ABS in-bound CATI survey

The National Intimate Partner and Sexual Violence Survey (NISVS)

AttE.1_CATI Survey_12.13.19

OMB: 0920-0822

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Attachment E.1

NISVS CATI Survey

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

Shape1

Public Reporting burden of this collection of information varies from 3 to 40 minutes with an estimated average of 22 minutes per person, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-0822).











National Intimate Partner and Sexual Violence Survey (NISVS) 4.0

12.13.2019

General Population




















Table of Contents


General Notes:

The question numbers are the variable names. Question numbers in parentheses are for administrative purposes and will not appear on the final data set. CATI-System and other contractor-created variables are included in the survey instrument, are surrounded by brackets, and may be included on the final data set.

The following abbreviations are used within the instrument: legitimate skip is LEGIT SKIP, DK is Don’t Know, REF is Refused, MTP is Made to Penetrate, and PTSD is Posttraumatic Stress Disorder. Responses of Don’t Know, Refused and LEGIT SKIP will be represented using codes -1, -2 and -3, respectively. Blank fields will be interpreted as inadvertent skips.

This survey will be administered both in English and in Spanish (following translation).

Interviewers will not read answer options listed in ALL CAPS. Answer options listed in both upper and lower case are read to the respondent.

The minimum number of relationships identified per respondent should equal the maximum number of perpetrators reported for that respondent across all violence victimization behaviors of a specific type endorsed? If 996 is entered before the minimum number of relationships have been provided, a soft error check should appear. For example, If SC05=2 and SC06 = 4, then we should expect, at a minimum, 4 relationships to be provided. If 996 is entered for  SC07_02 or SC07_03 or SC07_04, the soft check will appear.

The age at first occurrence of a victimization should be younger than the current age specified in RC1_CHK or calculated from RCMO and RCYR. If the age a victimization first occurred is older than current age, CATI will display a soft check: “It looks as though I may have entered your current age wrong. We just entered {fill: response from current question} but earlier I put your current age as {fill: RespAge}. Would you like me to go back and change your current age or the age I just entered?” Depending on the information provided, the interviewer will then either revise the current age, revise the age-at-first for the victimization behaviors in question, or suppress the check and keep the inconsistent responses. These occurrences should be tracked in real time. Age-at-first is a critical variable and if these inconsistencies are present at a high rate, we will want to reconsider the idea of a “soft check”.). One note of caution: If the respondent age is changed, it is possible that this will cause inconsistencies with age-at-first collected in sections earlier in the survey, resulting in data quality (QA) errors in the data delivery - these QA failures will need to be documented and explained.

CF. Control Form

SHHQUEX1 Hello, my name is ________ and I am calling regarding an important research study on health and injuries for the Centers for Disease Control and Prevention, the CDC.


If you are currently driving a car or doing any activity that requires your full attention, I need to call you back at a later time.

What is your age?

AGE: _______________ [RECORD AGE IN YEARS] {IF LANDLINE AND IF AGE > 18, GO TO (SFONECEL), IF AGE <18, GO TO SRAVAIL, IF CELL PHONE, GO TO INTUSE}

1 DON’T KNOW {Go to SHHQUEX10}

2 REFUSED {Go to SHHQUEX10}

3 PROBABLE BUSINESS {Go to PHONEUSE}

4 ANSWERING MACHINE/PRIVACY MANAGER {Go to INT51}

5 TELEPHONE COMPANY RECORDING { Go to TELCOREC and select the type of recording)

6 GO TO RESULT {For all others}



SHHQUEX10 Are you 18 years of age or older?



1 YES { IF LANDLINE: Go to SFONECEL, IF CELLPHONE:GO TO INTUSE}

2 NO {IF CELLPHONE SAMPLE, GO TO INT76, LANDLINE Go to SRAVAIL}

1 DON’T KNOW {LANDLINE Go to SRAVAIL. CELL Go to INT89 REFUSAL}

2 REFUSED {LANDLINE Go to SRAVAIL. CELL Go to INT89 REFUSAL}

6 GO TO RESULT {For all others}

IF LANDLINE ONLY: SFONECEL/S4CELL Is this a cell phone?


1 YES {GO TO S5B }

2 NO {GO TO SHHQUEX2 OR SFONEUSE}

3 GO TO RESULT {ALL OTHERS}


(NOTE: SFONECEL AND S4CELL ARE THE SAME QUESTION BUT DUE TO THE LOGIC SKIPS, A DIFFERENT VARIABLE NEEDED TO BE CREATED)



IF LANDLINE SAMPLE ONLY:SFONUSE/S4RES I need to ask you a few questions to see if someone in your household is eligible to participate in this important CDC study. If selected, we will send a check for {FILL: $10/$40 (NONRESPONSE FOLLOW-UP PHASE)} to a person in your household who completes the interview. Is this phone number for…


1 home use, {GO TO PHONEUSE}

2 home and business use, or {GO TO PHONEUSE

3 business use only? {INT71 }

4 GO TO RESULT {ALL OTHERS}


(NOTE: SFONUSE AND S4RES ARE THE SAME QUESTION BUT DUE TO THE LOGIC SKIPS, A DIFFERENT VARIABLE NEEDED TO BE CREATED)



CATI:

IF SPEAKING TO A MEMBER OF THE HOUSEHOLD 18 YEARS OR OLDER (SHHQUEX1 = 01 AND IF THIS IS A CELL PHONE (SFONECEL = 01 OR S4CELL = 01), GO TO PHONHUSE

ELSE, (SPEAKING TO A PROBABLE BUSINESS, SHHQUEX1 = 03), GO TO SHHQUEX2.



SHHQUEX2 [I'm calling regarding an important study on health and injuries for the Centers for Disease Control and Prevention, the CDC.]

Are you a member of this household and at least 18 years old?


1 YES {GO TO PHONHUSE}

2 NO {GO TO SRAVAIL}

3 GO TO RESULT {ALL OTHERS2}


INT51- ANSWERING MACHINE MESSAGE Hello, I'm calling for the Centers for Disease Control and Prevention, the CDC.We would like to include your thoughts and experiences in an important study on health and injuries. Your phone number was randomly selected and your answers will be kept confidential. We will call you back at another time or you may call us toll-free at 1-XXX-XXX-XXXX to participate in the study. Thank you for your time.


INT71 Thank you very much, but we are only interviewing people in private residences. [TERMINATE INTERVIEW]


INT 76 We are only interviewing adults age 18 or older, so those are all the questions I have for you. Thank you for your time. [END INTERVIEW; SCREEN OUT, INELIGIBLE AGE]


IF LANDLINE ONLY: SRAVAIL May I please speak with a household member who is at least 18 years old?


[HOUSEHOLD (HH) MEMBERS INCLUDE PEOPLE WHO THINK OF THIS HH AS THEIR PRIMARY PLACE OF RESIDENCE. IT INCLUDES PERSONS WHO USUALLY STAY IN THE HH BUT ARE TEMPORARILY AWAY ON BUSINESS , VACATION, IN A HOSPITAL, OR LIVING AT SCHOOL IN A DORM, FRATERNITY OR SORORITY.]


1 AVAILABLE {Go to SRELIG2}

2 NOT AVAILABLE {Go to INT89}

3 THERE ARE NONE { SUNDRAGE }

4 GO TO RESULT {All others}

( Note: INT 89 is a result code screen which includes refusal, appointment, problem and non residential options)

SRELIG Hello, my name is *** and I'm calling regarding an important study on health and injuries for the Centers for Disease Control and Prevention, the CDC.

Are you a member of this household and at least 18 years old?

1 YES {Go to PHONHUSE/S4RES}

2 NO {Go to SRAVAIL}

3 GO TO RESULTS { ALL OTHERS }

SRELIG2 Hello, my name is *** and I'm calling regarding an important study on health and injuries for the Centers for Disease Control and Prevention, the CDC.
Are you a member of this household and at least 18 years old?


1 YES {S4RES}

2 NO {SRAVAIL}

3 GO TO RESULT {ALL OTHERS}


CATI:

IF CF_INTRO = 2 AND THERE NO ONE IN THE HH 18 OR OVER, CODE OUT AS AGE INELIGIBLE.


SUNDRAGE [IF RESPONDENT IS A CHILD, ASK FOR AN OLDER HOUSEHOLD MEMBER]


1 NO ONE LIVING IN HH IS 18 OR OLDER {INT76-INELIGIBLE AGE}

2 THERE ARE HH MEMBERS 18 OR OLDER {SRAVAIL}

3 GO TO RESULT {ALL OTHERS}


PHONHUSE

{FILL: “Including the number I just dialed” (CF1=2: LANDLINE)} “How many telephone numbers do you have in your household that are used for talking, EXCLUDING cell phones or telephone lines that are used only for machines like faxes and computers?


_


RANGE [0-5 IF SFONECEL OR S4CELL =1: CELL PHONE; 1-5 IF SFONECEL OR S4CELL OR =2: LANDLINE]


-1


DON’T KNOW {HHOVER18}


-2


REFUSED {ALL OTHERS)







CATI:

ASK INTUSE TO ALL. REGARDLESS OF RESPONSE; FOR LANDLINE SAMPLE, GO TO SCONTINU, FOR CELL: GO TO SB5.


INTUSE Do you or any member of this household have access to the Internet using a –


Yes No

a. cellular data plan for a smartphone or other mobile
device? 1 2

b. broadband (high speed) Internet service such as
cable, fiber optic, or DSL service installed in this
household? 1 2

c. satellite Internet service installed in this household? 1 2

d. dial-up Internet service installed in this household? 1 2

e. some other Internet service? 1 2

-1


DON’T KNOW {HHOVER18}


-2


REFUSED {ALL OTHERS)



SCONTINU

{IF SFONECELL=2, FILL: “I need to randomly select one adult who lives in your household to be interviewed.”}

(HH18OVER) How many members of your household, including yourself, are 18 years or older?


_ _


RANGE [1-10 PEOPLE] { If 1 person GO TO S5B, if 2 or more Go to HH18male }



-1


DON’T KNOW

{GO TO ENUM}



-2


REFUSED

{GO TO ENUM}



CATI:

IF RESPONDENT DOES NOT KNOW OR REFUSES NUMBER OF PEOPLE IN HH, GO TO ENUM


CATI:

IF R SAYS THERE ARE 0 ADULTS IN HH, DC WILL CHECK IF R IS 18. IF R IS NOT 18 DC’S BACK UP AND CODE SHHQUEX1 APPROPRIATELY

IF LANDLINE RESPONDENT (SFONECEL OR S4CELL = 2) AND NUM_ADULTS > 1, GO TO HH18MALE.

IF LANDLINE RESPONDENT (SFONECEL OR S4CELL = 2) AND NUM_ADULTS = 1, GO TO S5B; CODE HH18MALE AND HH18FEM AS LEGIT SKIP..

IF CELL PHONE RESPONDENT (SFONECEL OR S4CELL = 1), GO TO S5B; CODE HH18MALE AND HH18FEM AS LEGIT SKIP.



H18MALE

How many of these adults are men?


_ _


RANGE [0-10 Men]


-2


REFUSED

[GO TO ENUM]


HH18FEM

How many of these adults are women?


_ _


RANGE [0-10 Women]


-2


REFUSED

[GO TO ENUM]


CATI:

IF NUM_ADULTS > 3, USE MOST RECENT BIRTHDAY SELECTION, GO TO GETNAME


S5B You have been selected to participate in this interview. Please tell me just your first name and age.

[IF FIRST NAME REFUSED, ASK FOR AGE/SEX, RELATION, INITIALS, OR OTHER IDENTIFYING INFORMATION.]

[PROBE: We need some way to ask for you if we need to call back.]

[Text Field ] {Unlimited Character} {GO TO S5B1}


S5B1 What is your age?

[Text Field] {Range 15-115} {GO TO S5B2}

-7 REFUSED {GO TO S5B2}

-8DON'T KNOW {GO TO s5b2}

S5B2. [ASK IF NEEDED:]

Are you male or female?


MALE {INTRO4A}

FEMALE {INTRO4A}

REFUSED {INTRO4A}

DON'T KNOW {INTRO4A}


IF 1 OF 2 IDENTIFIERS (AGE OR SEX) IS MISSING ((S5B1 = -7 or -8) or (S5B2 = -7 or -8))

S5B_CHK

S5B_CHK


S5B_CHK [PERSON MUST BE IDENTIFIED BY AGE OR GENDER.]

1 RETURN TO QUESTION





S5D The other adult in your household has been selected to participate in the interview. Please tell me just the first name and age of the other adult in the household.


[IF FIRST NAME REFUSED, ASK FOR AGE/SEX, RELATION, INITIALS, OR OTHER IDENTIFYING INFORMATION.]

[PROBE: We need some way to ask for this person if we need to call back.


[Text Field ] {GO TO S5D1}


S5D1 What is this person’s age?


[Text Field] {Range 15-115} {GO TO S5D2}

REFUSED (GO TO S5D2}

DON'T KNOW {GO TO S5D2}


S5D2 [ASK IF NEEDED:]

Is this person male or female?

MALE {GO TO INTRO1}

FEMALE {GO TO INTRO1}

REFUSED {GO TO INTRO1}

DON'T KNOW {GO TO INTRO1}

CATI:

IF 1 OF 2 IDENTIFIERS (AGE OR SEX) IS MISSING ((S5B1 = -7 or -8) or (S5B2 = -7 or -8))

S5B_CHK

S5B_CHK


(S5D_CHK )[PERSON MUST BE IDENTIFIED BY AGE OR GENDER.]

1 RETURN TO QUESTION





GETNAME Please tell me just the first name of the adult in this household who will have the next birthday.

[IF NEEDED: We interview only one adult in each household and asking this question helps the computer decide which person that should be.]

[IF FIRST NAME REFUSED OR DON’T KNOW, ASK FOR INITIALS, AGE/SEX, RELATION OR OTHER IDENTIFYING INFORMATION.]

[IF NEEDED: We need some way to ask for this person if we need to call back.]


01 NAME {GO TO NXTBIRTH}

02 DON’T KNOW BIRTHDAYS {GO TO ENUM}

-7 REFUSED {GO TO ENUM}

-8 DON’T KNOW {GO TO ENUM}


NXTBIRTH Are you that person?

1


YES

{GO TO BDAY2}


2

-7

-8


NO

REFUSED

DON’T KNOW

{GO TO BDAY2}

{GO TO ENUM}

{GO TO ENUM}

BDAY2 What is <your/ this person> first name?


[Please tell me just the first name and age of the adult in this household who will have the next birthday.]
[IF FIRST NAME REFUSED OR DON'T KNOW, ASK FOR AGE/SEX, RELATION, INITIALS, OR OTHER IDENTIFYING INFORMATION.]


_ _


RANGE [15 CHAR] {GO TO BDAYA}






BDAYA What’s <your/this person’s> age?


_ _


RANGE [15-115] {GO TO BDAYS}

-1


DON’T KNOW

{GO TO BDAYS}

-2


REFUSED

{GO TO BDAYS}


BDAYS [ASK IF NEEDED:]
 <Are you/is this person> male or female?

MALE {GO TO INTRO1/INTRO4A}

FEMALE {GO TO INTRO1/INTRO4A}

-REFUSED {GO TO INTRO1/INTRO4A}

-DON'T KNOW {GO TO INTRO1/INTRO4A}




CATI:

IF 1 OF 2 IDENTIFIERS (AGE OR SEX) IS MISSING ((BDAYA = -7 or -8) or (BDAYS = -7 or -8))

S5B_CHK

S5B_CHK


BDAY_CHK [PERSON MUST BE IDENTIFIED BY AGE OR GENDER.]

1 RETURN TO QUESTION



ENUM Starting with yourself, please tell me the first name and age of each adult who normally lives in this household who is age 18 and older.

INTERVIEWER: RECORD RESPONDENT’S FIRST NAME ONLY.

  • IF RESPONDENT REFUSES, ASK FOR A FIRST INITIAL OR SOME OTHER IDENTIFIER OR DESCRIPTIVE CHARACTERISTIC.

  • IF RESPONDENT STILL REFUSES, LEAVE BLANK AND CONTINUE.

FNAME What is <your/ this person’s> first name?



_ _


RANGE [15 CHAR] {GO TO R_AGE}

R_AGE What’s <your/this person’s> age?

_ _


RANGE [15-115] {GO TO R_SEX}

-1


DON’T KNOW

{GO TO R_SEX}

-2


REFUSED

{GO TO R_SEX}


R_SEX [ASK IF NEEDED:]
 <Are you/is this person> male or female?


  • MALE {GO TO MORE1}

  • FEMALE {GO TO MORE1}

  • REFUSED {GO TO MORE1}

  • DON'T KNOW {GO TO MORE1}


MORE1 [Are there any other adults in the household who we haven’t listed?]


YES {GO TO FNAME}

NO (GO TO INTRO1/INTRO4A}



CATI:

RECORD UPTO 15 PEOPLE AND RANDOMLY SELECT ONE ADULT RESPONDENT FROM ALL THE ADULTS ENTERED AT ENUM



CATI:

INTRO1 IS ONLY ASKED WHEN THE SCREENER R IS NOT SELECTED



INTRO1


May I speak with [fill: NAME/AGE/SEX]?


1


YES

{GO TO INTRO4}


2


NO

{SCHEDULE CALLBACK}


-2


REFUSED

[SOFT REFUSAL]




CATI:

IF SET AN APPOINTMENT AT ANY POINT DURING THE SCREENER AND SFone (IS THIS A CELL PHONE?) = 1 ASK TEXT_CONSENT

IF AN APPOINTMENT IS SET BEFORE CF1a HAS BEEN ASKED WE WILL NOT ASK FOR TEXT CONSENT. THIS IS TO AVOID ASKING A MINOR FOR TEXT CONSENT


ASKTEXT

We’d like to send you a brief text message with more information about our study. Do I have your consent to send this message?


1


YES

{GO TO TEXT_THANKS}


2


NO

{CALL BACK HAS BEEN SCHEDULED}


(THKTEXT)

Thank you for giving us permission to send you a text message with more information about the study. You can expect to receive the message within 24 to 48 hours.


1


CONTINUE

[CATI-CMS: CODES CASE AS: 23 “Text Message Needed”]



INTRO4 [WHEN SELECTED RESPONDENT COMES TO THE PHONE …]

Hello, I am calling on behalf of the Centers for Disease Control and Prevention, the CDC. The CDC is conducting a study on health and injuries. My name is __________. I am an interviewer with {CONTRACTOR}, and I am part of the research team. Let me assure you that this is not a sales call.


  1. Continue {GO TO INTRO4A}



INTRO4A You have been randomly chosen to participate in an important study. The Centers for Disease Control and Prevention (CDC) is doing a telephone study of up to {fill: (# OF INTERVIEWS)} people. Men and women age 18 and older will be asked questions about their health and injuries they may have experienced. The data we are collecting are very important and will be used to inform prevention efforts.


The survey will take approximately 30-40 minutes, on average. Since some of the questions are personal, we suggest that you be in a private setting during the survey.


  1. Continue {GO TO INTRO4B}




INTRO4B There are minimal benefits or risks to being in this voluntary study. The answers you give us will be combined with the answers from other people who are in the survey. No information that could personally identify you will be given to the CDC or anyone else. You can skip any question or stop the survey at any time.


If you complete the survey, as a token of our appreciation we will send you a check for {FILL: $10 / $40 (NON-RESPONSE FOLLOW-UP PHASE)}


  1. Continue {GO TO INTRO5}



INTRO5 If you choose to receive the money, I will collect your name and address so that we can mail the check to you. Your name and address will not be connected to the information you provide in the survey, and will be erased from our files at the end of this study.

You may want to have a pen or pencil and paper available to write down a few phone numbers. If you have questions or concerns about participating in the study, you may call the SurveyHelpdesk, at1-888-920-7631. If you have any questions about your rights as a research participant, please contact Westat Office of Research Protection toll-free at ###-###-####.



Do you have any questions before we begin?


1


CONTINUE

{GO TO CF14}


2


GO TO RESULT

{CODE APPROPRIATE RESULT, IF REFUSAL, GO TO REASREF}














REASREF

Could you please tell me why you do not wish to participate in the study at this time?

CODE ALL THAT APPLY.


1 HUNG-UP NO COMMENT {SOFT REFUSAL}


2


DOES NOT HAVE TIME

{SOFT REFUSAL}


3


INCONVENIENT NOW

{SOFT REFUSAL}


4


NOT INTERESTED

{THANK “R” AND END; HARD REFUSAL}


5


DON’T PARTICIPATE IN SURVEYS

{THANK “R” AND END; HARD REFUSAL}


6


OPPOSES GOVERNMENT INTRUDING ON PRIVACY

{THANK “R” AND END; HARD REFUSAL}


7


TOO PRIVATE/SENSITIVE/ EMBARRASSING

{THANK “R” AND END; HARD REFUSAL}


8


OTHER (SPECIFY)

{GO TO NIRFRES}


-1


DON’T KNOW

{THANK “R” AND END; HARD REFUSAL}


-2


REFUSED

{THANK “R” AND END; HARD REFUSAL}


CATI:

CODE ALL OF CF13a – CF13f THAT ARE MENTIONED AS 1(YES). CODE REMAINDER AS 2(NO). IF RESPONSE IS DK OR REF, CODE ALL AS SUCH. IF CF13g NE 1(YES), THEN THANK “R” AND END; CODE AS HARD REFUSAL. SKIP TO CF14; CODE CF13SPEC AS LEGIT SKIP. IF R CAN SCHEDULE A CALL BACK THE CASE WILL BE CODED WITH AN APPOINTMENT NOT A REFUSAL.


NIRFRES

SPECIFY OTHER REASON FOR NOT PARTICIPATING [MAXIMUM OF 40 CHARACTERS]

___________________________________________________


-3


LEGIT SKIP



-1


DON’T KNOW

{THANK “R” AND END; HARD REFUSAL}


-2


REFUSED

{THANK “R” AND END; HARD REFUSAL}


CF14

First, I’d like to confirm your gender.

What sex were you assigned at birth, on your original birth certificate?


1


Male

{SKIP TO NEXT SECTION}


2


Female

{SKIP TO NEXT SECTION}







-1


DON’T KNOW

{THANK “R” AND END; HARD REFUSAL}


-2


REFUSED

{THANK “R” AND END; HARD REFUSAL}

[IF NEEDED: We have to know your sex in order to direct you to the right questions.]

CATI:

IF CF14 IS MALE OR FEMALE, AUTO-FILL CATI SYSTEM VARIABLE “RESPSEX” AND SKIP TO THE NEXT SECTION; CODE CF15 AS LEGIT SKIP.


CF15

How do you describe your gender identity?


1


MALE



2


FEMALE



3


MALE-TO-FEMALE TRANSGENDER (MTF)



4


FEMALE-TO-MALE TRANSGENDER (FTM)



5


OTHER GENDER IDENTITY

SPECIFY_______________________

[MAXIMUM OF 40 CHARACTERS]



-1


DON’T KNOW

{THANK “R” AND END; HARD REFUSAL}


-2


REFUSED

{THANK “R” AND END; HARD REFUSAL}


-3


LEGIT SKIP



[RESPSEX]

CATI SYSTEM VARIABLE RESPONDENT SEX (NOT ASKED – USED FOR CATI READ-IN DISPLAYS)


[IF CF14=1 AND CF15=1 THEN CODE 1 (MALE); IF CF14=2 AND CF15=2, CODE 2 (FEMALE);

IF C15=3 THEN CODE 2 (FEMALE); IF CF15=4 CODE 1 (MALE); IF CF15=5 CODE RESPONSE FROM

CF14 (MALE OR FEMALE)]


1


MALE




2


FEMALE



RC. Respondent Characteristics

RCMO/RCYR

In what month and year were you born?

INTERVIEWER: IF R PROVIDES YEAR OF BIRTH BUT NOT MONTH, CODE MONTH AS REFUSED. CODE YEAR WITH R ANSWER.


_ _ / _ _ _ _ [MM / YYYY] (numeric) .…………..

{SKIP TO RC2}


1

January



2

February



3

March



4

April



5

May



6

June



7

July



8

August



9

September



10

October



11

November



12

December



-1 /-1

DON’T KNOW



-2 / -2

REFUSED



CATI:

IF SELECTED RESPONDENT IS THE SCREENER RESPONDENT AND THE AGE PROVIDED IN SCREENER IS NOT EQUAL TO THE CLACULATED AGE FROM DATE OF BIRTH THEN DISPLAY SOFT CHECK (SEE TEXT, GENERAL NOTES)


CATI:

ELIGIBLE YEARS OF BIRTH ARE: 1908-[READ-IN: CURRENT MONTH], CURRENT YEAR. IF YEAR OF BIRTH IS OUTSIDE ELIGIBLE RANGE, GO TO (RC1a). IF RESPONSE IS -2/-1, WE CANNOT CONFIRM THE RESPONDENT IS 18 OR OLDER, GO TO (RC1a_CHK)


(RC1a)

I’m sorry, but we are only speaking with people who are age 18 and older. I will have to end the interview now. Thank you for your interest, and have a nice day/evening.

INTERVIEWER: IF R VOLUNTEERS THEY ARE 18+, SELECT OPTION 2 TO CONTINUE.



1

R IS LESS THAN 18, THANK AND END

{BREAKOFF}



2

R VOLUNTEERS AGE 18+

{GO TO RC1_CHK}


CATI:

Soft check: If option 2 “R VOLUNTEERS AGE 18+” is selected and RCYR is a four-digit number, not -1 (DON’T KNOW) or -2 (REFUSED), the following text will be displayed:

“It looks as though I may have entered your birth year incorrectly. We just entered that your age is 18 or older but earlier I entered that you were born in {insert RC1YR}. Would you like me to go back and change your birth year?”

RC1_CHK

How old are you?

[RECORD AGE IN YEARS]


_ _ _

[RANGE 18-110 YEARS]

{IF AGE < 18, GO TO (RC1b)}


-2


R VOLUNTEERED 18+ BUT REFUSES TO PROVIDE AGE

{GO TO (RC1c) }


-3


LEGIT SKIP



CATI:

IF SELECTED RESPONDENT IS THE SCREENER RESPONDENT AND THE AGE PROVIDED IN SCREENER IS NOT EQUAL TO THE AGE AT RC1_CHK THEN DISPLAY SOFT CHECK (SEE TEXT, GENERAL NOTES)


(RC1b)

I’m sorry, but we are only speaking with people who are age 18 and older. I will have to end the interview now. Thank you for your interest, and have a nice day/evening.


(RC1c)

I’m sorry, for this survey we need to know your specific age. I will have to end the interview now. Thank you for your interest, and have a nice day/evening.


CATI:

CALCULATE CATI SYSTEM VARIABLE RESPONDENT AGE IN YEARS [RANGE: 18-110] BASED ON RCMO/RCYR (BIRTH MONTH/YEAR) USING A VALUE OF 15 FOR BIRTHDAY AND STORE IN VARIABLE [“RESPAGE”]. IF RC1_CHK IS ANSWERED, COPY THAT AGE INTO THE NEW VARAIBLE. VARIABLE RESPAGE SHOULD BE RETAINED ON THE DATA SET.



RC2

What is the highest level of education you have completed?

INTERVIEWER: IF NECESSARY: READ RESPONSE OPTIONS 1-9.

IF “R” INDICATES A NURSING DEGREE, ASK IF THIS WAS A 2 YEAR OR A 4 YEAR DEGREE.



1


NO SCHOOLING



2


1st-8th GRADE



3


SOME HIGH SCHOOL



4


HIGH SCHOOL GRADUATE/GED



5


TECHNICAL OR VOCATIONAL SCHOOL (ATTENDED/GRADUATED)



6


SOME COLLEGE



7


ASSOCIATES (2-YEAR) DEGREE



8


BACHELOR’S (4-YEAR COLLEGE) DEGREE



9


POSTGRADUATE DEGREE (MASTER’S DEGREE, DOCTORATE DEGREE, MD, JD)



-1


DON’T KNOW



-2


REFUSED



RC3

Are you of Hispanic or {FILL: “Latina” (FEMALE) / “Latino” {MALE)} origin?


1


YES



2


NO



-1


DON’T KNOW



-2


REFUSED



(RC4)

What is your race? You may choose more than one. Are you American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, or White? INTERVIEWER: IF RESPONDENT SAYS “CAUCASIAN” YOU CAN CODE “WHITE”

CODE ALL THAT APPLY

RC4a

1


White


RC4b

2


Black or African American


RC4c

3


Asian


RC4d

4


Native Hawaiian or Other Pacific Islander


RC4e

5


American Indian or Alaska Native


RC4f

6


[INTERVIEWER DON’T READ] - OTHER

{GO TO RC4SPEC}


-1


DON’T KNOW



-2


REFUSED



CATI:

CODE ALL OF RC4a-RC4f THAT ARE MENTIONED AS 1(YES). CODE REMAINDER AS 2(NO). IF RESPONSE IS DK OR REF, CODE ALL AS SUCH. IF RC4f NE 1(YES), SKIP TO RC5; CODE RC4SPEC AS LEGIT SKIP.



RC4SPEC

SPECIFY OTHER RACE [MAXIMUM OF 40 CHARACTERS]

___________________________________________________


-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP


RC5

Are you currently married, divorced, separated, widowed, not married but living with a partner, or

have you never been married?

INTERVIEWER: IF RESPONDENT SAYS THEY ARE “SINGLE” OR “ENGAGED” PLEASE PROBE FURTHER TO

FIND OUT WHICH OF THE LISTED CATEGORIES IS CORRECT.

IF R GIVES MULTIPLE CATEGORIES (E.G., DIVORCED AND WIDOWED; MARRIED AND SEPARATED), PLEASE PROBE FURTHER TO FIND OUT WHICH IS THE MOST RECENT STATUS.


1


Married

{SKIP TO RC6}


2


Divorced

{SKIP TO RC6}


3


Separated

{SKIP TO RC6}


4


Widowed

{SKIP TO RC6}


5


NOT MARRIED BUT LIVING WITH A PARTNER

{SKIP TO RC6}


6


NEVER MARRIED

{SKIP TO RC6}


7


SOMETHING ELSE (SPECIFY)

{GO TO RC5SPEC}


-1


DON’T KNOW

{SKIP TO RC6}


-2


REFUSED

{SKIP TO RC6}


CATI:

IF A5 NE 7, SKIP TO RC6; CODE A5SPEC AS LEGIT SKIP.


RC5SPEC

SPECIFY “SOMETHING ELSE” [MAXIMUM OF 40 CHARACTERS]

___________________________________________________


-3


LEGIT SKIP



-1


DON’T KNOW



-2


REFUSED




RC6

Which of the following best represents how you think of yourself?


1


Lesbian or gay



2


Straight, that is, not lesbian or gay



3


Bisexual



4


Something else



5


I don’t know the answer



-2


REFUSED



CATI:

RC6 SHOULD RESTRICT USE OF THE DON’T KNOW FUNCTION.


CATI:

IF “R” IS NATIVE AMERICAN/ALASKA NATIVE (RC4e=1), SKIP TO RC8; CODE RC7 AND RC7a AS LEGIT SKIP.



RC7

Were you born in the United States, including U.S. territories and U.S. military bases?


1


YES

{SKIP TO RC8}


2


NO



-1


DON’T KNOW

{SKIP TO RC8}


-2


REFUSED

{SKIP TO RC8}


-3


LEGIT SKIP



CATI:

IF RC7 is YES, DK, REF OR LEGIT SKIP, SKIP TO RC8; CODE RC7a AS LEGIT SKIP.




RC7a

How many years have you lived in the United States?

INTERVIEWER: IF R ANSWERS LESS THAN 1 YEAR CODE AS 0.

[RECORD NUMBER OF YEARS; A VALUE OF 0 = LESS THAN 1 YEAR; NUMBER ENTERED SHOULD NOT BE MORE THAN RESPONDENT AGE]


_ _ _

[RANGE 0-110 YEARS]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP




(RC8)

What was the total income from ALL household members during <fill previous year>, before taxes. Include income from all sources such as work, investments, child support, and public assistance.

Was it….

INTERVIEWER: STUDENTS SHOULD NOT INCLUDE THEIR PARENTS INCOME

ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

RC8a

… Less than $25,000?

1

2

-1

-2



SKIP TO …

{RC8b}

{RC8e}

{ RC9 }


RC8b

… Less than $20,000?

1

2

-1

-2

-3


SKIP TO …

{RC8c}

{ RC9 }


RC8c

… Less than $15,000?

1

2

-1

-2

-3


SKIP TO …

{RC8d}

{ RC9 }


RC8d

… Less than $10,000?

1

2

-1

-2

-3


SKIP TO …

{ RC9 }


RC8e

… Less than $35,000?

1

2

-1

-2

-3


SKIP TO …

{RC9}

{RC8f}

{ RC9 }


RC8f

… Less than $50,000?

1

2

-1

-2

-3


SKIP TO …

{RC9}

{RC8g}

{ RC9 }


RC8g

… Less than $75,000?

1

2

-1

-2

-3


SKIP TO …

{RC9}

{RC8h}

{ RC9 }


[DO NOT ASK – CODED AS 1 BY CATI WHEN RC8_7 = 2 BELOW]

RC8h

$75,000 OR MORE (NOT ASKED)

1

2

-1

-2

-3



RC9

What is your zip code? [REFER TO ZIP CODE LOOK-UP DATABASE]


_ _ _ _ _

[RANGE 00001--99950]



-1


DON’T KNOW

{ SKIP TO RC12}


-2


REFUSED

{ SKIP TO RC12}


CATI:

IF RC9 IS DK/REF, SKIP TO RC12; CODE RC10, RC10a AND RC11a AS LEGIT SKIP. IF ZIPCODE IS NOT FOUND IN LOOK-UP DATABASE, SKIP TO RC9a

IF ZIPCODE IS FOUND, SKIP TO RC10

RC9a

What is your zip code?


_ _ _ _ _

[RANGE 00001--99950]



-1


DON’T KNOW

{ SKIP TO RC12}


-2


REFUSED

{ SKIP TO RC12}

RC10

Is this in {FILL: COUTNY ANAD STATE BASED ON RESPONSE AT RC9}?





1 Yes

2 No



-1


DON’T KNOW

{ SKIP TO RC10a}


-2


REFUSED

{ SKIP TO RC10a}}



CATI:

Hard Error: If any of the following are selected: American Virgin Islands (VI), American Samoa (AS), Federated States of Micronesia (FM), Guam (GU), Marshall Islands (MH), Northern Mariana Islands (MP), Palua (PW), Puerto Rico (PR), Foreign Country (FC), or Other US Territory (OT) the screen below will appear:

“Thank you very much, but we are only interviewing residents of the U.S.  IF NECESSARY SAY:  We are only interviewing people who reside in the 50 states, and are not including U.S. territories. INTERVIEWER: CLOSE INTERVIEW TO HAVE CASE CODED OUT AS INELIGIBLE”

After closing of interview, code case as 52 “Lives Out of US”


CATI:

IF RC10 = YES, FILL RC9FPS WITH STATE FIPS AND SKIP TO NEXT SECTION

IF RC10 = NO, DISPLAY SOFT CHECK TO CONFIRM THE CORRECT ZIP CODE WAS ENTERTED AT RC9, IF COUTNY AND STATE ARE STILL NOT CORRECT, SKIP TO RC10a



RC10a

What state do you live in?

[CHOOSE FROM STATE DROP-DOWN LIST (STATE POSTAL CODE ABBREVIATIONS - APPENDIX III)]


_ _

[RANGE XX-XX]



-1


DON’T KNOW

{ SKIP TO RC12HC_INTRO}


-2


REFUSED

{ SKIP TO RC12}


-3


LEGIT SKIP



CATI:

Hard Error: If any of the following are selected: American Virgin Islands (VI), American Samoa (AS), Federated States of Micronesia (FM), Guam (GU), Marshall Islands (MH), Northern Mariana Islands (MP), Palua (PW), Puerto Rico (PR), Foreign Country (FC), or Other US Territory (OT) the screen below will appear:

“Thank you very much, but we are only interviewing residents of the U.S.  IF NECESSARY SAY:  We are only interviewing people who reside in the 50 states, and are not including U.S. territories. INTERVIEWER: CLOSE INTERVIEW TO HAVE CASE CODED OUT AS INELIGIBLE”

After closing of interview, code case as 52 “Lives Out of US”




RC11a

What county do you live in?

INTERVIEWER: “I heard you say that you live in [REPEAT BACK RESPONSE]. Is this the name of the city you live in or the county that your city is in?” IF CITY, ASK AGAIN FOR NAME OF COUNTY.

[STRING OF CHARACTER VARIABLES (UP TO 33 CHARACTERS)]

_____________________________________________________


-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP





RC12

I understand that people sometimes do not know their zip code, but for statistical purposes we

need to know in what area you live.

What state do you live in?

[CHOOSE FROM STATE POSTAL CODE ABBREVIATION DROP-DOWN LIST – (APPENDIX __)]


_ _

[RANGE XX-XX]



-1


DON’T KNOW

{SKIP TO NEXT SECTION}


-2


REFUSED

{SKIP TO NEXT SECTION}


-3


LEGIT SKIP


CATI:

Hard Error: If any of the following are selected: American Virgin Islands (VI), American Samoa (AS), Federated States of Micronesia (FM), Guam (GU), Marshall Islands (MH), Northern Mariana Islands (MP), Palua (PW), Puerto Rico (PR), Foreign Country (FC), or Other US Territory (OT) the following will appear: “Thank you very much, but we are only interviewing residents of the U.S.  IF NECESSARY SAY:  We are only interviewing people who reside in the 50 states, and are not including U.S. territories. INTERVIEWER: CLOSE INTERVIEW TO HAVE CASE CODED OUT AS INELIGIBLE”

After closing of interview, code case as 52 “Lives Out of US”



RC12a

What county do you live in?

INTERVIEWER: “I heard you say that you live in [REPEAT BACK RESPONSE]. Is this the name of the city you live in or the county that your city is in? ” IF CITY, ASK AGAIN FOR NAME OF COUNTY

-

[STRING OF CHARACTER VARIABLES (UP TO 33 CHARACTERS)]

_____________________________________________________



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

DEFINE CATI SYSTEM VARIABLE RESPONDENT STATE BASED ON RC10a OR RC12 AND STORE IN VARIABLE ["RESPSTATE"]. DEFINE CATI SYSTEM VARIABLE RESPONDENT COUNTY FIPS CODE BASED ON A11a OR RC12a AND STORE IN VARIABLE ["RESPCFIPS"].

IF COUNTY CANNOT BE FOUND IN SELECTED STATE OR IS NOT SELECTED, RESPCFIPS IS SET TO 99999 OR IS MISSING.



HC. Health Conditions

(HC_INTRO)

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


Do you have …

ITEM

QUESTION

YES

NO

DK

REF

HC01

… frequent headaches?

1

2

-1

-2

HC02

… chronic pain?

1

2

-1

-2

HC03

 Shape2

… difficulty sleeping?

1

2

-1

-2



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

ITEM

QUESTION

YES

NO

DK

REF

HC04

… Asthma?

1

2

-1

-2

HC05

… Irritable Bowel Syndrome or IBS?

1

2

-1

-2

ITEM

QUESTION

YES

NO

DK

REF

HC06



Have you ever, even once, taken any prescription pain medicine without a prescription or differently than how a doctor told you to use it ( for example, OxyContin, Vicodin, Lortab, or Percocet)?

1

2

-1

-2



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

ITEM

QUESTION

YES

NO

DK

REF

HC07

… any type of depression?

1

2

-1

-2



The next questions are about thoughts of suicide. Please remember that your answers are confidential.

ITEM

QUESTION

YES

NO

DK

REF

HC08_01

Have you ever seriously thought about trying to kill yourself?

1

2

-1

-2

If yes, ask HC08.

ITEM

QUESTION

YES

NO

DK

REF

HC08

Have you ever tried to kill yourself?

1

2

-1

-2



--. Introduction to Victimization

(V_INTRO)

When we began this survey, I told you we’d be discussing health and injuries.  The next set of questions asks about experiences that can directly impact your health or may have resulted in injury.  These experiences may or may not have happened to you. There will be some questions about physical injuries, harassing behaviors, and unwanted sexual activity. At any point, the questions are making you upset and you would like to speak with a trained professional, I can give you a phone number to call.


Remember, you don’t have to answer any question that you don’t want to. We suggest that you be in a private setting during the survey. If, at any time, you do not feel physically or emotionally safe, you can just say “Goodbye”. I will understand and I will not call you back. You can call me back if you’d like at {FILL: PRJ_CallInNumber}.



Do you have any questions? ANSWER ALL “R” QUESTIONS BEFORE CONTINUING

1


CONTINUE



V_CHK

Shall we continue?


1


YES



2


NO

{BREAKOFF: THANK & END}


-1


DON’T KNOW

{BREAKOFF: THANK & END}


-2


REFUSED

{BREAKOFF: THANK & END}


CATI:

If NO, DON’T KNOW, REFUSED, Code as a Break-Off; Thank “R” and end the interview. For any hostile refusals or distressed cases do not call back.



ST. Stalking

(ST_INTRO)

I’m going to ask you some detailed questions about times in your life when someone may have ever given you unwanted attention by repeatedly contacting you, following you, or harassing you. When answering, please think about anyone who may have done these things to you, including strangers, a romantic or sexual partner,

a family member, a friend, teacher, co-worker or supervisor, or someone you have known briefly.  

Please DO NOT include bill collectors, telephone solicitors, other sales people, or others following or contacting you as part of their job.


ITEM

QUESTION

YES

NO

DK

REF

Has anyone ever …

ST01

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

1

2

-1

-2

ST02

… approached you or showed up in places, such as your

home, work, or school when you did not want them

to?

1

2

-1

-2

ST03

… used technology, such as hidden cameras, computer software, apps, or GPS to monitor or track your location without your permission. This includes GPS used in a phone or in social media, such as Facebook.

IF NECESSARY: We are talking about times when you knew

or you thought someone was using GPS technology to

monitor you.

IF NECESSARY: GPS is Global Positioning Tracking

1

2

-1

-2

Has anyone ever …





ST04

… sneaked onto your property, such as your home or car, and did things to scare you by letting you know they had been there?

1

2

-1

-2

ST05

… made unwanted phone calls to you, sent you emails, voice, or text messages? Please do not include bill collectors or telephone solicitors.

1

2

-1

-2

Has anyone ever …





ST06

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

1

2

-1

-2

ST07

… sent you cards, letters, flowers, or presents when

they knew you didn’t want them to?

1

2

-1

-2


CATI:

IF “R” ENDORSES 0 BEHAVIORS FOR ST01-ST07 (INCLUDES RESPONSES OF DK AND REF), THEN SKIP TO SC_INTRO1; CODE ST08 – ST18_05 AS LEGIT SKIP.




**You said that someone had {FILL: LIST OF STALKING BEHAVIORS ENDORSED FROM ABOVE – USE THE

STALKING BEHAVIOR FILLS ( APPENDIX II); SEPARATE LAST TWO BEHAVIORS WITH THE WORD “and”}.

ST08_01 Has the same person done any of these things to you on more than one occasion?

If yes, ask ST08, If no go to SC_INTRO1.



ST08

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

[A VALUE OF 10 = 10 OR MORE]


_ _


[RANGE 0-10]

{IF = 0 SKIP TO SC_INTRO1}


-1


DON’T KNOW

{SKIP TO SC_INTRO1}


-2


REFUSED

{SKIP TO SC_INTRO1}


-3


LEGIT SKIP



CATI:

IF “R” RESPONDS 0, DK OR REF TO ST08, SKIP TO SC_INTRO1; CODE ST09 – ST18_05 AS LEGIT SKIP.

IF “R” RESPONDS 1 TO ST08, GO TO ST09_01



ST09_01 Now, thinking ONLY about the person who followed, contacted or harassed you on more than one occasion. Has this person ever made you fearful or feel threatened, or concerned for your safety or the safety of others?

1


YES



2


NO

{SKIP TO ST10_01}


-1


DON’T KNOW

{SKIP TO ST10_01}


-2


REFUSED

{SKIP TO ST10_01}







CATI:

IF “R” RESPONDS 1 TO ST09_01, FILL ST09 = 1, THEN SKIP TO ST10_01


ST09

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

[A VALUE OF 10 = 10 OR MORE PEOPLE]


_ _


[RANGE 0-10]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



ST10_01 Now, thinking ONLY about the person who followed contacted or harassed you on more than one occasion, did this person ever make threats to physically harm you?


Please include all threats to physically harm you even if you did not take the threat seriously or did not feel fearful, threatened, or concerned for your safety or the safety of others.

1


YES



2


NO

{SKIP TO BOX BEFORE ST11_01}


-1


DON’T KNOW

{SKIP TO BOX BEFORE ST11_01}


-2


REFUSED

{SKIP TO BOX BEFORE ST11_01}







CATI:

IF “R” RESPONDS 1 TO ST10_01, FILL ST10 = 1, THEN SKIP TO BOX BEFORE ST11_01


ST10

Now, thinking ONLY about the {fill: “person” (ST08=1)/ “people”} who followed contacted or harassed you on more than one occasion, how many of those people ever made threats to physically harm you? Please include ALL people who made threats to physically harm you EVEN IF you did not take the threat seriously or did not feel fearful, threatened, or concerned for your safety or the safety of others.

[A VALUE OF 10 = 10 OR MORE PEOPLE]


_ _


[RANGE 0-10]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP


CATI:

IF R RESPONDS ZERO, DK OR REF TO ST09 AND ST010, SKIP TO SC_INTRO1; CODE ST11_01 – ST18_05 AS LEGIT SKIP.

MAXIMUM NUMBER OF RELATIONSHIPS IN ST11_ SHOULD EQUAL THE MINIMUM NUMBER ENTERED IN EITHER ST08 OR (ST09 + ST10).


ST11_01

Now I’d like you to only think about the {fill: “person” (ST08=1 or ST09 + ST10 = 1)/ “people”} who {FILL: LIST OF STALKING BEHAVIORS ENDORSED IN ST01 – ST07} {Fill: IfST09_01 = 01 OR ST09 ≥ 1 and ST10_01 = 02, -7, OR -8 OR ST10 = 0, -7, OR -8, then display “made you feel fearful, threatened, or concerned for your safety or the safety of others”. If ST10_01 = 01 OR ST10 ≥ 1 and ST09_01 = 02, -7, OR -8 OR ST09 = 0, -7, OR -8 then display “made threats to physically harm you”, else display “made you feel fearful, threatened, or made threats to physically harm you, or made you feel concerned for your safety or the safety of others”}

The first time these things happened to you, how did you know the person who did {this/any of these things} to you?

If R reported 3 or less behaviors: fill in the question with the endorsements.

If R reported 4 or more behaviors: Now, I’d like you to only think about the person/people who followed, contacted, or harassed you …

IF NECESSARY: “What was your connection, if any, to this person?”


IF NECESSARY: Was this person male or female?

[USE THE RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]


_ _ _

[RANGE 100-800]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP




ST12

How old were you the first time this person did {this/any of these things} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110 YEARS]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF ST08=1 OR (ST09 + ST10=1) THEN SKIP TO ST13; CODE ST11_02 – ST11_10 AS LEGIT SKIP.

The first relationship has already been coded in ST11_01. Code additional relationships in the “ST11_” variables below using the Relationship/Sex template (Appendix I). Relationship categories may be repeated.


(ST11)

[IF MINIMUM VALUE BETWEEN ST08 or (ST09 + ST10) >1 ASK …]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-800]

NO MORE

DK

REF

LEGIT SKIP

ST11_02

Now I’m going to ask you about any additional people who may have done these things to you.

Remember, we are only talking about anyone who followed, contacted or harassed you on more than one occasion and made you feel fearful, or made threats to physically harm you, or made you feel concerned for your safety or the safety of others.

How did you know the 2nd person who did {this/any of these things} to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT

_ _ _

996

-1

-2

-3

ST11_03

How did you know the 3rd person who did any of these things to you?

_ _ _

996

-1

-2

-3

ST11_04

The 4th person?

_ _ _

996

-1

-2

-3

ST11_05

The 5th person?

_ _ _

996

-1

-2

-3

:

:






ST11_09

The 9th person?

_ _ _

996

-1

-2

-3

ST11_10

The 10th person?

_ _ _

996

-1

-2

-3


CATI:

SHOW ONLY THE ST11_## THAT ARE < THE MINIMUM VALUE BETWEEN ST08 OR ST09 + ST10 ONCE CODE 996 IS USED, REMAINING “ST11_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF ST11_## THAT CAN BE ANSWERED MUST BE THE MINIMUM

VALUE BETWEEN ST08 OR (ST09 + ST10).

EXAMPLE: IF ST08=3, ST09_1=2 AND ST09_2=3, ST12_04 – ST12_10 MUST BE CODED LEGIT SKIP.

NOTE: ITEMS ST11_02 – ST11_05 MAY NOT ALL HAVE RELATIONSHIP INFORMATION AS THE NUMBER IN ST08 IS FURTHER RESTRICTED TO THOSE WHO WERE COUNTED IN ST09 (fearful) AND/OR ST10 (threatened with physical harm).



CATI:

IF NONE OF “ST11_” ITEMS ARE AN INTIMATE PARTNER (ALL > 200), SKIP TO ST16; CODE ST13 – ST15 AS LEGIT SKIP.

ST13

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {this/any of these things} to you was {FILL: (INTIMATE RELATIONSHIP CODE 107, 157)/ “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM ST11_01 – ST11_10}. Is this correct?


1


YES

{SKIP TO ST15}


2


NO

{GO TO ST14}


-1


DON’T KNOW

{SKIP TO ST15}


-2


REFUSED

{SKIP TO ST15}


-3


LEGIT SKIP

{SKIP TO ST15}

CATI:

IF ST13=1, RECORD FIRST INTIMATE PARTNER RESPONSE FROM ST11_01 – ST11_10 IN ST14.


ST14

What was your relationship to this person?


_ _ _

[RANGE 100-199]




-3


LEGIT SKIP




CATI:

IF 100 < ST14 < 199 AND ST14 = ST11_01 THEN SKIP TO ST16; FILL ST15 = ST12 .


ST15

How old were you the first time this person did {this/any of these things} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110 YEARS]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP


CATI:

IF CURRENT AGE (RESPAGE) < ST15 THEN DISPLAY SOFT CHECK (SEE TEXT, GENERAL NOTES)


CATI:

IF ONE PERSON STALKED R (ST11_02 = 996 OR -3), GO TO ST16_01, ELSE GOT TO ST16


ST16_01 Think about the person who {FILL: LIST OF STALKING BEHAVIORS ENDORSED IN ST01 – ST07; USE THE STALKNG BEHAVIOR FILLS (APPENDIX II)})} and {Fill: IfST09_01 = 01 OR ST09 ≥ 1 and ST10_01 = 02, -7, OR -8 OR ST10 = 0, -7, OR -8, then display “made you feel fearful, threatened, or concerned for your safety or the safety of others”. If ST10_01 = 01 OR ST10 ≥ 1 and ST09_01 = 02, -7, OR -8 OR ST09 = 0, -7, OR -8 then display “made threats to physically harm you”, else display “made you feel fearful, threatened, or made threats to physically harm you, or made you feel concerned for your safety or the safety of others”}

1


YES



2


NO

{SKIP TO BOX AFTER ST16}


-1


DON’T KNOW

{SKIP TO BOX AFTER ST16}


-2


REFUSED

{SKIP TO BOX AFTER ST16}


CATI:

IF ST16_01 = 1, FILL ST16 = 1, THEN SKIP TO BOX AFTER ST16



ST16

Think about the {FILL: “person” (ST08=1 OR SC09 + SC10=1)/”people”} who {FILL: LIST OF STALKING BEHAVIORS ENDORSED IN ST01 – ST07; USE THE STALKNG BEHAVIOR FILLS (APPENDIX II)})} AND made you feel fearful or made threats to physically harm you, or made you feel concerned for your safety or the safety of others.  How many people did {this/any of these things} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]


_ _


[RANGE: 0 - 5]

{IF 0, SKIP TO SC_INTRO1}


-1


DON’T KNOW

{SKIP TO SC_INTRO1}


-2


REFUSED

{SKIP TO SC_INTRO1}


-3


LEGIT SKIP



CATI:

IF ST16 IS CODED AS ZERO, DK OR REF, SKIP TO SC_INTRO1; CODE ST17_1, ST17_01 – ST17_05 AS LEGIT SKIP.

CHECK: THE VALUE OF ST16 MUST BE < THE MINIMUM VALUE OF ST08 or THE SUM OF (ST09 + ST10).


CATI:

IF ONE RELATIONSHIP EVER (ST11_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (ST11_01=201-239,251-289) AND ONE RELATIONSHIP PAST 12 MONTHS (ST16=1), CODE ST18_01 WITH VALUE FROM ST11_01, AND SKIP TO SC_INTRO1; CODE ST17, ST18_02 – ST18_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (ST11_02 = 996) AND ONE RELATIONSHIP PAST 12 MONTHS (ST16=1), AND NOT A FAMILY MEMBER, A GROUPS OR UNKNOWN (ST11_01 = 700, 750, 710, OR 800) READ ST17 (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF ST16 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (ST18). CODE ST17 AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (ST11_02 < 996) AND ST16 = 1, GO TO (ST18). CODE SC17 AS LEGIT SKIP.

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED. ANY RELATIONSHIP RESPONSE IS ACCEPTABLE.



User Note:

↓

Relationships coded in the “ST18_” items below.

Code relationships specified using the Relationship/Sex template (Appendix II).

Note that relationships can change over time therefore past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned more than once.


[IF ST11_01 ANSWERED AND NOT 200-239, 250-289 AND ST11_02=996 or ST11_02=-3 LEGIT SKIP, READ …]

ST17

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556,)/ “your” ANY OTHER RELATIONSHIP CODES AT ST12_01} when {FILL: he/she} did {this/these things} to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN ST18_01 AND SKIP TO SC_INTRO1; CODE ST17_02 – ST17_05 AS LEGIT SKIP}


1


YES

{SKIP TO SC_INTRO1}


2


NO

{GO TO ST18_01}


-1


DON’T KNOW

{SKIP TO SC_INTRO1}


-2


REFUSED

{SKIP TO SC_INTRO1}


-3


LEGIT SKIP

{SKIP TO ST18_01}


CATI:

IF ST17 IS CODED AS 1, -1, -2, FILL ST18_01 WITH “FILL” VALUE FROM ST17 AND SKIP TO (SC_INTRO1); CODE ST18_02 – ST18_05 AS LEGIT SKIP.



(ST18)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-650]

DK

REF

NA

How did you know the “person” (ST16=1) / ”people” who did {this/these things} to you in the past 12 months?

[DO NOT READ ST18_01 - ST18_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT]

IF NECESSARY: Was this person male or female?

ST18_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

ST18_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

ST18_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

ST18_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

ST18_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3


CATI:

SHOW ONLY THE ST18_## THAT ARE < ST16. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF ST16 = 2, THEN ST18_01 AND ST18_02 MUST BE ANSWERED,

AND ST18_03 – ST18_05 MUST BE CODED AS LEGIT SKIP.





SC. Sexual Violence: Verbal Harassment, Unwanted Touching and Coerced Sex

(SC_INTRO1)

I’m going to ask you some detailed questions about times in your life when you may have ever experienced unwanted sexual situations with anyone, including strangers or someone you knew such as a romantic or sexual partner, a family member, a friend, teacher, co-worker or supervisor, or someone you have known for only a short time. These questions are detailed and the language is explicit, which some people may find upsetting. It is important that I ask the questions this way so that you understand what I mean. Your answers will help us to learn how often these things happen. You can skip questions you don’t want to answer and you can stop at any time.

First, I’m going to ask you about unwanted sexual situations, including verbal harassment and unwanted touching.

SC_CHK1

Shall we continue?


1


YES



2


NO

{BREAK-OFF: THANK & END}


-1


DON’T KNOW

{BREAK-OFF: THANK & END}


-2


REFUSED

{BREAK-OFF: THANK & END}


CATI:

If “R” responds NO, DON’T KNOW, or REFUSED, code as a break-off. Thank “R” and end the interview. For any hostile refusals or distressed cases do not call back.


ITEM

QUESTION

RANGE

[1-10]

NONE

DK

REF

LEGIT SKIP

SC01

  • In your lifetime, how many people from your WORKPLACE made unwanted sexual remarks or sexual jokes in your presence, or sexually offensive comments about your body or appearance? Please include people you work with or come into contact with through your job. This may have happened at work, or elsewhere with people connected to your workplace.

_ _

0

{SKIP

-1

TO

-2

SC03}

-3

SC02

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

_ _

0

-1

-2

-3

SC03

While you were in a PUBLIC place, how many people have ever verbally harassed you in a sexual way that made you feel uncomfortable?

_ _

0

{SKIP

-1

TO

-2

SC05}

-3

SC04

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

_ _

0

-1

-2

-3


ITEM

QUESTION

RANGE

[1-10]

NONE

DK

REF

LEGIT SKIP

How many people have ever …

SC05

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

_ _

0

-1

-2

-3

SC06

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

_ _

0

-1

-2

-3



CATI:

IF NEITHER SC05 NOR SC06 ENDORSED, SKIP TO SC_INTRO2; CODE SC07_01 – SC14 AS LEGIT SKIP.

SC07_01

Think about the first time anyone EVER {FILL: LIST OF UNWANTED TOUCHING BEHAVIORS ENDORSED IN SC05 – SC06) – USE THE UNWANTED TOUCHING BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} when you did not want them to.

The first time these things happened to you, how did you know the person who did {this/any of these things} to you?


IF NECESSARY: “What was your connection, if any, to this person?”


IF NECESSARY: “Was this person male or female?”

[CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]


_ _ _

[RANGE 100 – 800]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP


SC08

How old were you the first time this person did {this/any of these things} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110 YEARS]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP


CATI:

IF CURRENT AGE (RESPAGE) < SC08 THEN DISPLAY SOFT CHECK. (SEE GENERAL NOTES)


Note:

↓

The first relationship has already been coded in SC07_01. Code additional relationships in “SC07_” items below using the Relationship/Sex template (Appendix I). Note that relationship categories may be repeated.



(SC07)

[IF SC05+SC06>1, ASK …]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-800]

NO MORE

DK

REF

LEGITSKIP

SC07_02

Now I’m going to ask you about any additional people who may have done these things to you.

How did you know the 2nd person who did {FILL: “this” (JUST SC05) / “any of these things”} to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.

_ _ _

996

-1

-2

-3

SC07_03

How did you know the 3rd person who did {FILL: “this” (JUST SC05) / “any of these things”} to you?

_ _ _

996

-1

-2

-3

SC07_04

The 4th person?

_ _ _

996

-1

-2

-3

SC07_05

The 5th person?

_ _ _

996

-1

-2

-3

:

:






SC07_09

The 9th person?

_ _ _

996

-1

-2

-3

SC07_10

The 10th person?

_ _ _

996

-1

-2

-3


CATI:

SHOW ONLY THE SC07_## THAT ARE < THE SUM OF SC05+SC06 (THE MAXIMUM POSSIBLE).

ONCE CODE 996 IS USED, REMAINING “SC07_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “SC07_##” THAT CAN BE ANSWERED MUST BE < (SC05+SC06).

EXAMPLE: IF SC05=2 AND SC06=3, SC07_06 – SC07_10 MUST BE CODED LEGIT SKIP.


CATI:

IF NONE OF “SC07_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO SC12; CODE SC09 – SC11 AS LEGIT SKIP.


SC09

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {this/any of these things} to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM SC07_01 – SC07_10}. Is this correct?


1


YES

{CODE RELATIONSHIP IN SC10}


2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP


SC10

What was your relationship to this person?


_ _ _

[RANGE 100-199]




-3


LEGIT SKIP




CATI:

IF 100 < SC10 < 199 AND SC10= SC07_01 THEN SKIP TO SC12; FILL SC11=SC08.


SC11

How old were you the first time this person did {FILL: “this” (JUST SC05) / “any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]



_ _ _

[RANGE 0-110 YEARS]




-1


DON’T KNOW




-2


REFUSED




-3


LEGIT SKIP




CATI:

IF CURRENT AGE (RESPAGE) < SC11 THEN DISPLAY SOFT CHECK (SEE TEXT, GENERAL NOTES)


CATI:

IF ONLY ONE PERSON KIDDED OR TOUCHED R (SC07_02 = -3), GO TO SC12_01



SC12_01













SC12



Thinking about the person who {FILL: SC05 AND/OR SC06 BEHAVIORS AS APPROPRIATE – USE THE SEXUAL VIOLENCE BEHAVIOR FILLS (APPENDIX II)}. Did this person do {FILL: “this” (JUST SC05) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?




1


YES



2


NO

{GO TO SC_INTRO2 }


-1


DON’T KNOW

{GO TO SC_INTRO2}


-2


REFUSED

{GO TO SC_INTRO2}



CATI:

IF “R” RESPONDS 1 TO SC12_01, FILL SC12 = 1, GO TO BOX AFTER ST12



Thinking about the people who {FILL: SC05 AND/OR SC06 BEHAVIORS AS APPROPRIATE – USE THE SEXUAL VIOLENCE BEHAVIOR FILLS (APPENDIX II)} how many people did {FILL: “this” (JUST SC05) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]


_ _

[RANGE: 0 - 5]


-1


DON’T KNOW

{SKIP TO SC_INTRO2}


-2


REFUSED

{SKIP TO SC_INTRO2}


-3


LEGIT SKIP



CATI:

IF SC12 IS CODED AS 0, DK OR REF, SKIP TO SC_INTRO2; CODE SC13, SC14_01 – SC14_05 AS LEGIT SKIP.

CHECK: SC12 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN SC07_01 – SC07_10.


CATI:

IF ONE RELATIONSHIP EVER (SC07_01 ANSWERED AND SC07_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER (SC07_01 = 201 - 239, 251 - 289), CODE SC14_01 WITH THE RELATIONSHIP FROM SC07_01 AND SKIP TO SC_INTRO2 ; CODE SC14_01, SC14_02 – SC14_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (SC07_01 ANSWERED, SC07_02= 996) AND NOT A FAMILY MEMBER, A GROUP OR UNKNOWN RELATIONSHIP (SC07 = 700, 750, 710, 760, OR 800) AND ONE RELATIONSHIP PAST 12 MONTHS (SC12 = 1), READ SC13 (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF SC12 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (SC14). CODE SC13 AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (SC07_02 < 996) AND SC12=1, GO TO (SC14). CODE SC13 AS LEGIT SKIP.

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.


Note:

↓

Code Relationships in the “SC14_” items below.

If one relationship EVER (SC07_01 answered, SC07_02 = 996) and one relationship past 12 months (SC13=1), read text to confirm that the relationship has not change: If no change, code SC14_01 with the value of SC07_01. Otherwise code relationship reported. If more than one relationship EVER (answered at least SC07_01, SC07_02), read alternate text and code relationships specified using the Relationship/Sex template (Appendix II).

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned more than once.



[IF SC07_01 ANSWERED AND NOT 200-239, 250-289 AND SC07_02=996 or SC07_02=-3 LEGIT SKIP READ …]

SC13

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 “a” /(RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556) “your” /ANY OTHER RELATIONSHIP CODES AT SC07_01} when {FILL: he/she} did {this/these things} to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN SC14_01 AND SKIP TO SC_INTRO2; CODE SC14_02 – SC14_05 AS LEGIT SKIP}


1


YES

{SKIP TO SC_INTRO2}


2


NO

{GO TO SC14_01}


-1


DON’T KNOW

{SKIP TO SC_INTRO2}


-2


REFUSED

{SKIP TO SC_INTRO2}


-3


LEGIT SKIP

{SKIP TO SC_INTRO2}



CATI:

IF SC13 IS CODED AS 1, -1, -2, FILL SC14_01 WITH “FILL” VALUE FROM SC13 AND SKIP TO SC_INTRO2; CODE SC14_02 – SC14_05 AS LEGIT SKIP.



(SC14)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-650]

DK

REF

LEGIT SKIP

How did you know the “person” (SC13=1) / ”people” who did ”this” (JUST SC05) / ”these things” to you in the past 12 months? [DO NOT READ SC14_01 – SC14_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT]

IF NECESSARY: Was this person male or female?

SC14_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

SC14_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

SC14_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

SC14_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

SC14_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3

CATI:

SHOW ONLY THE SC14_## THAT ARE < SC12. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF SC12 = 2, THEN SC14_01 AND SC14_02 MUST BE ANSWERED,

AND SC14_03 – SC14_05 MUST BE CODED LEGIT SKIP.


(SC_INTRO2)

Sometimes unwanted sex happens after a person is pressured into it, such as through verbal and emotional pressure and other nonphysical kinds of pressure. The following questions are about times in your life when someone may have ever used verbal or other nonphysical pressure to make you have sex when you didn’t want to. This could be anyone, including strangers or someone you knew such as a romantic or sexual partner, a family member, a friend, teacher, co-worker or supervisor, or someone you have known for only a short time.


  • USER NOTE: ITEMS SC15 –SC22 ARE INCLUDED TO GET AT COERCED SEX

How many people have you had vaginal, oral, or anal sex with after they pressured you by doing any of the

following?

ITEM

QUESTION

RANGE

[1-10]

NONE

DK

REF

LEGIT SKIP

SC15

Telling you lies, making promises about

the future they knew were untrue,

threatening to end your relationship, or

threatening to spread rumors about you?

_ _

0

-1

-2

-3

SC16

Wearing you down by repeatedly asking

for sex, or showing they were unhappy?

_ _

0

-1

-2

-3

SC17

Using their influence or authority over

you, for example, your boss or your teacher?

IF NECESSARY: “We are asking about people other than parents or other family members”

_ _

0

-1

-2

-3


CATI:

IF NONE OF SC15 – SC17 ARE ENDORSED, SKIP TO AD_INTRO1; CODE SC18_01 – SC26_05 AS LEGIT SKIP.


SC18_01

The first time these things happened to you, how did you know the person who FILL: SC15 AND/OR SC16 AND/OR SC17 BEHAVIORS AS APPROPRIATE – USE THE CORECED SEX FILLS (APPENDIX II)} ?


IF NECESSARY: “What was your connection, if any, to this person?”


IF NECESSARY: “Was this person male or female?”

[CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]


_ _ _

[RANGE 100-800]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP


SC19

How old were you the first time this person did any of {this/these things} to you?

[RECORD AGE IN YEARS; A VAUE OF 0 = LESS THAN 1 YEAR]


_ _ _

[RANGE 0-110 YEARS]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < SC19 THEN DISPLAY SOFT CHECK (SEE TEXT, GENERAL NOTES)


Note:

↓

The first relationship has already been coded in SC18_01. Code additional relationships in “SC18_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.



(SC18)

[IF SUM SC15+SC16+SC17 > 1), ASK …]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-800]

NO MORE

DK

REF

LEGIT SKIP

SC18_02

Now I’m going to ask you about any additional people who may have done these things to you.

How did you know the 2nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.

_ _ _

996

-1

-2

-3

SC18_03

How did you know the 3rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

_ _ _

996

-1

-2

-3

SC18_04

The 4th person?

_ _ _

996

-1

-2

-3

SC18_05

The 5th person?

_ _ _

996

-1

-2

-3

:

:






SC18_09

The 9th person?

_ _ _

996

-1

-2

-3

SC18_10

The 10th person?

_ _ _

996

-1

-2

-3


CATI:

SHOW ONLY THE SC18_## THAT ARE < THE SUM OF SC15+SC16+SC17 (THE MAXIMUM POSSIBLE).

ONCE CODE 996 IS USED, REMAINING “SC18_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “SC18_##” THAT CAN BE ANSWERED MUST BE < SUM (SC15+SC16+SC17).

EXAMPLE: IF SC15=2 AND SC16=1 AND SC17=2, SC18_06 – SC18_10 MUST BE CODED LEGIT SKIP.


CATI:

IF NONE OF “SC18_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO SC23; CODE SC20 – SC22 AS LEGIT SKIP.


SC20

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {FILL: “this” (JUST SC17) / “any of these things“} to you was {FILL: (INTIMATE RELATIONSHIP CODES 107,157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM SC18_01 – SC18_10}. Is this correct?


1


YES

{CODE RELATIONSHIP IN SC21}


2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



SC21

What was your relationship to this person?


_ _ _

[RANGE 100-199]




-3


LEGIT SKIP




SC22

How old were you the first time this person did {FILL: “this” (JUST SC17) / “any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110 YEARS]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < SC22 THEN DISPLAY SOFT CHECK. (TEXT IN GENERAL NOTES AT BEGINNING OF THE SURVEY.)


  • USER NOTE: ITEMS SC23 AND SC24 ARE INCLUDED TO GET AT THE CONSEQUENCES OF COERCED SEX


ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

SC23

Did you ever get a sexually transmitted disease or other infection when {FILL: “this” (JUST SC17) / “any of these things”} happened? For example, did you get Chlamydia, Gonorrhea, HIV, or some other STD?

1

2

-1

-2

-3

[IF FEMALE “R” ASK …]

SC24

Did you ever get pregnant when FILL: “this” (JUST SC17) / “any of these things”} happened?

1

2

-1

-2

-3

CATI:

IF RESPONDENT IS NOT FEMALE, CODE SC24 AS LEGIT SKIP.

CATI:

IF ONLY ONE CORCED R (SC18_02 = -3), GO TO SC25_01



SC25_01

Thinking about the person who {FILL: LIST OF COERCIVE BEHAVIORS ENDORSED IN SC15 – SC17 – USE THE COERCIVE BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”}. Did this person do {FILL: “this” (JUST SC17) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?



1


YES



2


NO

{SKIP TO AD_INTRO1}


-1


DON’T KNOW

{SKIP TO AD_INTRO1}


-2


REFUSED

{SKIP TO AD_INTRO1}












SC25

CATI:

IF SC25_01 = 1, FILL SC25 = 1, GO TO BOX AFTER SC25



Thinking about people who {FILL: LIST OF COERCIVE BEHAVIORS ENDORSED IN SC15 – SC17 – USE THE COERCIVE BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”}, how many people did {FILL: “this” (JUST SC17) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]


_ _

[RANGE: 0 – 5]



-1


DON’T KNOW

{SKIP TO AD_INTRO1}


-2


REFUSED

{SKIP TO AD_INTRO1}


-3


LEGIT SKIP


CATI:

IF SC25 IS CODED AS NONE, DK OR REF, SKIP TO NEXT SECTION; CODE SC26, SC27_01 – SC27_05 LEGIT SKIP.

CHECK: SC25 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSHIPS LISTED IN

SC18_01 – SC18_10.


CATI:

IF ONE RELATIONSHIP EVER (SC18_01 ANSWERED, SC18_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (SC18_01 = 201 - 239, 251 - 289) CODE SC26_01 WITH VALUE FROM SC18_01, AND SKIP TO SV_INTRO1a; CODE SC26, SC26_02 – SC26_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (SC18_01 ANSWERED, SC18_02 = 996) AND NOT A FAMILY MEMBER, A GROUP OR UNKNOWN RELATIONSHIP AND ONE RELATIONSHIP PAST 12 MONTHS (D27 = 1), READ SC26a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF SC25 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (SC26). CODE SC26a AS LEGIT SJIP.

IF MORE THAN ONE RELATIONSHIP EVER (SC18_02 < 996) AND D27=1, GO TO (SC26).

CODE SC26a AS LEGIT SJIP.

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.


[IF SC18_01 ANSWERED AND NOT 200-239, 250-289 AND SC18_02=996 or SC18_02=-3 LEGIT SKIP, READ …]

SC26a

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556, 700,)/ “your” ANY OTHER RELATIONSHIP CODES AT SC18_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN SC26_01 AND SKIP TO AD_INTRO1; CODE SC26_02 – SC26_05 AS LEGIT SKIP}


1


YES

{SKIP TO AD_INTRO1}


2


NO

{GO TO SC26_01}


-1


DON’T KNOW

{SKIP TO AD_INTRO1}


-2


REFUSED

{SKIP TO AD_INTRO1}


-3


LEGIT SKIP

{SKIP TO AD_INTRO1}


CATI:

IF SC26 IS CODED AS 1, -1, -2, FILL SC26_01 WITH RELATIONSHIP FILL FROM SC26 AND SKIP TO AD_INTRO1; CODE SC26_02 – SC26_05 AS LEGIT SKIP.


Note:

↓

Code Relationships in the “SC26_” items below.

If one relationship EVER (SC18_01 answered, SC18_02 = 996) and one relationship past 12 months (SC25=1) AND relationship is NOT a family member, read text to confirm that the relationship has not changed: If no change, code SC26_01 with the value of SC18_01.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned more than once.


(SC26)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-569]

DK

REF

LEGIT SKIP

How did you know the “person” (SC25=1) / “people” who did “this” (ONE BEHAVIOR) / “these things” to you in the past 12 months?

[DO NOT READ SC26 _01-SC26_05; CODE RELATIONSHIPS MENTIONED. ORDER IS NOT IMPORTANT]

IF NECESSARY: Was this person male or female?

SC26_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

SC26_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

SC26_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

SC26_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

SC266_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3


CATI:

SHOW ONLY THE SC26_## THAT ARE < SC25. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF SC25 = 2, THEN SC26_01 AND SC26_02 MUST BE ANSWERED,

AND SC26_03 – SC26_05 MUST BE CODED LEGIT SKIP.




AD. Sexual Violence: Completed Alcohol/Drug-Facilitated Rape and Made to Penetrate

AD_INTRO1

In this section I will ask you about situations in your life in which you ever experienced unwanted sex or sexual contact. By this I mean sexual contact that you did not consent to and that you did not want to happen.

Sometimes unwanted sex or sexual contact happens when a person is unable to consent to it or stop it from happening because they are too drunk, high, drugged, or passed out from alcohol, drugs, or medications.  This can include times when they voluntarily consumed alcohol or drugs or times when they were given alcohol or drugs without their knowledge or consent. You might or might not have ever been in this type of situation. Please remember that even if someone uses alcohol or drugs, what happens to them is not their fault.


These questions use detailed and explicit language so that everyone is clear about what the questions are asking.

INTERVIEWER NOTE: PRESS “1” TO CONTINUE.

PRESS “7” IF RESPONDENT VOLUNTEERED THAT THEY HAVE NEVER BEEN DRUNK, HIGH, DRUGGED OR PASSED OUT FROM ALCOHOL OR DRUGS.


1


CONTINUE

{SKIP TO AD01}


7


R VOLUNTEERED NEVER DRUNK/HIGH

{SKIP TO AD_CHK1a}


-3


LEGIT SKIP


AD_CHK1a

I heard you say that you have never used alcohol or drugs.  We are also asking about times when you may have been given alcohol or drugs without your knowledge, or were using medication that could have impaired your ability to give consent.


INTERVIEWER NOTE: PRESS “1” TO CONTINUE.

PRESS “7” IF RESPONDENT VOLUNTEERED THAT THEY HAVE NEVER BEEN DRUNK, HIGH, DRUGGED OR PASSED OUT FROM ALCOHOL OR DRUGS.


1


CONTINUE



7


R VOLUNTEERED NEVER DRUNK/HIGH

{SKIP TO FC_INTRO1}


-3


LEGIT SKIP



CATI:

IF “R” CONTINUES TO VOLUNTEER THAT THEY HAVE NEVER BEEN DRUNK, HIGH, DRUGGED, OR PASSED OUT FROM ALCOHOL OR DRUGS, CODE AD_CHK1a AS 7 AND SKIP TO FC_INTRO1;

CODE AD01 – AD24 AS LEGIT SKIP.


CATI:

IF MALE RESPONDENT, SKIP TO AD05; CODE AD01 – AD04 AS LEGIT SKIP.



[IF FEMALE “R” ASK …]

ITEM

QUESTION

RANGE:

[1-10]

NONE

DK

REF

LEGIT SKIP

When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many PEOPLE ever did the following when you did not want them to?


AD01

Put their mouth on your vagina?

_ _

0

-1

-2

-3

AD02

Put their fingers or an object in your vagina or anus?

_ _

0

-1

-2

-3

When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many MALES ever did the following when you did not want them to …

AD03

Put their penis in your vagina?

_ _

0

-1

-2

-3

AD04

Put their penis in your mouth or anus?

_ _

0

-1

-2

-3


CATI:

IF FEMALE RESPONDENT, SKIP TO AD09; CODE AD05 – AD08 AS LEGIT SKIP.


[IF MALE “R” ASK …]

ITEM

QUESTION

RANGE:

[1-10]

NONE

DK

REF

LEGIT SKIP

When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many PEOPLE ever did the following when you did not want them to?

AD05

Put their fingers or an object in your anus?


_ _

0

-1

-2

-3

AD06

Put their mouth on your penis?

_ _

0

-1

-2

-3

When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many FEMALES ever did the following when you did not want them to …

AD07

Made you put your penis in their vagina?

_ _

0

-1

-2

-3

When you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many MALES ever did the following when you did not want them to …

AD08

Put their penis in your mouth or anus?

_ _

0

-1

-2

-3


↑

Note:

If at any point while answering AD01 – AD04 (FEMALE “R”) / AD05 – AD08 (MALE “R”), “R” volunteers that they have never been drunk, high, drugged, or passed out from alcohol or drugs, code AD_CHK1a as 7 and follow the appropriate skip pattern. If “R” volunteers this information AND has non-zero response to any of the AD01 – AD04 (FEMALE “R”) / AD05 – AD08 (MALE “R”) items already answered, probe as to whether or not that answer is correct BEFORE recoding AD_CHK1a to 7 and skipping out of this section.


CATI:

IF NONE OF AD01 – AD04 (FEMALE “R”) / AD05 – AD08 (MALE “R”) ARE ENDORSED, SKIP TO FC_INTRO1; CODE AD09 – AD24 AS LEGIT SKIP.

IF “R” VOLUNTEERS THAT THEY HAVE NEVER BEEN DRUNK, HIGH, DRUGGED, OR PASSSED OUT FROM ALCOHOL OR DRUGS, AND INTERVIEWER GOES BACK AND CODE AD_INTRO1 AND AD_CHK1a AS 7, SKIP TO FC_INTRO1; CODE AD09 – AD24 AS LEGIT SKIP. IF SOME OF THE AD01 – AD04 (FEMALE “R”) / AD05 – AD08 (MALE “R”) HAVE BEEN ANSWERED AS NONE, DK OR REF, RECODE TO LEGIT SKIP.


The next two questions are about your exposure to alcohol or drugs. Thinking about the times when {FILL: “this” (ONE BEHAVIOR) / “any of these things”} happened to you when you were unable to consent to sex or stop it from happening …

ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

AD09

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

1

2

-1

-2

-3

AD10

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

1

2

-1

-2

-3


CATI:

IF FEMALE “R” AND ANY OF AD01 – AD04 ENDORSED; OR IF MALE RESPONDENT AND EITHER AD05 OR AD08 IS ENDORSED, ASK AD11_01. ELSE SKIP TO AD_INTRO2; CODE AD11_01 – AD17 AS LEGIT SKIP.


  • USER NOTE: ITEMS AD11_01 – AD17 ARE INTENDED TO GET AT ALCOHOL/DRUG (A/D) FACILITATED RAPE.


AD11_01

Think about the first time anyone EVER {FILL: LIST OF A/D RAPE BEHAVIORS ENDORSED IN AD01 – AD04 (FEMALE “R”) / AD05, AD08 (MALE “R”) – USE THE RAPE BEHAVIOR FILLS (APPENDIX II);

SEPARATE LAST TWO BEHAVIORS WITH THE WORD “or” } when you were unable to consent to sex or stop it from happening , because you were too drunk, high, drugged, or passed out from alcohol or drugs.

The first time {this/these things} happened to you, how did you know the person who did {this/any of these things} to you?


IF NECESSARY: “What was your connection, if any, to this person?”

IF NECESSARY: “Was this person male or female?”

[CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)


_ _ _

[RANGE 100-800]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP


AD12

How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

[RECORD AGE IN YEARS; A VAUE OF 0 = LESS THAN 1 YEAR]


_ _ _

[RANGE 0-110]



-3


LEGIT SKIP



-1


DON’T KNOW



-2


REFUSED



CATI:

IF CURRENT AGE (RESPAGE) < AD12 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


Note:

↓

The first relationship has already been coded in AD11_01. Code additional relationships in “AD11_” items below using the Relationship/Sex template (Appendix I). Note that relationship categories may be repeated.


(AD11)

[IF SUM AD01 – AD04 (FEMALES) / AD05, AD08 (MALES) > 1, THEN ASK …]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-800]

NO MORE

DK

REF

LEGIT SKIP

AD11_02

Now I’m going to ask you about any additional people who may have done these things to you.

How did you know the 2nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things” to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.

_ _ _

996

-1

-2

-3

AD11_03

How did you know the 3rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

_ _ _

996

-1

-2

-3

AD11_04

The 4th person?

_ _ _

996

-1

-2

-3

AD11_05

The 5th person?

_ _ _

996

-1

-2

-3

:

:






AD11_09

The 9th person?

_ _ _

996

-1

-2

-3

AD11_10

The 10th person?

_ _ _

996

-1

-2

-3


CATI:

SHOW ONLY THE AD11_## THAT ARE < THE SUM OF AD01 – AD04 (FEMALES) / AD05, AD08 (MALES) (THE MAXIMUM POSSIBLE). ONCE CODE 996 IS USED, REMAINING “AD11_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “AD11_##” THAT CAN BE ANSWERED MUST BE < THE SUM OF

AD01 – AD04 (FEMALES) / AD05, AD08 (MALES).

EXAMPLE: IF AD05=2 AND AD08=1, AD11_06 – AD11_10 MUST BE CODED LEGIT SKIP.


CATI:

IF NONE OF “AD11_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO AD16; CODE AD13 – AD15 AS LEGIT SKIP.


AD13

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did any of these things to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157)/ “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM AD11_01 – AD11_10}. Is this correct?


1


YES

{CODE RELATIONSHIP IN AD13]


2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP




AD14

What was your relationship to this person?


_ _ _

[RANGE 100-189]




-3


LEGIT SKIP




CATI:

IF 100 < AD14 < 199 AND AD14 = AD11_01 THEN SKIP TO AD16; FILL AD15 = AD13.


AD15

How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED


-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < AD14 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


CATI:

IF R REPORTED ONE PERPATRATOR (AD11_02 = -3, GO TO AD16_01


AD16_01

Thinking about the person who {FILL: LIST OF A/D RAPE BEHAVIORS ENDORSED IN AD01 – AD04 (FEMALE “R”) / AD05, AD08 (MALE “R”) – USE THE RAPE BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”..} when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs. Did this person do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

[A VALUE OF 0 = 5 OR MORE PEOPLE]





1


YES




2


NO

{SKIP TO AD_INTRO2}



-1


DON’T KNOW

{SKIP TO AD_INTRO2}



-2


REFUSED

{SKIP TO AD_INTRO2}



CATI:

IF AD16_01 = 1, FILL AD16 = 1, THEN GO TO BOX AFTER AD16





AD16



Thinking about the people who {FILL: LIST OF A/D RAPE BEHAVIORS ENDORSED IN AD01 – AD04 (FEMALE “R”) / AD05, AD08 (MALE “R”) – USE THE RAPE BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”..} when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

[A VALUE OF 0 = 5 OR MORE PEOPLE]


_ _


[RANGE: 0 – 5]


-1


DON’T KNOW

{SKIP TO AD_INTRO2}


-2


REFUSED

{SKIP TO AD_INTRO2}


-3


LEGIT SKIP



CATI:

IF AD16 IS CODED AS NONE, DK OR REF, SKIP TO AD_INTRO2; CODE AD17a, AD17_01 – AD17_05, AD18 AS LEGIT SKIP.

CHECK: AD16 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSHIPS LISTED

IN AD11_01 – AD11_10.


CATI:

IF ONE RELATIONSHIP EVER (AD11_01 ANSWERED, AD11_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (AD11_01 = 201 - 239, 251 - 289) CODE AD17_01 WITH VALUE FROM AD11_01, AND SKIP TO AD18; CODE AD17a, AD17_02 – AD17_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (AD11_01 ANSWERED, AD11_02 = 996) AND NOT A FAMILY MEMBER, A GROUP, OR AN UNKNOWN RELATIONSHIP AND ONE RELATIONSHIP PAST 12 MONTHS (A16 = 1), READ AD17a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF AD16 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (AD17). CODE AD17a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (AD11_02 < 996) AND AD16=1, GO TO (AD17).

CODE AD17a AS LEGIT SKIP.


PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.


Note:

↓

Code Relationships in the “AD17_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned

more than once.


[IF AD11_01 ANSWERED NOT 200-239, 250-289 AND AD11_02 = 996 or AD1_02=-3 LEGIT SKIP, READ …]

AD17a

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556)/ “your” ANY OTHER RELATIONSHIP CODES AT AD11_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN AD17_01 AND SKIP TO AD18; CODE AD17_02 – AD17_05 AS LEGIT SKIP}


1


YES

{SKIP TO AD18}


2


NO

{GO TO AD17_01}


-1


DON’T KNOW

{SKIP TO AD18}


-2


REFUSED

{SKIP TO AD18}


-3


LEGIT SKIP

{SKIP TO AD18}


CATI:

IF AD17a IS CODED AS 1, -1, -2, FILL AD17_01 WITH RELATIONSHIP FILL FROM AD17a AND SKIP TO AD18; CODE AD17_02 – AD17_05 AS LEGIT SKIP.



(AD17)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-650]

DK

REF

LEGIT SKIP

How did you know the “person” (AD16=1)/ ”people” who did {FILL: ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months? [DO NOT READ AD17_01 – AD17_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT]

IF NECESSARY: Was this person male or female?

AD17_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

AD17_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

AD17_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

AD17_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

AD17_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3


CATI:

SHOW ONLY THE AD17_## THAT ARE < AD16. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF AD16 = 3, THEN AD117_01, AD17_02 AND AD17_03 MUST BE ANSWERED, AND AD17_04 – AD17_05 MUST BE CODED AS LEGIT SKIP.


AD18

Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months?


IF NECESSARY: “In total” refers to your combined experiences across all of the people who

did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.



------


[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]



999


TOO MANY TO COUNT




-1


DON’T KNOW




-2


REFUSED




-3


LEGIT SKIP




  • USER NOTE: ITEMS AD19 – AD26 ARE INTENDED TO GET AT ALCOHOL/DRUG-FACILITATED MADE TO PENETRATE (MTP)

CATI:

IF FEMALE “R” OR IF MALE “R” AND NEITHER AD06 NOR AD07 ENDORSED SKIP TO (FC_INTRO1); CODE AD19_01 – AD26 AS LEGIT SKIP.

IF MALE “R” AND AD06 OR AD07 IS ENDORSED ( > 1) AND ANY OF AD11_01 – AD18 ANSWERED, THEN DISPLAY (AD_INTRO2).

IF MALE “R” AND AD06 OR AD07 IS ENDORSED ( > 1) AND NONE OF AD11_01 – AD18 ANSWERED, THEN GO TO AD19_01.


(AD_INTRO2)

[IF MALE “R” AND EITHER OF AD06 OR AD07 IS ENDORSED AND ANY OF AD11_01 – AD18 ANSWERED (ENDORSED MALE RAPE QUESTIONS), THEN READ …]

“Now I am going to ask you about some of the other things that have happened to you.

AD19_01

Think about the first time anyone EVER {FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES, AD06 OR AD07) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE TWO BEHAVIORS WITH THE WORD “or” } when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs.

The first time these things happened to you, how did you know or what was your relationship to the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

IF NECESSARY: “What was your connection, if any, to this person?”



IF NECESSARY: “Was this person male or female?”

[CODE USING THE RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]


_ _ _

[RANGE 100-800]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP

AD20

How old were you the first time anyone did {FILL: “this” (ONE BEHAVIOR) / “any of these things”}

to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP


CATI:

IF CURRENT AGE (RESPAGE) < AD15 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


Note:

↓

The first relationship has already been coded in AD19_01. Code additional relationships in “AD19_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(AD19)

[IF SUM OF AD06 + AD07 (MALES) > 1, ASK …]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-800]

NO MORE


DK

REF

LEGIT SKIP

AD19_02

Now I’m going to ask you about any additional people who may have done these things to you.

How did you know the 2nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.

_ _ _

996


-1

-2

-3

AD19_03

How did you know the 3rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

_ _ _

996


-1

-2

-3

AD19_04

The 4th person?

_ _ _

996


-1

-2

-3

AD19_05

The 5th person?

_ _ _

996


-1

-2

-3

:

:







AD19_09

The 9th person?

_ _ _

996


-1

-2

-3

AD19_10

The 10th person?

_ _ _

996


-1

-2

-3


CATI:

SHOW ONLY THE AD19_ ## ITEMS THAT ARE < THE SUM (AD06 + AD07: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “AD19_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “AD19_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM (AD06 + AD07: MALES).

EXAMPLE: IF AD06=2 AND AD07=3, AD19_ 07 – AD19_10 MUST BE CODED LEGIT SKIP.


CATI:

IF NONE OF “AD19_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO AD24.


AD21

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {this/any of these things} to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM AD19_01 – AD19_10}. Is this correct?


1


YES

{CODE RELATIONSHIP IN AD22}


2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



AD22

What was your relationship to this person?


_ _ _

[RANGE 100-189]




-1


DON’T KNOW




-2


REFUSED




-3


LEGIT SKIP




CATI:

IF 100 < AD22 < 199 AND AD22 = AD19_01 THEN SKIP TO AD24; FILL AD23 = AD21


AD23

How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-3


LEGIT SKIP



-1


DON’T KNOW



-2


REFUSED


CATI:

IF CURRENT AGE (RESPAGE) < AD23 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


CATI:

IF R REPORTED ONE PERPATRATOR (AD19_02 = -3, GO TO AD24_01



AD24_01



















AD24



Thinking about the person who {FILL: LIST OF MTP BEHAVIORS ENDORSED IN AD06 OR AD07 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE TWO BEHAVIORS WITH THE WORD “or”..} when you were unable to consent to sex or stop it from happening , because you were too drunk, high, drugged, or passed out from alcohol or drugs. Did this person do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?



1


YES



2


NO

{SKIP TO FC_INTRO1}


-1


DON’T KNOW

{SKIP TO FC_INTRO1}


-2


REFUSED

{SKIP TO FC_INTRO1}


CATI:

IF AD24_01 = 1, FILL AD24 = 1, THEN GO TO BOX AFTER AD24



Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”)} who {FILL: LIST OF MTP BEHAVIORS ENDORSED IN AD06 OR AD07 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE TWO BEHAVIORS WITH THE WORD “or”..} when you were unable to consent to sex or stop it from happening , because you were too drunk, high, drugged, or passed out from alcohol or drugs, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]


_ _

[RANGE: 0 – 5]


-1


DON’T KNOW

{SKIP TO FC_INTRO1}


-2


REFUSED

{SKIP TO FC_INTRO1}


-3


LEGIT SKIP


CATI:

IF AD24 IS CODED AS NONE, DK OR REF, SKIP TO FC_INTRO1; CODE AD25a, AD25_01 –AD25_05, AD22 AS LEGIT SKIP.

CHECK: AD24 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN “AD19_”.


CATI:

IF ONE RELATIONSHIP EVER (AD19_01 ANSWERED, AD19_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (AD19_01 = 201 - 239, 251 - 289) CODE AD25_01 WITH VALUE FROM AD19_01, AND SKIP TO AD26; CODE AD25a, AD25_02 – AD25_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (AD19_01 ANSWERED, AD19_02 = 996) AND NOT A FAMILY MEMBER, A GROUP OR UNKNOWN RELATIONSHIP, AND ONE RELATIONSHIP PAST 12 MONTHS (AD24 = 1), READ AD25a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF AD24 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (AD25). CODE AD23a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (AD19_02 < 996) AND AD24=1, GO TO (AD25).

CODE A25a AS LEGIT SKIP.

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.


Note:

↓

Code Relationships in the “AD25_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned

more than once.


[IF AD19_01 ANSWERED AND NOT 200-239, 250-289 AND AD19_02 = 996 or AD19_02=-3 LEGIT SKIP, READ …]

AD25a

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556)/ “your” ANY OTHER RELATIONSHIP CODES AT AD19_01} when {FILL: he/she} did {this/these things} to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN AD25_01 AND SKIP TO AD26; CODE AD25_02 – AD25_05 AS LEGIT

SKIP}


1


YES

{SKIP TO AD26}


2


NO

{GO TO AD25_01}


-1


DON’T KNOW

{SKIP TO AD26}


-2


REFUSED

{SKIP TO AD26}


-3


LEGIT SKIP

{SKIP TO AD26}


CATI:

IF AD25a IS CODED AS 1, -1, -2, FILL AD25_01 WITH RELATIONSHIP FILL FROM AD25a AND SKIP TO AD26; CODE AD25_02 – AD25_05 AS LEGIT SKIP.


(AD25)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-650]

DK

REF

LEGIT SKIP

How did you know the {FILL: “person” (AD22=1)/”people”} who did ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months?

[DO NOT READ AD25_01 – AD25_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT]

IF NECESSARY: Was this person male or female?

AD25_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

AD25_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

AD25_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

AD25_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

AD25_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3


CATI:

SHOW ONLY THE AD25_## THAT ARE < AD24. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF AD24 = 3, THEN AD25_01, AD25_02 AND AD25_03 MUST BE ANSWERED, AND AD25_04 – AD25_05 MUST BE CODED AS LEGIT SKIP.


AD26

Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months?


IF NECESSARY: “In total” refers to your combined experiences across all of the people who

did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.


------


[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]


999


TOO MANY TO COUNT



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP






FC. Sexual Violence: Unwanted Sex Due to Threats of Harm/Physical Force

(FC_INTRO1)

Some people are threatened with harm or physically forced to have sex or sexual contact when they don’t want to. Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no. To be clear, we are now asking only about times in your life when sex was unwanted and you did not give consent.


CATI:

IF MALE RESPONDENT, SKIP TO FC05; CODE FC01 – FC04 AS LEGIT SKIP.


[IF FEMALE “R” ASK …]

ITEM

QUESTION

RANGE:

[1-10]

NONE

DK

REF

LEGIT SKIP

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

FC01

… put their mouth on your vagina?

_ _

0

-1

-2

-3

FC02

… put their fingers or an object in your vagina or

anus?

_ _

0

-1

-2

-3

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

FC03

… put their penis in your vagina?

_ _

0

-1

-2

-3

FC04

… put their penis in your mouth or anus?

_ _

0

-1

-2

-3


CATI:

IF FEMALE RESPONDENT, SKIP TO FC09; CODE FC05 – FC08 AS LEGIT SKIP.


[IF MALE “R” ASK …]

ITEM

QUESTION

RANGE:

[1-10]

NONE

DK

REF

LEGIT SKIP

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

FC05

… put their fingers or an object in your anus?

_ _

0

-1

-2

-3

FC06

… put their mouth on your penis or make you put your penis in their mouth?

_ _

0

-1

-2

-3

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

FC07

… make you put your penis in their vagina?

_ _

0

-1

-2

-3

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

FC08

… put their penis in your mouth or anus?

_ _

0

-1

-2

-3


CATI:

IF NONE OF FC01 – FC04 (FEMALE “R”) / FC05 – FC08 (MALE “R”) ENDORSED, SKIP TO FA_INTRO1; CODE FC09_01 – FC24 AS LEGIT SKIP.


CATI:

IF FEMALE “R” AND ANY OF FC01 – FC04 ENDORSED; OR IF MALE RESPONDENT AND EITHER FC05 or FC08 IS ENDORSED, ASK FC09_01. ELSE SKIP TO (FC_INTRO2); CODE FC09_01 – FC16 AS LEGIT SKIP.


  • USER NOTE: ITEMS FC09_01 – FC16 ARE INTENDED TO GET AT FORCED RAPE


FC09_01

Think about the first time anyone EVER {FILL: LIST OF FORCED RAPE BEHAVIORS ENDORSED IN FC01 – FC04 (FEMALE “R”) / FC05, FC08 (MALE “R”) – USE THE RAPE BEHAVIOR FILLS (APPENDIX II);

SEPARATE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm.

The first time these things happened to you, how did you know the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

IF NECESSARY: “What was your connection, if any, to this person?”



IF NECESSARY: “Was this person male or female?”

[CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)


_ _ _

[RANGE 100-800]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP


FC10

How old were you the first time this person did {this/any of these things} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < FC10 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


Note:

↓

The first relationship has already been coded in FC09_01. Code additional relationships in “FC09_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.


(FC09)

[IF SUM FC01 – FC04 (FEMALES) / FC05, FC08 (MALES) > 1, THEN ASK …]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-800]

NO MORE

DK

REF

LEGIT SKIP

FC09_02

Now I’m going to ask you about any additional people who may have done these things to you.

How did you know the 2nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things” to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.

_ _ _

996

-1

-2

-3

FC09_03

How did you know the 3rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

_ _ _

996

-1

-2

-3

FC09_04

The 4th person?

_ _ _

996

-1

-2

-3

FC09_05

The 5th person?

_ _ _

996

-1

-2

-3

:

:






FC09_09

The 9th person?

_ _ _

996

-1

-2

-3

FC09_10

The 10th person?

_ _ _

996

-1

-2

-3



CATI:

SHOW ONLY THE FC09_## ITEMS THAT ARE < THE SUM (FC01 – FC04: FEMALES) OR SUM(FC05 + FC08: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “FC09_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “FC09_##” ITEMS THAT CAN BE ANSWERED MUST BE < SUM

(FC01 – FC04: FEMALES) OR < SUM (FC05 + FC08: MALES).


CATI:

IF NONE OF “FC09_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO FC14; CODE FC11 – FC13 AS LEGIT SKIP.


FC11

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {this/any of these things} to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM THE PULL-DOWN MENU}. Is this correct?


1


YES

{CODE RELATIONSHIP IN FC12}


2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP




FC12

What was your relationship to this person?


_ _ _

[RANGE 100-189]




-3


LEGIT SKIP




CATI:

IF 100 < FC12 < 199 AND FC12 = FC09_01 THEN SKIP TO FC14; FILL FC13 = FC10.


FC13

How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) /

“any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-3


LEGIT SKIP



-1


DON’T KNOW



-2


REFUSED


CATI:

IF CURRENT AGE (RESPAGE) < FC13 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


CATI:

IF ONE PERPATRATOR REPORTED (FC09_02 = -3), GO TO FC14_01



FC14_01



Thinking about the person who {FILL: LIST OF

FORCED RAPE BEHAVIORS ENDORSED IN FC01 – FC04 (FEMALES) / FC05, FC08 (MALES) – USE THE RAPE BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm. Did this person do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?



1


YES



2


NO

{SKIP TO E_INTRO2B}


-1


DON’T KNOW

{SKIP TO E_INTRO2B}


-2


REFUSED

{SKIP TO E_INTRO2B}


CATI:

IF FC14_01 = 1, FILL AD14 = 1, THEN GO TO BOX AFTER FC14




FC14



Thinking about the people who {FILL: LIST OF

FORCED RAPE BEHAVIORS ENDORSED IN FC01 – FC04 (FEMALES) / FC05, FC08 (MALES) – USE THE RAPE BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 0 = 5 OR MORE PEOPLE]


_ _

[RANGE: 0 – 5]


-1


DON’T KNOW

{SKIP TO (E_INTRO2b)}


-2


REFUSED

{SKIP TO (E_INTRO2b)}


-3


LEGIT SKIP


CATI:

IF FC14 IS CODED AS NONE, DK OR REF, SKIP TO (FA_INTRO2); CODE FC15a, FC15_01-FC15_05, FC16 AS LEGIT SKIP.

CHECK: FC14 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN FC09_01 – FC09_10.


CATI:

IF ONE RELATIONSHIP EVER (FC09_01 ANSWERED, FC09_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (FC09_01=201-239,251-289) CODE FC15_01 WITH VALUE FROM FC09_01, AND SKIP TO FC16; CODE FC15a, FC15_02 – FC15_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (FC09_01 ANSWERED, FC09_02 = 996) AND NOT A FAMILY MEMBER, A GROOUP OR UNKNONWN RELATIONSHIP AND ONE RELATIONSHIP PAST 12 MONTHS (FC14=1), READ FC15a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF FC14 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (FC15). CODE FC15a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (FC09_02 < 996) AND FC14=1, GO TO (FC15).

CODE FC15a AS LEGIT SKIP.

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.



Note:

↓

Code Relationships in the “FC15_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned

more than once.

[IF FC09_01 ANSWERED AND FC09_01 NOT 200-239, 250-289 AND FC09_02 = 996 or FC09_02=-3 LEGIT SKIP, READ …]

FC15a

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556,)/ “your” ANY OTHER RELATIONSHIP CODES AT FC09_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN FC15_01 AND SKIP TO FC16; CODE FC15_02 – FC15_05 AS LEGIT SKIP}


1


YES

{SKIP TO FC16}


2


NO

{GO TO FC15_01}


-1


DON’T KNOW

{SKIP TO FC16}


-2


REFUSED

{SKIP TO FC16}


-3


LEGIT SKIP

{SKIP TO FC16}

CATI:

IF FC15a IS CODED AS 1, -1, -2, FILL FC15_01 WITH RELATIONSHIP FILL FROM FC15a AND SKIP TO FC16; CODE FC15_02 – FC15_05 AS LEGIT SKIP.


(FC15)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-650]

DK

REF

NA

How did you know the “person (FC14=1)/”people” who did ”this” (ONE BEHAVIOR) / ”these things” to you in the past 12 months?

[DO NOT READ FC15_01 – FC15_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT]

IF NECESSARY: Was this person male or female?

FC15_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

FC15_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

FC15_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

FC15_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

FC15_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3

CATI:

SHOW ONLY THE FC15_## THAT ARE < FC14. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF FC14 = 3, THEN FC15_01, FC15_02 AND FC15_03 MUST BE ANSWERED, AND FC15_04 – FC15_05 MUST BE CODED LEGIT SKIP.


FC16

Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months?


IF NECESSARY: “In total” refers to your combined experiences across all of the people who

did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.



------


[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]



999


TOO MANY TO COUNT




-1


DON’T KNOW




-2


REFUSED




-3


LEGIT SKIP




  • USER NOTE: ITEMS FC17_01 – FC24 ARE INTENDED TO GET AT FORCED MADE TO PENETRATE (MTP)

CATI:

IF FEMALE “R” OR IF MALE “R” AND NEITHER FC06 OR FC07 IS ENDORSED SKIP TO (FA_INTRO1); CODE FC17_01 – FC24 AS LEGIT SKIP.

IF MALE “R” AND EITHER FC06 OR FC07 IS ENDORSED ( > 1) AND EITHER FC05 OR, FC08 IS ENDORSED (> 1) ANSWERED, THEN DISPLAY (FC_INTRO2).

IF MALE “R” AND EITHER FC06 OR FC07 IS ENDORSED (> 1) AND NEITHER FC05 NOR FC08, ENDORSED, THEN GO TO FC17_01. NO NEED TO READ THE INTRODUCTION.

(FC_INTRO2b)

[IF MALE “R” AND EITHER FC06 OR FC07 IS ENDORSED (MTP) AND EITHER FC05 OR FC08 IS ENDORSED (MALE RAPE QUESTIONS), THEN READ …]

“Now I am going to ask you about some of the other things that have happened to you.


FC17_01

Think about the first time anyone EVER FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES, FC06 OR FC07) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”.

The first time {this/these things} happened to you, how did you know the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

IF NECESSARY: “What was your connection, if any, to this person?”

IF NECESSARY: “Was this person male or female?”

[CODE USING THE RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]


_ _ _

[RANGE 100-800]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP


FC18

How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP




CATI:

IF CURRENT AGE (RESPAGE) < FC18 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


Note:

↓

The first relationship has already been coded in FC17_01. Code additional relationships in “FC17_” below using the Relationship/Sex Template (Appendix I). A relationship type can be entered more than once.

(FC17)

[IF MALE “R” AND SUM (FC06 + FC07) > 1, ASK …]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-800]

NO MORE

DK

REF

LEGIT SKIP

FC17_02

Now I’m going to ask you about any additional people who may have done these things to you.

How did you know the 2nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.

_ _ _

996

-1

-2

-3

FC17_03

How did you know the 3rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

_ _ _

996

-1

-2

-3

FC17_04

The 4th person?

_ _ _

996

-1

-2

-3

FC17_05

The 5th person?

_ _ _

996

-1

-2

-3

:

:






FC17_09

The 9th person?

_ _ _

996

-1

-2

-3

FC17_10

The 10th person?

_ _ _

996

-1

-2

-3



CATI:

SHOW ONLY THE FC17_## ITEMS THAT ARE < THE SUM (FC06 + FC07: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “FC17_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “FC17_##” ITEMS THAT CAN BE ANSWERED MUST BE <

(FC06 + FC07: MALES)


CATI:

IF NONE OF “FC17_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO FC22; CODE FC19 – FC21 AS LEGIT SKIP.


FC19

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {this/any of these things} to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM FC17_01 – FC17_10}. Is this correct?


1


YES

{CODE RELATIONSHIP IN FC20]


2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



FC20

What was your relationship to this person?


_ _ _

[RANGE 100-189]




-3


LEGIT SKIP




CATI:

IF 100 < FC20 < 199 AND FC20 = FC17_01 THEN SKIP TO FC22; FILL FC21 = FC18.


FC21

How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) /

“any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED


-3


LEGIT SKIP




CATI:

IF CURRENT AGE (RESPAGE) < FC21 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


CATI:

IF ONE PERPETRATOR REPORTED (FC17_02 = -3), GO TO FC22_01



FC22_01

















FC22



Thinking about the person” (ONE BEHAVIOR, ONE PERSON) / who {FILL: LIST OF MTP BEHAVIORS ENDORSED IN FC06 – FC07 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of violence. Did this person do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?




1


YES



2


NO

{SKIP TO FA_INTRO1}


-1


DON’T KNOW

{SKIP TO FA_INTRO1}


-2


REFUSED

{SKIP TO FA_INTRO1


CATI:

IF FC22_01 = 1, FILL FC22 = 1, THEN GO TO BOX AFTER FC22





Thinking about the {FILL: “person” (ONE BEHAVIOR, ONE PERSON) / “people”} who {FILL: LIST OF MTP BEHAVIORS ENDORSED IN FC06 – FC07 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of violence, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]


_ _

[RANGE: 0 – 5]


-1


DON’T KNOW

{SKIP TO FA_INTRO1}


-2


REFUSED

{SKIP TO FA_INTRO1}


-3


LEGIT SKIP



CATI:

IF FC22 IS CODED AS ZERO, DK OR REF, SKIP TO FA_INTRO1; CODE FC23a, FC23_01 – FC23_05, FC24 AS LEGIT SKIP.

CHECK: FC22 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN FC17_01 – FC17_10.


CATI:

IF ONE RELATIONSHIP EVER (FC17_01 ANSWERED, FC17_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (FC17_01 = 201 - 239, 251 - 289) CODE FC23_01 WITH VALUE FROM FC17_01, AND SKIP TO FC24; CODE FC23a, FC23_02 – FC23_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (FC17_01 ANSWERED, FC17_02 = 996) AND NOT A FAMILY MEMBER, A GROUP, OR UNKNONW RELATIONSHIP AND ONE RELATIONSHIP PAST 12 MONTHS (FC22 = 1), READ FC23a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF FC22 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (E63). CODE FC23a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (FC17_02 < 996) AND FC22=1, GO TO (FC23).

CODE FC23a AS LEGIT SKIP.

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.


Note:

↓

Code Relationships in the “FC23_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned more than once.



[IF FC17_01 ANSWERED NOT 200-239, 250-289 AND FC17_02= 996 or FC17_02=-3 LEGIT SKIP, READ …]

FC23a

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556)/ “your” RELATIONSHIP FC17_01} when {FILL: he/she} did {this/these things} to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN FC23_01 AND SKIP TO FC24; CODE FC23_02 – FC23_05 AS LEGIT SKIP}


1


YES

{SKIP TO FC24}


2


NO

{GO TO FC23_01}


-1


DON’T KNOW

{SKIP TO FC24}


-2


REFUSED

{SKIP TO FC24}


-3


LEGIT SKIP

{SKIP TO FC24}


CATI:

IF FC23a IS CODED AS 1, -1, -2, FILL FC23_01 WITH RELATIONSHIP FILL FROM FC23a AND SKIP TO FC24; CODE FC23_02 – FC23_05 AS LEGIT SKIP.


(FC23)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-650]

DK

REF

LEGIT SKIP

How did you know the “person” (FC22=1)/ ”people” who did ”this” (ONE BEHAVIOR) /”these things” to you in the past 12 months? [DO NOT READ FC23_01 – FC23_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT.

IF NECESSARY: Was this person male or female?

FC23_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

FC23_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

FC23_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

FC23_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

FC23_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3

CATI:

SHOW ONLY THE FC23_## THAT ARE < FC22. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF FC22 = 3, THEN FC23_01, FC23_02 AND FC23_03 MUST BE ANSWERED,

AND FC23_04 – FC23_05 MUST BE CODED LEGIT SKIP.

FC24

Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months?


IF NECESSARY: “In total” refers to your combined experiences across all of the people who

did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.



------


[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]



999


TOO MANY TO COUNT




-1


DON’T KNOW




-2


REFUSED




-3


LEGIT SKIP








FA. Sexual Violence: Attempted Physically Forced Sex

(FA_INTRO1)

The next set of questions are about times in your life when someone ever ATTEMPTED to have sex or sexual contact with you by using physical force or threats of harm but sex did NOT happen. Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no. To be clear, we are now asking only about times when sex was unwanted and you did not give consent, and sex did not happen.


CATI:

IF MALE RESPONDENT, SKIP TO FA02; CODE FA01 AS LEGIT SKIP.


[IF FEMALE “R” ASK …]

ITEM

QUESTION

RANGE:

[1-10]

NONE

DK

REF

LEGIT SKIP

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

FA01

…TRY to put their penis in your vagina, mouth, or anus, but it did not happen?

_ _

0

-1

-2

-3


CATI:

IF FEMALE RESPONDENT, SKIP TO FA05_01; CODE FA02 – FA04 AS LEGIT SKIP.


[IF MALE “R” ASK …]

ITEM

QUESTION

RANGE:

[1-10]

NONE

DK

REF

LEGIT SKIP

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

FA02

… TRY to put their mouth on your penis, or to TRY to make you put your penis in their mouth, but it did not happen?

_ _

0

-1

-2

-3

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

FA03

… TRY to make you put your penis in their vagina, but it did not happen?

_ _

0

-1

-2

-3

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

FA04

… TRY to put their penis in your mouth or anus, but it did not happen?

_ _

0

-1

-2

-3


CATI:

IF NONE OF FA01 (FEMALE “R”) / FA02 – FA04 (MALE “R”) ARE ENDORSED, SKIP TO (OT_INTRO1); CODE FA05_01 – FA20 AS LEGIT SKIP.


CATI:

IF FEMALE “R” AND FA01 ENDORSED; OR IF MALE RESPONDENT AND FA04

ENDORSED, ASK FA05_01. ELSE SKIP TO (FA_INTRO2); CODE FA05 – FA12 AS LEGIT SKIP.


  • USER NOTE: ITEMS FA05_01– FA12 ARE INTENDED TO GET AT ATTEMPTED RAPE


FA05_01

Think about the first time anyone EVER {FILL: RAPE BEHAVIOR ENDORSED IN FA01

(FEMALES) / FA04 (MALES) – USE THE RAPE BEHAVIOR FILLS (APPENDIX II); SEPARATE

LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm, but sex DID NOT happen.

The first time thishappened to you, how did you know the person who did thisto you?

IF NECESSARY: “What was your connection, if any, to this person?”



IF NECESSARY: “Was this person male or female?”

[CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)


_ _ _

[RANGE 100-800]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP


FA06

How old were you the first time this person did this to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < FA06 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


Note:

↓

The first relationship has already been coded in FA05_01. Code additional relationships in “FA05_” below using the Relationship/Sex Template (Appendix I). Note that relationship categories may be repeated.


(FA05)

[IF FA01 (FEMALES) / FA04 (MALES) > 1, THEN ASK …]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-800]

NO MORE

DK

REF

LEGIT SKIP

FA05_02

Now I’m going to ask you about any additional people who may have done these things to you.

How did you know the 2nd person who did =this” to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.

_ _ _

996

-1

-2

-3

FA05_03

How did you know the 3rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

_ _ _

996

-1

-2

-3

FA05_04

The 4th person?

_ _ _

996

-1

-2

-3

FA05_05

The 5th person?

_ _ _

996

-1

-2

-3

:

:






FA05_09

The 9th person?

_ _ _

996

-1

-2

-3

FA05_10

The 10th person?

_ _ _

996

-1

-2

-3


CATI:

SHOW ONLY THE FA05_## ITEMS THAT ARE < THE SUM (FA01: FEMALES) / (FA04: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “FA05_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “FA05_##” ITEMS THAT CAN BE ANSWERED

MUST BE < (FA01: FEMALES) / SUM(FA04: MALES).


CATI:

IF NONE OF “FA05_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO FA10 ;

CODE FA07 – FA09 AS LEGIT SKIP.


FA07

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did this to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM FA07_01 – FA07_10}. Is this correct?


1


YES

{CODE RELATIONSHIP IN FA08}


2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



FA08

What was your relationship to this person?


_ _ _

[RANGE 100-189]



-3


LEGIT SKIP



CATI:

IF 100 < FA08 < 199 AND FA08 = FA05_01 THEN SKIP TO FA10; FILL FA09 = FA06.


FA09

How old were you the first time this person did this to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED


-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < FA09 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


CATI:

IF R REPORTED ONE PERPATRATOR FA05_02 = -3, GO TO FA10_01



FA10_01

















FA10



Thinking about the person” who {FILL:

ATTEMPTED RAPE BEHAVIORS ENDORSED IN FA01 (FEMALES) / FA04 (MALES) – USE THE ATTEMPTED RAPE BEHAVIORS (APPENDIX II); using physical force or threats of harm but sex did not happen. Did this person do this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?


1


YES



2


NO

{SKIP TO FA_INTRO2}


-1


DON’T KNOW

{SKIP TO FA_INTRO2}


-2


REFUSED

{SKIP TO FA_INTRO2}


CATI:

IF FA10_01 = 1, FILL FA10= 1, THEN GO TO BOX AFTER FA10




Thinking about the people who {FILL:

ATTEMPTED RAPE BEHAVIORS ENDORSED IN FA01 (FEMALES) / FA04 (MALES) – USE THE ATTEMPTED RAPE BEHAVIORS (APPENDIX II); using physical force or threats of harm but sex did not happen, how many people did this to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 0 = 5 OR MORE PEOPLE]


_ _ _

[RANGE: 0 – 5]


-1


DON’T KNOW

{SKIP TO FA_INTRO2}


-2


REFUSED

{SKIP TO FA_INTRO2}


-3


LEGIT SKIP



CATI:

IF FA10 IS CODED AS NONE, DK OR REF, SKIP TO FA_INTRO2; CODE FA11a, FA11_01 – FA11_05, FA12 AS LEGIT SKIP.

CHECK: FA10 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN FA05_01 – FA05_10.


CATI:

IF ONE RELATIONSHIP EVER (FA05_01 ANSWERED, FA05_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (FA05_01 = 201 - 239, 251 - 289) CODE FA11_01 WITH VALUE FROM FA05_01, AND SKIP TO FA12; CODE FA11a, FA11_02 – FA11_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (FA05_01 ANSWERED, FA05_02= 996) AND NOT A FAMILY MEMBER, A GROUP OR UNKNOWN RELATIONSHIP AND ONE RELATIONSHIP PAST 12 MONTHS (FA10=1), READ FA11a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF FA10 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (FA11). CODE FA11a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (FA05_02 < 996) AND FA10 = 1, GO TO (FA11).

CODE FA11a AS LEGIT SKIP.

PAST 12 MONTH RELATIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “FA11_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned more than once.


[IF FA05_01 ANSWERED AND NOT 200-239, 250-289 AND FA05_02_02= 996 or FA05_02=-3 LEGIT SKIP, READ …]

FA11a

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556)/ “your” ANY OTHER RELATIONSHIP CODES AT FA05_01} when {FILL: he/she} did this to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN FA11_01 AND SKIP TO FA12; CODE FA11_02 – FA11_05 AS LEGIT SKIP}


1


YES

{SKIP TO FA12}


2


NO

{GO TO FA11_01}


-1


DON’T KNOW

{SKIP TO FA12}


-2


REFUSED

{SKIP TO FA12}


-3


LEGIT SKIP

{SKIP TO FA12}


CATI:

IF FA11a IS CODED AS 1, -1, -2, FILL FA11_01 WITH RELATIONSHIP FILL FROM FA11a AND SKIP TO FA12; CODE FA11_02 – FA11_05 AS LEGIT SKIP.




(FA11)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-650]

DK

REF

LEGIT SKIP

How did you know the “person” (FA10=1)/” people” who did this to you in the past 12 months?

[DO NOT READ FA11_01-FA11_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT]

IF NECESSARY: Was this person male or female?

FA11_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

FA11_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

FA11_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

FA11_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

FA11_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3


CATI:

SHOW ONLY THE FA11_## THAT ARE < FA10. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF FA11 = 3, THEN FA11_01, FA11_02 AND FA11_03 MUST BE ANSWERED,

AND FA11_04 – FA11_05 MUST BE CODED AS LEGIT SKIP.


FA12

Think about the {person / all of the people} who did this to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did this happen to you in the past 12 months?

IF NECESSARY: “In total” refers to your combined experiences across all of the people who did

this to you in the past 12 months.





[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]



999


TOO MANY TO COUNT




-1


DON’T KNOW




-2


REFUSED




-3


LEGIT SKIP



  • USER NOTE: ITEMS FA13_01 - FA20 ARE INTENDED TO GET AT ATTEMPTED MADE TO PENETRATE (MTP) - MALES


CATI:

IF FEMALE “R” OR IF MALE “R” AND NEITHER FA02 – FA03 ENDORSED ( > 1) SKIP TO (OT_INTRO1). CODE FA13_01 – FA20 AS LEGIT SKIP.

IF MALE “R” AND EITHER FA02 OR FA03 IS ENDORSED ( > 1) AND ANY OF FA04, FA05_01 – FA12 ANSWERED (RAPE), THEN DISPLAY (FA_INTRO2).

IF MALE “R” AND EITHER OF FA02 OR FA03 IS ENDORSED ( > 1) AND NONE OF FA04, FA05_01 – FA12 ANSWERED, GO TO FA13_01.




(FA_INTRO2)

[IF MALE “R” AND EITHER FA02 OR FA03 (MTP) IS ENDORSED AND ANY OF FA05_01 – FA12 ANSWERED (ENDORSED ATTEMPTED MALE RAPE) THEN READ …]

“Now I am going to ask you about some of the other things that have happened to you.

FA13_01

Think about the first time anyone EVER {FILL: LIST OF MTP BEHAVIORS ENDORSED (MALES: FA02 – FA03) - USE THE MTP BEHAVIOR FILLS (APPENDIX II); SEPARATE THE TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of harm. The first time these things happened to you, how did you know the person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

IF NECESSARY: “What was your connection, if any, to this person?”

IF NECESSARY: “Was this person male or female?”

[CODE USING THE RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]


_ _ _

[RANGE 100-800]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP


FA14

How old were you the first time this person did {FILL: “this” / “any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110 YEARS]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < FA14 THEN DISPLAY SOFT CHECK. (SEE TEXT IN GENERAL NOTES)


Note:

↓

The first relationship has already been coded in FA13_01. Code additional relationships in “FA13_” below using the Relationship/Sex Template (Appendix I). Note that relationship categories may be repeated.


(FA13)

[IF SUM FA02 +– FA03 (MALES) > 1, ASK …]

ITEM

QUESTION

RELATIONSHIP

NO MORE

DK

REF

LEGIT

SKIP


FA13_02

Now I’m going to ask you about any additional people who may have done these things to you.

How did you know the 2nd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

IF NECESSARY: Was this person male or female?

INTERVIEWER: CODE 996 (NO MORE) THE FIRST TIME THE R INDICATES THAT THERE ARE NO ADDITIONAL PEOPLE TO REPORT.

_ 100 - 800_ _

996

-1

-2

-3


FA13_03

How did you know the 3rd person who did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

_ _ _

996

-1

-2

-3

FA13_04

The 4th person?

_ _ _

996

-1

-2

-3

FA13_05

The 5th person?

_ _ _

996

-1

-2

-3

:

:






FA13_09

The 9th person?

_ _ _

996

-1

-2

-3

FA13_10

The 10th person?

_ _ _

996

-1

-2

-3


CATI:

SHOW ONLY THE FA13_## ITEMS THAT ARE < (FA02 + FA03: MALES) WHICH IS THE MAXIMUM POSSIBLE. ONCE CODE 996 IS USED, REMAINING “FA13_” VARIABLES SHOULD BE CODED AS LEGIT SKIP.

CHECK: THE MAXIMUM NUMBER OF “FA13_##” ITEMS THAT CAN BE ANSWERED

MUST BE < SUM (FA02 + FA03: MALES).


CATI:

IF NONE OF “FA13_” ARE A CURRENT OR FORMER INTIMATE PARTNER (ALL > 200), SKIP TO FA18;

CODE FA15 – FA17 AS LEGIT SKIP.


FA15

I want to confirm that the FIRST romantic or sexual partner of yours who EVER did {this/any of these things} to you was {FILL: (INTIMATE RELATIONSHIP CODES 107, 157) / “your” {FILL: FIRST INTIMATE RELATIONSHIP FROM FA12_02 – FA13_10}. Is this correct?


1


YES

{CODE RELATIONSHIP IN FA16}


2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



FA16

What was your relationship to this person?


_ _ _

[RANGE 100-189]



-3


LEGIT SKIP



CATI:

IF 100 < FA16 < 199 AND FA16 = FA13_01 THEN SKIP TO FA18; FILL FA17 = FA14.


FA17

How old were you the first time this person did {FILL: “this” (ONE BEHAVIOR) / “any of these things”} to you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1

DON’T KNOW



-2

REFUSED


-3

LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < FA17 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


CATI:

IF R REPORTED ONE PERPATRATOR (FA13_02 = -3), GO GO FA18_01

FA18_01













FA18


Thinking about the person who {FILL: LIST OF MTP BEHAVIORS ENDORSED FA02 – FA03 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of violenc. Did this person do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?




1


YES



2


NO

{SKIP TO PA_INTRO1}


-1


DON’T KNOW

{SKIP TO PA_INTRO1}


-2


REFUSED

{SKIP TO AP_INTRO1}


CATI:

IF FA18_01 = 1, FILL FA18 = 1, THEN GO TO BOX AFTER FA18





Thinking about the { people who {FILL: LIST OF MTP BEHAVIORS ENDORSED FA02 – FA03 (MALES) – USE THE MTP BEHAVIORS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} using physical force or threats of violence, how many people did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]


_ _

[RANGE: 0 – 5]


-1


DON’T KNOW

{SKIP TO (PA_INTRO1)}


-2


REFUSED

{SKIP TO (PA_INTRO1)}


-3


LEGIT SKIP



CATI:

IF FA18 IS CODED AS NONE, DK OR REF, SKIP TO (PA_INTRO1); CODE FA19a, FA19_01 – FA19_05, FA20 AS LEGIT SKIP.

CHECK: FA18 MUST BE < THE NUMBER OF NON-UNIQUE RELATIONSIPS LISTED IN FA13_01 – FA13_10.


CATI:

IF ONE RELATIONSHIP EVER (FA13_01 ANSWERED, FA13_02 = 996) AND RELATIONSHIP IS A FAMILY MEMBER, (FA13_01 = 201 - 239, 251 - 289) CODE FA19_01 WITH VALUE FROM FA12_01, AND SKIP TO FA20; CODE FA19a, FA19_02 – FA19_05 AS LEGIT SKIP.

IF ONE RELATIONSHIP EVER (FA12_01 ANSWERED, FA12_02= 996) AND NOT A FAMILY MEMBER, A GROUP OR UNKNOWN RELATIONSHIP AND ONE RELATIONSHIP PAST 12 MONTHS (FA18=1), READ FA19a (TEXT TO CONFIRM RELATIONSHIP HAS NOT CHANGED).

IF FA18 > 1 (MORE THAN 1 PERSON PAST 12 MONTHS), GO TO (FA19). CODE FA19a AS LEGIT SKIP.

IF MORE THAN ONE RELATIONSHIP EVER (FA13_02 < 996) AND FA18 = 1, GO TO (FA19).

CODE FA19a AS LEGIT SKIP.

PAST 12 MONTH RELTIONSHIPS ARE NOT RESTRICTED TO THOSE PREVIOUSLY MENTIONED.

Note:

↓

Code Relationships in the “FA19_” items below.

Refer to the Relationship/Sex template (Appendix II) for relationship codes.

Note that relationships can change over time, therefore, past 12 month relationships are not restricted to those previously mentioned. In addition, a relationship type can be mentioned more than once.


[IF FA13_01 ANSWERED AND NOT 200-239, 250-289 AND FA13 _02= 996 or FA13_02=-3 LEGIT SKIP, READ …]

FA19a

I just want to confirm that this person was still {FILL: (RELATIONSHIP CODES 107, 157, 501, 502, 503, 551, 552, 553 / “a” (RELATIONSHIP CODES 105, 155, 406, 407, 456, 457, 504, 505, 506, 554, 555, 556)/ “your” ANY OTHER RELATIONSHIP CODES AT FA11_01} when {FILL: he/she} did these things to you in the past 12 months. Is this correct?

{IF YES, CODE RELATIONSHIP IN FA19_01 AND SKIP TO FA20; CODE FA19_02 – FA19_05 AS LEGIT

SKIP}



1


YES

{SKIP TO FA20}



2


NO

{GO TO FA19_01}



-1


DON’T KNOW

{SKIP TO FA20}



-2


REFUSED

{SKIP TO FA20}



-3


LEGIT SKIP

{SKIP TO FA20}



CATI:

IF FA19a IS CODED AS 1, -1, -2, FILL FA19_01 WITH RELATIONSHIP FILL FROM FA19a AND SKIP TO FA20; CODE FA19_02 – FA19_05 AS LEGIT SKIP.


(FA19)

[ENTER THE 3-DIGIT RELATIONSHIP CODE FOR EACH RELATIONSHIP ENDORSED IN THE PAST 12 MONTHS]

ITEM

QUESTION

RELATIONSHIP

[RANGE: 100-1-2]

DK

REF

LEGIT SKIP

How did you know the “person” (FA18=1) / “people” who did “this” (ONE BEHAVIOR) /”these things” to you in the past 12 months?

[DO NOT READ FA19_01 – FA19_05, JUST CODE THOSE MENTIONED. ORDER IS NOT IMPORTANT]

IF NECESSARY: Was this person male or female?

FA19_01

PAST 12 MONTH RELATIONSHIP 1

_ _ _

-1

-2

-3

FA19_02

PAST 12 MONTH RELATIONSHIP 2

_ _ _

-1

-2

-3

FA19_03

PAST 12 MONTH RELATIONSHIP 3

_ _ _

-1

-2

-3

FA19_04

PAST 12 MONTH RELATIONSHIP 4

_ _ _

-1

-2

-3

FA19_05

PAST 12 MONTH RELATIONSHIP 5

_ _ _

-1

-2

-3


CATI:

SHOW ONLY THE FA19_## THAT ARE < FA18. REMAINDER SHOULD BE CODED AS LEGIT SKIP.

EXAMPLE: IF FA19 = 3, THEN FA19_01, FA19_02 AND FA19_03 MUST BE ANSWERED,

AND FA19_04 – FA19_05 MUST BE CODED AS LEGIT SKIP.


FA20

Think about the {person / all of the people} who did {FILL: “this” (one behavior)/”these things”} to you in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}. How many times in total did {FILL: “this” (ONE BEHAVIOR) / “these things”} happen to you in the past 12 months?


IF NECESSARY: “In total” refers to your combined experiences across all of the people who

did {FILL: “this” (ONE BEHAVIOR) / “these things”} to you in the past 12 months.



------


[RECORD NUMBER OF TIMES] [RANGE = 1 – 100, 100 = 100+]



999


TOO MANY TO COUNT




-1


DON’T KNOW




-2


REFUSED




-3


LEGIT SKIP



OT. Sexual Violence: Outcomes of Rape and Made to Penetrate

(OT_INTRO1)

I have a few follow-up questions about the times in your life {FILL: “this person” (ONE BEHAVIOR, ONE PERSON) / “anyone”} ever {FILL: “made you” (FC01 – FC04(FEMALE)/FC05 – FC08(MALE)} have sex using physical force or threats of violence, {FILL: “tried to make you” (FA01 (FEMALE)/FA02 – FA04(MALE))} have sex using physical force or threats of violence; {FILL: made you have unwanted sex when you were unable to consent or refuse because you were too drunk, high, drugged, or passed out from alcohol or drugs” (AD01 – AD04(FEMALE)/AD05 – AD08(MALE)} – SEPARATE THE LAST TWO PHRASES WITH THE WORD “or”.

ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

OT01

Thinking about these experiences in your entire lifetime, when {FILL: “this” (IF JUST ONE BEHAVIOR ENDORSED FROM AD01 – AD04, FC01-FC04,FA01 (FEMALE)/AD05 – AD08, FC05-FC08,FA02-FA04 (MALE), / “any of these things”}  happened did you file a police report?

1

2

-1

-2

-3

OT02

Were you ever physically injured when {FILL: “this” (IF JUST ONE BEHAVIOR ENDORSED FROM AD01 – AD04,FC01-FC04,FA01 (FEMALE)/AD05 – AD08,FC05-FC08,FA02-FA04 (MALE) / “any of these things”}  happened? For example, did you have bruises, {FILL: “vaginal” or (FEMALES)} anal tears, or other internal or external injuries?

1

2

-1

-2

-3

[IF ANY OF AD01 – AD04, FC01 – FC04(FEMALES)/

AD05 – AD08, FC05 – FC08 (MALES) ENDORSED, ASK …]






OT03

Did you ever get an STD or other infection when {FILL: “this” (IF JUST ONE BEHAVIOR ENDORSED FROM AD01 – AD04, FC01-FC04 (FEMALE)/AD05 – AD08,FC05-FC08 (MALE) / “any of these things} happened? For example, did you get Chlamydia, Gonorrhea, HIV, or some other STD?

1

2

-1

-2

-3

[IF FEMALE AND EITHER AD03 OR FC03 ENDORSED, ASK …]






OT04

Did you ever get pregnant when {FILL: “this” (IF ONLY AD03 OR FC03 ENDORSED/ “any of these things”} happened?

1

2

-1

-2

-3


CATI:

IF MALE OR, IF FEMALE AND NEITHER AD03 NOR FC03 ARE ENDORSED, SKIP TO OT05;

CODE OT04 AS LEGIT SKIP.

ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

OT05

Were you ever concerned for your safety?

1

2

-1

-2

-3

OT06

Were you ever fearful for yourself or someone

Shape3

close to you?

1

2

-1

-2

-3

PA. Psychological Aggression

CHK1

{If R endorses 1 or more behaviors in Sexual Violence Section AD, FC, FA }


I’d like to check in with you to make sure you’re feeling alright and would like to continue the interview.  Shall we continue?

1

YES {go to PA_INTRO1}

2

NO {BREAKOFF AND CODE AS DISTRESS}

-1

DON’T KNOW {BREAKOFF AND CODE AS DISTRESS}

-2

REFUSED {BREAKOFF AND CODE AS DISTRESS}


(PA_INTRO1)

The next questions ask more generally about experiences you may have had in your life with your romantic or sexual partners. This includes spouses, boyfriends, girlfriends, people you have dated, or people you were seeing.Do not include first dates or one-time hook-up situations.


INTERVIEWER: IF R ASKS IF THEY SHOULD INCLUDE, OR IF R INDICATES INCLUDING PHYSICAL VIOLENCE,

TELL R PHYSICAL VIOLENCE DOES NOT COUNT HERE.


ITEM

QUESTION

RANGE:

[1-10]

NONE

DK

REF

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

PA01

… kept you from having your own money?

_ _

0

-1

-2

PA02

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

_ _

0

-1

-2

PA03

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

_ _

0

-1

-2

PA04

… made threats to physically harm you?

_ _

0

-1

-2

PA05

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

_ _

0

-1

-2

PA06

… made decisions that should have been yours to make?

_ _

0

-1

-2

PA07

… destroyed something on purpose that was important to you?

_ _

0

-1

-2

PA08

… insulted or humiliated you in front of others?

_ _

0

-1

-2


CATI:

IF NONE OF PA01 – PA08 ARE ENDORSED, SKIP TO PA_INTRO2; CODE PA09 – PA11 AS LEGIT SKIP.








PA09

How old were you the first time a current or ex partner FILL: WITH PA01 THROUGH PA08 BEHAVIORS AS APPROPRIATE – USE THE PSYCHOLOGICAL AGGRESSION BEHAVIOR FILLS (APPENDIX II)}?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110 YEARS]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < PA09 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


PA10

How many current or ex partners have done {FILL: “this” (JUST ONE OF F01 – F08) / “any of these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]


_ _

[RANGE: 0-5]



-1


DON’T KNOW

{SKIP TO (PA_INTRO2)}


-2


REFUSED

{SKIP TO (PA_INTRO2)}


-3


LEGIT SKIP



CATI:

IF PA10 = 0, DK OR REF, SKIP TO (PV_INTRO1); CODE PA11 AS LEGIT SKIP.


PA11

At the time that it was most frequent in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}, how often did a current or ex partner do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you?

Would you say …” (READ RESPONSE OPTIONS 1-5 BELOW).


1


ONCE



2


A FEW TIMES A YEAR



3


MONTHLY



4


WEEKLY



5


DAILY



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP


If R reported 3 or less behaviors through ST01-ST07: fill in the question with the endorsements.

If R reported 4 or more behaviors: this/these things.


[IF NEEDED: Your best estimate is fine.]
















(PA_INTRO2)

The next few questions are related to other experiences you may have had with a current or ex-romantic or sexual partner.

ITEM

QUESTION

RANGE:

[1-10]

NONE

DK

REF

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


[IF FEMALE ASK …]





PA12

… tried to get you pregnant when you did not want to become pregnant or tried to stop you from using birth control?

_ _

0

{SKIP

-1

TO

-2

PA14}


[IF MALE ASK …]





PA13

… tried to get pregnant when you didn’t want them to get pregnant} or tried to stop you from using birth control?

_ _

0

{SKIP

-1

TO

-2

PA14}

PA14

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

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]

_ _

0

-1

-2

PA15

… refused to use a condom when you wanted them to use one?

_ _

0

{SKIP

-1

TO

-2

PV_INTRO1}

PA16

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

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]

_ _

0

-1

-2


CATI:

IF MALE, CODE PA12 AS LEGIT SKIP; IF FEMALE, CODE PA13 AS LEGIT SKIP.



PV. Physical Violence

(PV_INTRO1)

The next questions are related to physical acts you may have experienced with your current or ex-romantic or sexual partners.


  • USER NOTE: THESE NEXT FEW QUESTIONS REFER TO MINOR PHYSICAL ACTS OF VIOLENCE.

ITEM

QUESTION

RANGE

[1-10]

NONE

DK

REF

How many of your current or ex partners have ever…

PV01

… slapped, pushed, or shoved you?

_ _

0

-1

-2


CATI:

IF PV01 NOT ENDORSED, SKIP TO PV_INTRO2; CODE PV02 – PV03 AS LEGIT SKIP.


PV02

How old were you the first time a current or ex partner did thist o you?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < PV02 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


PV03

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

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 =5 OR MORE PEOPLE]


_ _

[RANGE: 0 - 5]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

CHECK: PV03 MUST BE < PV01.


  • USER NOTE: THESE NEXT FEW QUESTIONS REFER TO MORE SEVERE PHYSICAL ACTS OF VIOLENCE.


ITEM

QUESTION

RANGE

[1-10]

NONE

DK

REF


How many of your current or ex partners have ever …

PV04

… hit you with a fist or something hard?

_ _

0

-1

-2


PV05

… kicked you or stomped on you?

_ _

0

-1

-2


PV06

… hurt you by pulling your hair?

_ _

0

-1

-2


How many of your current or ex partners have ever …

PV07

… slammed you against something?

_ _

0

-1

-2


PV08

… tried to hurt you by choking or suffocating you?

_ _

0

-1

-2


How many of your current or ex partners have ever …

PV09

… used a knife on you?

_ _

0

-1

-2


PV10

… used a gun on you?

_ _

0

-1

-2



CATI:

IF NONE OF PV04 – PV10 ENDORSED, SKIP TO PV13; CODE PV11 – PV12 AS LEGIT SKIP. IF NONE OF PV01, PV04-PV10 ARE ENDORSED, SKIP TO CHK2; MARK PV11 – PV15 AS LEGIT SKIP.


PV11

How old were you the first time a current or ex partner {FILL: LIST OF SEVERE PHYSICAL ACT BEHAVIORS ENDORSED IN PV04 – PV10 – USE THE SEVERE PHYSICAL VIOLENCE BEHAVIOR FILLS (APPENDIX II) - SEPARATE THE LAST TWO BEHAVIORS ENDORSED WITH “or”}?

[RECORD AGE IN YEARS; A VALUE OF 0 = LESS THAN 1 YEAR OLD]


_ _ _

[RANGE 0-110]



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP



CATI:

IF CURRENT AGE (RESPAGE) < PV11 THEN DISPLAY SOFT CHECK (SEE TEXT IN GENERAL NOTES)


PV12

How many current or ex partners have done {FILL: “this” (ONE BEHAVIOR, ONE PERSON)/ “these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

INTERVIEWER: ENTER 5 FOR MORE THAN 5 PEOPLE.

[A VALUE OF 5 = 5 OR MORE PEOPLE]


_ _

[RANGE: 0 – 5]


-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP




CATI:

CHECK: PV12 MUST BE < SUM(PV04 THRU PV10).


  • USER NOTE: THESE NEXT FEW QUESTIONS COMBINE THE MINOR AND MORE SEVERE BEHAVIORS PHYSICAL

ACTS OF VIOLENCE.


PV13

Think about {FILL: “the person” (ONLY ONE OF PV01, PV04 – PV10 ENDORSED AND ONLY 1 PERSON) / “all of the people”} who {FILL: ENDORSED BEHAVIORS PV01, PV04 – PV10 - USE THE PHYSICAL VIOLENCE BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO BEHAVIORS WITH THE WORD “or”} in your lifetime. What was your relationship with the first current or ex partner who did {FILL: “this” (ONE BEHAVIOR)/ “any of these things”} to you the FIRST time?

IF NECESSARY: “Was this person male or female?”

[CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]


_ _ _

[RANGE 100-199]


-1


DON’T KNOW


-2


REFUSED


-3


LEGIT SKIP



CATI:

IF PV03 = 0 AND PV12 = 0 THEN SKIP TO CHK2; MARK PV14 – PV15 AS LEGIT SKIP.




PV14

What was your relationship with the {FILL: “first” (SUM PV03+PV12>1)} current or ex partner who did {FILL: “this” (ONE BEHAVIOR)/ “any of these things”} to you in the past 12 months? That is since {FILL: DATE 12 MONTHS AGO}?

IF NECESSARY: “Was this person male or female?”

[CODE USING RELATIONSHIP/SEX TEMPLATE (APPENDIX I)]


_ _ _

[RANGE 100-139, 150-189]


-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP




PV15

At the time that it was most frequent in the past 12 months, that is since {FILL: DATE 12 MONTHS AGO}, how often did a current or ex partner do {FILL: “this” (ONE BEHAVIOR) / “these things”} to you?

Would you say …” READ RESPONSE OPTIONS 1-5 BELOW BELOW.




1


ONCE



2


A FEW TIMES A YEAR



3


MONTHLY



4


WEEKLY



5


DAILY



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP





If R reported 3 or less behaviors through PV01-PV07: fill in the question with the endorsements.

If R reported 4 or more behaviors: this/these things.

[IF NEEDED: Your best estimate is fine.]




CQ. Consequences of Intimate Partner Violence

CHK2

{If R endorses 3+ behaviors in Stalking, Psychological Aggression, Physical Violence – Sections ST, PA, PV }

I’d like to check in with you to make sure you’re feeling alright and would like to continue the interview.  Shall we continue?

1

YES {go to CQ_INTRO}

2

NO {BREAKOFF AND CODE AS DISTRESS}

-1

(VOL) DON’T KNOW {BREAKOFF AND CODE AS DISTRESS}

-2

(VOL) REFUSED {BREAKOFF AND CODE AS DISTRESS}


  • USER NOTE: The next section gets at the consequences of intimate partner violence. Intimate partner violence includes the following forms of victimization by an intimate partner: stalking, unwanted sexual contact, sexual coercion, and completed or attempted rape or those being made to penetrate someone else, and physical violence by an intimate partner. While questions are not asked of those who specifically endorsed psychological aggression by an intimate partner, respondents may be considering these experiences when responding to these questions.


(CQ_INTRO)

[IF ANY OF PV01, PV04-PV10 (PV BY AN INTIMATE PARTNER) AND/OR ANY OF ST09, ST10, SC05, SC06, SC15-SC17, AD01-AD04 (FEMALES)/AD05-AD08(MALES), FC01-FC04 (FEMALES)/FC05-FC08 (MALES), FA01(FEMALES)/

FA02-FA04(MALES) GE 1 AND ONE OR MORE RELATIONSHIP WAS AN INTIMATE PARTNER (CODES 100-139,

150-189) (VIOLENCE BY AN INTIMATE PARTNER), READ …]

We want to talk now about the consequences of the different experiences that you have shared with us involving a current or ex-romantic or sexual partner. These could be physical acts, unwanted sexual situations, or repeated unwanted attempts to contact, follow, or harass you. We are interested in understanding the consequence of these experiences for you.

You told me previously that current or ex romantic or sexual partners have {fill: all endorsed behaviors/conditions from those mentioned in CQ_INTRO above}.

CATI:

IF NONE OF PV01, PV04 THRU PV10 GE 1 AND ALL OF ST14, SC10,SC21,AD13,AD20, FC12,FC20,FA08,FA16 = 3 (LEGIT SKIP), THEN SKIP TO INTLANG; CODE CQ01 – CQ31 AS LEGIT SKIP.


ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

CQ01

When any of those things happened, were you ever concerned for your safety?

1

2

{SKIP

-1

TO

-2

CQ03}

-3

CQ02

Were you concerned for your safety in the past 12 months?

1

2

-1

-2

-3

CQ03

When any of those things happened,

were you ever fearful for yourself or someone

Shape4

close to you?

1

2

{SKIP

-1

TO

-2

CQ05}

-3

CQ04

Were you fearful in the past 12 months?

1

2

-1

-2

-3

CATI:

IF R RESPONDS NO, DK OR REF TO THE CQ01, SKIP TO CQ03; CODE CQ02 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO THE CQ03, SKIP TO CQ05; CODE CQ04 AS LEGIT SKIP.

  • USER NOTE: ITEMS CQ05 – CQ08 ARE INTENDED TO GET AT SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER.


Thinking back to the physical acts, unwanted sexual situations, or repeated unwanted attempts to contact, follow, or harass you by a current or ex romantic or sexual partner …

ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

CQ05

… did you ever have nightmares?

1

2

-1

-2

-3

CQ06

… did you ever try hard not to think about or go

out of your way to avoid being reminded of the

Shape5

things that were done to you?

1

2

-1

-2

-3

CQ07

… did you ever feel like you were constantly on

Shape6

guard, watchful, or easily startled?

1

2

-1

-2

-3

CQ08

… did you ever feel numb or detached from others,

Shape7

your activities, or your surroundings?

1

2

-1

-2

-3


CATI:

IF NONE OF CQ05 – CQ08 ARE ENDORSED (INCLUDES RESPONSES OF DK AND REF), SKIP TO CQ10; CODE CQ09 AS LEGIT SKIP.


[IF ONE OR MORE OF CQ05-CQ08 ARE ENDORSED, READ …]

You told me that you {FILL: LIST PTSD SYMPTOMS ENDORSED IN CQ5 – CQ8 – USE THE SYMPTOMS OF PTSD BEHAVIOR FILLS (APPENDIX II); SEPARATE THE LAST TWO SYMPTOMS WITH THE WORD “or”} because of what a current or ex partner did to you.

CQ09

Did you ever feel this way in the past 12 months?


1


YES



2


NO



-1


DON’T KNOW



-2


REFUSED



-3


LEGIT SKIP




I am going to read you a list of possible injuries. Please tell me which of these you have experienced because of the physical acts, unwanted sexual situations, or repeated unwanted attempts to contact, follow, or harass you by a current or ex partner.

Did you ever experience …

ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

CQ10

… minor bruises or scratches?

1

2

-1

-2

-3

CQ11

… cuts, major bruises, or black eyes?

1

2

-1

-2

-3




ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

CQ12

Injury to any ligaments, muscles or tendons?

1

2

-1

-2

-3

CQ13

Broken bones or teeth?

1

2

-1

-2

-3

CQ14

Back or neck injury?

1

2

-1

-2

-3

CQ15

Being knocked out after getting hit, slammed against something or choked?

1

2

-1

-2

-3


ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

CQ16

A concussion is when a blow to the head caused you to have one or more symptoms such as blurred or double vision, sensitivity to light or noise, headaches, dizziness or balance problems, nausea, being dazed or confused, difficulty remembering, difficulty concentrating, or being knocked out. 

Did you ever experience a concussion because of what a current or ex partner did to you?

{IF NECESSARY: Do not include situations where you were hurt accidentally.}

1

2

-1

-2

-3


ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

CQ17

Did you ever experience mental or emotional harm (for example, anxiety or depression) because of what a current or ex partner did to you?

1

2

-1

-2

-3

[IF ANY OF CQ10 – CQ17 IS YES, ASK CQ18]






CQ18

Did you ever need medical care because of what a current or ex partner did to you?

1

2

{SKIP

-1

TO

-2

CQ20}

-3

CQ19

Were you able to get the medical care you needed?

1

2

-1

-2

-3

CQ20

In the past 12 months were you injured because of the things a current or ex partner did to you?

1

2

{SKIP

-1

TO

-2

CQ22}

-3

[IF CQ18=YES AND CQ20=YES, ASK…]






CQ21

In the past 12 months did you need medical care for any of these injuries?

1

2

-1

-2

-3


CATI:

IF R RESPONDS NO, DK OR REF TO ALL OF CQ10 – CQ17, GO TO CQ22; CODE CQ18 – CQ21 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO CQ18, SKIP TO CQ20; CODE CQ19 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO CQ20, SKIP TO CQ22; CODE CQ21 AS LEGIT SKIP.

IF R RESPONDS YES TO CQ20 AND DOES NOT RESPOND YES TO CQ19, SKIP TO CQ22;

CODE CQ21 AS LEGIT SKIP.

Now I will read you a list of services and assistance you might have needed because of what a current or or ex-romantic or sexual partner did to you.

ITEM

QUESTION

YES

NO

DK

REF

LEGIT SKIP

CQ22

Have you ever talked to a crisis hotline

operator?

1

2

-1

-2

-3

CQ23

Did you ever need housing services?

1

2

-1

-2

-3

CQ24

Did you ever need victim’s advocate services?

1

2

-1

-2

-3

CQ25

Did you ever need legal services or the advice of an attorney?

1

2

-1

-2

-3

CQ26

Did you ever file a police report because of the things that a current or ex partner did to you?

1

2

{SKIP

-1

TO

-2

CQ28}

-3

CQ27

In the past 12 months did you file a police report because of the things that a current or ex partner did to you?

1

2

-1

-2

-3


CATI:

IF R RESPONDS NO, DK OR REF TO CQ26, SKIP TO CQ28; CODE CQ27 AS LEGIT SKIP.


ITEM

QUESTION

RANGE:

[1-365 DAYS]

NO DAYS

DK

REF

NA

CQ28

About how many days of work did you ever have to miss when a current or ex partner did these things to you?

_ _ _

0

{SKIP

-1

TO

-2

CQ30}

-3

CQ29

In the past 12 months how many days of work did you have to miss when a current or ex partner did these things to you?

_ _ _

0

-1

-2

-3

CQ30

About how many days of school did you ever have to miss when a current or ex partner did these things to you?

_ _ _

0

{SKIP

-1

TO

-2

CQ31}

-3

CQ31

In the past 12 months how many days of school did you have to miss when a current or ex partner did these things to you?

_ _ _

0

-1

-2

-3

CATI:

IF R RESPONDS NO, DK OR REF TO CQ28, SKIP TO CQ30; CODE CQ29 AS LEGIT SKIP.

IF R RESPONDS NO, DK OR REF TO CQ30, SKIP TO INTLANG; CODE CQ31 AS LEGIT SKIP.


DEBRIEFING QUESTIONS



ITEM COUNT


PROGRAMMER NOTE: RANDOMLY ASSIGN RESPONDENTS INTO TWO GROUPS: GROUP A GET IC1 AND GROUP 2 GET IC2.



[IC1] Next is a list of three things that may happen to some people. In the past 12 months, how many of these things happened to you?

YES

NO

REFUSED

DON’T KNOW

In the past 12 months, have you had something stolen or taken away from your porch, lawn, or other parts of your property?

(A)

(A)

(A)

(A)

In the past 12 months, have you had something you carry; such as cell phone, money, wallet etc., stolen or taken away from you?

(B)

(B)

(B)

(B)

Have you received a traffic ticket?

(C)

(C)

(C)

(C)





[IC2] Next is a list of four things that may happen to some people. In the past 12 months, how many of these things happened to you?

YES

NO

REFUSED

DON’T KNOW

In the past 12 months, have you had something stolen or taken away from your porch, lawn, or other parts of your property?

(A)

(A)

(A)

(A)

In the past 12 months, have you had something you carry; such as cell phone, money, wallet etc., stolen or taken away from you?

(B)

(B)

(B)

(B)

Have you been kissed, fondled, groped, grabbed or touched in a sexual way when you didn’t want it to happen?

(C)

(C)

(C)

(C)

Have you received a traffic ticket?

(D)

(D)

(D)

(D)



____________________________




ST11_REVIEW>0 OR SC05>0 OR SC06>0 OR SC17_REVIEW>0 OR AD11_REVIEW>0 OR  AD19_REVIEW > 0  OR  FC09_REVIEW>0 OR FC17_REVIEW>0 OR FA01>0 OR FA04>0 OR FA13_REVIEW>0 THEN ASK NARRATIVE. ELSE GO TO DQ_INTRO.


[DQ_INTRO] Thank you for answering these questions. We appreciate that you were willing to share your personal experiences and answer questions about some very private and sensitive issues in this survey.



The following questions are about your reactions to this survey. Please indicate how strongly you agree or disagree with each statement.



[D1] You experienced intense emotions while completing the survey. Would you say…


Strongly Disagree 1

Disagree 2

Neutral 3

Agree 4

Strongly Agree 5



[D2] The survey made you think about things you didn’t want to think about. Would you say…


Strongly Disagree 1

Disagree 2

Neutral 3

Agree 4

Strongly Agree 5



[D3] You believe you have been able to help others by participating in this study.


Strongly Disagree 1

Disagree 2

Neutral 3

Agree 4

Strongly Agree 5



[D5] Now that you know what the survey is about, you would have made the same choice to participate. Would you say…


Strongly Disagree 1

Disagree 2

Neutral 3

Agree 4

Strongly Agree 5





DEBRIEFING ON ENVIRONMENT


[D6] Where were you when completing the survey? Were you…


At home, in a room with all doors
closed 1

At home, in a room with doors, but
at least one door was not closed 2

At home, in a room without any doors 3

On public transportation (e.g., bus,
train) 4

In another public place (specify
) 5

Other setting (specify
) 6


IF D6 = 1, 2, 3, ASK D7. ELSE GO TO D10.



[D7] Was anyone else in the room while you were completing the survey?


Yes 1

No 2


IF D7 = 1, ASK D8 AND D9. ELSE GO TO D10.



[D8] When someone was in the room, was this because…?


The person walked through the area 1

The person was sitting or standing
in the room for less than 5 minutes 2

The person was sitting or standing
in the room for at least 5 minutes 3



[D9] Who else was in the room while you were completing the survey?


Your spouse or partner 1

Some other adult 2

A child/children 3



[D10] Do you think anyone in your household knows what this survey is about?


Yes, someone in my household knows 1

No, no one in my household knows 2

I am not sure if anyone knows 3





[D11] Overall, how burdensome was this survey to you? Would you say…


Very burdensome 1

Somewhat burdensome 2

A little burdensome 3

Not at all burdensome 4



[D12] How sensitive did you feel the questions asked in this survey were? Would you say…


Very sensitive 1

Somewhat sensitive 2

A little sensitive 3

Not at all sensitive 4


[D13] Do you feel that the length of this interview was too long, too short, or about right?


Too long 1

Too short 2

About right 3



[D14] How would you rate your understanding of the questions asked in this survey? Would you say…


Excellent 1

Very good 2

Good 3

Fair 4

Poor 5



[D15] How sure are you that you’ve reported all things happened to you? Would you say…


Very sure 1

Somewhat sure 2

Somewhat unsure 3

Very unsure 4





W. Wrap-up



W1

In appreciation of your time and effort in completing this interview, we would like to send you a {INSERT INCENTIVE}. In order to mail you your incentive, I need to collect your full name and mailing address. This information will never be connected with your answers in the survey.{FILL: INSERT INCENTIVE} (INTERVIEWED IN NON-RESPONSE FOLLOW-UP PHASE}


1


RECEIVE INCENTIVE



2


REFUSED



W2_FName

[Can I have your full name?]

[RECORD FIRST NAME]

W2_LNAME

[RECORD FIRST NAME]



What is your mailing address? Let’s start with the street address.

W2_Address

[RECORD STREET ADDRESS]



W2_ZIP

What is your zip code? [REFER TO ZIP CODE LOOK-UP DATABASE]


_ _ _ _ _

[RANGE 00001--99950]



















CATI:

IF ZIP CODE NOT FOUND, SKIP TO CHEKZIPA

IF ZIPCODE FOUND, SKIP TO CITYSTAT




CHEKZIPA What is your zipcode?

________ [RANGE 00001 -99950] {SKIP TO W2_CITY}

CITYSTAT Is this in {FILL: CITY AND STATE BASED ON RESPONSE AT W2_ZIP}?

1. Yes {SKIP TO W3}

2. No

W2_City

[RECORD CITY]



W2_State

[RECORD STATE FROM LIST]

W3

If you have any questions or concerns about participating in the survey, please feel free to call the survey helpdesk , at 1-###-###-####}. You will hear an option to speak with a project staff member.

Thank you for participating in CDC’s study of health and injuries. We realize that some of the topics covered are quite personal and can be difficult to think and talk about.  We appreciate your willingness to be a part of this study and want you to know that we recognize the important contribution you have made.   Sometimes when people have participated in a study like this, they realize that they are interested in following up on some of the issues that they have been asked about in the study with someone who is professionally trained to deal with these kinds of issues. We are going to provide you the toll-free numbers of resources that you can use now or in the future if you want to speak further with someone.  

You can reach the National Domestic Violence Hotline at 1-800-799-SAFE (7233).  You can reach the National Sexual Assault Hotline at 1-800-656-HOPE (4673). You can reach the National Child Abuse Hotline at 1-800-4-A-Child (1-800-422-4453). You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

[PAUSE THEN SAY: Would you like me to repeat these numbers?]

That completes the interview. Thank you for your participation. {We will be mailing your ($10/$40) check within the next few weeks. }


[DID R HANG UP BEFORE HEARING ALL THE HOTLINE NUMBERS?]


1. YES,

2. NO


1……………..CONTINUE



W4

INTERVIEWER: DID THE respondent MENTION ANYTHING ABOUT A GROUP OF PERPETRATORS?

1………………..YES, THE RESPONDENT MENTIONED A GROUP OF PERPETRATORS

2………………..NO






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