0703-0064_2023 Family Study Folow-Up Survey_2_8.4.2021
Prospective Studies of US Military Forces and Their Families: The Millennium Cohort Program
0703-0064_2023 Family Study Folow-Up Survey_2_8.4.2021
OMB: 0703-0064
Privacy Act Statement
You have rights under the Privacy Act.
The following statement describes how that ACT applies to this study:
The Privacy Act System of Records Notice (SORN) for this study is N6500-1. The SORN was published on the Defense Privacy and Civil Liberties Division (DPCLD) website on November 14, 2014, and can be found here: https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570396/n06500-1/
Authority: Authority to request this information is granted under: 10 USC 136, Under Secretary of Defense for Personnel and Readiness, 10 USC 1782, Surveys of Military Families, 10 USC 2358, Research and Development Projects, Under Secretary of Defense Memorandum #: 99-028, 30 SEP 99 "Establishment of DoD Centers for Deployment Health” and Executive Order 9396, Numbering System for Federal Accounts Relating to Individual Persons.
Purpose: To create a probability-based database of service members and veterans who have, or have not, deployed overseas so that various longitudinal health and research studies may be conducted over a 67-year period. The database will be used: (a.) To systematically collect population-based demographic and health data to evaluate the health of Armed Forces personnel throughout their careers and after leaving the service. (b.) To evaluate the impact of operational deployments on various measures of health over time including medically unexplained symptoms and chronic diseases to include cancer, heart disease and diabetes. (c.) To serve as a foundation upon which other routinely captured medical and deployment data may be added to answer future questions regarding the health risks of operational deployment, occupations, and general service in the Armed Forces. (d.) To examine characteristics of service in the Armed Forces associated with common clinician-diagnosed diseases and with scores on several standardized self-reported health inventories for physical and psychological functional status. (e.) To provide a data repository and available representative Armed Forces cohort that future investigators and policy makers might use to study important aspects of service in the Armed Forces including disease outcomes among an Armed Forces cohort.
In addition to revealing changes in service member and veteran health status over time, the Millennium Cohort Study will serve as a data repository, providing a solid foundation upon which additional epidemiological studies may be constructed.
Routine Uses: The information provided in this questionnaire will be maintained in data files at the Deployment Health Research Department at the Naval Health Research Center and used only for medical research purposes. Use of these data may be granted to other federal and non-federal medical research agencies as approved by the Naval Health Research Center's Institutional Review Board. In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C.
522a(b)(3).
To the Department of Veterans Affairs (DVA) for (1) considering individual claims for benefits for which that DVA is responsible; and (2) for use in scientific, medical and other analysis regarding health outcomes research associated with military service. To the Department of Health and Human Services, Centers for Disease Control and Prevention for use in scientific, medical and other analysis regarding health outcome research associated with military service.
NOTE: All disclosures to the DVA and HHS must have prior approval of the Naval Health Research Center Institutional Review Board and a Memorandum of Understanding must be entered into to ensure the right and obligations of the signatories are clear. Access to data 1) is provided on need-to-know basis only; 2) must adhere to the rule of minimization in that only information necessary to accomplish the purpose for which the disclosure is being made is releasable; and 3) must follow strict guidelines established in the data sharing agreement. To the Social Security Administration (SSA) for considering individual claims for benefits for which that SSA is responsible. The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of systems of records notices apply to this system.
NOTE: This system of records contains individually identifiable health information. The DoD Health Information Privacy Regulation (DoD 6025.18-R) issued pursuant to the Health Insurance Portability and Accountability Act of 1996, applies to most such health information. DoD 6025.18-R may place additional procedural requirements on the uses and disclosures of such information beyond those found in the Privacy Act of 1974 or mentioned in this system of records notice.
Voluntary Disclosure: Completion of the questionnaire is voluntary. Failure to respond to any of the questions will NOT result in any disadvantages or penalties except possible lack of representation of your views in the final results and outcomes.
Agency Disclosure Notice
The public reporting burden for this collection of information, OMB Control Number 0703-0064, is estimated to average 50 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
FOR
INTERNAL USE ONLY
FOR
INTERNAL USE ONLY
BACKGROUND
Before
we
begin,
we
would
like
to
ask
you some
background
questions.
These
questions
help
to
determine
what
sections of
the
survey
are
most
appropriate
for
your situation.
If you feel we have not reached the correct
person, please contact the Family Study team at
[email protected]
or
(800)
571-9248.
Thank
you!
What is your year of birth?
“Your
spouse”
refers
to the individual to whom you were married on <completion date of
baseline survey>, when
you
first
participated
in
the
Family
Study.
Even
if
your
marital
status
has
changed
and
this
person
is
no
longer
your
current
spouse,
please
think
about
this
individual
when “your
spouse”
is
mentioned.
“Your spouse” refers to the individual to whom you were married on <completion date of baseline survey>, when you first participated in the Family Study. Even if your marital status has changed and this person is no longer your current spouse, please think about this individual when “your spouse” is mentioned.
What is your current marital status with your spouse?
O Currently married
In what year did you marry your spouse?
Year
O Separated
In what year did you and your spouse separate?
Year
-
In what year did you marry your spouse?
Year
O Divorced
(Divorced participant will see “your ex-spouse” in place of “your spouse” for the remainder of the survey)
In what year did you and your spouse separate?
Year
O Not applicable
In what year did you and your spouse divorce?
Year
In what year did you marry your spouse?
Year
Are you remarried? If so, in what year did you remarry?
O
No
O Yes
Year
How would you describe your current relationship with your spouse?
O Very unfriendly
O Somewhat unfriendly
FOR
INTERNAL USE ONLY
O Somewhat friendly
O Very friendly
O Your spouse is deceased participant will fall under same skips as widowed but
will see Relationship after Divorce single question
O No contact with your spouse
O Widowed
-
In what year did you marry your spouse?
Year
In what year did your spouse die?
Year
Are you remarried? If so, in what year did you remarry?
O
No
O Yes
Year
(If widowed, participant SKIPS all questions related to spouse’s employment or residence, Relationship with Spouse, Deployment, Return and Reunion, Transition from Military, Military Life, Parenting.)
Has your spouse served in the military (Active Duty, Reserve, and/or National Guard) for any portion of the past 3 years?
O
No
O Yes
What is your spouse’s current military status?
O Active Duty
O Reserve or National Guard
O Both (Active Duty and Reserve or National Guard)
O Separated from military service
O Retired
O Do not know
Which of the following best describes your spouse’s current employment status? (Choose the single best answer.)
(Only seen if your spouse is NOT currently Active Duty)
O Full-time work (greater than or equal to 30 hours per week)
O Part-time work (less than 30 hours per week)
O Homemaker
O Not employed, looking for work
O Not employed, not looking for work
O
Not
employed,
retired
O
Not
employed, disabled
O
Other
(please
specify):
On average, during the past month, or the most recent month your spouse was not deployed, how many hours did he/she work per week (including weekends)?
hours
per week
O Your spouse is not currently working
O I don’t know
-
FOR INTERNAL USE ONLY
How many total months was your spouse away from home in the past year for reasons related to his/her military or civilian work (for example: work-related travel, deployments, training, temporary duty, TDY/TAD)?
months
in
the
past
year
O Your spouse is not currently working
O I don’t know
In the last 3 years, have you served in the U.S. military? Mark all that apply.
No
Yes,
Regular
Active
Duty
(not
a member
of
the
National
Guard
or
Reserve)Yes, Activated National Guard or Reserve (full-time Active Duty program: AGR/FTS/AR)
Yes, Traditional National Guard or Reserve (e.g., drilling unit, IMA, IPR)
a. In the last 3 years, have you deployed for more than 30 days?
O No
O Yes
-
How
many
children
do you
have?
(Please
include
biological,
adopted,
foster,
legal
guardianship,
and
stepchildren
of
all
ages.)
(0 – 10 or more)
(If “0” children, then participant SKIPS Your Children section and Parenting section later in survey.)
Please record the age(s) of your child(ren) from oldest to youngest.
(Only seen if number of children is greater than 0. Number of boxes auto-populates based on number of children indicated.)
(If “10 or more” selected in previous question, : If you have more than 10 children, please provide the ages for your 10 youngest children.)
Oldest Youngest
Including yourself, how many people currently reside in your household?
(Please include your spouse even if currently deployed, on temporary duty, or in training, if he/she lives and sleeps in your household the majority of the time. Please do not include anyone who does not live or sleep in your household the majority of the time, such as visiting relatives.)
(First
sentence
in
parentheses
will
not
be
seen
if
widowed.)
adults (18 or older) children (17 and younger)
Does your spouse currently reside in your household the majority of the time?
O No
O Yes
PHYSICAL HEALTH
We
would
like
to
begin
by
asking you
some
questions
about
your
physical
health,
how
you
feel,
and
how
well you are able to do your
usual activities. These items allow us to assess changes in your
general
health
over
time and if
those
changes
may
be
related
to other
information
you provide.
-
How
tall
are
you?
feet inches
What is your current weight? (If you are currently pregnant, please provide your weight before pregnancy.)
pounds
In general, would you say your health is:
O Excellent O Very good O Good
O Fair
FOR
INTERNAL USE ONLY
The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?
No,
not
limited
at all
Yes,
limited
a
little
Yes,
limited
a
lot
Moderate
activities,
such
as
moving
a
table,
pushing
a
vacuum
cleaner,
bowling,
or
playing
golf
O
O
O
Climbing
several
flights
of
stairs
O
O
O
l
During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?
-
No, none
of the time
Yes, a little
of the time
Yes, some
of the time
Yes, most
of the time
Yes, all of
the time
Accomplished less than you
would like
O
O
O
O
O
Were limited in the kind of work or
other activities
O
O
O
O
O
During the past 4 weeks, how much bodily pain have you had?
O None
O Very mild
O Mild
O Moderate
O Severe
O Very severe
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
O Not at all O A little bit O Moderately
O Quite a bit O Extremely
During any period in the last 12 months, have you taken any of the following regularly (at least once per week)?
-
Never
Less than
1 week
1-2
weeks
3-4
weeks
More than
4 weeks
Prescription pain medication (e.g., Codeine, OxyContin, Percocet, Vicodin)
O
O
O
O
O
Over-the-counter pain medication (e.g., Advil, Tylenol, Bayer, Capsaicin)
O
O
O
O
O
Prescription sleep medication (e.g., Ambien, Lunesta, Rozerem)
O
O
O
O
O
Over-the-counter sleep medication (e.g.,
Unisom, Melatonin, Valerian)
O
O
O
O
O
19b. (Only seen if participant endorsed using prescription pain or sleep medication above)
FOR
INTERNAL USE ONLY
Healthcare Healthcare Civilian Emergency Family Internet/ Dealer Other
provider provider healthcare Room member mail or street
at an MTF provider or friend order pharmacist
Prescription pain medication (e.g., Codeine, OxyContin, Percocet, Vicodin) |
O |
O |
O |
O |
O |
O |
O |
O |
Prescription sleep medication (e.g., Ambien, Lunesta, Rozerem) |
O |
O |
O |
O |
O |
O |
O |
O |
at a VA facility
In the past 12 months, have you used any prescription pain reliever in any way a doctor did not direct you to use it? This includes: using it without a prescription of your own; using it in greater amounts, more often, or longer than you were told to take it; using it in any other way a doctor did not direct you to use it.
O No
O Yes
During the past 4 weeks, how much have you been bothered by any of the following problems?
-
Not
bothered
Bothered a
little
Bothered a
lot
Stomach pain
O
O
O
Back pain
O
O
O
Pain in your arms, legs, or joints (knees, hips, etc.)
O
O
O
Pain or problems during sexual intercourse
O
O
O
Headaches
O
O
O
Chest pain
O
O
O
Dizziness
O
O
O
Fainting spells
O
O
O
Feeling your heart pound or race
O
O
O
Shortness of breath
O
O
O
Constipation, loose bowels, or diarrhea
O
O
O
Nausea, gas, or indigestion
O
O
O
Menstrual cramps or other problems with your period
(Only seen if participant is female)
O
O
O
Little or no sexual desire or pleasure during sex
O
O
O
In the last 3 years, has a doctor or other health professional told you that you have any of the following conditions?
No Yes
If yes, in what year were you first diagnosed?
Mark
here if ever
hospitalized
for
this
condition
-
Hypertension
O
O
□
High cholesterol requiring medication
O
O
□
Coronary heart disease
O
O
□
Diabetes
O
O
□
Rheumatoid arthritis
O
O
□
Has your doctor or other health professional ever told you that you have COVID-19 (Coronavirus disease 2019) or have you ever tested positive for SARS-CoV-2?
O No
O Yes, once (or multiple times within a 14-day period)
O Yes, more than once where you were tested at least 14 days apart
-
FOR INTERNAL USE ONLY
Since the beginning of the COVID-19 pandemic, have you:
O Become seriously ill with COVID-19? Yes/no
O Been hospitalized with COVID-19? Yes/no
O Recovered from COVID-19? Yes/no
O Experienced persistent COVID-related symptoms that did not resolve after the acute illness period?”
Have you ever received a vaccine for COVID-19?
O No
O Yes, received all doses of vaccine in the series
O Yes, but only received some of the vaccine doses in the series
bb. If yes, month/year of first dose of vaccination ___(mo) ____ (year)
-
Over
the
past
3
years,
approximately
how
many
days
were
you
hospitalized
because
of
illness
or
injury
(exclude
hospitalization
for
pregnancy
and
childbirth)?
days
-
FOR INTERNAL USE ONLY
Over the past 3 years, approximately how many days were you unable to work or perform your usual activities because of illness or injury (exclude lost time for pregnancy and childbirth)?
days
In the past 3 years, were you TRICARE eligible?
O No
O Yes
In the past 3 years, where have you gone for medical care (e.g., medical, behavioral, mental)? Mark all that apply.
Military Treatment Facility (MTF) or other military source
Veterans Affairs (VA) Medical Center or other VA setting
Civilian provider – TRICARE
Civilian provider – Other
Nonprofit or community health clinic (i.e., free or reduced cost care)
I did not use healthcare facilities/providers
Other
What kind of health care coverage or insurance do you currently have? Mark all that apply.
No health coverage or insurance
VA health care
TRICARE or military health insurance
Medicaid
Medicare
Health insurance from employer, school, or other source
We
would
like
to
end
this
section
by
asking
about
pregnancy
and
fertility.
Have you ever been pregnant? Include live births, stillbirths, miscarriages, and other pregnancies.
(Only seen if participant is female)
O
No
O Yes
How many times?
Have you given birth within the last 3 years?
O No
O Yes
Are you currently pregnant?
O No
O Yes
(Widowed participants and divorced participants w/ deceased ex-spouse will skip to the next section)
In the last 3 years, if you and your spouse got pregnant, did you have a miscarriage?
O Does not apply (no pregnancy)
O No miscarriage
O
Yes,
1
miscarriage
Year
O Yes, 2 miscarriages Years
O Yes, 3 or more miscarriages Years
In the last 3 years, have you and your spouse been unsuccessful getting pregnant for a year or more (not including time spent apart, such as deployment)?
O No
O Yes
O Not applicable, we have not tried to get pregnant
In the last 3 years, have you and your spouse decided to forgo or delay trying to get pregnant because of military life demands?
O No
O Yes
WELL-BEING
FOR
INTERNAL USE ONLY
Now we would like to ask you about your mental
well-being. These questions are about how you feel and
how things have been going over
the past 4 weeks. Some of these questions will seem slightly
repetitive,
but
we
assure you that
they
are
actually
different
and
each
has
a
specific
purpose.
Remember,
there
are
no right
or
wrong
answers.
During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?
-
No, none
of the time
Yes, a little
of the time
Yes, some
of the time
Yes, most
of the time
Yes, all of
the time
Accomplished less than you
would like
O
O
O
O
O
Did work or activities less carefully than usual
O
O
O
O
O
During the past 4 weeks, how much of the time…
-
None of
the time
A little of
the time
Some of
the time
A good bit
of the time
Most of
the time
All of the
time
Have you felt calm and peaceful?
O
O
O
O
O
O
Did you have a lot of energy?
O
O
O
O
O
O
Have you felt downhearted and
blue?
O
O
O
O
O
O
How often in the past 4 weeks did you…
-
Never
One time
Two times
Three or
four times
Five or
more times
Get angry at someone and yell or shout at them?
O
O
O
O
O
Get angry with someone and
kick/smash something, slam the door, punch the wall, etc.?
O
O
O
O
O
Get into a fight with someone and hit the person?
O
O
O
O
O
In the past 4 weeks, how often have you…
-
Never
Almost
never
Sometimes
Fairly
often
Very
often
Felt that you were unable to control the important things in your life?
O
O
O
O
O
Felt confident about your ability to handle personal problems?
O
O
O
O
O
Felt that things were going your way?
O
O
O
O
O
Felt difficulties were piling up so high that you could not overcome them?
O
O
O
O
O
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives)?
O None of the time O A little of the time O Some of the time O Most of the time O All of the time
Below is a list of problems that people sometimes have in response to a very stressful experience. Please indicate how much you have been bothered by that problem in the past month.
-
FOR INTERNAL USE ONLY
In the past month, how much were you bothered by…
-
Not
at all
A little
bit
Moderately
Quite
a bit
Extremely
Repeated, disturbing, and unwanted memories of the stressful experience?
O
O
O
O
O
Repeated, disturbing dreams of the stressful experience?
O
O
O
O
O
Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
O
O
O
O
O
Feeling very upset when something reminded you of the stressful experience?
O
O
O
O
O
Having strong physical reactions when something reminded you of the stressful experience (for example,
heart pounding, trouble breathing, sweating)?
O
O
O
O
O
Avoiding memories, thoughts, or feelings related to the stressful experience?
O
O
O
O
O
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities,
objects, or situations)?
O
O
O
O
O
Trouble remembering important parts of the stressful experience?
O
O
O
O
O
Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely
dangerous)?
O
O
O
O
O
Blaming yourself or someone else for the stressful experience or what happened after it?
O
O
O
O
O
Having strong negative feelings such as fear, horror, anger, guilt, or shame?
O
O
O
O
O
Loss of interest in activities that you used to enjoy?
O
O
O
O
O
Feeling distant or cut off from other people?
O
O
O
O
O
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
O
O
O
O
O
Irritable behavior, angry outbursts, or acting aggressively?
O
O
O
O
O
Taking too many risks or doing things that could cause you harm?
O
O
O
O
O
Being “super alert” or watchful or on guard?
O
O
O
O
O
Feeling jumpy or easily startled?
O
O
O
O
O
Having difficulty concentrating?
O
O
O
O
O
Trouble falling or staying asleep?
O
O
O
O
O
Feeling emotionally numb, or being unable to have loving feelings for those close to you?
O
O
O
FOR INTERNAL USE ONLY
O
O
Feeling as if your future will somehow be cut short?
O
O
O
O
O
Now
we
would
like
to
ask
you
how
you’ve
been
feeling
in
the
last 2
weeks.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
-
Not at all
Several
days
More than
half the days
Nearly
every day
Little interest or pleasure in doing things
O
O
O
O
Feeling down, depressed, or hopeless
O
O
O
O
-
Trouble falling asleep or staying asleep, or sleeping too much
O
O
O
O
Feeling tired or having little energy
O
O
O
O
Poor appetite or overeating
O
O
O
O
Feeling bad about yourself – or that you are a failure or have let yourself or your family down
O
O
O
O
Trouble concentrating on things, such as reading the newspaper or watching television
O
O
O
O
Moving or speaking so slowly that other people could have noticed, or the opposite – being so fidgety or restless that you have been moving
around a lot more than usual
O
O
O
O
Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?
O
O
O
O
Over the last 2 weeks, how often have you been bothered by any of the following problems?
-
Not at all
Several
days
More than
half the days
Nearly
every day
Feeling nervous, anxious or on edge
O
O
O
O
Not being able to stop or control worrying
O
O
O
O
Worrying too much about different things
O
O
O
O
Trouble relaxing
O
O
O
O
Being so restless that it’s hard to sit still
O
O
O
O
Becoming easily annoyed or irritable
O
O
O
O
Feeling afraid as if something awful might happen
O
O
O
O
Indicate the degree to which each statement describes your feelings or behavior.
-
Not at all
A little bit
Moderately
A lot
Very
much
I often find myself getting angry at people or situations
O
O
O
O
O
When I get angry, I get really mad
O
O
O
O
O
When I get angry, I stay angry
O
O
O
O
O
When I get angry at someone, I want to clobber the person
O
O
O
O
O
My anger prevents me from getting along with people as well as I’d like to
O
O
O
O
O
In the last 3 years, has a doctor or other health professional told you that you have any of the following conditions?
FOR
INTERNAL USE ONLY
|
No |
Yes |
Anxiety |
O |
O |
Depression |
O |
O |
Manic-depressive disorder/bipolar disorder |
O |
O |
Posttraumatic stress disorder |
O |
O |
Eating disorder |
O |
O |
Postpartum anxiety (PPA) (Only seen if participant is female) |
O |
O |
Postpartum depression (PPD) (Only seen if participant is female) |
O |
O |
SUPPORT AND COPING
We
would
like
to
ask
you
some
questions
about your
available
social
support
and
how
you
cope
with
life’s
challenges.
Please indicate how you feel about each statement.
-
Very
strongly disagree
Strongly disagree
Mildly disagree
Neutral
Mildly agree
Strongly agree
Very
strongly agree
There is a special person who is around when I am in need
O
O
O
O
O
O
O
I get the emotional help and
support I need from my family
O
O
O
O
O
O
O
I have a special person who is a real source of comfort to me
O
O
O
O
O
O
O
I have friends with whom I can share my joys and sorrows
O
O
O
O
O
O
O
My family is willing to help me make decisions
O
O
O
O
O
O
O
I can talk about my problems with my friends
O
O
O
O
O
O
O
Please indicate your response as it applies to the past 7 days:
-
FOR INTERNAL USE ONLY
Not at all
A little bit
Somewhat
Quite a bit
Very much
I have a reason for living
O
O
O
O
O
My life has been productive
O
O
O
O
O
I feel a sense of purpose in my life
O
O
O
O
O
The following statements are intended to assess your beliefs about your current problems. Please read each statement carefully and select the response that best describes how you feel right now.
-
Hardly ever
Some of the time
Often
How often do you feel that you lack companionship?
O
O
O
How often do you feel left out?
O
O
O
How often do you feel isolated from others?
O
O
O
Please read each statement and select the answer that best reflects your own views.
-
Disagree
Somewhat disagree
Neutral
Somewhat agree
Agree
I hide my aches and pains from others.
O
O
O
O
O
I manage my own problems without help from anyone.
O
O
O
O
O
Have you ever wished you were dead or wished you could go to sleep and not wake up?
O No
O Yes
-
FOR INTERNAL USE ONLY
In the last 3 years, have you received ANY mental health services (including therapy sessions, group sessions, counseling)?
O No
O
Yes
In the last 12 months, how many times did you receive ANY mental health services (including therapy sessions, group sessions, counseling)?
O None
O 1-3 times
O 4-5 times
O 6-8 times
O 9-12 times
O 13-20 times
O 21-29 times
O More than 30 times
Where have you received mental health services? (Select all that apply.)
Civilian provider (using Military OneSource)
Civilian provider (using TRICARE)
Civilian provider (out-of-pocket payment or non-TRICARE insurance)
Military installation family support center
Military hospital or clinic
Veterans Affairs (VA) facility
Other
Are you currently receiving mental health services?
(Only seen if greater than “None” mental health services in sub-question a)
O No
O Yes
In the last 3 years, have you taken any of the following medications?
-
No
Yes, I am
currently taking this medication
Yes, but I am not currently taking
this medication
Anti-anxiety medication (e.g., Xanax, Ativan, Valium, Dalmane)
O
O
O
Anti-depressant medication (e.g., Zoloft, Prozac, Celexa, Lexapro, Paxil)
O
O
O
Over-the-counter mental health medication (e.g., B-vitamins, St. John’s wort, SamE, essential oils)
O
O
O
In the past year, did you think about seeking help for an emotional or psychological problem (e.g., stress, depression, anxiety), but decided not to?
O No
O Yes
In the past year, did you encourage your spouse to seek help for an emotional or psychological problem they were not admitting or were hesitant to deal with?
(NOT seen if separated from your spouse for more than a year, or divorced or widowed from your spouse)
O No
O Yes
-
FOR INTERNAL USE ONLY
Please rate each of the possible concerns that might affect your decision to seek treatment for an emotional or psychological problem from a mental health professional (e.g., a psychologist or counselor).
-
Strongly
disagree
Disagree
Neither agree
nor disagree
Agree
Strongly
agree
People would think less of me or treat me differently
O
O
O
O
O
I don’t trust treatment providers or believe they can really help
O
O
O
O
O
It is hard for me to get care because of cost, availability, scheduling, or transportation
O
O
O
O
O
Treatment might hurt my career or my spouse’s career
O
O
O
O
O
I would prefer to manage psychological problems on my own.
O
O
O
O
O
Mental health care can be helpful for those who need it.
O
O
O
O
O
In the past 3 years, about how often have you participated in any of the following community groups or organizations?
-
Never
Once or
twice
Once a
month
Once a
week
More than
once a week
Church, synagogue, or other religious/spiritual meetings/gatherings
O
O
O
O
O
Professional organizations (e.g., union/guild meetings, professional conferences)
O
O
O
O
O
Social clubs or recreational groups (e.g., fraternities/sororities, Audubon society, travel
club, etc.)
O
O
O
O
O
Sports, hobby, or special interest clubs (e.g., athletic teams, book club, community theater, knitting circle)
O
O
O
O
O
Service or volunteer organizations/events (e.g., food bank, local shelter, Kiwanis club,
activist groups)
O
O
O
O
O
Educational events, meetings, or classes
O
O
O
O
O
In
the
past
3
years,
have
you
used
any
of
the
following
sources
of
support
to
help
you
or your
family
cope
with
difficult challenges
or
solve
problems?
-
No
Yes
Online social networking (e.g., blogs, chat groups, Facebook)
O
O
In-person support groups (e.g., family readiness, military spouse, parenting support)
O
O
Self-help information (e.g., Combat Operational Stress Control website, WebMD, books, downloadable apps)
O
O
Military OneSource
O
O
Nonprofit agencies (e.g., Red Cross, Goodwill, Navy Marine Corps Relief Society)
O
O
Federal or State agencies (e.g., Child and Family Services, WIC)
O
O
Religious or spiritual leader (e.g., pastor, chaplain, rabbi)
O
O
Military family service center
O
O
-
You
indicated you used Military OneSource in the past 3 years.
Specifically, did you:
(Mark
all
that
apply.)
(Only seen if “Yes” to “Military OneSource”)
Look at information on the website
Contact the call center
Receive non-medical counseling through their network
You indicated you used the following services in the past 3 years. Please specify whether these were military or civilian services.
FOR
INTERNAL USE ONLY
-
Military
Civilian
Both
(Auto-generate from selection above)
O
O
O
(Auto-generate from selection above)
O
O
O
Please read each of the following statements about the neighborhood in which you live and indicate how much you agree or disagree.
People in my neighborhood:
-
Strongly
disagree
Disagree
Neither agree
nor disagree
Agree
Strongly
agree
Know the names of their neighbors
O
O
O
O
O
Look out for one another
O
O
O
O
O
Offer help or assistance to one another in times of need
O
O
O
O
O
Talk to or visit with neighbors
O
O
O
O
O
LIFE EXPERIENCES
We
are
aware
that
many of
these
questions
are
quite
personal,
but
we
would
appreciate
your
candid
response.
We
want to
assure you that
all
your answers
are
strictly
confidential.
Please indicate your level of agreement with the statement below.
-
Strongly disagree
Disagree
Slightly disagree
Neither
agree nor disagree
Slightly agree
Agree
Strongly agree
I am satisfied with my life
O
O
O
O
O
O
O
In the last 3 years, have any of the following life events happen to you?
-
If YES, list most recent year
You changed job, assignment, or career path involuntarily (for example, you lost a job, or you had to take a job you did not like)
O No
O Yes
You or your partner had an unplanned pregnancy
O No
O Yes
You experienced infidelity or unfaithfulness in a committed relationship
O No
O Yes
You were divorced or separated
O No
O Yes
You suffered major financial problems (such as bankruptcy)
O No
O Yes
You suffered forced sexual relations or sexual assault
O No
O Yes
You experienced sexual harassment
O No
O Yes
You were stalked
O No
O Yes
You suffered a violent assault
O No
O Yes
Had a family member or loved one who became severely ill
O No
O Yes
Had a family member or loved one who died
O No
O Yes
You suffered a disabling illness or injury
O No
O Yes
You moved or changed primary residence more than once
O No
O Yes
You slept in a shelter, on the streets, or in another non-residential setting
O No
O Yes
Some people keep guns for recreational purposes such as hunting or sport shooting. People also keep guns in the home for protection. Please include firearms such as pistols, revolvers, shotguns, and rifles; but not BB guns or guns that cannot fire. Include those kept in a garage, outdoor storage area, or motor vehicle.
Are any firearms now kept in or around your home?
O Yes
O No
O Don’t know/not sure
O Refuse to answer
In the past 3 years, how many times have you had unwanted experiences where a person(s) sexually touched you (e.g., intentional touching of genitalia, breasts, or buttocks), made you sexually touch them, or attempted to or actually made you have sexual intercourse/oral or anal sex (including penetration with finger/object) without your consent?
FOR
INTERNAL USE ONLY
O Once
O Twice
O A few times
O Many times
You indicated that you have experienced
unwanted sexual contact or sexual assault. These unwanted
experiences
may
vary
in severity
and
can
happen to
women
and
men.
Please
answer
the
next
questions
thinking about any experiences,
in the past 3 years, no matter who did it to you or where it
happened, even if you or others
were drinking or intoxicated. Please include unwanted sexual
experience(s) without your
consent involving any type of sexual contact, forced sexual
relations, or
sexual assault.
Your individual answers on this survey are
confidential and will not be reported to anyone outside the
Millennium Cohort Family Study
team. If you have experienced any of these situations, please
consider
calling
the
toll
free
National
Sexual
Assault
Hotline
at
1-800-656-HOPE
(4673) or
visiting https://rainn.org/.
In the past 3 years, no matter who did it or where it happened, did any of the unwanted sexual experiences occur while you were married to a military service member or during your own military service, if you were serving?
O
No
O
Yes
FOR
INTERNAL USE ONLY
In the past 3 years, at the time that any of the unwanted sexual experiences occurred, was/were the offender(s): (Please mark all that apply)
-
No
Yes
A current or former intimate partner?
O
O
A member of the U.S. military at the time?
O
O
Did the offender: (Please mark all that apply)
-
Make you have sexual intercourse (make you perform or receive sex, oral sex, anal sex, or penetration with a finger or object)?
O
O
Take advantage of you when you couldn’t defend yourself (e.g., too drunk/high or asleep)
O
O
Use physical force/violence, or threaten you/someone close to you with physical harm
O
O
YOUR ALCOHOL USE
Alcoholic
beverages
include
beer,
wine,
and
liquor
(such
as
whiskey,
gin,
etc.).
For
the
purpose
of
this questionnaire:
One
drink
=
one 12-ounce
beer, one
4-ounce
glass of
wine,
or
one
1.5-ounce shot
of liquor
In the past year, how often did you typically drink any type of alcoholic beverage?
O Never SKIP to next section, Your Tobacco Use
O
Rarely
O
Monthly
O
Weekly
O
Daily
a.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
i) (This version seen if participant is male) In the past year, how often did you typically have 5 or more drinks of alcoholic beverages within a 2-hour period?
O Never
O Monthly or less
O 2-4 times per month
O More than 4 times per month
ii) (This version seen if participant is female) In the past year, how often did you typically have 4 or more drinks of alcoholic beverages within a 2-hour period?
O Never
O Monthly or less
O 2-4 times per month
O More than 4 times per month
In the last 12 months, have any of the following happened to you more than once?
-
No
Yes
You drank alcohol even though a doctor suggested that you stop drinking because of a problem with your health
O
O
FOR INTERNAL USE ONLY
You drank alcohol, were high from alcohol, or hung over while you were working, going to school, or taking care of children or other responsibilities
O
O
You missed or were late for work, school, or other activities because you were
drinking or hung over
O
O
You had a problem getting along with people while you were drinking
O
O
You drove a car after having several drinks or after drinking too much
O
O
-
65b) In the past 12 months where did you most often purchase alcohol?
O Mainly on base
O Mainly off base
O Equally on and off base
O I have not bought alcohol in the past 12 months
FOR
INTERNAL USE ONLY
YOUR TOBACCO USE
In the past year, have you used any of the following tobacco/nicotine products?
-
No
Yes
Cigarettes (smoke)
O
O
Electronic cigarettes or vape products
O
O
Cigars
O
O
Pipes
O
O
Smokeless tobacco (chew, dip, snuff)
O
O
In your lifetime, have you smoked at least 100 cigarettes (5 packs)?
O No -> SKIP to next section, Your Sleep Quality
O Yes
When smoking, how many packs per day did you or do you smoke?
O Less than half a pack per day
O Half to 1 pack per day
O 1 to 2 packs per day
O More than 2 packs per day
Have you ever tried to quit smoking?
O No
O Yes, but not successfully
O Yes, and succeeded
Do you CURRENTLY smoke cigarettes?
(Only seen if “Yes” for cigarettes)
O No, not at all
O Yes, some days
O Yes, every day
Do you CURRENTLY use e-cigarettes or vape products?
(Only seen if “Yes” for e-cigarettes)
O No, not at all
O Yes, some days
O Yes, every day
YOUR SLEEP QUALITY
Even
if you
are
pregnant or
have
a
newborn
that
is
disturbing your sleep,
please
answer
the
questions
by
reflecting
on
your
current
sleep pattern.
-
Over
the
past
month,
how
many
hours
of
sleep
did you
get
in
an
average
24-hour
period?
hours
Please rate your sleep pattern for the past 2 weeks.
-
None
Mild
Moderate
Severe
Very severe
Difficulty falling asleep
O
O
O
O
O
Difficulty staying asleep
O
O
O
O
O
Problem waking up too early
O
O
O
O
O
Snoring
O Do not know
O
O
O
O
O
How satisfied/dissatisfied are you with your current sleep pattern?
-
Very satisfied
1
Somewhat satisfied
2
Neither satisfied nor dissatisfied
3
Somewhat dissatisfied
4
Very dissatisfied
5
O
O
O
O
O
To what extent do you consider your sleep pattern to interfere with your daily functioning (daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.)?
FOR
INTERNAL USE ONLY
O A little
O Somewhat
O Much
O Very much interfering
How noticeable to others do you think your sleep pattern is in terms of impairing the quality of your life?
O Not at all noticeable
O Barely
O Somewhat
O Much
O Very much noticeable
How worried/distressed are you about your current sleep pattern?
O Not at all
O A little
O Somewhat
O Much
O Very much
EXERCISE
Now
we’re
going
to
ask
you
some
questions
about your
exercise
habits.
We
realize
that
some
participants
may
be
pregnant,
injured,
or
suffering
from
an
illness
when
they
take
the
survey,
so
please
think
about
your
exercise
habits
in
a
typical
week.
In a typical week, how much time do you spend participating in…?
(Please mark both your typical “days per week” and “minutes per day” doing these activities.)
-
#
of days
per week you exercise
On those days, how many minutes per day on average do
you exercise
Strength training or work that
strengthens your muscles (such as lifting/pushing/pulling weights)
days
AND
minutes
OR
O None
O Cannot physically do
Vigorous exercise or work that causes heavy sweating or large increases in breathing or heart
rate (such as running, active sports, biking)
days
AND
minutes
OR
O None
O Cannot physically do
Moderate or light exercise or work that causes light sweating or slight increases in breathing or heart rate (such as walking,
cleaning, slow jogging)
days
AND
minutes
OR
O None
O Cannot physically do
What sex were you assigned at birth, on your original birth certificate?
O Male
O Female
How would you describe your current gender?
O Male
O Female
O Transgender, male to female
O Transgender, female to male
O Prefer not to answer
O Not listed, please specify: ___________
Do you consider yourself to be:
O Heterosexual or straight
O Gay or lesbian
O Bisexual
O Prefer not to answer
O Something else, please specify: ________
Who have you EVER had sex with?
O Men only
O Women only
O Both men and women
FOR
INTERNAL USE ONLY
O Prefer not to answer
FOR
INTERNAL USE ONLY
YOUR MILITARY SERVICE
This section is only seen if participant served in the military in the past 3 years.
Are you currently serving in the U.S. military?
O No
O
Yes,
Regular
Active
Duty
(not
a member
of the
National
Guard
or
Reserve)
O Yes, Activated National Guard or Reserve (full-time Active Duty program: AGR/FTS/AR)
O Yes, Traditional National Guard or Reserve (e.g., drilling unit, IMA, IPR)
What is your overall feeling about your military service?
O Negative
O Somewhat negative
O Neither negative nor positive
O Somewhat positive
O Positive
In the last 3 years, how often have you experienced the following during deployment?
(Only
seen
if
participant
indicated
having
deployed
at least
30 days
in
the
last
3
years)
Please indicate whether you personally had any of the following military experiences in the past 3 years.
-
If YES, did this event occur in the
last 12 months?
You had a problem in your military career (e.g., demotion, poor fitness report, passed over for promotion, etc.)
O No
O Yes
O No
O Yes
You had a potentially dangerous job assignment not during deployment
O No
O Yes
O No
O Yes
You had problems with your unit (work mates weren’t supportive,
poor leadership)
O No
O Yes
O No
O Yes
You had a non-combat injury as a result of military duties
O No
O Yes
O No
O Yes
You had an unaccompanied tour
O No
O Yes
O No
O Yes
You had an unexpected change in military duty station assignment
O No
O Yes
O No
O Yes
You experienced leadership raising the possibility of forced downsizing or forced restructuring
O No
O Yes
O No
O Yes
-
You had a non-combat deployment or duty assignment requiring
you to be away from home
O No
O Yes
O No
O Yes
You worked remote operations in intelligence surveillance or reconnaissance, cyber defense/warfare, or as a virtual remote
operator (e.g., drone operator)
O No
O Yes
O No
O Yes
You worked as part of a Special Operational Forces (SOF) unit in either an operational or support role
O No
O Yes
O No
O Yes
(The following items are only seen if participant is in the Reserves)
You had a scheduled call to active duty from reserve status
O No
O Yes
O No
O Yes
You had an unscheduled call to active duty from reserve status
O No
O Yes
O No
O Yes
FOR
INTERNAL USE ONLY
FOR
INTERNAL USE ONLY
EDUCATION AND EMPLOYMENT
What is the highest level of education that you have completed? (Choose the single best answer.)
O Less than high school completion/diploma
O High school degree/GED/or equivalent
O Some college, no degree
O Associate’s degree
O Bachelor’s degree
O Master’s, doctorate, or professional degree
Since you became a military spouse, has your spouse transferred the GI Bill educational benefits to you or a dependent child?
(Widowed participants will NOT see this question, but will see the sub-question)
O No, your spouse used/plans to use the benefits
O No, your spouse plans to transfer the benefits in the future
O No, your spouse is ineligible for benefits
O
Yes,
to
me
O Yes, to one or more of our dependent children
O I don’t know
Have you or your dependent child(ren) used any portion of your spouse’s GI Bill educational benefits? (Widowed participants will see this question)
O No
O Yes, in the past 12 months
O Yes, in the past 3 years
O Yes, more than 3 years ago
Have you used a Military Spouse Career Advancement Account (MyCAA) Scholarship?
O No, I do not qualify for this resource O No, I was not aware of this resource O No, but I am aware of this resource O Yes, in the past 3 years
O Yes, more than 3 years ago
Are you currently a student?
O No
O Yes, full-time
O Yes, part-time
Which of the following best describes your current paid employment status? (Choose the single best answer.)
O
Full-time
paid
work
(greater
than or
equal
to 30
hours per
week)
O Part-time paid work (less than 30 hours per week)
O Not employed, looking for work (actively looking for paid employment in the last 4 weeks)
O Not employed, not looking for work
(If “Full-time work” or “Part-time work”)
How satisfying is your current employment?
-
Extremely
dissatisfying
Dissatisfying
Somewhat dissatisfying
Undecided
Somewhat satisfying
Satisfying
Extremely
satisfying
1
2
3
4
5
6
7
O
O
O
O
O
O
O
(“Part-time
work”
only)
Would
you
prefer
to
have
a
full-time
job?
O No
O Yes
Does your current employment require you to have a professional or occupational state license or credential?
FOR
INTERNAL USE ONLY
O
O
O
Does not apply
After your most recent permanent change of station (PCS), how long did it take you to acquire a new professional or occupational state license or credential?
O Less than 1 month
O 1 to 3 months
O 4 to 6 months
O 7 to 9 months
O 10 months or more
O Not applicable, I did not acquire a new license or certification
O Not applicable, I have not experienced a PCS
Do any of these circumstances describe your current employment?
-
Yes
No
I work fewer hours than I would like to
O
O
I have more training and/or experience than is required for my current job
O
O
My pay level is lower in my current position than in my previous position
O
O
(If “Part-time work” or “Not employed, looking” or “Not employed, not looking)
The following are possible reasons why you are currently not employed full-time. Please check any that are reasons for you.
I want to be able to stay home to care for my child(ren)
Child care would cost more than what I expect to earn
Child care is not available to me
I stay home to homeschool my child(ren)
I am attending school or training
There are no jobs in my career field where I currently live
I cannot find work that matches my skills
Professional or occupational license or credential is not current or valid locally
I am preparing for/recovering from a PCS move
It is not practical to work while my spouse is deployed
I am not physically prepared to work (e.g., pregnant, sick, disabled, recovering from having a baby)
I do not want to work
My spouse does not want me to work
Household responsibilities
Service members’ day-to-day job demands make it too difficult
Volunteer activities
-
Other:
FOR
INTERNAL USE ONLY
How satisfying is your current status, whether employed or not employed?
-
Extremely
dissatisfying
Dissatisfying
Somewhat dissatisfying
Undecided
Somewhat satisfying
Satisfying
Extremely
satisfying
1
2
3
4
5
6
7
O
O
O
O
O
O
O
How long did it take you to find paid employment after your last permanent change of station (PCS)?
O Less than 1 month
O 1 to 4 months
O 5 to 8 months
O 9 months to 1 year
O More than 1 year
O Not applicable, have not found paid employment
O Not applicable, have not experienced a PCS
What is your annual income? Please only include income solely attributable to you.
O
$0
O
$1-$9,999
O
$10,000-$24,999
O
$25,000-$49,999
O
$50,000-$74,999
O
$75,000-$99,999
O
$100,000-$149,999
O
$150,000 or more
What is your TOTAL annual household income? Please include Basic Allowance for Housing (BAH), even if you live in base housing, and any other regular income that your family receives.
O
Less
than
$25,000
O
$25,000-$49,999
O
$50,000-$74,999
O
$75,000-$99,999
O
$100,000-$124,999
O
$125,000-$149,999
O
$150,000
or
more
Which best describes the financial condition of you and your family?
O Very comfortable and secure
O Able to make ends meet without much difficulty
O Occasionally have some difficulty making ends meet
O Tough to make ends meet but keeping our heads above water
O In over our heads
92b. Have you ever, received benefits from the following programs?
FOR
INTERNAL USE ONLY
-
Supplemental Nutrition Assistance Program (SNAP) or Food Stamp benefits
O No
O Yes
O No
O Yes
Women, Infants and Children program (WIC)
O No
O Yes
O No
O Yes
Military relief organizations (e.g. Army Emergency Relief, Navy-Marine Corps Relief Society, Air Force Aid)
O No
O Yes
O No
O Yes
National School Lunch Program (Free and Reduced Lunch Program)
O No
O Yes
O No
O Yes
92c. These next questions are about the financial status of you and your household.
-
Are you able to pay for all necessary expenses each month, such as mortgage/rent, debt payments, and groceries?
O No
O Yes
Does your household have at least 3 months of your typical income set aside in case of an unexpected financial event?
O No
O Yes
Has your household begun to set aside money for retirement?
O No
O Yes
Are you currently concerned that you will lose your housing and be unable to find stable alternative housing?
O No
O Yes
92c. These next questions are about the food eaten in your household in the last 12 months and whether you were able to afford the food you need.
Never Sometimes Often True True True
-
I worried whether my food would run out before I got money to buy more
O
O
O
The food that I bought just didn’t last, and I didn’t have money to get more
O
O
O
DEPLOYMENT
This section is only seen if participant responded that your spouse served in the military in the past 3 years.
Now
we
would
like
to
ask
you some
questions
regarding
the
deployment
experience.
If participant indicated they are “Separated” or “Divorced” from your spouse, they will receive the following caution before each of the following sections: Deployment, Return and Reunion, Transition from the Military, Military Life, Relationship, Family, Parenting, and Children.
It is very important to understand the health and well-being of spouses and children after a change in marital status. We have attempted to make the questions in this section apply to everyone, but we understand that not all of these questions will apply to you.
In the last 3 years, has your spouse been deployed for more than 30 days?
O No SKIP to Your Spouse’s Transition from the Military section
O Yes
O I don’t know SKIP to Your Spouse’s Transition from the Military section
How stressful was your spouse’s most recent deployment for you?
O Not at all stressful
O Slightly stressful
O Moderately stressful
O Very stressful
-
FOR INTERNAL USE ONLY
Is your spouse currently deployed?
O No
O
Yes
O I don’t know
Has your spouse deployed previously?
O No SKIP to Your Spouse’s Transition from the Military section
O Yes
How much has your spouse shared his/her deployment experiences with you from his/her last completed deployment?
O
None
O A little
O Somewhat
O A lot
To what degree were/are you bothered by the deployment experiences your spouse shared with you?
O Not at all
O A little bit
O Moderately
O Quite a bit
O Extremely
How often did you communicate with your spouse during his/her last completed deployment?
O Almost daily
O Every few days
O About once a week
O About once or twice a month
O Less than once a month
Please estimate how much advance notification you had before your spouse left for his/her last completed deployment.
O 24 hours or less
O Less than 1 week
O Less than 1 month
O Less than 3 months
O 3-6 months
O More than 6 months
In your opinion, what was the level of danger for your spouse during his/her last completed deployment?
-
Very little danger
1
Some danger
2
Unsure
3
Some danger
4
Extreme danger
5
O
O
O
O
O
Was your spouse’s last completed deployment extended beyond what you originally expected?
O No, not extended
O Yes, extended less than 2 weeks
O Yes, extended between 2 weeks and 2 months
O Yes, extended more than 2 months
During your spouse’s last completed deployment, how satisfied were you with the emotional/social support you received from family, friends, and your community?
O Very dissatisfied
O Somewhat satisfied
O Generally satisfied
O Very satisfied
FOR
INTERNAL USE ONLY
Which best describes your permanent household situation during your spouse’s last completed deployment?
O Military housing, on base
O Military housing, off base
O Civilian housing
During your spouse’s last completed deployment, did you voluntarily relocate or have someone relocate to live with you for more than 30 days for any of the following reasons? Mark all that apply.
O
No
O Yes, I relocated
O Yes, someone relocated to live with me
Please mark the reason(s) for relocation:
Needed child care
Better job opportunities
Better educational opportunities
Financial problems (making ends meet)
Wanted to be near relatives/friends
Lack of support at location you moved from
Personal safety/security
-
Other
reasons:
When do you expect your spouse’s next deployment?
O Does not apply, I do not expect my spouse to be deployed
O Within 3 months
O In 4-6 months
O In 7-9 months
O In 10-12 months
O In 13-18 months
O In 19-24 months
O In more than 24 months
FOR
INTERNAL USE ONLY
DEPLOYMENT RETURN AND REUNION
This section is only seen if participant responded “Yes” to your spouse being deployed for more than 30 days.
The
deployment return
and
reunion
process
can
often
be
challenging.
The
next
questions
refer
to
those
experiences.
Following your spouse’s last completed deployment, please rate the following statement: The process of reunion/reintegration was stressful.
O Does not apply
O Strongly disagree O Disagree
O Neither agree nor disagree
O Agree
O Strongly agree
Following your spouse’s last completed deployment, please describe the impact of the reunion/reintegration process for:
-
Very negative
Negative
Neither positive nor
negative
Positive
Very positive
You
O
O
O
O
O
Your spouse
O
O
O
O
O
Your child(ren)
(Only seen if participant reported having 1 or more children)
O
O
O
O
O
YOUR SPOUSE’S TRANSITION FROM THE MILITARY
This section is only seen if participant responded that your spouse is not CURRENTLY in the military.
Did you participate in a Transition Assistance Program (TAP) briefing prior to your spouse’s military separation?
O No
O Yes
Please rate the following statement: The process of your spouse’s transition from the military was stressful.
O Strongly disagree
O Disagree
O Neither agree nor disagree
O Agree
O Strongly agree
Please describe the impact of your spouse’s military transition process for:
-
Very negative
Negative
Neither positive nor
negative
Positive
Very positive
You
O
O
O
O
O
Your spouse
O
O
O
O
O
Your child(ren)
(Only seen if participant reported having 1 or more children)
O
O
O
O
O
110b. How did you feel about your spouse leaving the military?
O I strongly favored staying
O I somewhat favored staying
O I had no opinion one way or the other
O I somewhat favored leaving
110c. Thinking back on your spouse’s military service, how much do you agree or disagree with the following statement?
-
Strongly disagree
Strongly agree
If I had to do it all over again, I would support my spouse repeating the military service
O
O
O
O
O
My military experiences had an overall positive impact on my life.
O
O
O
O
O
110d. Not including time spent pursuing further education or training, how long did it take your spouse to find paid employment after leaving the military?
O Less than 1 month
O 1 to 4 months
O 5 to 8 months
O 9 months to 1 year
O More than 1 year
O My spouse has been pursuing his/her education or training since leaving the military
O My spouse has not found paid employment
O My spouse has not looked for paid employment
110e. [Only seen if the spouse is a veteran themselves) How long did it take you to find paid employment after your spouse left the military?
O No time; continued same job after my spouse left the military
O Less than 1 month
O 1 to 4 months
O 5 to 8 months
O 9 months to 1 year
O More than 1 year
O My spouse has been pursuing his/her education or training since leaving the military
O Still looking for paid employment
O NA, not in the paid work force (e.g., homemaker, student, retired)
FOR
INTERNAL USE ONLY
110f. In the first few years after your spouse left the military, did you and your family ever:
-
No
Yes
[If yes, then prompt additional question]
Did this occur during the first year after your spouse left the military?
No
Yes
Did you…?
Return to school?
O
O
O
O
Complete your education?
O
O
O
O
Start a new job?
O
O
O
O
Change your relationship status (e.g., separated, divorced, remarried)?
O
O
O
O
Did your family…?
Have trouble paying bills?
O
O
O
O
Receive unemployment compensation?
O
O
O
O
Start a business?
O
O
O
O
Buy a house?
O
O
O
O
Have trouble finding or keeping housing?
O
O
O
O
Struggle with hunger or receive help buying food?
O
O
O
O
Have trouble getting medical care for yourself or your family?
O
O
O
O
Have a child (biological, adopted, or foster)?
O
O
O
O
110g. How stressful were each of the following aspects of transitioning out of service life for you and your family:
-
Not at all
Slightly
Fairly
Very
Extremely
Change in identity going from a military to a veteran family
O
O
O
O
O
Loss of friendships and support from people you knew in the military community
O
O
O
O
O
Loss of support programs and services only available in the military community
O
O
O
O
O
Regrets about leaving the service
O
O
O
O
O
Disagreements about what choices to make next in civilian life
O
O
O
O
O
Change in your family’s daily routines
O
O
O
O
O
Change in your own family responsibilities
O
O
O
O
O
Change in your spouse’s family responsibilities
O
O
O
O
O
FOR
INTERNAL USE ONLY
-
Not at all
Slightly
Fairly
Very
Extremely
Immediate family
O
O
O
O
O
Extended family
O
O
O
O
O
Friends
O
O
O
O
O
Non-profit veteran service organizations (e.g., VFW)
O
O
O
O
O
DoD transition services (e.g., TAP)
O
O
O
O
O
VA transition services
O
O
O
O
O
Your family savings, budgeting, or non-military income
O
O
O
O
O
Transferable job skills from your spouses’ military service
O
O
O
O
O
Education (e.g., college) or training (e.g. DoD Skill bridge Program) your spouse obtained while in service
O
O
O
O
O
110i. What VA benefits are your family aware of and which of the benefits have you or your spouse applied for?
-
If yes For those benefits that you ARE aware of, what benefits have you/your spouse applied for?
We are aware of this benefit
Applied, but no determination yet
Applied and got this benefit
Applied but was not eligible
Have not applied but intend to
Have not applied; don’t intend to
VA Home loan guaranty
O No O Yes
O
O
O
O
O
VA Disability compensation
O No O Yes
O
O
O
O
O
VA Health benefits
O No O Yes
O
O
O
O
O
VA Vocational benefits (ex: Veteran Readiness & Employment)
O No O Yes
O
O
O
O
O
VA Education benefits (ex: Post-9/11 GI Bill)
O No O Yes
O
O
O
O
O
Veteran’s Group Life Insurance (VGLI)
O No O Yes
O
O
O
O
O
VA Caregiver Support Program
O No O Yes
O
O
O
O
O
FOR
INTERNAL USE ONLY
MILITARY LIFE
This section is only seen if your spouse is currently in the military OR separated/retired in the last 3 years, AND currently married OR separated/divorced in the last 3 years.
Now
we’d
like
to
ask you
some
questions
about
the
stress
of
military
life
and
the
military’s
efforts
to
help
you
and
your
family
deal
with those
stressors.
Please indicate whether you and your family had any of the following military experiences in the past 3 years.
-
If YES, did this event occur in the
last 12 months?
Problems in your spouse’s military career (e.g., demotion, poor
fitness report, passed over for promotion, etc.)
O No
O Yes
O No
O Yes
Potentially dangerous job assignment for your spouse not during
deployment
O No
O Yes
O No
O Yes
Your spouse had problems with unit (work mates were not
supportive, poor leadership)
O No
O Yes
O No
O Yes
Non-combat injury to your spouse as a result of military duties
O No
O Yes
O No
O Yes
Unaccompanied tour for your spouse
O No
O Yes
O No
O Yes
Unexpected change in military duty station assignment for your
spouse
O No
O Yes
O No
O Yes
Your spouse’s leadership raised the possibility of forced
downsizing or forced restructuring
O No
O Yes
O No
O Yes
Non-combat deployment or duty assignment requiring your
spouse to be away from home
O No
O Yes
O No
O Yes
Your spouse worked remote operations in intelligence
surveillance or reconnaissance, cyber defense/warfare, or as a virtual remote operator (e.g., drone operator)
O No
O Yes
O No
O Yes
Your spouse worked as part of a Special Operational Forces
(SOF) unit in either an operational or support role
O No
O Yes
O No
O Yes
(The following items are only seen if your spouse is in the Reserves)
Your spouse had a scheduled call to active duty from reserve status
O No
O Yes
O No
O Yes
Your spouse had an unscheduled call to active duty from
reserve status
O No
O Yes
O No
O Yes
Experiences related to your family:
Inability to get military support services for you or your family (e.g.,
family service center program, military installation housing, military child care)
O No
O Yes
O No
O Yes
Dissatisfaction with military pay/benefits
O No
O Yes
O No
O Yes
Foreign residence (e.g., OCONUS, overseas) for you and your family
O No
O Yes
O No
O Yes
Remote residence (rural area or location with no local military installation) for you and your family
O No
O Yes
O No
O Yes
Permanent change of station (PCS) for you and your family
O No
O Yes
O No
O Yes
In general, how stressful do you feel military life has been for you and your family?
O Not at all stressful
O Slightly stressful
O Moderately stressful
O Very stressful
Generally, on a day-to-day basis, I am proud to be a military spouse.
(Only seen if your spouse is currently in the military)
(Divorced participants will see: Generally, on a day-to-day basis, I was proud to be a military spouse.)
FOR
INTERNAL USE ONLY
O Strongly disagree O Mildly disagree O Neutral
O Mildly agree
O Strongly agree
O Very strongly agree
In the past year, while your spouse was away from home because of military duties (e.g., deployments, TDYs, training, time at sea, field exercises/alerts), how satisfied were you with his/her access to communication?
-
Very dissatisfied
1
Dissatisfied
2
Neither satisfied nor dissatisfied
3
Satisfied
4
Very satisfied
5
O
O
O
O
O
In the past year, when you communicated with your spouse during his/her time away from home because of military duties (e.g., deployments, TDYs, training, time at sea, field exercises/alerts), how satisfied were you with your ability to support each other (connect emotionally and/or spiritually)?
-
Very dissatisfied
1
Dissatisfied
2
Neither satisfied nor dissatisfied
3
Satisfied
4
Very satisfied
5
O
O
O
O
O
How comfortable are you with your ability to take care of yourself and your family if your spouse were unexpectedly required to deploy?
O Very uncomfortable
O Uncomfortable
O Neutral
O Comfortable
O Very comfortable
116b. When your military spouse is away from you (field assignments, temporary duty, etc.) how well are you able to:
-
No Problem
Yes, small problem
Yes, big problem
No children
Handle/discipline the child(ren)
O
O
O
O
Get jobs done at home (cook meals, do laundry, do maintenance work, etc.)
O
O
O
O
Go to and use military and civilian stores and services
O
O
O
O
Offer support and encouragement to your child(ren)
O
O
O
O
Handle family finances
O
O
O
O
Keep busy and do things you value and are interested in
O
O
O
O
Make decisions for your family
O
O
O
O
Maintain a “positive attitude” toward your spouse being away
O
O
O
O
Handle emergencies (medical, major breakdown in household equipment, theft, etc.)
O
O
O
O
116c. Thinking about your spouse’s military service, how much do you agree or disagree with the following statements?
-
Strongly
disagree
Disagree
Neither agree
nor disagree
Agree
Strongly
agree
My spouse’s supervisor and chain of command take my family’s needs into consideration for upcoming deployments or military orders
O
O
O
O
O
I know how to make the military life a benefit to our family
O
O
O
O
O
FOR
INTERNAL USE ONLY
116d. Now thinking only about military deployment, how much do you agree or disagree with the following statements?
-
Strongly
disagree
Disagree
Neither agree
nor disagree
Agree
Strongly
agree
I feel mentally ready for a future spouse deployment.
O
O
O
O
O
When it comes to deployment, I'm as ready as I'll ever be
O
O
O
O
O
I am satisfied with my level of preparation for deployment in particular.
O
O
O
O
O
I am ready to meet the challenges that deployment may bring.
O
O
O
O
O
I am committed to overcoming any obstacles that arise for my family during a deployment.
O
O
O
O
O
I have made concrete plans in preparation for a future deployment.
O
O
O
O
O
I know of military services and resources to help my family deal with deployment's challenges.
O
O
O
O
O
In the past 3 years, have you experienced any of the following due to conflicts between your spouse’s military duties and civilian employent?
(Only seen if your spouse is in the Reserves)
-
No
Yes
Financial difficulties
O
O
Employment problems
O
O
Disruption in healthcare coverage
O
O
FOR
INTERNAL USE ONLY
Do you think your spouse should stay in or leave the military?
O I strongly favor staying
O I somewhat favor staying
O I have no opinion one way or the other
O I somewhat favor leaving
O I strongly favor leaving
O I strongly favored leaving
Overall, how would you rate the military’s efforts to help your family deal with the stresses of military life?
O Poor
O Fair
O Good
O Very good
O Excellent
Please indicate to what extent you feel being a military spouse has impacted the following aspects of your life:
-
Very
negative impact
Negative impact
Neither
negative nor positive impact
Positive impact
Very
positive impact
Not applicable
Career development
O
O
O
O
O
O
Education development
O
O
O
O
O
O
Access to healthcare for self and family
O
O
O
O
O
O
Access to child care
O
O
O
O
O
O
Overall financial stability
O
O
O
O
O
O
Recreation, travel, and entertainment activities
O
O
O
O
O
O
What is your overall feeling about military life?
O Negative
O Somewhat negative
O Neither negative nor positive
O Somewhat positive
O Positive
In the last 3 years, how many times have you experienced a permanent change of station (PCS)?
times
(If 1 time or more) When was your most recent PCS?
O Within the last 12 months
O Within the last 3 years
Which best describes where you currently live?
O Military housing, on base
O Military housing, off base
O Civilian housing
O Homeless, sleeping in a shelter or living on the streets
FOR
INTERNAL USE ONLY
RELATIONSHIP WITH SPOUSE
This section is only seen if participant indicated currently married or separated.
In
order
to
better
understand
how
military
life affects
families,
this
next
section
asks
you
questions about
your
relationship with
your
spouse.
Once
again, we’d
like
to remind
you
that
all
your
answers
are
strictly
confidential.
Taking all things together, how would you describe your marriage?
-
Very
unhappy
Unhappy
Somewhat unhappy
Neither unhappy nor happy
Somewhat happy
Happy
Very
happy
1
2
3
4
5
6
7
O
O
O
O
O
O
O
Please rate the following statements about your relationship with your spouse:
-
Strongly
disagree
Disagree
Neither agree
nor disagree
Agree
Strongly
agree
I have a good marriage
O
O
O
O
O
My relationship with my spouse is very stable
O
O
O
O
O
I really feel like part of a team with my
spouse
O
O
O
O
O
Please rate the following statement about your relationship with your spouse:
-
Very strongly disagree
1
Strongly disagree
2
Mildly disagree
3
Neutral
4
Mildly agree
5
Strongly agree
6
Very strongly agree
7
I feel that I can trust my partner completely
O
O
O
O
O
O
O
Please rate the following statements regarding you and your spouse.
-
Strongly
disagree
Moderately
Disagree
Neither agree
nor disagree
Moderately
Agree
Strongly
agree
If both of us are working, both spouses should do the same amount of household chores
O
O
O
O
O
In our family, one spouse should not work outside the home unless it is an absolute financial necessity
O
O
O
O
O
In our marriage, my spouse is always the leader of our family
O
O
O
O
O
If there are (were) young children, one spouse should not work outside the home
O
O
O
O
O
In the last year, have you or your spouse seriously suggested the idea of divorce or permanent separation?
(Only seen if participant reported being “Currently married”)
O No
O Yes
FOR
INTERNAL USE ONLY
In the last 3 years, have you and your spouse received marital counseling?
O Never
O Once or twice
O 3-5 times
O 6-10 times
O 11 or more times
In your opinion, does your spouse consume too much alcohol in a typical week when he/she is at home (or if your spouse is currently deployed, please refer to the most recent month your spouse was home)?
O No
O Yes
Pop-up
message:
If
you
are
experiencing
physical
or
emotional
abuse
from
your
spouse,
please
consider
calling
the
toll-free
National Domestic Violence Hotline at 1-800-799-SAFE (7233) or
visiting
http://www.hotline.org/. Add:
Skip/exit
button
to
quickly
decline
if
the
abuser
is
close
by
or
can
see
the
survey.
Sometimes
in close relationships, people do or say things that are hurtful
during a disagreement or in a
difficult
situation. In the next series of questions, please tell us if
something like this has occurred in your
relationship.
How often has this happened in the past 6 months?
-
Never
1
2
3
4
Frequently
5
You screamed or cursed at your spouse
(e.g., yelled at them, swore at them, etc.)
O
O
O
O
O
Your spouse screamed or cursed at you
(e.g., yelled at you, swore at you, etc.)
O
O
O
O
O
You insulted or talked down to your spouse
(e.g., called them names, belittled them, etc.)
O
O
O
O
O
Your spouse insulted or talked down to you
(e.g., called you names, belittled you, etc.)
O
O
O
O
O
You threatened your spouse with harm (e.g., threatened to hit, throw something, or
hurt them; intimidated them; punched a wall in
front of them, etc.)
O
O
O
O
O
Your spouse threatened you with harm (e.g., threatened to hit, throw something, or
hurt you; intimidated you; punched a wall in front of you, etc.)
O
O
O
O
O
You physically hurt your spouse
(e.g., pushed, slapped, grabbed, punched, kicked, etc.)
O
O
O
O
O
Your spouse physically hurt you (e.g., pushed, slapped, grabbed, punched, kicked, etc.)
O
O
O
O
O
Please rate how frequently you use each of the following communication styles to deal with arguments or disagreements with your spouse:
-
Never
1
2
3
4
Always
5
Launching personal attacks
O
O
O
O
O
Focusing on the problem at hand
O
O
O
O
O
Remaining silent for long periods of time
O
O
O
O
O
Not being willing to stick up for myself
O
O
O
O
O
Exploding and getting out of control
O
O
O
O
O
Sitting down and discussing differences constructively
O
O
O
O
O
Reaching a limit, “shutting down”, or refusing to talk anymore
O
O
O
O
O
Being too compliant or agreeable
O
O
O
O
O
Getting carried away and saying things you don’t mean
O
O
O
O
O
Finding alternatives that are acceptable to each of us
O
O
O
O
O
Tuning the other person out
O
O
O
O
O
Not defending my position
O
O
O
O
O
Throwing insults and digs
O
O
O
O
O
Negotiating and compromising
O
O
O
O
O
Withdrawing, acting distant and not interested
O
O
O
O
O
Giving in with little attempt to present my side of the issue
O
O
O
O
O
FOR
INTERNAL USE ONLY
RELATIONSHIP WITH SPOUSE AFTER DIVORCE
This section is only seen if participant indicated divorced.
If divorced and your spouse is deceased, participant will only see question on reasons for divorce.
In
order
to
better
understand
how
military
life
affects
families,
this
next
section
asks
you
questions about
your
relationship with
your
spouse
after your
divorce.
Once
again,
we’d
like
to
remind
you
that
all
your
answers
are
strictly
confidential.
In the last 3 years, did you and your spouse receive marital counseling?
(Only seen if participant reported divorced from your spouse within the last 3 years)
O Never
O Once or twice
O 3-5 times
O 6-10 times
O 11 or more times
Please indicate the extent to which each of the following reasons contributed to your divorce from your spouse.
(If divorced and your spouse is deceased, this is the only question in this section that participant will see.)
-
Not at all
Small
extent
Moderate
extent
Large
extent
Very large
Extent
Lack of communication
O
O
O
O
O
Too much conflict and arguing
O
O
O
O
O
Lack of equality in the relationship
O
O
O
O
O
Financial problems
O
O
O
O
O
Religious differences
O
O
O
O
O
Alcohol or drug abuse
O
O
O
O
O
Domestic violence/abuse
O
O
O
O
O
Physical or mental health problems
O
O
O
O
O
Sexual problems
O
O
O
O
O
Infidelity or extramarital affairs
O
O
O
O
O
Your spouse worked too many hours
O
O
O
O
O
How we divided household and/or child care responsibilities
O
O
O
O
O
Differences over raising our children
(Only seen if participant has children)
O
O
O
O
O
Other:
O
O
O
O
O
During the past year, how often have you had any contact with your spouse by phone, mail, email, or in person?
O Not at all
O About once a year
FOR
INTERNAL USE ONLY
O One to three times a month
O About once a week
O More than once a week
YOUR FAMILY
This section is only seen if participant indicated currently married or separated.
Please rate the following statements regarding your spouse’s current job or jobs.
(Only seen if your spouse is currently employed – either in the military OR full-time or part-time work)
-
Strongly
disagree
Disagree
Neither agree
nor disagree
Agree
Strongly
agree
The demands of my spouse’s work interfere with our home and family life
O
O
O
O
O
The amount of time my spouse’s job takes up makes it difficult for him/her to fulfill family responsibilities
O
O
O
O
O
My spouse’s job produces stress/strain that makes it difficult for him/her to
fulfill family responsibilities
O
O
O
O
O
My spouse’s job produces stress/strain
that makes it difficult for me to fulfill family responsibilities
O
O
O
O
O
Frequent TDY/TAD (training duty) interferes with our home and family life (Only seen if your spouse is currently
in military)
O
O
O
O
O
Frequent work-related travel interferes with our home and family life
(Only seen if your spouse is no longer
in military)
O
O
O
O
O
We are interested in how your family deals with stressful situations and ongoing challenges. Please read each statement below and indicate how much this is true for your family, including you, your spouse, and your children (if applicable).
-
Rarely
or never
Not
often
Some-
times
Often
Almost
always
Our family faces difficulties together as a team, rather than individually
O
O
O
O
O
We view distress in stressful situations as common and understandable
O
O
O
O
O
We approach a crisis as a challenge we can manage and master with shared efforts
O
O
O
O
O
We try to make sense of stressful situations and focus on
our options
O
O
O
O
O
We remain hopeful and confident that we will overcome difficulties
O
O
O
O
O
We encourage each other and build on our strengths
O
O
O
O
O
We seize opportunities, take action, and persist in our efforts
O
O
O
O
O
We focus on possibilities and try to accept what we can’t change
O
O
O
O
O
We share important values and life purpose that help us
rise above difficulties
O
O
O
O
O
We draw on spiritual resources (religious or non-religious) to help us cope
O
O
O
O
O
Our hardship has increased our compassion and desire to
help others
O
O
O
O
O
We believe we can learn and become stronger from our challenges
O
O
O
O
O
FOR
INTERNAL USE ONLY
Please rate the following statements in regard to your family, including you, your spouse, and your children (if applicable).
-
Strongly
disagree
Generally
disagree
Undecid-
ed
Generally
agree
Strongly
agree
Family members are satisfied with how they communicate with each other
O
O
O
O
O
Family members are very good listeners
O
O
O
O
O
Family members express affection to each other
O
O
O
O
O
Family members are able to ask each other for what they want
O
O
O
O
O
Family members can calmly discuss problems with each other
O
O
O
O
O
Family members discuss their ideas and beliefs
with each other
O
O
O
O
O
When family members ask questions of each other, they get honest answers
O
O
O
O
O
Family members try to understand each other's feelings
O
O
O
O
O
When angry, family members seldom say negative
things about each other
O
O
O
O
O
Family members express their true feelings to each other
O
O
O
O
O
Please read the following statements and rate how much you agree or disagree with each one in regard to your family, including you, your spouse, and your children (if applicable).
-
Strongly
disagree
Generally
disagree
Undecid-
ed
Generally
agree
Strongly
agree
Family members are involved in each other's lives
O
O
O
O
O
Our family tries new ways of dealing with problems
O
O
O
O
O
Family members feel very close to each other
O
O
O
O
O
Family members are supportive of each other during difficult times
O
O
O
O
O
Family members consult with each other on
important decisions
O
O
O
O
O
Our family is able to adjust to change when necessary
O
O
O
O
O
Family members like to spend some of their free time with each other
O
O
O
O
O
We shift household responsibilities from person to
person
O
O
O
O
O
Although family members have individual interests, they still participate in family activities
O
O
O
O
O
We have clear rules and roles in our family
O
O
O
O
O
Our family has a good balance of separateness and closeness
O
O
O
O
O
When problems arise, family members compromise with each other
O
O
O
O
O
In the last 12 months, have you been a caregiver to any of the following people because of a special medical need (e.g., illness, injury, or emotional/behavioral problem)?
-
No
Yes, unpaid
Yes, paid
Your spouse
O
O
O
Child(ren)
O
O
O
Other relative
O
O
O
Non-relative
O
O
O
(If “Yes” to any of the above)
How physically stressful would you say providing this care is/was for you?
O Not at all stressful
FOR
INTERNAL USE ONLY
O Moderately stressful
O Very stressful
How emotionally stressful would you say providing this care is/was for you?
O Not at all stressful
O Slightly stressful
O Moderately stressful
O Very stressful
How financially stressful would you say providing this care is/was for you?
O Not at all stressful
O Slightly stressful
O Moderately stressful
O Very stressful
(If “Yes” to your spouse) Is/was your spouse’s special need a result of a combat-related injury?
O No
O Yes
Is your family currently enrolled in the Exceptional Family Member Program (EFMP)?
(Only seen if Active Duty family – either participant or your spouse is currently Active Duty)
O Does not apply, no special medical/educational needs for my family
O No
O
Yes
Which family member is enrolled in EFMP? Mark all that apply.
Self
My spouse
Our child(ren)
Other relative
(This question appears underneath each family member selected above) What special medical and/or educational needs does this family member have? Mark all that apply.
Physical health
Mental health
Educational
FOR
INTERNAL USE ONLY
PARENTING
This section is only seen if participant reported having children.
The questions listed below concern what happens between you and your spouse. While you may not find an answer which exactly describes what you think, please mark the answer that comes closest to what you think. Your first reaction should be your first answer.
(NOT seen if participant reported divorced from your spouse AND your spouse is deceased)
-
Strongly
disagree
Disagree
Not
sure
Agree
Strongly
agree
Your spouse is willing to make personal sacrifices to
help take care of our child(ren)
O
O
O
O
O
Your spouse pays a great deal of attention to our
child(ren)
O
O
O
O
O
Your spouse knows how to handle children well
O
O
O
O
O
Your spouse and I are a good team
O
O
O
O
O
Your spouse makes my job of being a parent easier
O
O
O
O
O
In general, how well do you feel you are coping with the day-to-day demands of parenthood/raising children?
O Very poorly
O Poorly
O Fair
O Somewhat well
O Very well
FOR
INTERNAL USE ONLY
YOUR CHILDREN
This section is only seen if participant reported having children
Now
we
would
like
to
ask you about
your
children.
We
realize
that
these
questions
are
sensitive,
but
it
is
important to answer them as
accurately as you can. Your answers will provide insight into how
families
and children are coping with
military life and deployment. If you feel your child needs medical
care or
counseling, you
should
make
contact
with the
appropriate
medical
personnel.
You noted that you have child(ren) and child(ren) live(s) in your household. Please answer the following questions for each of your children who are 17 years old or younger.
Child’s
age
Child’s
gender
Relationship
to
you
Relationship
to
your
spouse
Does
this child
currently
live
in
the
same
household
as
your
spouse?
How
many years
has
this child
ived
in the same
household
as
your
spouse for
the
majority
of
the
year?
Your
##-year-old
(Auto-populates
from
earlier
question)
(Number
of rows
auto-populates
based
on number of
children,
child_num)
O
Male O
Female
O
Biological
O Adopted
O
Stepchild O
Legal
guardian O
Foster
O
Romantic
partner’s
child
O Child
of
relative(s)
living
with
you O
Child
of
non-
relative
housemate(s)
O
Biological
O Adopted
O
None O
Other
(If
“None”,
right
two
columns
will
be
grayed
out)
(NOT
seen if
widowed,
or if
divorced
and
your
spouse
is
deceased) O
No
O
Yes
(Less
than
1 year,
1,
2,
… 17)
(Ages
0-17)
(If
participant did not
previously
provide
age)
O
Male O
Female
O
Biological
O Adopted
O
Stepchild O
Legal
guardian O
Foster
O
Romantic
partner’s
child
O Child
of
relative(s)
living
with
you O
Child
of
non-
relative
housemate(s)
O
Biological
O Adopted
O
None O
Other
(If
“None”,
right
two
columns
will
be
grayed
out)
O
No O
Yes
(Less
than
1 year,
1,
2,
… 17)
Pop-up
message
(if
participant
comes
back
to
make
changes
to
the
focal
child
after
having
answered
some
of
the focal child questions a few pages from now, this message will
warn them that this action will alter
their
filled-in
answers.):
You are changing information about your
specific child who was selected for questions you have
answered
about
them
and
their
behaviors.
If
you alter
this
information,
then
your
previous
answers
will
be
erased,
and
a
new
child
may
be
chosen.
In the last 3 years, where has/have your child(ren) 17 or younger gone for healthcare (medical, behavioral, mental)? Mark all that apply.
Military Treatment Facility (MTF)
Civilian provider – TRICARE
Civilian provider – Other
Nonprofit or community health clinic (i.e., free or reduced cost care)
My child(ren) did not use healthcare facilities/providers
Since you became a military spouse, have you routinely used child care so you or your spouse could work?
FOR
INTERNAL USE ONLY
O No
O
Yes
How much of your child care is/was from a military-based provider (e.g., Child Development Center – CDC, Family Child Care – FCC)?
O None
O A little
O Some
O A lot
Which of the following describes your overall experience with obtaining child care?
O Very difficult
O Somewhat difficult
O Neither difficult nor easy
O Somewhat easy
O Very easy
Please rate how much you agree with the following statement:
-
Strongly
disagree
Disagree
Not
sure
Agree
Strongly
agree
I would encourage my child(ren) to serve in the military
O
O
O
O
O
To best understand the dynamics of healthcare utilization and the needs of service members and their families, are you willing to allow us to link your survey data to DoD medical records of any children you may have that are 17 or younger?
(Only seen if participant did not previously answer this question on 2014-2016 survey)
O No
O Yes
Based on child’s age, relationship to participant, and relationship to spouse, a focal child will be randomly
selected from among the participant’s own biological/adopted children AND spouse’s biological/adopted children. If child’s relationship is not biological or adopted for both parties, or if no child age is provided, participant skips the rest of this section.
The next questions will just focus on your
XX-year-old child. If you decide to participate in future
surveys, we will continue to ask
about this child so we can observe how children change and
grow over time. To help make it
easier to recall this child in future surveys, please provide a
“name code” for your
XX-year-old child. This should be a code constructed from the second
and
third letters of your child’s
given first name and their birth year. For example, if your child’s
name
is Robert and he was born in
2005, the second and third letters would be “OB” and his
birth year
would
be
2005.
Note
that
this
information
will
only
be
used
to
help
you
remember
which
child
was
chosen
today, and
will
not
be
used
by
the research
team
or
the DoD
for
any
other
purpose.
Special option: For same-gender twins/children born in the same year (based on age, gender, relationship to participant, and relationship to spouse), if one of these children is picked as the focal child, replace the first sentence with: The next questions will focus on one of your two XX-year-old’s.
Please choose only one of these children for these next questions. And add after the last sentence:
If your two children have the same name code (same second and third letters in their first name and same birth year), then please think of the first born/older of the two children in your responses below.
FOR
INTERNAL USE ONLY
-
Child’s age
Second and third letters
of first name
Year of birth
Name code
Relationship to you
Relationship to your spouse
Gender
Auto-filled
from above
Auto-generate name code from left two boxes
Auto-filled
from above
Auto-filled
from above
Auto-filled
from above
2 letters only
Year
Has your <name code> participated in the following types of youth programs?
-
No
Yes, 1 hour
per week
Yes, 2-3
hours per week
Yes, 4 or more
hours per week
(If one of the “Yes” options is selected, then this column appears)
Was this program on a military installation?
Community service and/or leadership development programs (e.g., Youth of the
Year, Congressional Awards, youth councils, 4-H, Scout programs)
O
O
O
O
O No
O Yes
Education support and/or career development programs (e.g., homework assistance, tutoring, mentor programs,
internships)
O
O
O
O
O No
O Yes
Life skills programs (e.g., Money Matters, Smart Girls, CPR training)
O
O
O
O
O No
O Yes
Art programs (e.g., art classes, music lessons, band, dance classes)
O
O
O
O
O No
O Yes
Sports or recreation programs (e.g., sports
teams, swimming lessons, geo-hunt)
O
O
O
O
O No
O Yes
For your <name code>, please provide your answers on the basis of his/her behavior in the past month.
(Only seen if focal child is between 3-17 years old)
-
Not
true
Somewhat
true
Certainly
true
Considerate of other people’s feelings
O
O
O
Restless, overactive, cannot stay still for long
O
O
O
Often complains of headaches, stomach-aches or sickness
O
O
O
Shares readily with other children, for example toys, treats, pencils
O
O
O
Often loses temper
O
O
O
Rather solitary, prefers to play alone
O
O
O
Generally well behaved, usually does what adults request
O
O
O
Many worries or often seems worried
O
O
O
Helpful if someone is hurt, upset or feeling ill
O
O
O
Constantly fidgeting or squirming
O
O
O
Has at least one good friend
O
O
O
Often fights with other children or bullies them
O
O
O
Often unhappy, depressed or tearful
O
O
O
Generally liked by other children
O
O
O
Easily distracted, concentration wanders
O
O
O
Nervous or clingy in new situations, easily loses confidence
O
O
O
Kind to younger children
O
O
O
Often lies or cheats
O
O
O
Picked on or bullied by other children
O
O
O
Often offers to help others (parents, teachers, other children)
O
O
O
Thinks things out before acting
O
O
O
Steals from home, school or elsewhere
O
O
FOR INTERNAL USE ONLY
O
Gets along better with adults than with other children
O
O
O
Many fears, easily scared
O
O
O
Good attention span, sees work through to the end
O
O
O
Is <name code> currently enrolled in K-12 education?
O Yes
O No
In their lifetime In the past year
During the past 12 month, how would you describe <name code>’s grades in school?
O Mostly A’s
O Mostly B’s
O Mostly C’s
O Mostly D’s or F’s
O Not sure
Thinking about your child <name code>, please indicate to what extent you disagree or agree with the following statements:
-
Strongly
disagree
Disagree
Not
sure
Agree
Strongly
agree
My child is thriving in his/her school
O
O
O
O
O
The level of communication from the school my child attends is excellent
O
O
O
O
O
My child seems to feel a strong sense of belonging to his/her school
O
O
O
O
O
On a typical day, how much time does your <name code> spend watching TV/videos, using a computer, or playing video games?
hours
per
day
(List
should
include
“Less
than
1”
as
an
option)
Please indicate the degree to which your <name code> was disturbed or upset by your spouse’s most recent or current deployment, separation, or active duty assignment:
O Not at all
O Only a little
O A moderate amount
O More than just a moderate amount
O A lot
O N/A – no current/recent deployment or active duty assignment
O N/A – current/recent deployment/assignment occurred before child was born
During the past month, how often have you felt:
-
Never
Rarely
Some-
times
Usually
Always
<Name code> is much harder to care for than most children his/her age?
O
O
O
O
O
<Name code> does things that really bother you a lot?
O
O
O
O
O
Angry with <name code>?
O
O
O
O
O
In the last 3 years, has your <name code> received any of these services or been placed in any of the following:
-
No
Yes,
within the past year
Yes, more
than a year ago
Outpatient or in-home counseling for a mental, emotional, or behavioral health problem
O
O
O
Inpatient or residential treatment for a mental, emotional, or behavioral health problem
O
O
O
Self-help/social support groups for a mental, emotional, or behavioral problem
O
O
O
Special education services or school counseling for a mental,
emotional, or behavioral problem
O
O
O
Special education services for a learning disability or delayed academic progress
O
O
O
Foster care or other child welfare services
O
O
O
Legal services (e.g., court counselor, juvenile detention, probation)
O
O
O
State-sponsored case management
O
O
O
Earlier in the survey, you reported that you were providing care for a child with special needs. Is this child your <name code>?
(Only seen if participant responded “Yes” to caregiving for child(ren))
O No
O Yes
-
FOR INTERNAL USE ONLY
Has a doctor or health professional ever told you that your <name code> has any of the following conditions?
-
No
Yes
If YES, would you describe his/her condition as mild, moderate, or severe?
How old was your child when you were first told by a doctor or other healthcare provider that
he/she had the condition?
Attention Deficit Disorder or Attention Deficit Hyperactive
Disorder (ADD or ADHD)
O
O
O
Mild
O
Moderate
O
Severe
Depression
O
O
O
Mild
O
Moderate
O
Severe
Anxiety (or other emotional problems)
O
O
O
Mild
O
Moderate
O
Severe
Behavior or conduct problems
O
O
O
Mild
O
Moderate
O
Severe
Autism, Asperger’s Disorder, pervasive development disorder, or other autism spectrum disorder
(ASD)
O
O
O
Mild
O
Moderate
O
Severe
Developmental delay or intellectual disability
O
O
O
Mild
O
Moderate
O
Severe
Chronic health condition (e.g., diabetes, asthma, hearing/vision problems)
O
O
O
Mild
O
Moderate
O
Severe
Overweight or obese
O
O
O
Mild
O
Moderate
O
Severe
Disruptive Mood Dysregulation Disorder
O
O
O
Mild
O
Moderate
O
Severe
-
FOR INTERNAL USE ONLY
In the last year, how often have you done any of the following things for your <name code>?
-
Never
Sometimes
Frequently
Always
Kissed, hugged, or told your <name code> that you loved them
O
O
O
O
Paid attention to your <name code> when they were upset or crying
O
O
O
O
Done things with your <name code> that were fun and interesting to them
O
O
O
O
Helped your <name code> learn something new, look at books/read, or do schoolwork
O
O
O
O
Planned and/or monitored what your <name code> ate to
be sure they have a healthy diet
O
O
O
O
Taken your <name code> to a medical provider or dentist for regular check-ups
O
O
O
O
Made sure there was an adult around to supervise or
help your <name code> when needed
O
O
O
O
In general, how would you describe your <name code>?
O Excellent
O Very good
O Good
O Fair
O Poor
-
Did your <name code> ever live with a parent or guardian who got divorced or
separated after they were born?
O No O Yes
Did your <name code> ever live with a parent or guardian who died?
O No O Yes
Did your <name code> ever live with a parent or guardian who served time in jail or
prison after they were born?
O No O Yes
Did your <name code> ever see or hear any parents, guardians, or any other adults
in their home slap, hit, kick, punch, or beat each other up?
O No O Yes
Was your <name code> ever the victim of violence or witnessed any violence in
their neighborhood?
O No O Yes
Did your <name code> ever live with anyone who was mentally ill or suicidal, or
severely depressed for more than a couple of weeks?
O No O Yes
Did your <name code> ever live with anyone who had a problem with alcohol or drugs?
O No O Yes
Since your <name code> was born, how often has it been very hard to get by on your family’s income, for example, it was hard to cover the basics like food or housing?
O Very often
O Somewhat often O Not very often
O Never
What proportion of the time are you the parent/caretaker for your <name code>? For example, if you generally share parenting responsibilities equally with another person, choose “half of the time”.
O None of the time
O Less than half of the time
O Half of the time
O More than half of the time
O Full time
-
FOR INTERNAL USE ONLY
What proportion of the time do you have physical custody for your <name code>? Even if you share parenting responsibilities with your spouse, if a judge has awarded you full custody, please choose “100%”. Similarly, whether or not you share half the parenting responsibilities, if legally you have equal custody with your spouse, then please choose “50%”.
(Only seen if participant is divorced from your spouse and your spouse is NOT deceased)
(0%,
10%,
20%,
30%,
40%,
50%,
60%,
70%,
80%,
90%,
100%)
Do you have any concerns about your health that are not covered in this questionnaire that you would like to share? If so, please send us an email at [email protected].
Thank
you
for
your
participation
in
our
study.
Your
survey
is
now
complete.
For
more
information
about
the
survey,
research
findings,
and
the
study
team,
please
visit
the
Millennium
Cohort
Family
Study’s
website:
http://www.familycohort.org.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Lexi Takata |
| File Modified | 0000-00-00 |
| File Created | 2022-05-05 |
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