|
YOUNGER……………………………………... ABOUT THE SAME AGE……………………... MORE THAN 5 YEARS OLDER……………... MORE THAN 10 YEARS OLDER……………. DON’T KNOW………………………………… DECLINED…………………………………….. |
1 2 3 4 -98 -99 |
|
||
Q608 |
Where were you when this happened to you? |
SOMEONE’S HOME AN OUTSIDE LOCATION SCHOOL INSIDE A CAR/BUS Bar, club OR restaurant........................ Other ................................................................ don’t know DECLINED |
1 2 3 4 5 -97 -98 -99 |
|
||
Q609
|
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) AFTERNOON (noon to sunset) EVENING (SUNSET TO MIDNIGHT) LATE AT NIGHT (Midnight to sunrise) don’t know DECLINED |
1 2 3 4 -98 -99 |
|
||
|
|
|||||
Q610 |
SV1B: TOUCHING – FIRST TIME
Did this happen to you within the past 12 months? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
|
||
if q601=1, continue with q611 and 612 as written if q601=2/98/99, read “how old were you when this happened” for q611 and “when this happened, did one person or more than one person do this to you” for q612 |
||||||
Q611
|
How old were you the first time anyone touched you in a sexual way against your will but did not try to force you to have sex? |
YEARS OLD:
DON’T KNOW DECLINED |
-98 -99 |
Q611A
Q612 |
||
Q611A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
||
Q612
|
The first time this happened, did one person or more than one person do this to you?
|
1 PERSON............................................................ MORE THAN 1 PERSON................................... DON’T KNOW DECLINED |
1 2 -98 -99 |
|
||
|
IF Q612>1, PROVIDE TEXT BELOW IF Q612=1/-98/-99, GO TO Q613
Of these people who touched you in a sexual way against your will the first time, think of the person who hurt you most for the following questions: |
|||||
Q613 |
What was this person’s relationship to you? |
CURRENT OR EX Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other don’t know declined |
1 2 3
4 5 6 -97 -98 -99 |
|
||
Q614 |
Was this person male or female? |
male female don’t know Declined |
1 2 -98 -99 |
|
||
Q615
|
How old was this person at that time? Please give your best guess. |
YEARS OLD:
DON’T KNOW DECLINED |
-98 -99 |
Q616
Q615A |
||
Q615A |
Would you say this person was:
|
YOUNGER……………………………………... ABOUT THE SAME AGE……………………... MORE THAN 5 YEARS OLDER……………... MORE THAN 10 YEARS OLDER……………. DON’T KNOW………………………………… DECLINED…………………………………….. |
1 2 3 4 -98 -99 |
|
||
Q616 |
Where were you when this happened to you? |
SOMEONE’S HOME AN OUTSIDE LOCATION SCHOOL INSIDE A CAR/BUS Bar, club OR restaurant....................... Other................................................................. don’t know DECLINED |
1 2 3 4 5 -97 -98 -99 |
|
||
Q617
|
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) AFTERNOON (noon to sunset) EVENING (SUNSET TO MIDNIGHT) LATE AT NIGHT (Midnight to sunrise) don’t know DECLINED |
1 2 3 4 -98 -99 |
|
||
1
These next questions ask you about sex, by sex I mean vaginal, oral, or anal sex or the insertion of hands, fingers, or other objects into your vagina or anus by someone else.
Information contained in [ ] brackets is meant for participants who have had an intimate partner. |
IF Q44=1/2 (EVER MARRIED OR LIVED WITH SOMEONE AS MARRIED) OR Q43=1 (EVER PARTNERED), THEN ASK Q700A, Q700B, Q800A, Q800B, Q900A, Q900B, Q1000A AND Q1000B. AND PROGRAM “ELSE” FOR Q700B, Q800B, Q900B, AND Q1000B. |
IF Q44=3/-98/-99 (NEVER MARRIED OR LIVED WITH SOMEONE AS MARRIED/DK/DTA) OR Q43=2/-98/-99 (NEVER PARTNERED/DK/DTA), THEN SKIP Q700A, Q800A, Q900A, Q1000A. |
Q700
|
ATTEMPTED FORCED SEX
|
||||||||||||||||||||
IF Q700A=1 OR 700B=1, CONTINUE TO Q701 IF 700A=2/-98/-99 AND 700B=2/-98/-99, SKIP TO Q800 |
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Q701
|
SV2: ATTEMPTED SEX- LIFETIME
Has anyone tried to physically force you to have sex or tried to pressure you to have sex through harassment or threats, but the sex did not happen, more than once? |
YES................................................................................. NO................................................................................... DON’T KNOW............................................................... DECLINED..................................................................... |
2 -98 -99
|
Q710
|
|||||||||||||||||
Q702
|
SV2A: ATTEMPTED SEX – MOST RECENT
Was the last time this happened within the past 12 months? |
YES................................................................................. NO................................................................................... DON’T KNOW............................................................... DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
Q703
|
How old were you the last time this happened? |
YEARS OLD:
DON’T KNOW ......................................................... DECLINED ......................................................... |
-98 -99 |
Q704
Q703A |
|||||||||||||||||
Q703A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q704
|
The last time this happened, did one person or more than one person try to make you have sex against your will? |
1 PERSON...................................................................... MORE THAN ONE PERSON....................................... don’t know DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
|
IF Q704>1, PROVIDE TEXT BELOW IF Q704=1/-98/-99, GO TO Q705
Of these people who tried to have sex with you against your will this last time, think of the person who hurt you the most for the following questions: |
||||||||||||||||||||
Q705 |
What was this person’s relationship to you? |
current or ex Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other don’t know declined |
1 2 3
4 5 6 -97 -98 -99 |
|
|||||||||||||||||
Q706 |
Was this person male or female? |
male female don’t know Declined |
1 2 -98 -99 |
|
|||||||||||||||||
Q707
|
How old was this person at that time? Please give your best guess. |
YEARS OLD:
don’t know .............................................................. DECLINED .................................................................... |
-98 -99 |
Q708
Q707A |
|||||||||||||||||
Q707A |
Would you say this person was:
|
YOUNGER……………………………………............. ABOUT THE SAME AGE MORE THAN 5 YEARS OLDER…………….............. MORE THAN 10 YEARS OLDER……………............ DON’T KNOW…………………………………........... DECLINED……………………………………............. |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q708 |
Where were you when this happened to you? |
SOMEONE’S HOME AN OUTSIDE LOCATION SCHOOL......................................................................... INSIDE A CAR/BUS ...................................................... Bar, club or restaurant.................................. Other........................................................................... don’t know .............................................................. DECLINED .................................................................... |
1 2 3 4 5 -97 -98 -99 |
|
|||||||||||||||||
Q709
|
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) .............................. AFTERNOON (noon to sunset) EVENING (SUNSET TO MIDNIGHT) LATE AT NIGHT (Midnight to sunrise) don’t know DECLINED |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
|
skip to Q710 |
||||||||||||||||||||
Q710
|
SV2B: ATTEMPTED SEX - FIRST TIME Did this happen to you within the past 12 months? |
YES................................................................................. NO................................................................................... DON’T KNOW............................................................... DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
IF Q701=1, CONTINUE WITH q711 AS WRITTEN IF Q701=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED?” FOR Q711 AND “WHEN THIS HAPPENED, did one person or more than one person try to make you have sex against your will?” FOR Q712 |
|||||||||||||||||||||
Q711
|
How old were you the first time anyone tried to make you have sex against your will but it did not happen? |
YEARS OLD:
don’t know DECLINED..................................................................... |
-98 -99 |
q712
q711a |
|||||||||||||||||
Q711A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q712
|
The first time this happened, did one person or more than one person try to make you have sex against your will?
|
1 PERSON...................................................................... MORE THAN 1 PERSON.............................................. don’t know DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
|
IF Q712>1 PROVIDE TEXT BELOW IF Q712=1/-98/-99 GO TO Q713 Of these people who attempted to have sex with you against your will this first time, think of the person who hurt you the most the following questions: |
||||||||||||||||||||
Q713 |
What was this person’s relationship to you? |
CURRENT OR EX Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other don’t know declined |
1 2 3
4 5 6 -97 -98 -99 |
|
|||||||||||||||||
Q714 |
Was this person male or female? |
male female don’t know Declined |
1 2 -98 -99 |
|
|||||||||||||||||
Q715
|
How old was this person at the time? Please give your best guess. |
DON’T KNOW............................................................... DECLINED..................................................................... |
-98 -99 |
Q716
Q715A |
|||||||||||||||||
Q715A |
Would you say this person was:
|
YOUNGER……………………………………............. ABOUT THE SAME AGE……………………............. MORE THAN 5 YEARS OLDER…………….............. MORE THAN 10 YEARS OLDER…………………… DON’T KNOW………………………………………... DECLINED……………………………………………. |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q716 |
Where were you when this happened to you? |
SOMEONE’S HOME ..................................................... AN OUTSIDE LOCATION ........................................... SCHOOL ......................................................................... INSIDE A CAR/BUS ...................................................... Bar, club OR restaurant.................................. Other........................................................................... don’t know ............................................................... DECLINED ..................................................................... |
1 2 3 4 5 -97 -98 -99 |
|
|||||||||||||||||
Q716A
|
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) .............................. AFTERNOON (noon to sunset) ........................... EVENING (SUNSET TO MIDNIGHT) ......................... LATE AT NIGHT (Midnight to sunrise) ........... don’t know ............................................................... DECLINED ..................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
|
|
||||||||||||||||||||
Q800
|
PHYSICALLY FORCED SEX
|
||||||||||||||||||||
|
IF Q404=4 AND Q800A OR Q800B =2/-98/-99, THEN: “WE KNOW IT MAY BE HARD TO REMEMBER OR SHARE CERTAIN THINGS THAT HAVE HAPPENED TO YOU. BECAUSE YOUR EXPERIENCES ARE IMPORTANT, WE WANT TO MAKE SURE WE HAVE ACCURATELY CAPTURED THEM. THEN REASK THE QUESTION(S) FOR WHICH WE HAVE INCONSISTENT DATA.” |
||||||||||||||||||||
|
IF Q800A=1 OR Q800B=2/-98/-99, CONTINUE TO Q801 IF Q800A=2/-98/-99 AND Q800B=2/-98/-99, SKIP TO Q900 |
||||||||||||||||||||
Q801
|
SV3: PHYSICALLY FORCED SEX- LIFETIME Have you been physically forced to have sex more than once? |
YES ................................................................................. NO ................................................................................... don’t know ............................................................... DECLINED..................................................................... |
2 -98 -99 |
Q810 |
|||||||||||||||||
Q802
|
SV3A: PHYSICALLY FORCED SEX – MOST RECENT
Was the last time this happened within the past 12 months? |
YES ................................................................................. NO ................................................................................... don’t know ............................................................... DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
Q803
|
How old were you the last time this happened? |
don’t know ............................................................... DECLINED..................................................................... |
-98 -99 |
Q804
Q803A |
|||||||||||||||||
Q803A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q804
|
The last time this happened, did one person or more than one person physically force you to have sex? |
1 PERSON...................................................................... MORE THAN 1 PERSON.............................................. DON’T KNOW DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
|
IF Q804>1, PROVIDE TEXT BELOW IF Q804=1/-98/-99, GO TO Q805
Of the people who physically forced you to have sex the last time, think of the person who hurt you the most for the following questions: |
||||||||||||||||||||
Q805 |
What was this person’s relationship to you? |
CURRENT OR EX Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other don’t know declined |
1 2 3
4 5 6 -97 -98 -99 |
|
|||||||||||||||||
Q806 |
Was this person male or female? |
male female don’t know Declined |
1 2 -98 -99 |
|
|||||||||||||||||
Q807 |
How old was this person at the time? Please give your best guess. |
don’t know ............................................................... DECLINED..................................................................... |
-98 -99 |
Q808
Q807A
|
|||||||||||||||||
Q807A |
Would you say this person was:
|
YOUNGER……………………………………............. ABOUT THE SAME AGE……………………............. MORE THAN 5 YEARS OLDER…………….............. MORE THAN 10 YEARS OLDER…………………… DON’T KNOW………………………………………... DECLINED……………………………………………. |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q808
|
Did the person who did this to you this last time use a weapon such as a gun or knife?
|
YES ................................................................................. NO ................................................................................... don’t know ............................................................... DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
Q809 |
Where were you when this happened to you? |
SOMEONE’S HOME ..................................................... AN OUTSIDE LOCATION ........................................... SCHOOL ......................................................................... INSIDE A CAR/BUS ...................................................... Bar, club OR restaurant.................................. Other........................................................................... don’t know ............................................................... DECLINED ..................................................................... |
1 2 3 4 5 -97 -98 -99 |
|
|||||||||||||||||
Q810 |
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) .............................. AFTERNOON (noon to sunset) ........................... EVENING (SUNSET TO MIDNIGHT) ......................... LATE AT NIGHT (Midnight to sunrise) ........... don’t know ............................................................... DECLINED ..................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
|
|
||||||||||||||||||||
Q811
|
SV3B: PHYSICALLY FORCED SEX – FIRST TIME
Did this happen to you within the past 12 months? |
YES ................................................................................. NO ................................................................................... don’t know ............................................................... DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
IF Q801=1, CONTINUE WITH q812 AS WRITTEN IF Q801=2/98/99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED?” FOR Q812 AND “WHEN THIS HAPPENED, did one person or more than one person physically force you to have sex?” FOR Q813 |
|||||||||||||||||||||
Q812
|
How old were you the first time anyone physically forced you to have sex? |
YEARS OLD:
DON’T KNOW DECLINED..................................................................... |
-98 -99 |
Q813
Q812A |
|||||||||||||||||
Q812A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED..................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q813
|
The first time this happened, did one person or more than one person physically force you to have sex? |
1 PERSON...................................................................... MORE THAN 1 PERSON.............................................. DON’T KNOW DECLINED..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
|
IF Q813>1, PROVIDE TEXT BELOW IF Q813=1/-98/-99, GO TO Q814
Of the people who physically forced you to have sex the first time, think of the person who hurt you the most for the following questions: |
||||||||||||||||||||
Q814 |
What was this person’s relationship to you? |
CURRENT OR EX Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other don’t know declined |
1 2 3
4 5 6 -97 -98 -99 |
|
|||||||||||||||||
Q815 |
Was this person male or female? |
male female don’t know Declined |
1 2 -98 -99 |
|
|||||||||||||||||
Q816
|
How old was this person? Please give your best guess. |
don’t know DECLINED..................................................................... |
-98 -99 |
Q817
Q816A |
|||||||||||||||||
Q816A |
Would you say this person was:
|
YOUNGER……………………………………............. ABOUT THE SAME AGE……………………............. MORE THAN 5 YEARS OLDER…………….............. MORE THAN 10 YEARS OLDER…………………… DON’T KNOW………………………………………... DECLINED……………………………………………. |
1 2 3 4 -98 -99 |
|
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Q817 |
Did the person who did this to you the first time use a weapon such as a gun or knife?
|
YES ................................................................................. NO ................................................................................... don’t know ............................................................... DECLINED ..................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
Q818 |
Where were you when this happened to you? |
SOMEONE’S HOME ..................................................... AN OUTSIDE LOCATION ........................................... SCHOOL ......................................................................... INSIDE A CAR/BUS ...................................................... Bar, club OR restaurant.................................. Other........................................................................... don’t know ............................................................... DECLINED ..................................................................... |
1 2 3 4 5 -97 -98 -99 |
|
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Q819
|
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) .............................. AFTERNOON (noon to sunset) ........................... EVENING (SUNSET TO MIDNIGHT) ......................... LATE AT NIGHT (Midnight to sunrise) ........... don’t know ............................................................... DECLINED ..................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
|
IFQ43=1, CONTINUE TO Q900A IF Q43=2/-98/-99, SKIP TO Q900B (DO NOT INCLUDE ‘ELSE’) |
||||||||||||||||||||
Q900
|
PRESSURED SEX
|
||||||||||||||||||||
|
IF Q404=2 AND Q900A=2 OR Q900B=2/-98/-99, THEN: “WE KNOW IT MAY BE HARD TO REMEMBER OR SHARE CERTAIN THINGS THAT HAVE HAPPENED TO YOU. BECAUSE YOUR EXPERIENCES ARE IMPORTANT, WE WANT TO MAKE SURE WE HAVE ACCURATELY CAPTURED THEM. THEN REASK THE QUESTION(S) FOR WHICH WE HAVE INCONSISTENT DATA.” |
||||||||||||||||||||
|
IF Q900A=1 OR Q900B=1, CONTINUE TO Q901 IF Q900A=2/-98/-99 AND Q900B=2/-98/-99, SKIP TO Q1000 |
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Q901
|
SV4: PRESSURED SEX- LIFETIME
Have you been pressured to have sex against your will through harassment or threats more than once? |
YES ..................................................................................... NO...................................................................................... don’t know .................................................................. DECLINED ........................................................................ |
2 -98 -99 |
Q909 |
|||||||||||||||||
Q902
|
SV4A: PRESSURED INTO SEX – MOST RECENT
Was the last time this happened within the past 12 months? |
YES ..................................................................................... NO ....................................................................................... don’t know ................................................................... DECLINED ......................................................................... |
1 2 -98 -99 |
|
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Q903
|
How old were you the last time this happened? |
DON’T KNOW DECLINED......................................................................... |
-98 -99 |
Q904
Q903A |
|||||||||||||||||
Q903A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED ......................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q904
|
The last time this happened, did one person or more than one person do this to you? |
1 PERSON.......................................................................... MORE tHAN 1 PERSON.................................................. don’t know DECLINED......................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
|
IF Q904>1, PROVIDE TEXT BELOW IF Q904=1/-98/-99, GO TO Q905
Of the people who pressured you to have to have sex against your will the last time, think of the person who hurt you the most for the following questions: |
||||||||||||||||||||
Q905 |
What was this person’s relationship to you? |
CURRENT OR EX Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other don’t know DECLINED......................................................................... |
1 2 3
4 5 6 -97 -98 -99 |
|
|||||||||||||||||
Q905A |
Was this person male or female? |
male female don’t know Declined ………………………………………………. |
1 2 -98 -99 |
|
|||||||||||||||||
Q906
|
How old was this person at the time? Please give your best guess. |
YEARS OLD:
DON’T KNOW ................................................................... DECLINED ......................................................................... |
-98 -99 |
Q907
Q906A |
|||||||||||||||||
Q906A |
Would you say this person was:
|
YOUNGER……………………………………................. ABOUT THE SAME AGE……………………................. MORE THAN 5 YEARS OLDER…………….................. MORE THAN 10 YEARS OLDER……………………… DON’T KNOW…………………………………………... DECLINED………………………………………………. |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q907 |
Where were you when this happened to you? |
SOMEONE’S HOME ......................................................... AN OUTSIDE LOCATION ............................................... SCHOOL ............................................................................. INSIDE A CAR/BUS .......................................................... Bar, club OR restaurant...................................... Other............................................................................... don’t know ................................................................... DECLINED ......................................................................... |
1 2 3 4 5 -97 -98 -99 |
|
|||||||||||||||||
Q908
|
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) .................................. AFTERNOON (noon to sunset) ............................... EVENING (SUNSET TO MIDNIGHT) ............................. LATE AT NIGHT (Midnight to sunrise) ............... don’t know ................................................................... DECLINED ......................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
|
|
||||||||||||||||||||
Q909
|
SV4B: PRESSURED INTO SEX – FIRST TIME
Did this happen to you within the past 12 months? |
YES ..................................................................................... NO ....................................................................................... don’t know ................................................................... DECLINED ......................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
IF Q901=1, CONTINUE WITH q910 AS WRITTEN IF Q901=2/-98/-99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED?” FOR Q910 AND “WHEN THIS HAPPENED, did one person or more than one person pressure you to have sex against your will?” FOR Q911 |
|||||||||||||||||||||
Q910
|
How old were you the first time anyone pressured you to have sex against your will? |
don’t know ................................................................... DECLINED......................................................................... |
-98 -99 |
Q911
Q910A |
|||||||||||||||||
Q910A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED ......................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q911
|
The first time this happened, did one person or more than one person pressure you to have sex against your will? |
1 PERSON.......................................................................... MORE tHAN ONE PERSON........................................... DON’T KNOW DECLINED ......................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
|
IF Q911>1, PROVIDE TEXT BELOW IF Q911=1/-98/-99, GO TO Q912
Of the people who pressured you to have sex against your will the first time, think of the person who hurt you the most for the following questions: |
||||||||||||||||||||
Q912 |
What was this person’s relationship to you? |
CURRENT OR EX Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other DON’T KNOW DECLINED ......................................................................... |
1 2 3
4 5 6 -97 -98 -99 |
|
|||||||||||||||||
Q913 |
Was this person male or female? |
male female DON’T KNOW DECLINED ......................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
Q914
|
How old was this person at the time? Please give your best guess. |
YEARS OLD:
DON’T KNOW DECLINED ......................................................................... |
-98 -99 |
Q915
Q914A |
|||||||||||||||||
Q914A |
Would you say this person was:
|
YOUNGER……………………………………................. ABOUT THE SAME AGE……………………................. MORE THAN 5 YEARS OLDER…………….................. MORE THAN 10 YEARS OLDER……………………… DON’T KNOW…………………………………………... DECLINED………………………………………………. |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q915 |
Where were you when this happened to you? |
SOMEONE’S HOME ......................................................... AN OUTSIDE LOCATION ............................................... SCHOOL ............................................................................. INSIDE A CAR/BUS .......................................................... Bar, club OR restaurant...................................... Other............................................................................... don’t know ................................................................... DECLINED ......................................................................... |
1 2 3 4 5 -97 -98 -99 |
|
|||||||||||||||||
Q916
|
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) .................................. AFTERNOON (noon to sunset) ............................... EVENING (SUNSET TO MIDNIGHT) ............................. LATE AT NIGHT (Midnight to sunrise) ............... don’t know ................................................................... DECLINED ......................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
REFER TO Q1000 FOR ROUTING TO NEXT SECTION: IF Q1000A=1 OR Q1000B=1, THEN MOVE TO Q1001 ELSE IF Q420=1 (EVER PREGNANT), MOVE TO Q1100 (PREGNANCY OUTCOMES) ELSE IF Q420=2/-98/-99, MOVE TO Q1200
|
|||||||||||||||||||||
Q1000
|
ALCOHOL FACILITATED FORCED SEX
|
||||||||||||||||||||
Q1000A=1 OR Q1000B=1, THEN MOVE TO Q1001
IF Q600=1 AND Q1000A/B=2/-98/-99, MOVE TO Q1200
IF Q600 ANDQ1000A/B=2/-98/-99 CHECK THE FOLLOWING: IF Q44=3/-98/-99 (NEVER MARRIED/NEVER LIVED W/ SOMEONE AS MARRIED/DK/DTA) AND Q43=2/-98/-99 (NEVER PARTNER), MOVE TO Q1301
IF Q44=1/2 (EVER MARRIED OR LIVED WITH SOMEONE AS MARRIED) OR Q43=1 (EVER PARTNERED), MOVE TO Q1300 |
|||||||||||||||||||||
Q1001
|
SV5: LIFETIME ALCOHOL/DRUG FACILITATED FORCED SEX You indicated that someone had sex with you when you were unable to consent to it or stop it from happening because you were too drunk, high, or drugged. Has this happened more than once?
|
YES ..................................................................................... NO ....................................................................................... don’t know ................................................................... DECLINED ......................................................................... |
2 -98 -99 |
Q1010 |
|||||||||||||||||
Q1002
|
SV5A: ALCOHOL FACILITATED SEX – MOST RECENT
Was the last time this happened within the past 12 months? |
YES ..................................................................................... NO ....................................................................................... don’t know ................................................................... DECLINED ......................................................................... |
1 2 -98 -99 |
|
|||||||||||||||||
Q1003
|
How old were you the last time this happened? |
YEARS OLD:
DON’T KNOW DECLINED......................................................................... |
-98 -99 |
Q1004
Q1003A |
|||||||||||||||||
Q1003A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED ......................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q1004
|
This last time this happened, did one person or more than one person have sex with you when you were unable to consent to it or stop it from happening because you were too drunk, high, or drugged? |
1 PERSON.......................................................................... MORE tHAN 1 PERSON.................................................. DON’T KNOW ................................................................... DECLINED ………………………………………………. |
1 2 -98 -99 |
|
|||||||||||||||||
|
IF Q1004>1 PROVIDE TEXT BELOW IF Q1004=1/-98/-99 GO TO Q1005
Of the people who you had sex with when you were unable to consent this last time, think of the person who hurt you the most for the following questions: |
||||||||||||||||||||
Q1005 |
What was this person’s relationship to you? |
CURRENT OR EX Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other don’t know declined |
1 2 3
4 5 6 -97 -98 -99 |
|
|||||||||||||||||
Q1006 |
Was this person male or female? |
male female don’t know Declined |
1 2 -98 -99 |
|
|||||||||||||||||
Q1007
|
How old was this person at the time? Please give your best guess. |
YEARS OLD:
DON’T KNOW DECLINED......................................................................... |
-98 -99 |
Q1008
Q1007A |
|||||||||||||||||
Q1007A |
Would you say this person was:
|
YOUNGER……………………………………................. ABOUT THE SAME AGE……………………................. MORE THAN 5 YEARS OLDER…………….................. MORE THAN 10 YEARS OLDER……………………… DON’T KNOW…………………………………………... DECLINED………………………………………………. |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q1008 |
Where were you when this happened to you? |
SOMEONE’S HOME ......................................................... AN OUTSIDE LOCATION ............................................... SCHOOL ............................................................................. INSIDE A CAR/BUS .......................................................... Bar, club OR restaurant...................................... Other............................................................................... don’t know ................................................................... DECLINED ......................................................................... |
1 2 3 4 5 -97 -98 -99 |
|
|||||||||||||||||
Q1009 |
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) .................................. AFTERNOON (noon to sunset) ............................... EVENING (SUNSET TO MIDNIGHT) ............................. LATE AT NIGHT (Midnight to sunrise) ............... don’t know ................................................................... DECLINED ......................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
|
|
||||||||||||||||||||
Q1010
|
SV5B: ALCOHOL/DRUG FACILITATED FORCED SEX – FIRST TIME
Did this happen to you within the past 12 months? |
YES NO don’t know DECLINED |
1 2 -98 -99 |
|
|||||||||||||||||
IF Q1001=1, CONTINUE WITH q1011 AS WRITTEN IF Q1001=2/-98/-99, READ “HOW OLD WERE YOU WHEN THIS HAPPENED?” FOR Q1011 AND “WHEN THIS HAPPENED, did one person or more than one person have sex with you when you were unable to consent to it or stop it from happening because you were too drunk, high, or drugged?” FOR Q1012 |
|||||||||||||||||||||
Q1011
|
How old were you the first time anyone had sex with you when you were unable to consent to it or stop it from happening because you were too drunk, high, or drugged? |
YEARS OLD:
DON’T KNOW DECLINED......................................................................... |
-98 -99 |
Q1012
Q1011A |
|||||||||||||||||
Q1011A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED......................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q1012 |
This first time this happened, did one person or more than one person have sex with you when you were unable to consent to it or stop it from happening because you were too drunk, high, or drugged? |
1 PERSON.......................................................................... MORE tHAN 1 PERSON.................................................. DON’T KNOW ................................................................... DECLINED ………………………………………………. |
1 2 -98 -99 |
|
|||||||||||||||||
|
IF Q1012>1 PROVIDE TEXT BELOW IF Q1012=1/-98/-99 GO TO Q1013
Of the people who you had sex with when you were unable to consent the first time, think of the person who hurt you the most for the following questions: |
||||||||||||||||||||
Q1013 |
What was this person’s relationship to you? |
CURRENT OR EX Dating partner relative classmate/schoolmate authority figure (like teacher or police officer) friend stranger other don’t know declined |
1 2 3
4 5 6 -97 -98 -99 |
|
|||||||||||||||||
Q1014 |
Was this person male or female? |
male female don’t know Declined |
1 2 -98 -99 |
|
|||||||||||||||||
Q1015 |
How old was this person at the time? Please give your best guess. |
YEARS OLD:
DON’T KNOW…………………………………………... DECLINED………………………………………………. |
-98 -99 |
Q1015A |
|||||||||||||||||
Q1015A |
Would you say this person was:
|
YOUNGER……………………………………................. ABOUT THE SAME AGE……………………................. MORE THAN 5 YEARS OLDER…………….................. MORE THAN 10 YEARS OLDER……………………… DON’T KNOW…………………………………………... DECLINED………………………………………………. |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q1016 |
Where were you when this happened to you? |
SOMEONE’S HOME ......................................................... AN OUTSIDE LOCATION ............................................... SCHOOL ............................................................................. INSIDE A CAR/BUS .......................................................... Bar, club OR restaurant...................................... Other............................................................................... don’t know ................................................................... DECLINED ......................................................................... |
1 2 3 4 5 -97 -98 -99 |
|
|||||||||||||||||
Q1017 |
About what time of day did this happen? |
MORNING (SUNRISE TO NOON) .................................. AFTERNOON (noon to sunset) ............................... EVENING (SUNSET TO MIDNIGHT) ............................. LATE AT NIGHT (Midnight to sunrise) ............... don’t know ................................................................... DECLINED ......................................................................... |
1 2 3 4 -98 -99 |
|
|||||||||||||||||
Q1100
|
PREGNANCY OUTCOMES (FEMALES ONLY):
Did you ever get pregnant as a result of being physically forced or pressured to have sex, or when you were unable to consent to it or stop it from happening because you were too drunk or high? |
YES ..................................................................................... NO ....................................................................................... DON’t KNOW DECLINED ………………………………………………. |
2 -98 -99 |
Q1200 |
|||||||||||||||||
|
IF Q1100=1 AND Q407=2, THEN: “IT MAY BE HARD TO REMEMBER OR SHARE CERTAIN THINGS THAT HAVE HAPPENED TO YOU. YOUR EXPERIENCES ARE IMPORTANT TO ACCURATELY CAPTURE.” THEN QUESTION(S) FOR WHICH WE HAVE INCONSISTENT DATA WILL BE RE-ASKED. |
||||||||||||||||||||
Q1200
|
SV SERVICES: Did you ever have to miss school because anyone we just asked about had sex with you when you were unable to consent to it or stop it from happening because you were too drunk, high, or drugged? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
|||||||||||||||||
Q1201
|
Did you know of a place to go for help because anyone we just asked about had sex with you when you were unable to consent to it or stop it from happening because you were too drunk, high, or drugged? |
YES NO DON’t KNOW DECLINED |
2 -98 -99 |
Q1206B |
|||||||||||||||||
Q1202
|
Did you try to seek professional help or services because anyone we just asked about had sex with you when you were unable to consent to it or stop it from happening because you were too drunk, high, or drugged? |
YES NO DON’t KNOW DECLINED |
2 -98 -99 |
q1204 |
|||||||||||||||||
Q1203
|
There are many reasons why people do not seek professional help or services when they have been hurt. Do you agree or disagree with each of the following as reasons you did not seek help?
I did not seek help because…
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
IF Q1202= 2/-98/-99 THEN SKIP TO Q1206B |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1204
|
Did you receive professional help or services?
|
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1205 |
From whom did you receive professional help or services? |
HEALTHCARE PROFESSIONAL........................................ POLICE................................................................................... LAWYER OR LEGAL PROFESSIONAL............................. SOCIAL WORKER OR COUNSELOR / CHILD PROTECTIVE SERVICES..................................................... 911........................................................................................... other.................................................................................... DON’t KNOW DECLINED |
1 2 3
4 5 -97 -98 -99 |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1206A
|
Besides the professional service providers we just talked about, did you tell anyone else about any of these experiences? |
YES NO DON’t KNOW DECLINED |
2 -98 -99 |
Q1207
Q1208 |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1206B
|
Did you tell anyone about any of these experiences? |
YES NO DON’t KNOW DECLINED |
2 -98 -99 |
Q1208 |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1207 |
Whom did you tell? SELECT ALL THAT APPLY
|
CURRENT OR EX DATING PARTNER RELATIVE FRIEND OR NEIGHBOR SERVICE PROVIDER (like a doctor or counselor) AUTHORITY FIGURE (like a teacher or police officer) oTHER DON’T KNOW DECLINED |
1 2 3
4
5 -97 -98 -99 |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1208 |
There are many reasons why people do not tell anyone when they have been hurt. Do you agree or disagree with each of the following as reasons you did not tell anyone?
I did not tell anyone because…
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
IF Q44=3/-98/-99 (NEVER MARRIED/NEVER LIVED W/ SOMEONE AS MARRIED/DK/DTA) AND Q43=2/-98/-99 (NEVER PARTNER) SKIP TO Q1301
IF Q44=1/2 (EVER MARRIED OR LIVED WITH SOMEONE AS MARRIED) OR Q43=1 (EVER PARTNER) CONTINUE WITH Q1300 |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1300
|
SV PERPETRATION:
Have you ever forced a current or ex-partner to have sex with you when they did not want to?
|
YES NO DON’t KNOW DECLINED |
1
-98 -99 |
Q1303
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1301
|
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1302 |
How old were you the first time this happened? |
years old:
don’T know declined |
-98 -99 |
q1303
q1302a |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1302A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED |
1 2 3 4 -98 -99 |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1303
|
Have you ever forced someone who was not your current or ex-partner to have sex with you when they did not want to? |
YES NO DON’t KNOW DECLINED |
1
-98 -99 |
Q1400
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1304
|
Did this happen in the past 12 months? |
YES NO DON’t KNOW DECLINED |
1 2 -98 -99 |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1305 |
How old were you the first time this happened? |
years old:
don’T know declined |
-98 -99 |
q1400
q1305a |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1305A |
Would you say that you were:
|
0-5 YEARS OLD 6-11 YEARS OLD 12-17 YEARS OLD 18 YEARS OR OLDER DON’T KNOW DECLINED................................................................................ |
1 2 3 4 -98 -99 |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Q1400 |
UNWANTED SEXUAL EXPERIENCES ONLINE:
The next questions are about sexual things that might have taken place on the internet, on social media apps, through email, or through text messaging.
In the past 12 months did you have access to the internet, social media apps, email, or text messaging?
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IF Q1400A=1 OR Q1400B=1 OR 1400C=1 OR 1400D=1, CONTINUE TO 1401 IF Q1400A=2/-98/-99 AND Q1400B=2/-98/-99 AND Q1400C=2/-98/-99 AND Q1400D=2/-98/-99, SKIP TO Q1500 |
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Q1401 |
In the past 12 months did you talk about sexual acts with someone on the internet, on social media, through email or through text messaging because you were pressured to do so against your will? |
YES NO DON’T KNOW DECLINED |
2 -98 -99 |
Q1403 |
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Q1402 |
CURRENT OR EX DATING PARTNER................................. FRIEND OR CLASSMATE...................................................... STRANGER............................................................................... SOMEONE ELSE...................................................................... DON’T KNOW DECLINED |
1 2 3 -97 -98 -99 |
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Q1403 |
In the past 12 months did you send a photo or video showing your private parts on the internet, on social media, through email or through text messaging because you were pressured to do so against your will? |
YES NO DON’T KNOW DECLINED................................................................................ |
1
-98 -99 |
Q1405
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Q1404 |
What was this person’s relationship to you? |
CURRENT OR EX DATING PARTNER................................. FRIEND OR CLASSMATE...................................................... STRANGER.............................................................................. SOMEONE ELSE..................................................................... DON’T KNOW DECLINED................................................................................. |
1 2 3 -97 -98 -99 |
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Q1405 |
In the past 12 months, did you do anything else sexual on the internet, on social media, through email or through text messaging because you were pressured to do so against your will?? |
YES NO DON’T KNOW DECLINED................................................................................. |
2 -98 -99 |
Q1407
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Q1406 |
What was this person’s relationship to you? |
CURRENT OR EX DATING PARTNER................................. FRIEND OR CLASSMATE...................................................... STRANGER............................................................................... SOMEONE ELSE...................................................................... DON’T KNOW DECLINED................................................................................ |
1 2 3 -97 -98 -99 |
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Q1407 |
In the past 12 months did you pressure a partner or ex-partner against their will to talk about sexual acts on the internet, on social media, through email or through text message? |
YES NO DON’T KNOW DECLINED................................................................................. |
1 2 -98 -99 |
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Q1408 |
In the past 12 months did you pressure anyone [else] against their will to talk about sexual acts on the internet, on social media, through email or through text message? |
YES NO DON’T KNOW DECLINED................................................................................. |
1 2 -98 -99 |
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Q1409 |
In the past 12 months did you pressure a partner or ex-partner against their will to send you a photo or video showing their private parts on the internet, on social media, through email or through text message?
|
YES NO DON’T KNOW DECLINED................................................................................ |
1 2 -98 -99 |
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Q1410 |
In the past 12 months did you pressure anyone [else] against their will to send you a photo or video showing their private parts on the internet, on social media, through email or through text message?
|
YES NO DON’T KNOW DECLINED................................................................................. |
1 2 -98 -99 |
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Q1411 |
In the past 12 months did you pressure a partner or ex-partner against their will to do anything else sexual on the internet, on social media, through email or through text message? |
YES NO DON’T KNOW DECLINED................................................................................. |
1 2 -98 -99 |
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Q1412 |
In the past 12 months did you pressure anyone [else] against their will to do anything else sexual on the internet, on social media, through email or through text message? |
YES NO DON’T KNOW DECLINED................................................................................. |
1 2 -98 -99
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Q1413 |
Did you tell anyone about any of these unwanted sexual experiences online? |
YES NO DON’t KNOW DECLINED................................................................................. |
1 2 -98 -99 |
Q1500 |
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Q1414 |
Whom did you tell? SELECT ALL THAT APPLY
|
CURRENT OR EX DATING PARTNER RELATIVE FRIEND OR NEIGHBOR SERVICE PROVIDER (like a doctor or counselor) AUTHORITY FIGURE (like a teacher or police officer) oTHER DON’T KNOW DECLINED |
1 2 3
4
5 -97 -98 -99 |
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Q1500
|
SUBSTANCE ABUSE
During the past 30 days, on how many days did you have at least one drink of alcohol? |
I did not drink alcohol in past 30 days............... 1-2 days................................................................................... 3-5 days................................................................................... 6-9 days................................................................................... 10-19 days............................................................................... 20-29 days............................................................................... all 30 days............................................................................ don’t know.......................................................................... declined................................................................................ |
2 3 4 5 6 7
-99 |
Q1502
1500a
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1500A |
During the past 30 days, did you have at least one drink of alcohol on more than 10 days or less than 10 days? |
more than 10 DAYS....................................... ..................... less than 10 DAYS .............................................................. don’t know ........................................................................... declined ................................................................................. |
1 2 -98 -99 |
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Q1501
|
In the past 30 days, on how many days did you have 4 or more drinks of alcohol in a row, that is within a couple of hours?
[Note for females it is 4 or more drinks and for males it is 5 or more drinks] |
NUMBER OF DAYS:
DON’T KNOW DECLINED |
-98 -99 |
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Q1502
|
This question is about smoking cigarettes (ones that have to be lit and burned). In the past 30 days, have you smoked a cigarette, even one or two puffs? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1503 |
This question is about electronic cigarettes or e-cigarettes, such as JUUL, Vuse, blu, and Logic. E-cigarettes are battery powered devices that usually contain a nicotine-based liquid that is vaporized and inhaled. You may also know them as e-cigs, vape-pens, e-hookas, vapes, or mods. In the past 30 days, have you used an e-cigarette? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1504
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In the past 30 days have you used any of the following drugs (choose all that apply):
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Q1505 |
In the past 30 days have you taken prescription pain medicine without a doctor’s prescription or different than how a doctor told you to use it? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1506 |
In the last 30 days, would you say that in general your health has been excellent, very good, good, fair, or poor? |
EXCEllent............................................................................. very good............................................................................. good......................................................................................... fair........................................................................................... poor......................................................................................... Don’t know.......................................................................... declined................................................................................ |
1 2 3 4 5 -98 -99 |
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Q1507
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MENTAL HEALTH: During the past 30 days, how often did you feel the following ways: all the time, most of the time, some of the time, a little of the time, or none of the time? (Read categories below)
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Q1508
|
Have you ever hurt yourself on purpose in any way? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1509
|
During the past 12 months, did you ever seriously consider attempting suicide?
|
YES NO DON’T KNOW DECLINED |
2 -98 -99 |
Q1511 |
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Q1510
|
During the past 12 months did you actually attempt suicide? |
YES NO DON’T KNOW DECLINED
|
1 2 -98 -99 |
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Q1511 |
STD/STI:
Have you ever tested positive for:
|
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1512
|
Have you ever had any of the following when you thought you might have a sexually transmitted disease or infection?
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Q1513 |
The questionnaire is almost finished. Please answer just a few more questions about your experiences.
Thinking of all of these experiences we have asked about today, do you feel like you are in immediate danger? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1514 |
Thinking about all of these experiences we have asked about today, do you feel unsafe in your current living situation? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1600 |
RESPONSES TO SENSITIVE QUESTIONS:
Thank you for taking the time to answer these questions. We would like to ask you about your opinion of this survey and the questions that you were asked.
Do you feel that participating in this survey was a good use of your time? |
YES, WORTHWHILE NO, NOT WORTHWHILE DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1601 |
At any point during the interview, were you afraid that someone might see your answers and hurt or embarrass you in any way because of what they saw? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1602
|
Did any of the questions make you feel upset because of a past experience? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1603
|
Did you find it upsetting or stressful to answer any of these questions? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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Q1604 |
Do you think surveys like this should ask questions about violence? |
YES NO DON’T KNOW DECLINED |
1 2 -98 -99 |
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IF Q1602=1 OR Q1603=1, CONTINUE WITH Q1605 IF Q1602=2/-98/-99 AND Q1603=2/-98/-99, GO TO Q1606 |
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Q1605
|
Why did you find it upsetting or stressful to answer these questions? |
HARD TO ANSWER QUESTIONS ABOUT DIFFICULT EXPERIENCES IN MY LIFE I FELT UNCOMFORTABLE ANSWERING SUCH PERSONAL QUESTIONS QUESTIONS ABOUT SEX MAKE ME UNCOMFORTABLE OTHER DON’T KNOW DECLINED……………………………………………………. |
1 2
3
4 -97 -98 -99 |
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Q1606
|
You were asked some difficult things. How has sharing these things made you feel? Do you feel better, about the same, or worse than you did before you started answering these questions? |
MUCH BETTER SOMEWHAT BETTER ABOUT THE SAME SOMEWHAT WORSE MUCH WORSE DON’T KNOW DECLINED……………………………………………………. |
1 2 3 4 5 -98 -99 |
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RECORD THE TIME THE INTERVIEW ENDED: |
TIME: (00:00) |
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CORE QUESTIONNAIRE CLOSING PROGRAMMING TRIGGERED RESPONSE PLAN: ANSWERED YES TO: Thinking of all of these experiences we have talked about today, do you feel like you are in immediate danger? ANSWERED YES TO: Thinking about all of these experiences we have talked about today, do you feel unsafe in your current living situation? ANSERED YES TO: PV, EV, SV IN THE PAST 12 MONTHS ANSWERED YES TO: 12 MONTHS THOUGHTS OF OR ATTEMPTED SUICIDE
INTERVIEWER TRIGGERD RESPONSE PLAN: INTERVIEWER NOTES PARTICIPANT BECAME UPSET E.G. BEING TEARFUL, ANGRY, SAD, SHAKING BODY, DIFFICULTY IN BREATHING ETC.? PARTICPANT ASKS INTERVIEWER FOR HELP WITH CURRENT OR PAST EXPERIENCES OF VIOLENCE
IF NO WAS SELECTED FOR ALL OF THE ABOVE AND THE PARTICIPANT DID NOT DISCLOSE ANY VIOLENCE, CONTINUE TO FINISH OPTION 1.
IF YES WAS SELECTED FOR ANY OF THE ABOVE, CONTINUE TO FINISH OPTION 2.
FINISH OPTION 1: PARTICIPANT DID NOT MEET ANY RESPONSE PLAN CRITERIA
I would like to thank you very much for helping me. I appreciate your time. I realize that these questions may have been difficult for you to answer, but it is only by listening to young people like you that we can really understand about the health and life experiences of young people in Baltimore/Maryland.
The questions may have reminded you of times when you, or people you know, have experienced difficulties in life and you may want to talk to someone about this, either now or in the future. Here is a list of organizations that provide various services that could be helpful to you. Please contact them if you need help or just want to find out more information about what they offer. You can contact them anytime.
Do you have any questions you would like to ask me?
FINISH OPTION 2: PARTICIPANT MET ONE OR MORE RESPONSE PLAN CRITERIA
I would like to thank you very much for helping me. I appreciate the time that you have taken. I realize that these questions may have been difficult for you to answer, but it is only by listening to young people like you that that we can really understand about the health and experiences of children and young people in Baltimore/Maryland.
I understand that you have experienced some very difficult times in your life. No one has the right to treat anyone in those ways and you have the right to receive protection and support when you need it. You are not alone. I want you to know that we care about everyone we interview, and we are committed to making sure that you know about how to get support and help.
There may be a time when you would like to talk to someone about your experiences, either now or in the future. Here is a list of organizations that provide various services that could be helpful to you, such as just listening, or providing legal advice or other help you might need. Please contact them if you want to talk about your experiences, need help or want to find out more information about what they offer. You can contact them whenever you feel ready, either soon or in the future.
I also understand that it can be very difficult to ask for help when you need it. If you would like, I can help connect you to our project’s independent social worker who is specially trained to listen and support people with problems similar to the ones you either told me about or entered into the tablet. I can help arrange an opportunity for you to talk to or meet with her in a safe place. Sometimes having someone listen to your thoughts and feelings can be very helpful to relieve stress and help you decide what would be most helpful to you.
There are also other services in this area that offer support and our social worker could tell you about them, and help put you in touch with someone who is trained to help young people, if you want.
If I put you in touch with the social worker for our project, I will only share with that person the information you say it’s OK for me to share. As I explained at the beginning, your survey answers will stay confidential.
Do you think that you would like to talk to one of our social workers/arrange for a social worker to speak with you?
It is fine that you do not want to speak with a social worker now. However, if you change your mind at any time in the future, please contact any of the services provided in the list if you would like to talk over your situation with someone. You can go whenever you feel ready, either soon or later on.
Do you have any questions you would like to ask me? |
YES
IF 13-15: Because you are not 16, I will need your parent or
guardian’s permission. Do you want me to ask them if I can
put you in touch with our social worker? (IF 16 OR OLDER: CONTINUE
TO SERVICE REFERRAL FORM; OR CONTACT SOCIAL WORKER FROM RESPONSE
TEAM IF RELEVANT)
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| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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