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Start of Block: Privacy Act Statement
OMB CONTROL NUMBER: 0703-0080
OMB EXPIRATION DATE: 08/31/2022
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0703-0080, is estimated to
average 30 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.
Privacy Act Statement
This statement serves to inform you of the purpose for collecting personal information required
by this system and how it will be used.
AUTHORITY: 10 U.S.C. Chapter 55, Medical and Dental Care; 32 CFR 199.17, TRICARE
program; and E.O. 9397 (SSN), as amended.
PURPOSE: To collect information from Navy service members in order to create a sexual
assault prevention and alcohol reduction intervention specific to Sailors ages 18-24
ROUTINE USES: Use and disclosure of your records outside of DoD may also occur in
accordance with the DoD Blanket Route Uses published at
http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html and as permitted by the
Privacy Act of 1974, as amended (5 U.S.C. 552a(b)). Any protected health information (PHI) in
your records may be used and disclosed generally as permitted by the HIPAA Privacy Rule (45
CFR Parts 160 and 164), as implemented within DoD. Permitted uses and disclosures of PHI
include, but are not limited to, treatment, payment, and healthcare operations.
DISCLOSURE: Voluntary; however, failure to provide information may result in the denial of
enrollment.
OMB Control Number 0703-0080
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End of Block: Privacy Act Statement
Start of Block: Screening Questions
To ensure that you qualify for this survey, we need to ask you some anonymous brief screening
questions. Please indicate that you agree to respond to these screening questions.
o I accept/agree (1)
o I do not accept/agree (2)
OMB Control Number 0703-0080
Skip To: Q54 If To ensure that you qualify for this survey, we need to ask you some anonymous brief
screening que... = I accept/agree
Skip To: Q57 If To ensure that you qualify for this survey, we need to ask you some anonymous brief
screening que... = I do not accept/agree
Are you a U.S. active duty Sailor?
o Yes (1)
o No (2)
OMB Control Number 0703-0080
Skip To: Q55 If Are you a U.S. active duty Sailor? = Yes
Skip To: Q57 If Are you a U.S. active duty Sailor? = No
Page 2 of 67
What is your age?
o Under 18 years old (1)
o 18-24 years old (2)
o Over 24 years old (3)
OMB Control Number 0703-0080
Skip To: Q57 If What is your age? = Under 18 years old
Skip To: Q57 If What is your age? = Over 24 years old
Skip To: End of Block If What is your age? = 18-24 years old
Thank you for your interest in this study. Unfortunately, you do not meet the eligibility criteria.
Please remember to close this browser to protect your privacy.
OMB Control Number 0703-0080
Skip To: End of Survey If Thank you for your interest in this study. Unfortunately, you do not meet the
eligibility criteri... Is Displayed
End of Block: Screening Questions
Start of Block: Block 21
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Meets 2018 Common Rule Requirements
Naval Health Research Center
CONSENT TO PARTICIPATE IN RESEARCH
Title: Personalized Web-based Sexual Assault Prevention for Service Members
Principal Investigator: Kristen Walter, PhD
You may be eligible to take part in this research study. This form gives you important
information about the study.
Please take time to carefully review this information. You are welcome to contact the
researchers about the research study and ask them any questions you may have. You may also
wish to talk to others (for example, your friends, family, or your personal physician) about your
potential participation in this research study. You do not have to take part in this study.
Participation is voluntary. You may also leave the research study at any time without penalty.
1. KEY INFORMATION: The following focused information is being presented to assist you in
understanding the key elements of this study, as well as the basic reasons why you may or may
not wish to consider taking part. This section is only a summary; more detailed information,
including how to contact the research team for additional information or questions, follows within
the remainder of this document.
a. We invite you to take part in a research study titled “Personalized Web-based Sexual
Assault Prevention for Service Members” examining the general health behaviors within the US
Navy among 18- to 24-year-old Sailors. The purpose of this study is to learn about how best to
adapt a program designed to prevent sexual assault to meet the needs of service members.
Signing a consent form and participating in this research is voluntary.
b. This study is the first phase of a research project designed to develop a new, innovative
sexual assault prevention program for Sailors. You are being asked if you would like to
participate in this study because you are a U.S. Navy service member between the ages of 18
and 24. This study is being conducted by researchers at the Naval Health Research Center
(NHRC), Rhode Island Hospital (RIH), Georgia State University (GSU), and Arizona State
University with funding from the Congressionally Directed Medical Research Programs
(CDMRP).
c. In general, your participation in this research will involve taking part in a 30-minute
anonymous online survey.
d. This survey can be completed at a time convenient for you and on a personal electronic
device. If you complete this survey during off-duty hours, you will be eligible for compensation
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for your participation. The survey is entirely confidential. Your responses to survey items will not
be linked to any information that could identify you. Your responses will also not be shared with
your command.
e. If you take part in this study, you will help researchers better tailor a sexual assault
prevention program to the Navy population. Additionally, you will receive a $30 Amazon gift card
code for your full participation in this study.
f. If you take part in this study, there is a small potential risk of loss of privacy and/or
confidential information about you. This is explained in more detail in the full consent form.
Additionally, it is possible that you may feel some discomfort about answering questions during
the online survey. At any time, if you feel uncomfortable, you may skip any specific survey
questions or discontinue your participation without negative consequences.
Your decision will not affect your military career or any care you receive while in the military. If
you decide to take part in this research study, you will be asked to sign this document. Before
you sign this document, be sure you understand what the research study is about in all sections
of the consent form, including the risks and possible benefits to you.
Please tell the researchers if you are taking part in another research study.
NOTE: If you are providing consent as a legally authorized representative (LAR), “you” or “your”
refers to the research participant.
2. WHAT IS THE PURPOSE AND DURATION OF THIS RESEARCH AND WHO WILL TAKE
PART?
The purpose of this research study is to learn about the health behaviors within the US Navy
among 18- to 24-year-old Sailors to adapt a program designed to prevent sexual assault to
meet the needs of service members. The total duration of participation in this anonymous online
survey is 30 minutes. There will be about 500 Sailors taking part in this study over a period of
approximately one year. At the end of this research study, the results, including research results
about you, will not be shared with you.
3. SCREENING PROCESS TO QUALIFY FOR PARTICIPATION IN THIS STUDY
Because you are a Sailor aged 18 to 24 you are eligible to participate in this research study.
4. WHAT WILL HAPPEN IF YOU DECIDE TO BE IN THIS RESEARCH?
You will participate in a 30 minute anonymous online survey. This survey can be completed at
a time convenient for you and on a personal electronic device. During this survey you will be
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asked about health behaviors, such as alcohol use, sexual health, and your attitudes/beliefs.
The survey is entirely confidential. Your responses to survey items will not be linked to any
information that could identify you. If you complete this survey during off-duty hours, you will be
eligible for compensation for your participation.
5. WHAT ARE THE RISKS OR DISCOMFORTS FROM BEING IN THIS RESEARCH?
If you choose to take part in this study, there is a risk of:
• Discomfort of answering sensitive questions: Some of the questions we ask could make you
feel uncomfortable. You can choose not to answer any question without any negative
consequences.
• Loss of anonymity or confidentiality: Confidentiality will be maintained to the degree
permitted by the technology used. Although data are encrypted using a secure server, your
participation in this online screening survey involves risks like a person’s everyday use of the
Internet. For example, if you complete this survey in a public location, it is possible that others
may see your responses. In addition, there is always the possibility of tampering from an outside
source when using the internet for collecting information. While the confidentiality of your
responses will be protected once the data are downloaded from the internet, there is always a
possibility of hacking or other security breaches that could threaten the confidentiality of your
responses. Please know that you are free to decide not to answer any question.
All your survey data will be anonymous. Also, the secure program will NOT document your IP
address when recording responses to the internet survey. You will be redirected to a new
website (that can only be accessed from the end of the survey) where you will enter your name
and contact information, which will only be used to provide compensation for your study
participation.
6. WHAT ARE THE POSSIBLE BENEFITS FROM THIS RESEARCH?
There may or may not be any direct benefits to you for taking part in the study. However, others
may benefit in the future from the information learned during this study because it will help us
understand more about how to prevent sexual assault in the Navy.
7. WHAT ARE THE ALTERNATIVES TO TAKING PART IN THIS RESEARCH?
This study does not involve medical treatment. There is no other treatment available. Choosing
not to take part in this research study is also an option.
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8. IS THERE COMPENSATION FOR YOUR PARTICIPATION IN THIS RESEARCH?
Yes, for your participation, you will receive a $30 Amazon gift card code via e-mail.
9. ARE THERE COSTS FOR PARTICIPATING IN THIS RESEARCH?
No, there are no costs to you for taking part in this research study.
10. PRINCIPAL INVESTIGATOR (the person(s) responsible for the scientific and technical
direction of the study)
NHRC Site Principal Investigator:
Dr. Kristen H. Walter
(619) 540-4108
[email protected]
11. STUDY SPONSOR (the organizations or persons who oversee the study and are
responsible for analyzing the study data)
Congressionally Directed Medical Research Programs (CDMRP)
820 Chandler Street
Fort Detrick, MD 21702
As the sponsor of this research, the Department of Defense may have access to your research
data in accordance with DoDI 3216.02p.
12. SOURCE OF FUNDING
This study is being conducted with funding from the Congressionally Directed Medical
Research Programs (CDMRP).
13. LOCATION OF THE RESEARCH
This study is being conducted by researchers at the Naval Health Research Center (NHRC) in
San Diego, California.
14. DISCLOSURE OF FINANCIAL INTERESTS AND OTHER PERSONAL
ARRANGEMENTS
There are no financial interests or other personal arrangements to be disclosed.
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15. WHO WILL SEE MY INFORMATION (PRIVACY) AND HOW WILL IT BE PROTECTED
(CONFIDENTIALITY)?
Records of your participation in this research study may only be disclosed in accordance with
state and federal law, including the Federal Privacy Act, 5 U.S.C.552a, and its implementing
regulations. DD Form 2005, Privacy Act Statement - Military Health Records, contains the
Privacy Act Statement for the records. A copy of DD Form 2005 can be given to you upon
request, or you can read on-line
at: https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2005.pdf
The research team will keep your research records. These records may be looked at by
members of the study team listed in the currently approved protocol, the Institutional Review
Board (IRB), and the DoD Higher Level Review as part of their duties. These duties include
making sure that the research participants are protected. Confidentiality of your records will be
protected to the extent possible under existing regulations and laws but cannot be guaranteed.
Procedures to protect the confidentiality of the data in this study include but are not limited to:
We will not share your name with others (except for the reasons we discuss below), and we will
follow legal requirements carefully as we maintain your records.
Electronic data will be stored on secure password-protected servers. These records may be
viewed by representatives of the DoD (e.g., Human Research Protection Program staff, the
NHRC Institutional Review Board, the Department of the Navy Human Research Protection
Program (DoN HRPP) as part of their normal duties. These duties include making sure that the
research participants are protected.
Confidentiality of your records will be protected to the extent possible under existing regulations
and laws but cannot be guaranteed. Complete confidentiality cannot be promised for military
personnel because information regarding your health or disclosures of sexual harassment
and/or sexual assault are required to be reported to appropriate medical or command authorities
to ensure the proper execution of the military mission, including evaluation of fitness for duty.
Your name will not appear in any published paper or presentation related to this study.
Access to all data will be limited to the staff involved in this study, and results may be published
in DoD technical reports, scientific journals, or presented at scientific meetings. No publication
or presentation about the research study described above will reveal your identity without
another authorization from you. Lastly, individuals from official government agencies, such as
the Department of Defense and the U.S. Navy may inspect your research records to ensure that
the rights and safety of all research participants are protected.
By signing this consent form, you are giving permission to use the information listed above for
the purposes described in this form. If you refuse to give permission, you will not be able to
participate in this study.
Page 8 of 67
Researchers will make every effort to protect your privacy and confidentiality; however, there
are risks of breach of information security and information loss.
Study researchers and research staff will have access to your research records and agree to
safeguard your protected health information by using and disclosing it only as permitted by you
in this consent or as directed by state and federal law.
Information gained from your participation in this research study may be published in literature,
discussed for educational purposes, and used generally to further science. You will not be
personally identified when your information is shared in these ways; all information will deidentified.
16. LONG-TERM USE OF DATA
The investigator has requested to save selected data collected from your participation in this
research study for possible use in future research. All data you provide will be de-identified,
meaning that the information will not be associated with your name, or any other method of
identifying you. You have a number of options with regard to this request. If the stored data has
an identifying link you can request to be contacted and sign a separate consent form to allow
the use of these data in another study. You may also choose either to not allow any further use
of your data, allow use of only de-identified data, or give consent now for the use of your
identifiable data to be used in future studies. This future research may be in the same area as
the original study or it may be for a different kind of study. You will be provided choices at the
end of this consent form to allow or deny use in future research studies.
Any future research using your retained data will require a research protocol for the proposed
study approved by an Institutional Review Board (IRB) (a committee responsible for protecting
research participants) or other authorized official responsible for protecting human subjects of
research. The data protections for privacy and confidentiality described in this consent form will
apply to any future use of your stored data.
17. USE OF INFORMATION AND SPECIMENS
During this research study, you will not be asked to provide any samples (biological
specimens).
18. INCIDENTAL FINDINGS
No incidental findings are expected to result from this research.
19. VOLUNTARY PARTICIPATION
Page 9 of 67
The decision to take part in this research study is completely voluntary on your part, which
means you do not have to take part if you do not want to. You may also leave the research
study at any time. If you choose not to take part in this research study or if you leave the study
before it is finished, there will be no penalty or loss of benefits to which you are otherwise
entitled.
You will be informed if significant new findings develop during this research study that may
relate to your decision to continue participation.
20. WHAT HAPPENS IF I WITHDRAW FROM THIS RESEARCH?
Because we have no way to link your name to the survey data, there is not a way to withdraw
your survey data once it is submitted. You can choose to stop the survey at any time prior to
completion. If you stop the survey prior to completion, you will no longer be allowed to continue
your participation in the study, and you will not receive the $30 Amazon gift card code. You
cannot restart the survey from where you left off if you choose stop the survey prior to
completion. If you would like to restart the survey at a later date, you must start a new survey
submission. Information that has already been gathered may still be used and there is no
guarantee that it will be removed from the electronic database for this study.
The principal investigator of this research study may terminate your participation in this
research study at any time if she determines this to be in your best interest, if you are unable to
comply with the procedures required, or if you no longer meet eligibility criteria.
21. CONTACT INFORMATION
The Principal Investigator or a member of the research staff will be available to answer any
questions you may have throughout this study.
Principal Investigator: Kristen H. Walter, PhD
Phone: (619) 540-4108
Email: [email protected]
Institutional Review Board (IRB) Office
If you have any questions about your rights as a research participant or if you have concerns or
complaints about the research study, please contact the IRB Chair, Lt Col Patricia Rohrbeck,
at:
Phone: 619-553-8424; Email: [email protected].
IF THERE IS ANY PORTION OF THIS DOCUMENT THAT YOU DO NOT UNDERSTAND,
ASK THE INVESTIGATOR BEFORE SIGNING. YOU MAY CONSULT WITH YOUR
PERSONAL PHYSICIAN OR LEGAL ADVISOR, IF YOU WISH.
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You have the option of saving a signed copy of this document via an electronic platform (e.g.,
Qualtrics).
SIGNATURE OF PARTICIPANT
By signing this form electronically below, I agree that I have been provided time to read the
information describing the research study in the consent form. The content and meaning of this
information has been explained to me. I have been provided with the opportunity to ask
questions. I voluntarily consent to participate in this study. By signing this form electronically, I
have not given up any of my legal rights as a research participant.
iMed IRIS Data Corporation
IRB Number: NHRC.2021.0014
IRB Approval Date: 9/21/21
IRB Expiration Date: 4/01/25
OMB Control Number 0703-0080
Page Break
Page 11 of 67
PERMISSION FOR LONG-TERM USE OF DATA:
o I give permission for my data to be used in future studies. (1)
o I do not give permission for my data to be used in future studies. (2)
OMB Control Number 0703-0080
Skip To: End of Block If PERMISSION FOR LONG-TERM USE OF DATA: = I give permission for my data
to be used in future studies.
End of Block: Block 21
Start of Block: Demographics
What is your age in years?
Age (1)
▼ 18 (1) ... Prefer not to answer (9)
Please describe your current marital status:
o Not dating or in a relationship (1)
o Dating but not exclusively (2)
o Dating exclusively for less than 6 months (3)
o Dating exclusively for more than 6 months (4)
o Engaged (5)
o Separated/Divorced (999)
o Married (1000)
o Other (1001) ________________________________________________
Page 12 of 67
What sex were you assigned at birth, on your original birth certificate?
o Male (0)
o Female (1)
o Prefer not to answer (999)
How would you describe your current gender?
o Male (0)
o Female (1)
_______________________________________________
o Prefer not to answer (999)
Do you consider yourself to be Hispanic or Latino? (Please check one only)
o Yes (1)
o No (2)
Page 13 of 67
What is your race?
▢
▢
▢
▢
▢
American Indian or Alaska Native (1)
Asian (2)
Black or African American (3)
Native Hawaiian or Other Pacific Islander (4)
White (5)
Do you consider yourself to be:
o Heterosexual or straight (1)
o Gay or Lesbian (2)
o Bisexual (3)
o
Something else, please specify (4)
________________________________________________
o Prefer not to answer (999)
Thinking about your entire life, how many sex partners have you had?
________________________________________________________________
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Who have you EVER had sex with?
o Men only (1)
o Women only (2)
o Both men and women (3)
o I have not had sex (4)
o Prefer not to answer (999)
OMB Control Number 0703-0080
End of Block: Demographics
Start of Block: Sexual Strategies Scale
Page 15 of 67
In the past, which if any of the following strategies have you used to convince someone to have
sex (oral, anal, or vaginal intercourse) after they initially said ‘‘no’’?
Continuing to touch and kiss them in the
hopes that they will give in to sex.
(sexstrategies.1_BL)
▼ Yes (1) ... Prefer not to answer (3)
Telling them lies (e.g., saying "I love you"
when you don't). (sexstrategies.2_BL)
▼ Yes (1) ... Prefer not to answer (3)
Using your older age to convince them.
(sexstrategies.3_BL)
▼ Yes (1) ... Prefer not to answer (3)
Getting them drunk/high in order to convince
them to have sex. (sexstrategies.4_BL)
▼ Yes (1) ... Prefer not to answer (3)
Threatening to tell others a secret or lie about
them if they don't have sex (i.e., blackmail).
(sexstrategies.5_BL)
▼ Yes (1) ... Prefer not to answer (3)
Asking them repeatedly to have sex.
(sexstrategies.6_BL)
▼ Yes (1) ... Prefer not to answer (3)
Blocking them if they try to leave the room.
(sexstrategies.7_BL)
▼ Yes (1) ... Prefer not to answer (3)
Threatening to harm them physically if they
don't have sex. (sexstrategies.8_BL)
▼ Yes (1) ... Prefer not to answer (3)
Taking advantage of the fact that they are
drunk/high. (sexstrategies.9_BL)
▼ Yes (1) ... Prefer not to answer (3)
Threatening to harm yourself if they don't have
sex. (sexstrategies.10_BL)
▼ Yes (1) ... Prefer not to answer (3)
Using a weapon to frighten them into having
sex. (sexstrategies.11_BL)
▼ Yes (1) ... Prefer not to answer (3)
Taking off their clothes in the hopes that they
will give in to sex. (sexstrategies.12_BL)
▼ Yes (1) ... Prefer not to answer (3)
Taking off your clothes in the hopes that they
will give in to sex. (sexstrategies.13_BL)
▼ Yes (1) ... Prefer not to answer (3)
Using physical restraint. (sexstrategies.14_BL)
▼ Yes (1) ... Prefer not to answer (3)
Threatening to break up with them if they don't
have sex. (sexstrategies.15_BL)
▼ Yes (1) ... Prefer not to answer (3)
Questioning their sexuality (e.g., calling them
a lesbian/gay). (sexstrategies.16_BL)
▼ Yes (1) ... Prefer not to answer (3)
Using your authority to convince them (e.g., if
you were their boss, their supervisor, etc).
(sexstrategies.17_BL)
▼ Yes (1) ... Prefer not to answer (3)
Page 16 of 67
Harming them physically. Tying them up.
(sexstrategies.18_BL)
▼ Yes (1) ... Prefer not to answer (3)
Questioning their commitment to the
relationship (e.g., saying "if you loved me, you
would"). (sexstrategies.19_BL)
▼ Yes (1) ... Prefer not to answer (3)
Accusing them of "leading you on" or being "a
tease." (sexstrategies.20_BL)
▼ Yes (1) ... Prefer not to answer (3)
Slipping them drugs (e.g., GHB or "Roofies")
so that you can take advantage of them.
(sexstrategies.21_BL)
▼ Yes (1) ... Prefer not to answer (3)
Made someone penetrate you with their penis,
finger, or another object.
(sexstrategies.23_BL)
▼ Yes (1) ... Prefer not to answer (3)
I have never used ANY of the above
strategies. (Q95_25)
▼ Yes (1) ... Prefer not to answer (3)
OMB Control Number 0703-0080
End of Block: Sexual Strategies Scale
Start of Block: IRMAS
Page 17 of 67
Please respond to the following statements. There are no right or wrong answers, we just ask
for your most honest response.
I think:
If a girl is raped while she is drunk, she is at
least somewhat responsible for letting things
get out of control. (RMA_1)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
When girls go to parties wearing slutty clothes,
they are asking for trouble. (RMA_2)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
If a girl goes to a room alone with a guy at a
party, it is her own fault if she is raped.
(RMA_3)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
If a girl acts like a slut, eventually she is going
to get into trouble. (RMA_4)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
When girls are raped it is often because the
way they said “no” was unclear. (RMA_5)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
If a girl initiates kissing or hooking up, she
should not be surprised if a guy assumes she
wants to have sex. (RMA_6)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
When guys rape, it is usually because of their
strong desire for sex. (RMA_7)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
Guys don’t usually intend to force sex on a
girl, but sometimes they get too sexually
carried away. (RMA_8)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
Rape happens when a guy’s sex drive gets
out of control. (RMA_9)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
If a guy is drunk, he might rape someone
unintentionally. (RMA_10)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
It shouldn’t be considered rape if a guy is
drunk and didn’t realize what he was doing.
(RMA_11)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
If both people are drunk, it can’t be rape.
(RMA_12)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
If a girl doesn’t physically resist sex—even if
protesting verbally—it can’t be considered
▼ Strongly Agree (1) ... Prefer not to answer
(6)
Page 18 of 67
rape. (RMA_13)
If a girl doesn’t physically fight back, you can’t
really say it was rape. (RMA_14)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
A rape probably didn’t happen if the girl has no
bruises or marks. (RMA_15)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
If the accused “rapist” doesn’t have a weapon,
you really can’t call it rape. (RMA_16)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
If a girl doesn’t say “no” she can’t claim rape.
(RMA_17)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
A lot of times, girls who say they were raped
agreed to have sex and then regret it.
(RMA_18)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
Rape accusations are often used as a way of
getting back at guys. (RMA_19)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
A lot of times, girls who say they were raped
often led the guy on and then had regrets.
(RMA_20)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
A lot of times, girls who claim they were raped
just have emotional problems. (RMA_21)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
Girls who are caught cheating on their
boyfriends sometimes claim that it was a rape.
(RMA_22)
▼ Strongly Agree (1) ... Prefer not to answer
(6)
OMB Control Number 0703-0080
End of Block: IRMAS
Start of Block: Sexual Social Norms Inventory
Page 19 of 67
Please rate how you would respond to the following statements:
If I witnessed someone pressuring another
person to leave with them, I would ask if
everything was okay. (sexnorms_1)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If I saw someone mistreating a person I know,
I would do something to help them.
(sexnorms_2)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If I saw someone put something in another
person's drink, I would tell them. (sexnorms_3)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If I saw someone emotionally abusing a
person I know, I would try to help them.
(sexnorms_4)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If I witnessed someone hitting another person,
I would call the police. (sexnorms_5)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If I witnessed sexual harassment, I would stay
out of it. (sexnorms_6)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If I witnessed a rape, I would call the police.
(sexnorms_7)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
I have a problem with people joking about
having sex. (sexnorms_8)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
I feel uncomfortable if a friend brags about
having sex. (sexnorms_9)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
It bothers me if I'm with a group of friends and
someone puts women down by making jokes
or comments about them. (sexnorms_10)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
I don't like it when people use words like “slut”
or “bitch” to insult women. (sexnorms_11)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
It's embarrassing when people I am with make
sexual comments about others they don't
know. (sexnorms_12)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
It's fun to watch a porno video with a group of
friends. (sexnorms_13)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If I thought a friend was lying to someone to
obtain sex I would tell them. (sexnorms_14)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
Even if someone has their clothes off,
he/she/they still has/have the right to say no to
sex. (sexnorms_15)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
Only people who are promiscuous get raped.
(sexnorms_16)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
Page 20 of 67
Being drunk is no excuse for forcing someone
to have sex. (sexnorms_17)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
Even if someone is dressed seductively,
he/she/they do(es) not deserve to be raped.
(sexnorms_18)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If a woman lets a man kiss her, it means she
wants to have sex with him. (sexnorms_19)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If someone has been drinking, it is his/her/their
fault if he/she/they get(s) raped.
(sexnorms_20)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If a friend planned to give someone drugs in
order to have sex with another person, I would
try to stop him/her/them. (sexnorms_21)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
I would have sex with someone without
his/her/their permission if no one would know.
(sexnorms_22)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
I will stop sexual activity when asked to, even
if I am already sexually aroused.
(sexnorms_23)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
I use date rape drugs to obtain sex.
(sexnorms_24)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If a person goes home with a service member,
it means they want to have sex.
(sexnorms_25)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
Sometimes people say no to sex so they won't
seem easy. (sexnorms_26)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
When someone is very sexually aroused, they
may not even realize that the other person is
resisting their advances. (sexnorms_27)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
I would rather have a good relationship with
one person than sex with many different
people. (sexnorms_28)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
I encourage my date to drink so he/she/they
will let me have sex with him/her/them.
(sexnorms_29)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
At parties, I look for people who are drunk and
might be more willing to have sex with me.
(sexnorms_30)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
If my date says no to sex, I try to change
his/her/their mind (sexnorms_31)
▼ Strongly Disagree (1) ... Prefer Not to
Answer (6)
Page 21 of 67
OMB Control Number 0703-0080
End of Block: Sexual Social Norms Inventory
Start of Block: Alcohol and Sexual Behaviors
Please indicate how likely you are to engage in each of the following: (Sexual activity includes
any kind of sexual behavior (kissing, touching, or sexual intercourse). How likely would you be
to:
WHILE DRINKING: ask for verbal consent
when I am sexual with someone, even if we
are in a long-term relationship. (Verbal
consent means to ask that a sexual activity is
OK, before starting it). (alcsex_1)
▼ Not at all likely (1) ... Prefer not to answer
(7)
WHILE SOBER: ask for verbal consent when I
am sexual with someone, even if we are in a
long-term relationship. (Verbal consent means
to ask that a sexual activity is OK, before
starting it). (alcsex_2)
▼ Not at all likely (1) ... Prefer not to answer
(7)
WHILE DRINKING: stop sexual activity when
asked to, even if I am already sexually
aroused. (alcsex_3)
▼ Not at all likely (1) ... Prefer not to answer
(7)
WHILE SOBER: stop sexual activity when
asked to, even if I am already sexually
aroused. (alcsex_4)
▼ Not at all likely (1) ... Prefer not to answer
(7)
WHILE DRINKING: stop a sexual activity with
someone if they say to stop, even if they were
OK with it when it started. (alcsex_5)
▼ Not at all likely (1) ... Prefer not to answer
(7)
WHILE SOBER: stop a sexual activity with
someone if they say to stop, even if they were
OK with it when it started. (alcsex_6)
▼ Not at all likely (1) ... Prefer not to answer
(7)
WHILE DRINKING: decide not to have sexual
activity with someone who is drunk. (alcsex_7)
▼ Not at all likely (1) ... Prefer not to answer
(7)
WHILE SOBER: decide not to have sexual
activity with someone who is drunk. (alcsex_8)
▼ Not at all likely (1) ... Prefer not to answer
(7)
OMB Control Number 0703-0080
Page 22 of 67
End of Block: Alcohol and Sexual Behaviors
Start of Block: Stages of Change
Page 23 of 67
These questions are about your views about sexual violence. Sexual violence includes any type
of sexual behaviors that are unwanted by the person they are done to; unwanted sexual
behaviors may include unwanted touching, verbal pressure to have sex, and attempts to or
actual unwanted oral, anal, or vaginal sex (that involves penetration) that can happen through
the use of force, threat of force, or when the person is asleep or passed out and can't agree to
what is happening.
Prefer not to
Strongly
Strongly
Disagree (2)
Agree (3)
answer
Disagree (1)
Agree (4)
(999)
1. I don’t think
sexual assault is a
big problem among
Sailors. (soc_1)
2. I don’t think
there is much I can
do about sexual
assault among
Sailors. (soc_2)
3. There isn’t much
need for me to
think about sexual
assault among
Sailors, that’s the
job of the
SAPRO/Command.
(soc_3)
4. Sometimes I
think I should learn
more about sexual
assault but I
haven’t done so
yet. (soc_4)
5. I think I can do
something about
sexual assault and
am planning to find
out what I can do
about the problem.
(soc_5)
6. I am planning to
learn more about
the problem of
sexual assault
among Sailors.
(soc_6)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 24 of 67
7. I have recently
attended a
program about
sexual assault
among Sailors that
wasn't required of
me. (soc_7)
8. I am actively
involved in projects
to deal with sexual
assault among
Sailors beyond
what is required of
me. (soc_8)
9. I have recently
taken part in
activities or
volunteered my
time on projects
focused on ending
sexual assault
among Sailors that
were not required
of me. (soc_9)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
OMB Control Number 0703-0080
End of Block: Stages of Change
Start of Block: Intentions to Intervene with Peers
Page 25 of 67
How likely are YOU to do something to try and stop what's happening if a peer or friend of yours
is:
Making rude or disrespectful comments about
someone else's body, clothing, or make-up.
(IIP_1)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
Fighting with someone where they are starting
to cuss at or threaten the other person. (IIP_3)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
Doing unwelcome or uninvited things toward
another person such as howling, whistling or
making sexual gestures. (IIP_4)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
Bragging about what them and their partner
may do sexually. (IIP_5)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
Shoving, grabbing, or otherwise physically
hurting another person. (IIP_6)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
Showing other people sexual messages or
naked/sexual pictures on a cell phone or the
internet. (IIP_7)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
Telling sexual jokes that disrespect someone.
(IIP_10)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
Taking sexual advantage of a person (like
touching, kissing, having sex with) who is
drunk, high from drugs, or passed out.
(IIP_11)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
Telling someone who they can talk to or hang
out with. (Q18_13)
▼ Very Unlikely (1) ... Prefer not to answer
(13)
OMB Control Number 0703-0080
End of Block: Intentions to Intervene with Peers
Start of Block: Bystander Efficacy Scale
Page 26 of 67
Please read the following list of behaviors and using the scale below. Please indicate how
CONFIDENT you are in performing each of the following:
Please indicate how confident you are using a
scale of 0 (not confident at all) to 100 (very
confident). (1)
1. Express discomfort/concern if someone
makes a joke about someone's body. (1)
2. Express my discomfort if someone says that
rape victims are to blame for being raped. (2)
3. Call for help (i.e., call 911) if I hear
someone where I live yelling 'help'. (3)
4. Talk to a friend who I suspect is in an
abusive relationship. (4)
5. Get help and resources for a friend who
tells me they have been raped. (5)
6. Ask a stranger who looks very upset at a
party if they are okay or need help. (6)
7. Ask a friend if they need to be walked home
from a party. (7)
Page 27 of 67
8. Ask a stranger if they need to be walked
home from a party. (8)
9. Speak up if someone is providing
misinformation about sexual assault. (9)
10. Criticize a friend who tells me that they
had sex with someone who was passed out or
who didn't give consent. (10)
11. Do something to help a very drunk person
who is being brought upstairs to a bedroom by
a group of people at a party. (11)
12. Do something if I see a woman
surrounded by a group of men at a party who
looks very uncomfortable. (12)
13. Get help if I hear that another Sailor is in
an abusive relationship. (13)
14. Tell someone in Command or a SARC
(sexual assault response coordinator) about
information I have that might help in a sexual
assault case even if pressured by my peers to
stay silent. (14)
OMB Control Number 0703-0080
Page 28 of 67
End of Block: Bystander Efficacy Scale
Start of Block: Drinking Information
This information will be used for the questions on the following pages; there are no
questions on this page.
OMB Control Number 0703-0080
End of Block: Drinking Information
Start of Block: Daily Drinking Questionnaire
This section asks you about your alcohol consumption over the course of a typical week. For
each day of the week, please respond with the number of drinks you typically consume,
followed by the number of hours it takes you to consume that amount. If NO drinking occurred
on a given day, please enter 0 to both fields pertaining to that day of the week.
# of Drinks (1)
Over how many hours? (2)
Page 29 of 67
How many drinks do you
consume on a typical
MONDAY? (DDQ1_1)
How many drinks do you
consume on a typical
TUESDAY? (DDQ1_2)
How many drinks do you
consume on a typical
WEDNESDAY? (DDQ1_3)
How many drinks do you
consume on a typical
THURSDAY? (DDQ1_4)
How many drinks do you
consume on a typical
FRIDAY? (DDQ1_5)
How many drinks do you
consume on a typical
SATURDAY? (DDQ1_6)
How many drinks do you
consume on a typical
SUNDAY? (DDQ1_7)
OMB Control Number 0703-0080
Page 30 of 67
End of Block: Daily Drinking Questionnaire
Start of Block: Sexual History
What percent of sexual assaults among Sailors are falsely reported? Please enter only a
number and not the percent sign
________________________________________________________________
Have you EVER had sexual intercourse (this includes oral, vaginal, or anal sex)?
o Yes (1)
o No (0)
o Prefer not to answer (999)
OMB Control Number 0703-0080
End of Block: Sexual History
Start of Block: Insert Sexual Experiences Survey- Short Form Perpetration (SES-SFP) vict
Page 31 of 67
The following questions concern sexual experiences that you may have had that were
unwanted. We know that these are personal questions, so we do not ask your name or other
identifying information. Your information is completely confidential. We hope that this helps
you to feel comfortable answering each question honestly. Place a check mark in each box
showing the number of times each experience has happened to you. The time since starting
military service is from when you first joined the military, up until today. Since age 14 refers to
your life starting on your 14th birthday and stopping when you first joined the military.
How old were you when you first started military service?
________________________________________________________________
1. Someone fondled, kissed, or rubbed up against the private areas of my body (lips,
breast/chest, crotch, butt) or removed some of my clothes without my consent (but did not
attempt sexual penetration) by:
How many times since starting
military service?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
How many times since age 14 but
before joining the military?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
Page 32 of 67
Telling lies,
threatening to
end the
relationship,
threatening to
spread rumors
about me,
making
promises I
knew were
untrue, or
continually
verbally
pressuring me
after I said I
didn't want to.
(SESVICA1)
o o o o o
o o o o o
Showing
displeasure,
criticizing my
sexuality or
attractiveness,
getting angry
but not using
physical force,
after I said I
didn't want to.
(SESVICA2)
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
Taking
advantage of
me when I
was too drunk
or out of it to
stop what was
happening.
(SESVICA3)
Threatening to
physically
harm me or
someone
close to me.
(SESVICA4)
Using force,
for example
holding me
down with
their body
weight,
Page 33 of 67
pinning my
arms, or
having a
weapon.
(SESVICA5)
2. Someone had oral sex with me or made me have oral sex with them without my consent by:
How many times since starting
How many times since age 14 but
military service?
before joining the military?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
Page 34 of 67
Telling lies,
threatening to
end the
relationship,
threatening to
spread rumors
about me,
making
promises I
knew were
untrue, or
continually
verbally
pressuring me
after I said I
didn't want to.
(SESVICB1)
o o o o o
o o o o o
Showing
displeasure,
criticizing my
sexuality or
attractiveness,
getting angry
but not using
physical force,
after I said I
didn't want to.
(SESVICB2)
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
Taking
advantage of
me when I
was too drunk
or out of it to
stop what was
happening.
(SESVICB3)
Threatening to
physically
harm me or
someone
close to me.
(SESVICB4)
Using force,
for example
holding me
down with
their body
weight,
Page 35 of 67
pinning my
arms, or
having a
weapon.
(SESVICB5)
3. A man put his penis into my vagina, or someone inserted fingers or objects without my
consent by:
How many times since starting
military service?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
How many times since age 14 but
before joining the military?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
Page 36 of 67
Telling lies,
threatening to
end the
relationship,
threatening to
spread rumors
about me,
making
promises I
knew were
untrue, or
continually
verbally
pressuring me
after I said I
didn't want to.
(SESVICC1)
o o o o o
o o o o o
Showing
displeasure,
criticizing my
sexuality or
attractiveness,
getting angry
but not using
physical force,
after I said I
didn't want to.
(SESVICC2)
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
Taking
advantage of
me when I
was too drunk
or out of it to
stop what was
happening.
(SESVICC3)
Threatening to
physically
harm me or
someone
close to me.
(SESVICC4)
Using force,
for example
holding me
down with
their body
weight,
Page 37 of 67
pinning my
arms, or
having a
weapon.
(SESVICC5)
4. A man put his penis into my butt, or someone inserted fingers or objects without my consent
by:
How many times since starting
How many times since age 14 but
military service?
before joining the military?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
Page 38 of 67
Telling lies,
threatening to
end the
relationship,
threatening to
spread rumors
about me,
making
promises I
knew were
untrue, or
continually
verbally
pressuring me
after I said I
didn't want to.
(SESVICD1)
o o o o o
o o o o o
Showing
displeasure,
criticizing my
sexuality or
attractiveness,
getting angry
but not using
physical force,
after I said I
didn't want to.
(SESVICD2)
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
Taking
advantage of
me when I
was too drunk
or out of it to
stop what was
happening.
(SESVICD3)
Threatening to
physically
harm me or
someone
close to me.
(SESVICD4)
Using force,
for example
holding me
down with
their body
weight,
Page 39 of 67
pinning my
arms, or
having a
weapon.
(SESVICD5)
5. Even though it didn't happen, someone TRIED to have oral sex with me, or make me have
oral sex with them without my consent by:
How many times since starting
military service?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
How many times since age 14 but
before joining the military?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
Page 40 of 67
Telling lies,
threatening to
end the
relationship,
threatening to
spread rumors
about me,
making
promises I
knew were
untrue, or
continually
verbally
pressuring me
after I said I
didn't want to.
(SESVICE1)
o o o o o
o o o o o
Showing
displeasure,
criticizing my
sexuality or
attractiveness,
getting angry
but not using
physical force,
after I said I
didn't want to.
(SESVICE2)
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
Taking
advantage of
me when I
was too drunk
or out of it to
stop what was
happening.
(SESVICE3)
Threatening to
physically
harm me or
someone
close to me.
(SESVICE4)
Using force,
for example
holding me
down with
their body
weight,
Page 41 of 67
pinning my
arms, or
having a
weapon.
(SESVICE5)
6. Even though it didn't happen, a man TRIED to put his penis into my vagina, or someone tried
to stick in fingers or objects without my consent by:
How many times since starting
military service?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
How many times since age 14 but
before joining the military?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
Page 42 of 67
Telling lies,
threatening to
end the
relationship,
threatening to
spread rumors
about me,
making
promises I
knew were
untrue, or
continually
verbally
pressuring me
after I said I
didn't want to.
(SESVICF1)
o o o o o
o o o o o
Showing
displeasure,
criticizing my
sexuality or
attractiveness,
getting angry
but not using
physical force,
after I said I
didn't want to.
(SESVICF2)
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
Taking
advantage of
me when I
was too drunk
or out of it to
stop what was
happening.
(SESVICF3)
Threatening to
physically
harm me or
someone
close to me.
(SESVICF4)
Using force,
for example
holding me
down with
their body
weight,
Page 43 of 67
pinning my
arms, or
having a
weapon.
(SESVICF5)
7. Even through it didn't happen, a man TRIED to put his penis into my butt, or someone tried to
stick in objects or fingers without my consent by:
How many times since starting
military service?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
How many times since age 14 but
before joining the military?
0 (0)
1 (1)
2 (2)
3+
(3)
Prefer
not to
answer
(999)
Page 44 of 67
Telling lies,
threatening to
end the
relationship,
threatening to
spread rumors
about me,
making
promises I
knew were
untrue, or
continually
verbally
pressuring me
after I said I
didn't want to.
(SESVICG1)
o o o o o
o o o o o
Showing
displeasure,
criticizing my
sexuality or
attractiveness,
getting angry
but not using
physical force,
after I said I
didn't want to.
(SESVICG2)
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
o o o o o
Taking
advantage of
me when I
was too drunk
or out of it to
stop what was
happening.
(SESVICG3)
Threatening to
physically
harm me or
someone
close to me.
(SESVICG4)
Using force,
for example
holding me
down with
their body
weight,
Page 45 of 67
pinning my
arms, or
having a
weapon.
(SESVICG5)
Has someone made you penetrate them with your penis, finger, or another object?
o Yes (1)
o No (0)
o Prefer not to answer (999)
Have you made someone else penetrate you with their penis, finger, or another object?
o Yes (1)
o No (0)
o Prefer not to answer (999)
Page 46 of 67
If you answered yes to any of these items during military service, think of the experience you
consider to be the most severe. Was the person that did this to you a member of the military?
o Yes (1)
o No (0)
o I reported no experiences (2)
o Prefer not to answer (999)
OMB Control Number 0703-0080
End of Block: Insert Sexual Experiences Survey- Short Form Perpetration (SES-SFP) -vict
Start of Block: Sexual Assault Likelihood
Page 47 of 67
WHILE DRINKING, how likely would you be to intervene when you witness any of the following
situations among your fellow Sailors?
Prefer
Very
Very
not to
Unlikely
2 (2)
3 (3)
4 (4)
5 (5)
6 (6)
Likely
answer
(1)
(7)
(999)
Unwanted
fondling.
(SAL_1_1)
Verbal
pressure or
coercion to
engage in
unwanted
sexual
activities that
do not
include
intercourse.
(SAL_1_2)
Physical
restraint to
engage in
unwanted
sexual
activities that
do not
include
intercourse.
(SAL_1_3)
Incapacitation
by alcohol
while
engaging in
unwanted
sexual
activities that
do not
include
intercourse.
(SAL_1_4)
Verbal
pressure or
coercion to
engage in
unwanted
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 48 of 67
sexual
intercourse.
(SAL_1_5)
Physical
restraint to
engage in
unwanted
sexual
intercourse.
(SAL_1_6)
Incapacitation
by alcohol
while
engaging in
unwanted
sexual
intercourse.
(SAL_1_7)
Rape.
(SAL_1_8)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 49 of 67
WHILE SOBER, how likely would you be to intervene when you witness any of the following
situations occurring amongst your fellow Sailors?
Prefer
Very
Very
not to
unlikely
2 (2)
3 (3)
4 (4)
5 (5)
6 (6)
likely
answer
(1)
(7)
(999)
Unwanted
fondling. (1)
Verbal
pressure or
coercion to
engage in
unwanted
sexual
activities that
do not
include
intercourse.
(2)
Physical
restraint to
engage in
unwanted
sexual
activities that
do not
include
intercourse.
(3)
Incapacitation
by alcohol
while
engaging in
unwanted
sexual
activities that
do not incude
intercourse.
(4)
Verbal
pressure or
coercion to
engage in
unwanted
sexual
intercourse.
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 50 of 67
(5)
Physical
restraint to
engage in
unwanted
sexual
intercourse.
(6)
Incapacitation
by alcohol
while
engaging in
unwanted
sexual
intercourse.
(7)
Rape. (8)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
How likely would you be to go to a chaplain -- or another confidential resource -- if you
experienced sexual assault?
o Very Unlikely (1)
o 2 (2)
o 3 (3)
o 4 (4)
o 5 (5)
o 6 (6)
o Very Likely (7)
o Prefer not to answer (999)
Page 51 of 67
How likely would you be to report sexual assault to the local police if you experienced it?
o Very Unlikely (1)
o 2 (2)
o 3 (3)
o 4 (4)
o 5 (5)
o 6 (6)
o Very Likely (7)
o Prefer not to answer (999)
How likely would you be to report sexual assault to a military authority if you experienced it?
o Very Unlikely (1)
o 2 (2)
o 3 (3)
o 4 (4)
o 5 (5)
o 6 (6)
o Very Likely (7)
o Prefer not to answer (999)
OMB Control Number 0703-0080
Page 52 of 67
End of Block: Sexual Assault Likelihood
Start of Block: Injunctive Drinking Behaviors Scale
How acceptable (or unacceptable) do you think you and other Sailors find each of the following
behaviors:
I find this behavior to be:
I believe that MO
(1)Unacceptable
(1)
2
(2)
3
(3)
4
(4)
5
(5)
6
(6)
(7)Acceptable
(7)
Prefer
not to
answer
(999)
(1)Unacceptable
(1)
Page 53 of 67
2
(2
1.
Playing
drinking games
(1)
o
ooooo o
o
o
o
o
ooooo o
ooooo o
o
o
o
o
o
ooooo o
o
o
o
o
ooooo o
ooooo o
o
o
o
o
7.
Drinking
alcohol every
weekend (7)
o
ooooo o
o
o
8.
Drinking
under the age of
21 (8)
o
ooooo o
o
o
o
ooooo o
o
o
10.
Drinking
to blow off steam
(10)
o
ooooo o
o
o
11.
Driving a
car after drinking
(11)
o
ooooo o
o
o
o
o
ooooo o
ooooo o
o
o
o
o
o
ooooo o
o
o
o
ooooo o
o
o
2.
Drinking
to have fun (2)
3.
Drinking
shots (3)
4.
Drinking
to meet people
(4)
5.
Drinking
to get drunk (5)
6.
Drinking
with friends (6)
9.
Drinking
alcohol (9)
12.
Drinking
alcohol daily (12)
13.
Drinking
alone (13)
14.
Drinking
enough alcohol
to pass out (14)
15. Never
drinking (15)
Page 54 of 67
16. Encouraging
someone to
drink so that it is
easier to have
sex with them
(18)
17. Having sex
with someone
you just met
when you are
drunk/intoxicated
(19)
18. Having sex
with a regular
partner when
you are
drunk/intoxicated
(20)
o
ooooo o
o
o
o
ooooo o
o
o
o
ooooo o
o
o
OMB Control Number 0703-0080
End of Block: Injunctive Drinking Behaviors Scale
Start of Block: NIDA Clinical trials network PHQ-2
Over the past 2 weeks, how often have you been bothered by the following problems?
More than
Several days
Nearly
Prefer not to
Not at all (0)
half the days
(1)
everyday (3)
answer (999)
(2)
Feeling
down,
depressed, or
hopeless (1)
o
o
o
o
o
Little interest
or pleasure in
doing things
(2)
o
o
o
o
o
OMB Control Number 0703-0080
Page 55 of 67
End of Block: NIDA Clinical trials network PHQ-2
Start of Block: rand sexual harassment items
Page 56 of 67
In this section, you will be asked about several things that someone from work might have done
to you that were upsetting or offensive, and that happened in the PAST YEAR.
When the question says “someone from work,” please include any person you have contact with
as part of your military duties. “Someone from work” could be a supervisor, someone above or
below you in rank, or a civilian employee/contractor. They could be in your unit or in other units.
These things may have occurred on-duty or off-duty, on-base or off-base. Please include them
as long as the person who did them to you was someone from your military work. This could be
involving someone of any gender, who is Military Personnel (Active Duty or National
Guard/Reserve) who are On- or Off- duty, and On- or Off-installation or ship; or involving
DoD/Service Civilian Employees and/or Contractors in your workplace or on your
installation/ship.This could be involving someone of any gender, who is Military Personnel
(Active Duty or National Guard/Reserve) who are on-duty or off-duty, on- or off-installation or
ship.
Remember, all the information you share will be kept confidential.
How often during the past 12 months have you been in situations where someone from work...
Prefer not
Once or
Sometimes
Very Often
Never (1)
Often (4)
to answer
Twice (2)
(3)
(5)
(999)
Repeatedly
told sexual
stories or
jokes that
were
offensive to
you?
(PF30_1)
Referred to
people of
your gender
in insulting
or offensive
terms?
(PF30_2)
Made
offensive
remarks
about your or
somebody
else's appearance,
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 57 of 67
body, or
sexual
activities?
(PF30_5)
Made
offensive
sexist
remarks
(e.g.,
suggesting
that people
of your
gender are
not suited
for the kind
of work you
do)?
(PF30_7)
o
o
o
o
o
o
How many of these behaviors that you selected as happening to you, do you consider to have
been sexual harassment?
o None were sexual harassment (1)
o Some were sexual harassment; some were not sexual harassment (2)
o All were sexual harassment (3)
o Prefer not to answer (999)
OMB Control Number 0703-0080
End of Block: rand sexual harassment items
Start of Block: SEQ-DoD
The following questions concern sexual experiences in the military that you may have had that
were unwanted. We know that these are personal questions, so we do not ask your name or
other identifying information. Your information is completely confidential. We hope this helps you
Page 58 of 67
feel comfortable answering each question honestly. Place a check mark in the box showing the
number of times each experience has happened to you since joining the military.
Since joining the military, has anyone,
Whistled, called, or hooted at you in a sexual
way? (2)
▼ Never (1) ... Prefer not to answer (4)
Made unwelcome attempts to draw you into a
discussion of sexual matters (for example,
attempted to discuss or comment on your sex
life)? (3)
▼ Never (1) ... Prefer not to answer (4)
Made crude and offensive sexual remarks,
either publicly (for example, in your workplace)
or to you privately? (4)
▼ Never (1) ... Prefer not to answer (4)
Treated you "differently" because of your sex
(for example, mistreated, slighted, or ignored
you)? (5)
▼ Never (1) ... Prefer not to answer (4)
Made offensive remarks about your
appearance, body, or sexual activities? (6)
▼ Never (1) ... Prefer not to answer (4)
Made gestures or used body language of a
sexual nature which embarrassed or offended
you? (7)
▼ Never (1) ... Prefer not to answer (4)
Displayed, used, or distributed sexist or
suggestive material (for example, pictures,
stories, or pornography which you found
offensive)? (8)
▼ Never (1) ... Prefer not to answer (4)
Made unwanted attempts to establish a
romantic sexual relationship with you despite
your efforts to discourage it? (10)
▼ Never (1) ... Prefer not to answer (4)
Put you down or was condescending to you
because of your sex? (11)
▼ Never (1) ... Prefer not to answer (4)
Stared, leered, or ogled you in a way that
made you feel uncomfortable? (12)
▼ Never (1) ... Prefer not to answer (4)
Exposed themselves physically (for example,
“mooned” you) in a way that embarrassed you
or made you feel uncomfortable? (13)
▼ Never (1) ... Prefer not to answer (4)
Continued to ask you for dates, drinks, dinner,
etc., even though you said “No”? (14)
▼ Never (1) ... Prefer not to answer (4)
Page 59 of 67
Made you feel like you were being bribed with
some sort of reward or special treatment to
engage in sexual behavior? (15)
▼ Never (1) ... Prefer not to answer (4)
Made you feel threatened with some sort of
retaliation for not being sexually cooperative
(for example, by mentioning an upcoming
review)? (16)
▼ Never (1) ... Prefer not to answer (4)
Touched you in a way that made you feel
uncomfortable? (17)
▼ Never (1) ... Prefer not to answer (4)
Made unwanted attempts to stroke, fondle, or
kiss you? (18)
▼ Never (1) ... Prefer not to answer (4)
Treated you badly for refusing to have sex?
(19)
▼ Never (1) ... Prefer not to answer (4)
Implied faster promotions or better treatment if
you were sexually cooperative? (20)
▼ Never (1) ... Prefer not to answer (4)
Made you afraid you would be treated poorly if
you didn’t cooperate sexually? (21)
▼ Never (1) ... Prefer not to answer (4)
OMB Control Number 0703-0080
End of Block: SEQ-DoD
Start of Block: Perceptions of Peers Willingness
Page 60 of 67
Most Sailors in the military would...
Strongly
disagree
(1)
Make sure
their friend is
okay if they
see him/her in
an
uncomfortable
sexual
situation at a
party. (1)
Warn
someone if
they saw a
drug being
slipped into
their drink. (2)
Discourage a
friend who
said they
planned to get
someone
drunk to have
sex. (3)
Disagree
(2)
Somewhat
disagree
(3)
Neither
agree
nor
disagree
(4)
Somewhat
agree (5)
Agree
(6)
Strongly
agree
(7)
Prefer
not to
answer
(999)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
OMB Control Number 0703-0080
End of Block: Perceptions of Peers Willingness
Start of Block: Injunctive Questions
Page 61 of 67
Please rate the extent to which you agree or disagree with each statement:
Strongly
Disagree
Strongly
Disagree
Neutral (3)
Agree (4)
(2)
Agree (5)
(1)
I believe it
is important
to stop
sexual
activity
when a
partner
says no to
a sexual
act. (1)
MOST
Sailors
believe it is
important
to stop
sexual
activity
when a
partner
says no to
a sexual
act. (2)
I think it is
NOT OK to
engage in
sexual
activity with
someone
who is high
or drunk.
(3)
MOST
Sailors
think it is
NOT OK to
engage in
sexual
activity with
someone
who is high
or drunk.
(4)
Prefer not
to answer
(999)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 62 of 67
I think it is
useful to
limit how
much I
drink in
situations
where I
might be
sexually
active. (5)
MOST
Sailors
think it is
useful to
limit how
much they
drink in
situations
where they
might be
sexually
active. (6)
I would
respect
another
Sailor who
reports
sexual
harassment
or assault.
(7)
MOST
Sailors
would
respect
another
Sailor who
reports
sexual
harassment
or assault.
(8)
I would
believe
another
Sailor who
says they
were
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 63 of 67
sexually
assaulted.
(9)
MOST
Sailors
would
believe
another
Sailor who
says they
were
sexually
assaulted.
(10)
I am
bothered
by sexual
jokes and
comments
about other
Sailors.
(11)
MOST
Sailors are
bothered
by sexual
jokes and
comments
about other
Sailors.
(12)
I would
want
another
Sailor to
intervene if
I was trying
to hook up
with
someone
who had
had too
much to
drink. (13)
MOST
Sailors
would want
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 64 of 67
another
Sailor to
intervene if
they were
trying to
hook up
with
someone
who had
had too
much to
drink. (14)
I would
help
another
Sailor who
is drinking
too heavily.
(15)
MOST
Sailors
would help
another
Sailor who
is drinking
too heavily.
(16)
I would
verbally
and/or
physically
resist (i.e.,
say "no,"
push, hit) if
someone
tried to
engage me
in
unwanted
sexual
activity.
(17)
MOST
Sailors
would
verbally
and/or
physically
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 65 of 67
resist (i.e.,
say "no,"
push, hit) if
someone
tried to
engage
them in
unwanted
sexual
activity.
(18)
OMB Control Number 0703-0080
End of Block: Injunctive Questions
Start of Block: AUDIT-C
How often did you have a drink containing alcohol in the past year?
o Never (1)
o Monthly or less (2)
o 2 to 4 times a month (3)
o 2 to 3 times a week (4)
o 4 or more times a week (5)
Skip To: End of Block If How often did you have a drink containing alcohol in the past year? = Never
Page 66 of 67
How many drinks containing alcohol did you have on a typical day when you were drinking in
the past year?
o 1 or 2 drinks (1)
o 3 or 4 drinks (2)
o 5 or 6 drinks (3)
o 7 or 9 drinks (4)
o 10 or more drinks (5)
How often did you have six or more drinks on one occasion in the past year?
o Never (1)
o Less than monthly (2)
o Monthly (3)
o Weekly (4)
o Daily or almost daily (5)
OMB Control Number 0703-0080
End of Block: AUDIT-C
Page 67 of 67
| File Type | application/pdf |
| File Title | Microsoft Word - Change_Sailors_-_Norms_Survey-3.docx |
| File Modified | 2022-07-28 |
| File Created | 2022-04-12 |