Form 0920-0822 Att K_Web_Phone Screeners and Survey Instrument_English
[NCIPC] The National Intimate Partner and Sexual Violence Survey (NISVS)
Att K_Web_Phone Screeners and Survey Instrument_English_REV1.10.23Clean
Questionnaire, phone (Att. K-L)
OMB: 0920-0822
Attachment K
English Screener and Survey (for both Web and Phone)
Form
Approved
OMB No: 0920-0822
Exp. Date: xx/xx/xxxx
Health and Injury Study
Public Reporting burden of this collection of information is estimated to be between 25 minutes for the web format and 40 minutes for the phone format per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-0822).
09NOTES
Each screen will include links to help desk information and victim resources (i.e., help lines).
Each screen will include a quick exit button (for safety purposes).
For victimization sections that include perpetrator follow-up, the program will document up to 5 perpetrators.
Error Prompts.
Soft Prompts. Unless otherwise specified later in this document, if the respondent selects “Next>” without selecting an answer:
The program will make the following answer options visible to the respondent:
DON’T
KNOW
PREFER NOT TO ANSWER
The program will also display a 508-compliant error message in red to prompt for a selection to be made. .
Numeric Ranges. If a respondent enters a number outside of the range allowed for an answer, the program will display a 508-compliant error message in red to prompt for a response to be provided which falls within the allowable range.
Age at time of an event. If the respondent reports an event as having occurred at an age that is more than one year older than the respondent’s current age as provided in AGE_SELECTED or as subsequently corrected, a 508-compliant error message in red will be displayed to prompt for a correction.
Required Questions. To be compliant with Section 508 of the Rehabilitation Act, all required questions will either followed by an asterisk (*) or by a verbal notice like this: “This question is required.”
Drop-down/Scrolling lists.
Number of people. For all questions asking for number of people who did something to the respondent:
[Display a drop-down or scrolling list showing the following options:
1
2
3
4
5
6
7
8
9
10
More than 10
]
Age. For all questions asking for age an event occurred, display a drop-down or scrolling list showing the set of numbers starting at 0 and extending through 110, or, if technically feasible, starting at 0 and extending through the current age reported by the respondent or through the current age plus one year.
What Sample Members See.
Text shown in blue font is for internal and programming use and will not be seen by respondents on the web screen.
Text shown in black or red font will appear on the screen for respondents and interviewers.
Exception: Variable names appear in black font, bold and in brackets, in this document. However, these labels will only appear on the programmed screens during testing. They will not appear in the final programmed versions accessible to sample members.
Numeric codes will not appear next to fixed-choice answer options in the programmed screener or survey. Selection bubbles or boxes will appear instead.
[TelMode]. When an interviewer is speaking with a sampled household member, she will access this web screener and survey from within the NISVS-5 telephone case management system. When the NISVS-5 telephone case management system accesses a web screener or web survey case, it will send instructions to set TelMode=1.
When TelMode=1, for all questions whose answer options only include “Yes” and “No”, the following note will appear above answer options: ONLY READ ANSWER OPTIONS IF NEEDED.
When Telmode=1, the following two options will appear for all questions except those marked as required. These options will be available for interviewers to select but interviewers will be trained to never to read them aloud:
DON’T
KNOW
PREFER NOT TO ANSWER
Emphasis Tags. To enable people using assistive readers to perceive intended emphasis, the screener and survey program will use the following html tags.
The html <strong > tag will be used to produce bold text for sighted sample members.
In some cases, words will both be in all-caps and bold text.
The html <em> tag will be used to produce italicized text for sighted sample members.
This survey will be administered in both English and Spanish.
All time stamps will record the number of seconds that have elapsed since the sample member entered the survey.
At the top of the screen, the study name (Health and Injury Study) and the CDC logo will appear.
At the bottom of each screen, the following static text will appear:
If you would like more information about the study, please call [insert toll-free #] or send an email to [email protected].
[If accessed from the CATI-CMS (TELMODE=1), skip to the next question.]
[If accessed online directly by a sample member, show this introduction.]
[SCR_INTRO]
Help the CDC (Centers for Disease Control and Prevention) learn about health and injuries across our nation and receive up to [If Phase=1, fill $25; If Phase=2, fill $50]. Opportunities come in two separate steps.
Step 1 is to tell us a little about your household. It is easy and generally takes less than 5 minutes.
Answers to each question are important and voluntary. All answers will be kept private and confidential.
After you’re done with Step 1, you will get $10.
Click the “Next>” button to continue.
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[Show to all.]
[ADULT]
Are you an adult, at least 18 years of age or older?
For this question, an answer is required.
Yes 1
No 2
[If the respondent selects “Next>” without providing an answer, display this message in red: “For this question, an answer is required.”]
[If ADULT=1, go to INTERNET]
[Show if ADULT=2]
[ADULTS_ANY]
Do any adults, age 18 years of age or older, live in your household?
For this question, an answer is required.
Yes 1
No 2
[If the respondent selects “Next>” without providing an answer, display this message in red: “For this question, an answer is required. ”]
[If ADULTS_ANY =1, go to INTERNET.]
[Show if ADULTS_ANY=1 ]
[SCRR_INEL]
Please give the study’s letters and postcards to an adult in your household and ask them to participate. Thank you for your time.
[If the respondent selects “Next>” at SCRR_INEL, set SCRR_INEL=1, exit the survey, and jump back to CF_INTRO. PROGRAMMER: Clear out previous responses through CF_INTRO, but keep SCRR_INNEL=1 value.]
[Show if ADULTS_ANY=2 ]
[HH_INEL_AGE]
We are only interviewing adults aged 18 or older, so those are all the questions we have for you. Thank you for your time.
[After showing INEL_AGE, record “1” in the data for HH_INEL_AGE, END INTERVIEW; SCREEN OUT, CODE AS INELIGIBLE AGE]
[Show if ADULT=1]
[INTERNET]
Do you or anyone living with you have access to the Internet when you are home?
Include Internet access on cell phones.
Yes – At least one of us can access the Internet at home. 1
No – No one can access the Internet at home. 2
[Show INTERNET_EASE if INTERNET=1; else go to the next question]
[INTERNET_EASE]
When you access the Internet at home, how easy or difficult is it to use?
Very Easy 1
Easy 2
Neither easy nor difficult 3
Difficult 4
Very Difficult 5
[Show if ADULT=1 (Yes, the screener respondent is an adult)]
[NUM_ADULTS]
Including yourself, how many people living in this household are adults, 18 years of age or older?
(For this question, an answer is required.)
Number of adults: __________
[Display a drop-down or scrolling list showing the following options:
1 adult
2 adults
3 adults
4 adults
5 adults
6 adults
7 adults
8 adults
9 adults
10 or more adults
]
[If the respondent goes to next screen without selecting a number, display a message in red saying: “We need to know the number of adults living in your household in order to randomly select an adult and then invite that adult to participate in the second part of our study. Please select the number of adults living in your household.”)
[If NUM_ADULTS=1 , set SURVEYR =1]
[IF NUM_ADULTS ≥ 2:
|
[Show if NUM_ADULTS=1]
[SRVYR_INTRO]
You just need to answer a few more questions to complete Step 1 and then get [If TelMode=1, fill $5; else, fill $10].
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[Show if NUM_ADULTS>1]
[ROSTER_INTRO]
To ensure that we include a full variety of US residents in our study, we will randomly choose and invite one adult to participate in Step 2. Once invited, the adult can complete a survey (Step 2) and get [If Phase=1, fill $15; If Phase=2, fill $40].
To help us randomly choose one adult, please tell us a little about yourself and each of the adults who usually live with you.
Let’s start with you.
[After the participant clicks the “Next>” button, record “1” in the data for ROSTER_INTRO]
[Show if ADULT=1 (Yes, the screener respondent is an adult)]
[HHA1_NAME]
Please provide your first name, initials, or nickname.
If we send an invitation, we need to know who to send it to.
(For this question, an answer is required.)
First name, initials, or nickname: _________________________________ [allow 35 characters]
[If the respondent selects “Next>” without providing at least one character as an answer, display this message in red: “We need to know each household member’s first name, initials, or nickname in order to randomly select and invite an adult to Step 2. Please provide an answer.”]
[Show if ADULT=1 (Yes, the screener respondent is an adult)]
[HHA1_SEX]
Are you…?
(For this question, an answer is required.)
Male 1
Female 2
Other 3
[If TelMode=1, put parentheses around “Other” in option 3.]
[If the respondent selects “Next>” without providing an answer, display this message in red: “We need to know each household member’s sex in order to randomly select and invite an adult to Step 2. Please provide an answer. ”]
[If NUM_ADULTS=1, go to the first instance of SRVYR_NAMEF]
[Show if NUM_ADULTS=2]
[HHA2_NAME_2OF2]
Please provide the other adult’s first name, initials, or nickname.
(If we send an invitation, we need to know who to send it to.)
(For this question, an answer is required.)
First name, initials, or nickname: _________________________________ [allow 35 characters]
[If the respondent selects “Next>” without providing at least one character as an answer, display this message in red: “We need to know each household member’s first name, initials, or nickname in order to randomly select and invite an adult to Step 2. Please provide an answer.”]
[Show if NUM_ADULTS=2]
[HHA2_SEX_2OF2]
Is the other adult…?
(For this question, an answer is required.)
Male 1
Female 2
Other 3
[If TelMode=1, put parentheses around “Other” in option 3.]
[If the respondent selects “Next>” without providing an answer, display this message in red: “We need to know each household member’s sex in order to randomly select and invite an adult to Step 2. Please provide an answer. ”]
[Show if NUM_ADULTS=2]
[SELECT_FROM2]
The computer randomly selected one adult from your household to invite to participate in the second part of this study.
[If SURVEYR =1 (the screener respondent was selected), fill: “That person is you.”]
[If SURVEYR >1 (the screener respondent was not selected), fill: “That person is the other household adult.”]
[After the participant clicks the “Next>” button, record “1” in the data for this question.]
[After SELECT_FROM2, go to where SRVYR_NAMEF is set for the first time.]
[Show if NUM_ADULTS≥3]
[HHA2_NAME]
You told us about yourself.
Now, please tell us about another adult who usually lives with you.
Please provide the adult’s first name, initials, or nickname.
(If we send an invitation, we need to know who to send it to.)
(For this question, an answer is required.)
First name, initials, or nickname: _________________________________ [allow 35 characters]
[If the respondent selects “Next>” without providing at least one character as an answer, display this message in red: “We need to know each household member’s first name, initials, or nickname to randomly select and invite an adult to Step 2. Please provide an answer.”]
[If the most recently reported adult has the same values for HHA_NAME as another household member, show the following in red: “You already provided [fill the answer provided for this instance of HHA_NAME*] as the first name, initials, or nickname for another adult. Please provide a unique first name, initials, or nickname for this adult.”
[Show if NUM_ADULTS≥3]
[HHA2_SEX]
Is [fill the first name, initials, or nickname reported in HHA2_NAME] …
(For this question, an answer is required.)
Male 1
Female 2
Other 3
[If TelMode=1, put parentheses around “Other” in option 3.]
[If the respondent selects “Next>” without providing an answer, display this message in red: “We need to know each household member’s sex to randomly select and invite an adult to Step 2. Please provide an answer. ”]
[If NUM_ADULTS≥3, show an instance of question (NUM_ADULT-2) times]
[HHAX_NAME*]
You told us about yourself and the following adult(s): [for each adult already reported, list the name, initials or nickname, then show the reported sex in parentheses. Put commas between each adult’s set of information.]
Now, please tell us about another adult who usually lives with you.
Please provide the adult’s first name, initials, or nickname.
(If we send an invitation, we need to know who to send it to.)
(For this question, an answer is required.)
First name, initials, or nickname: _________________________________ [allow 35 characters]
[If the respondent selects “Next>” without providing at least one character as an answer, display this message in red: “We need to know each household member’s first name, initials, or nickname to randomly select and invite an adult to Step 2. Please provide an answer.”]
[If the most recently reported adult has the same values for HHA_NAME as another household member, show the following in red: “You already provided [fill the answer provided for this instance of HHA_NAME*] as the first name, initials, or nickname for another adult. Please provide a unique first name, initials, or nickname for this adult.”
[If NUM_ADULTS≥3, show an instance of this question (NUM_ADULT-2) times]
[HHAX_SEX*]
Is [fill the first name, initials, or nickname reported in the corresponding instance of HHA_NAME*] …
(For this question, an answer is required.)
Male 1
Female 2
Other 3
[If TelMode=1, put parentheses around “Other” in option 3.]
[If the respondent selects “Next>” without providing an answer, display this message in red: “We need to know each household member’s sex to randomly select and invite an adult to Step 2. Please provide an answer. ”]
[Set for all]
[SRVYR_NAMEF]
[Set SRVYR_NAMEF to equal the answer given at the HHA*_NAME* question corresponding to the value of SURVEYR. For example, if NUM_ADULTS≥3, and SURVEYR=3, set SRVYR_NAMEF to equal the value reported in the first instance of HHAX_NAME*]
[Set for all]
[SRVYR_SEX]
[Set SRVYR_SEX to equal the answer given at the HHA*_SEX* question corresponding to the value of SURVEYR. For example, if NUM_ADULTS≥3, and SURVEYR=3, set SRVYR_SEX to equal the value reported in the first instance of HHAX_SEX*]
[Show if NUM_ADULTS≥3]
[SELECT_MULTI]
The computer has randomly selected one adult from your household to participate in the rest of this study.
[If SRVYR=1, show:
That adult is you.
After completing a survey (Step 2), you will receive [If Phase=1, fill $15; If Phase=2, fill $40].
[If SRVYR≥2, show:
That adult is the [If SRVYR_SEX=1, fill: male] [If SRVYR_SEX=2, fill: female] [If SRVYR_SEX=3, fill: person], whose name, initials or nickname is [fill, in bold: SRVYR_NAMEF].
After completing a survey, [fill: SRVYR_NAMEF] will receive [If Phase=1, fill $15; If Phase=2, fill $40].
]
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[Show if SURVEYR=1 (the person selected to complete the survey is the screener participant)]
[SRVYR_AGE]
How old are you?
(For this question, an answer is required.)
18-34 1
35-54 2
55 or older 3
|
[If the respondent selects “Next>” without providing an answer, display this message in red: “For this question, an answer is required.”
[Show if SURVEYR≥2 (the person selected to complete the survey is not the screener participant)]
[SRVYRO_AGE]
How old is [fill, in bold: the SRVYR_NAMEF]?
(For this question, an answer is required.)
18-34 1
35-54 2
55 or older 3
|
[If the respondent selects “Next>” without providing an answer, display a 508-compliant message in red to prompt for a response.]
[Show if SURVEYR≥2 (the person selected to complete the survey is not the screener participant)]
[SRVYRO_NAMES]
Before you ask the [If SRVYR_SEX=1, fill: male] [If SRVYR_SEX =2, fill: female] [If SRVYR_SEX=3, fill: person] whose name, initials or nickname is [fill: SRVYR_NAMEF] to take the main survey, we would like to get that person’s full name.
Providing a full name for [fill, in italics and bold: SRVYR_NAMEF] is helpful but optional.
First name: [SRVYRO_NAMEF]
Last name: [SRVYRO_NAMEL]
[After the participant clicks the “Next>” button, record “1” in SRVYRO_NAMES and advance to the next question]
[Set if SURVEYR≥2 (the person selected to complete the survey is not the screener participant)]
[SRVYR_NAMEF]
[If SRVYRO_NAMEF has two or more characters in it, reset SRVYR_NAMEF to contain what was entered at SRVYRO_NAMEF, otherwise retain the value previously set from the appropriate HHA*_NAME* question.]
[Show if SURVEYR≥2 (the person selected to complete the survey is not the screener participant)]
[TELLR]
Please ask [Fill, in bold: SRVYR_NAMEF] to log in to the survey using the same information that you used. Let them know that we are conducting a study on health and injury and we would like for them to participate in the second step. We will provide them [If Phase=1, fill $15; If Phase=2, fill $40] if they complete the second-step survey.
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[Show if SURVEYR≥2 (the person selected to complete the survey is not the screener participant)]
[DIGINVO]
Many people like to read about the study in an email or text message and we can send them instantly. How should we send digital invitations to [SRVYR_NAMEF]?
Select all that apply.
Email 1
Text 2
No digital invitations 3 [exclusive]
[If “No digital invitations” is selected, deselect the other answer options]
[Show if DIGINVO=1 or DIGINVO=1, 2 (email invitation is one of the ways chosen for inviting the selected adult)]
[SRVYRO_EMAIL]
Please provide the email address through which we should send invitations to [SRVYR_NAMEF].
We will send one invitation and may send limited reminders about the survey and getting the [If Phase=1, fill $15; If Phase=2, fill $40].
Email address ([email protected]): [only allow valid email address formats]
Retype email address ([email protected]): [only allow valid email address formats]
[If the email addresses provided do not match, show in red: “The email addresses you typed do not match. Please enter them both again.]
[If either of email addresses is invalid, show in red: “Email address is invalid. Please provide a valid email address ([email protected]).]
[Show if DIGINVO=2 or DIGINVO=1, 2 (text invitation is one of the ways chosen for inviting the selected adult)]
[SRVYRO_CELL]
Please provide the cell phone number through which we should send invitations to [SRVYR_NAMEF].
We will send one invitation and may send limited reminders about the survey and getting the [If Phase=1, fill $15; If Phase=2, fill $40].
Cell phone number (10 digits): [only allow valid telephone numbers]
[If the cell phone number is invalid, show in red: “Phone number is invalid. Please provide a 10-digit cell phone number, without any dashes or parentheses (##########).]
[Show if SURVEYR =2 (screener respondent is not selected) & DIGINVO includes 1 or 2 (email or text messages chosen)]
[DIGINTRO]
[If only email chosen at DIGINVO: “Please let [FILL: SRVYR_NAMEF] know that you asked us to send an email to introduce the study.]
[If only text chosen at DIGINVO: “Please let [FILL: SRVYR_NAMEF] know that you asked us to send a text message to introduce the study.”]
[If both email and text chosen at DIGINVO: “Please let [FILL: SRVYR_NAMEF] know that you asked us to send an email and a text message to introduce the study.”]
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[Show if SURVEYR≥2 (the person selected to complete the survey is not the screener participant) AND
the screener is currently being viewed in Spanish mode AND
DIGINVO includes 1 or 2 (email or text messages chosen).]
[SRVYR_LANG]
Would [Fill, in bold: SRVYR_NAMEF] prefer to read about the survey in Spanish or English?
Spanish 1
English 2
[Show if SURVEYR≥2 (the person selected to complete the survey is not the screener participant)]
[SCRR_INCENT]
Would you like us to send your [If TelMode=1, fill $5; else, fill $10] to you by email or would you prefer to receive it in the mail, as a paper check?
If you choose email, we will send your [If TelMode=1, fill $5; else, fill $10] instantly by email as a VISA gift card.
If you choose to receive a paper check by mail, you will receive it within 2-4 weeks.
[If TelMode=1 (interviewer is reading the questions aloud), fill in blue: ONLY READ ANSWER OPTIONS IF NEEDED]
By email 1
By mail as a paper check 2
Don’t want the [If TelMode=1, fill $5; else, fill $10]. 3
[Show if SCRR_INCENT=1 (screener respondent was not selected and wants $ by email)]
[SCRR_EMAIL]
Please provide the email address to which we should send your [If TelMode=1, fill $5; else, fill $10].
Email address ([email protected]): [only allow valid email address formats]
Retype email address ([email protected]): [only allow valid email address formats]
[If the email addresses provided do not match, show in red: “The email addresses you typed do not match. Please enter them both again.]
[If either of email addresses is invalid, show in red: “Email address is invalid. Please provide a valid email address ([email protected]).]
[Show if SCRR_INCENT=2 (screener respondent was not selected and wants $ by paper check)]
[SCRR_NAME]
Please provide your first and last name, as it should appear on your check.
First name: [SCRR_NAMEF]
Last name: [SCRR_NAMEL]
[IF R MOVES FORWARD WITHOUT PROVIDING BOTH A FIRST NAME AND A LAST NAME, DISPLAY A 508-COMPLIANT MESSAGE IN RED TO PROMPT FOR A RESPONSE.
[Show if SURVEYR≥2 (the person selected to complete the survey is not the screener participant)]
[SCRR_Exit]
Thank you for your help!
If you have any questions about the study, please call [insert toll-free number here] or send an email to [email protected].
[END SCREENER]
[Show if SURVEYR=1 (screener respondent is selected)]
[SRVYR_INCENT]
Thank you. As a token of appreciation, we would like to give you [If TelMode=1, fill $5; else, fill $10].
Would you like us to send that to you instantly by email as a VISA gift card or would you prefer to receive it in the mail, as a check?
By email 1
By mail as a check 2
Don’t want the [If TelMode=1, fill $5; else, fill $10]. 3
[Show if SRVYR_INCENT=1]
[SRVYR_EMAIL]
Please provide the email address to which we should send your [If TelMode=1, fill $5; else, fill $10].
Email address ([email protected]): [only allow valid email address formats]
Retype email address ([email protected]): [only allow valid email address formats]
[If the email addresses provided do not match, show in red: “The email addresses you typed do not match. Please enter them both again.]
[If either of email addresses is invalid, show in red: “Email address is invalid. Please provide a valid email address ([email protected]).]
[Show if SRVYR_INCENT =1]
[SRVYR_NAMEE]
Please provide your first and last name, so we know who to address the email to.
First name: [SRVYR_NAMEEF]
Last name: [SRVYR_NAMEEL]
[Show if SRVYR_INCENT=2]
[SRVYR_NAMEC]
Please provide your first and last name, as it should appear on your check.
First name: [SRVYR_NAMECF]
Last name: [SRVYR_NAMECL]
[IF R MOVES FORWARD WITHOUT PROVIDING BOTH A FIRST NAME AND A LAST NAME, DISPLAY A 508-COMPLIANT MESSAGE IN RED TO PROMPT FOR A RESPONSE.]
[Show if SURVEYR=1 (the person selected to complete the survey is the screener participant) and SRVYR_EMAIL contains a valid, confirmed email address]
[SRVYR_DIGINV]
In case you would like to finish the survey (Step 2) and get your [If Phase=1, fill $15; If Phase=2, fill $40] later, would you like us to send you an invitation and link to the survey by email now?
We will send one invitation and may send limited reminders about the survey and getting the [If Phase=1, fill $15; If Phase=2, fill $40].
Yes 1
No 2
[Show if SURVEYR=1 (the person selected to complete the survey is the screener participant)]
[SRVYR_TOSRVY]
Please continue on to the rest of the survey.
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[BEGINNING OF SURVEY]
[LANDING PAGE]
[To reach SURVEY_INTRO1, the respondent will need to login using the code shown in one of the study’s letters or postcards.]
[SURVEY_INTRO1]
Thank you for your interest in participating in this important research study on health and injuries for the Centers for Disease Control and Prevention, the CDC.
If you complete the survey, you will get [If Phase=1, fill $15; If Phase=2, fill $40].
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[SURVEY_INTRO2]
If you exit the survey and want to pick up where you left off, you will need to log back in using two items: the login code provided in the letter or postcard you received plus a password that you will create. For security purposes, only you will know your password and it cannot be recovered.
Please provide a password that you will remember.
Your password must be 6 - 15 characters long
Create a password: ________________ [range 6 to 15 characters]
Repeat your password: ________________ [range 6 to 15 characters]
[If the passwords provided do not match, show in red: “The passwords you provided do not match. Please provide and repeat your password again. It must be 6-15 characters long.”]
[If one of the passwords is missing, show in red: “Password is missing. Please enter a password. It must be 6-15 character long.”]
[If one of the passwords is less than 6 characters long or more than 15 characters long, show in red: “Password is invalid. Please enter a password. It must be 6-15 characters long.”]
[SURVEY_INTRO3]
On each screen, you will be asked about experiences that have happened to you. Click on your answer or type in an answer, and then click the “Next>” button to continue to the next screen. With a few exceptions, you can skip any question you don’t know the answer to or prefer not to answer by leaving the question blank and clicking the “Next>” button.
If you need to review or change an answer, you can click the “<Back” button at the bottom of this screen to go back to an earlier screen. Do not click the backward-facing arrow that shows at the top of your browser.
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[GO TO CF_INTRO1b]
[CF_INTRO1b]
You have been randomly chosen to participate in an important research study conducted by the Centers for Disease Control and Prevention (CDC). Men and women age 18 and older will be asked questions about their health and injuries they may have experienced. Your answers are very important and will be combined with the answers from other people to inform prevention efforts.
The survey will take approximately 15-25 minutes, on average. Since some of the questions are personal, we suggest that you be in a private setting during the survey.
Participation is voluntary, and you can stop or quit the survey at any time. With a few exceptions, you can skip any question. The questions that are required are used to determine which additional questions you will receive. No information that could personally identify you will be given to the CDC or anyone else. Your survey responses will be kept confidential.
If you have questions or concerns about participating in the study, you may call the Survey Helpdesk at [insert toll-free number here]. If you have any questions about your rights as a research participant, please call the RTI Office of Research Protection at 1-866-214-2043.
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[GO TO AGE_SELECTED]
[DEMOGRAPHICS]
[Show to all.]
[AGE_SELECTED]
How old are you?
For this question an answer is required.
Years old: [Display a drop-down or scrolling list showing the set of numbers starting at “less than 18”, extending from 18 through 110, and then ending with “more than 110”]
[If the respondent selects “Next>” without providing an answer, the program will display a 508-compliant error message in red to prompt for a selection to be made.]
[Show to all.]
[AGE_CONF]
We’d like to make sure that we recorded your age correctly.
Are you [fill answer provided in AGE_SELECTED, in bold] years old now?
For this question an answer is required.
Yes 1
No 2
[If the respondent selects “Next>” without providing an answer, the program will display a 508-compliant error message in red to prompt for a selection to be made.]
[If the respondent selects “No”, the program will also display a 508-compliant error message in red to prompt for correction of the age provided in AGE_SELECTED.]
[Set for all.]
[SRVYR_ADULT]
[Do not pause or show this as a screen in the programmed survey, simply set the value of SRVYR_ADULT as follows.]
[AGE_CONF=1 (Yes, confirmed age) and AGE_SELECTED is less than 18, set SRVYR_ADULT=0]
[AGE_CONF=1 (Yes, confirmed age) and AGE_SELECTED is 18 or older, set SRVYR_ADULT=1]
[Show if AGE_CONF =1 (Yes, confirmed age) AND SRVYR_ADULT=0 (No, is not an adult)]
[SRVYR_INEL]
We are only interviewing adults aged 18 or older, so those are all the questions we have for you.
Please give the study’s letters and postcards to an adult in your household and ask them to participate. Thank you for your time.
[If the respondent selects “Next>” at SRVYR_INEL, set SRVYR_INEL=1, exit the survey, clear out previous survey responses and calculated values, but keep screener data and keep the SRVYR_INEL=1 value.]
[Only proceed with the rest of the survey if SRVYR_ADULT=1 (the respondent is an adult)]
[AGE]
[Do not pause or show this as a screen in the programmed survey, simply set the value of AGE as follows.]
[AGE_CONF=1 (Yes) and SRVYR_ADULT=1 (R is an adult), set AGE=AGE_SELECTED]
[RC01]
What sex were you assigned at birth, on your original birth certificate?
[TelMode=1, Fill: ONLY READ ANSWER OPTIONS IF NEEDED.]
[Show the following options only if the survey is being directly accessed by the respondent (TELMODE≠1)]
Male 1
Female 2
Prefer not to answer 3
I don’t know 4
[Show the following options only if the survey is being accessed by an interviewer (TELMODE=1)]
Male 1
Female 2
PREFER NOT TO ANSWER 3
DON’T KNOW 4
[RC02]
Do you currently describe yourself as male, female, or transgender?
Male 1
Female 2
Transgender 3
None of these 4
[SHOW THIS ERROR MESSAGE IF (RC01=3 (prefer not to answer) or RC01=4 (does not know own sex) or RC01 was not answered) OR RC02 was not answered)]
In later sections you will be asked questions using specific language that reference your sexual anatomy. We have to know both your sex and gender identity to direct you to the questions most relevant to you. If you choose not to answer, we will have to end the survey. If you would like to answer the sex and gender questions, click “Answer Questions”. If you would like to end the survey, click “ “End”.
If the respondent clicks on the words "Answer Questions", go back to RC01.
If the respondent clicks on the words "End", go to RC02_END.
[Show if the respondent clicked “End” in the error message for RC02]
[RC02_END]
Thank you very much for your time.
[END SURVEY.]
[RC03]
Which of the following best represents how you think of yourself?
Lesbian or gay 1
Straight, that is, not lesbian or gay 2
Bisexual 3
Something else 4
[Show the following option only if the survey is being directly accessed by the respondent (TELMODE≠1)]
I don’t know the answer 5
[Show the following option only if the survey is being accessed by an interviewer (TELMODE=1)]
You don’t know the answer 6
[RC04]
Are
you of Hispanic or Latino origin?
Yes 1
No 2
[PROGRAMMER NOTE:
CHECK BOXES TO ALLOW R TO SELECT MORE THAN ONE.
PROVIDE A TEXT FIELD THAT TAKES UP TO 40 CHARACTERS FOR ‘OTHER (PLEASE SPECIFY)’ OPTION.] |
[RC05]
What is your race?
You may choose more than one category.
White 1
Black or African American 2
Asian 3
Native Hawaiian or Other Pacific Islander 4
American Indian or Alaska Native 5
Other 6
[Show if RC05=6]
[RC05_OTH] You selected “other” as a race. Please specify the other race you had in mind.
___________ [allow up to 40 characters]
[RC06]
What is the highest level of education you have completed?
No schooling 1
1st-8th grade 2
Some high school 3
High school graduate/GED 4
Technical or vocational school (Attended/graduated) 5
Some college 6
Associates (2-year) degree 7
Bachelor’s (4-year) degree 8
Postgraduate degree (Master’s degree, Doctorate degree, M.D., J.D.) 9
[RC07]
Are you now…?
Married 1
Divorced 2
Separated 3
Widowed 4
Not married but living with a partner 5
Never married 6
[RC08]
What was the total income from ALL household members during [fill previous year], before taxes?
Include income from all sources such as work, investments, child support, and public assistance. If you are a student living separately from your parents, you should NOT include your parents’ income.
Less than $10,000 1
$10,000 to less than $15,000 2
$15,000 to less than $20,000 3
$20,000 to less than $25,000 4
$25,000 to less than $35,000 5
$35,000 to less than $50,000 6
$50,000 to less than $75,000 7
$75,000 or more 8
[GO TO HC_INTRO]
[HEALTH CONDITIONS]
[HC_INTRO]
The following questions are about health conditions that you may have.
[HC01]
Do you have …
frequent headaches?
Yes 1
No 2
[HC02]
Do you have …
chronic pain?
Yes 1
No 2
[HC03]
Do you have …
difficulty sleeping?
Yes 1
No 2
[HC04]
Have you ever been told by a doctor, nurse, or other health professional that you have …
asthma?
Yes 1
No 2
[HC05]
Have you ever been told by a doctor, nurse, or other health professional that you have …
Irritable Bowel Syndrome or IBS?
Yes 1
No 2
[HC06]
Have you ever been told by a doctor, nurse, or other health professional that you have…
diabetes?
Yes 1
No 2
[HC07]
(Have you ever been told by a doctor, nurse, or other health professional that you have…)
high blood pressure?
Yes 1
No 2
[HC08]
(Have you ever been told by a doctor, nurse, or other health professional that you have…)
HIV/AIDS?
Yes 1
No 2
[HC09]
Are you deaf or do you have serious difficulty hearing?
Yes 1
No 2
[HC10]
Are you blind or do you have serious difficulty seeing, even when wearing glasses?
Yes 1
No 2
[HC11]
Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?
Yes 1
No 2
[HC12]
Do you have serious difficulty walking or climbing stairs?
Yes 1
No 2
[HC13]
Do you have difficulty dressing or bathing?
Yes 1
No 2
[HC14]
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?
Yes 1
No 2
[ANX]
How
often do you feel worried, nervous or anxious? Would you say daily,
weekly, monthly, a few
times
a year, or never?
Daily 1
Weekly 2
Monthly 3
A few times a year 4
Never 5
[DEP]
How
often do you feel depressed? Would you say daily, weekly, monthly, a
few times a year, or
never?
Daily 1
Weekly 2
Monthly 3
A few times a year 4
Never 5
[GO TO V_INTRO]
[STALKING]
[V_INTRO]
The next set of questions asks about experiences that can directly impact your health or may have resulted in injury. The questions ask about physical injuries, harassing behaviors, and unwanted sexual activity.
Remember, you don’t have to answer any question that you don’t want to. We suggest that you be in a private setting during the remainder of the survey. If, at any time, you do not feel physically or emotionally safe, you can just quit the survey by closing the browser. You can come back to the survey whenever you want by using your login code and the password you created for yourself earlier.
If at any point, the questions are making you upset and you would like to speak with a trained professional, please click on “Help”.
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[GO TO ST_INTRO]
[ST_INTRO]
First are some detailed questions about times in your life when someone may have repeatedly contacted, followed, or spied on you in ways that made you afraid, concerned for your safety, threatened, or caused emotional suffering.
When answering, please think about anyone who may have done these things to you at any time in your life including strangers, a romantic or sexual partner, family member, friend, teacher, co-worker or supervisor, neighbor, or someone you have known briefly.
Please DO NOT include bill collectors, telephone solicitors, other sales people, or others following or contacting you as part of their job.
[After the participant clicks the “Next>” button, record “1” in the data and advance to the next question]
[ST01]
Please think about whether anyone ever followed, contacted, tracked, or spied on you in a way that was intentional, unwanted, and made you feel afraid, concerned for your safety, threatened, or caused emotional suffering.
Specifically, in your lifetime, has anyone ever done any of the following things to you?
Select all that apply.
Please include times when you knew or you thought someone was doing any of these things.
[PROGRAMMING: SHOW THE LIST OF STALKING TACTICS ON ONE SCREEN]
Followed you around, watched or spied on your when you did not want them to. [1]
Approached you or showed up in places such as your home, work, or school when you did not want them to. [2]
Sneaked onto your property such as your home or car, and do things to scare you by letting you know they had been there. [3]
Sent you cards, letters, flowers, or presents when they knew you didn’t want them to. [4]
Repeatedly made unwanted phone calls to you or sent you unwanted emails, voice, or text messages. Please do not include spam, robocalls, bill collectors or telephone solicitors. [5]
Repeatedly sent you unwanted messages through social media, such as Facebook, Instagram, and chat rooms. [6]
Watched or spied on you with a hidden camera. [7]
Used social media to monitor or track you, your communication, or your location without your permission. Examples of social media include Facebook, Twitter, Instagram, TikTok, and SnapChat. [8]
Used location technology, such as a GPS (Global Positioning System) device, app, or other electronic tracking system to track your location without your permission. This includes GPS used in a phone. [9]
Used technology, such as computer software, apps, or stalkerware to monitor your communication or activities without your permission. [10]
None of the above. [11]
[ If any option other than 11 (“None of the above”) is selected for ST01, GO TO ST02; ELSE GO TO SH_INTRO]
[Show if any option other than 11 (“None of the above”) is selected for ST01.]
[ST02]
In total, how many DIFFERENT PEOPLE did any of these things to you on more than one occasion?
Number of people______________
[IF ST02 ≥ 1, THEN GO TO ST_R1]
[IF ST02 = 0, THEN GO TO SH_INTRO]
[STALKING: PERSON 1/2/3/4/5]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Contacted, followed, or spied: Person 1) ON THE SAME SCREEN] |
[PROGRAMMING NOTE: THIS SECTION IS TO FOLLOW UP ON PERPETRATORS TO ASSESS STALKING VICTIMIZATION. MAX NUMBER OF PERPETRATORS TO FOLLOW IS 5]
[ST_R1]
[When looping through this section to ask about the 2nd or later perpetrator, show: Thank you for your participation. Your responses are very important to this study.]
We would like to learn more about your experience. You said [FILL: NUMBER FROM ST02] people did one or more of the following, on more than one occasion:
[fill items selected at ST01 as a bulleted list]
Think about the [1st / 2nd / 3rd / 4th / 5th] person who did any of those things to you on more than one occasion.
Was this person male or female?
Male 1
Female 2
Transgender 3
None of these 4
[ST_R2]
Please choose a category that best describes how you knew them at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if ST_R2=12]
[ST_R2_OTH]
You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[ST_R3]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A] |
[ST03]
Please continue to think about the [1st / 2nd / 3rd / 4th / 5th] person who contacted, followed, or spied on you on more than one occasion.
Please include times when you knew or you thought the person was doing any of these things.
Did this [FILL: RELATIONSHIP TYPE FROM ST_R3]….
|
1 |
2 |
1. follow you around, watch, or spy on you when you did not want them to? |
Yes |
No |
2. approach you or show up in places, such as your home, work, or school when you did not want them to? |
Yes |
No |
3. sneak onto your property, such as your home or car, and do things to scare you by letting you know they had been there? |
Yes |
No |
4. send you cards, letters, flowers, or presents when they knew you didn’t want them to? |
Yes |
No |
5. repeatedly make unwanted phone calls to you or send you unwanted emails, voice, or text messages? Please do not include spam, robocalls, bill collectors or telephone solicitors. |
Yes |
No |
6. repeatedly send you unwanted messages through social media, such as Facebook, Instagram, and chat rooms? |
Yes |
No |
7. watch or spy on you with a hidden camera? |
Yes |
No |
8. use social media to monitor or track you, your communication, or your location without your permission? Examples of social media include Facebook, Twitter, Instagram, TikTok, SnapChat. We are talking about times when you knew or you thought someone was using social media to monitor you. |
Yes |
No |
9. use location technology such as GPS(Global Positioning System) device, app, or other electronic tracking system to track your location without your permission? This includes GPS used in a phone. We are talking about times when you knew or you thought someone was using GPS or other location technology to track you. |
Yes |
No |
10. use technology, such as computer software, apps, or stalkerware to monitor your communication or activities without your permission? (We are talking about times when you knew or you thought someone was using technology to monitor you.) |
Yes |
No |
[If needed in the programmed instrument, the ST03 grid may be split into multiple screens with the stem question repeated at the start of each segment. Alternatively, if only scrolling will be used, the stem question may be repeated periodically through the list.]
[PROGRAMMING NOTE: IF RESPONDENT ANSWERS YES TO ANY OF THE TACTICS (ST03_1-10), THEN THEY WILL ANSWER THE STALKING CRITERIA QUESTIONS (ST04)]
[IF ST02 ≥ 1 AND (ST03_01 = YES OR ST03_2 = YES OR ST03_3 =YES OR ST03_4 = YES OR ST03_5 = YES OR ST03_6 = YES OR ST03_7 = YES OR ST03_8 = YES OR ST03_9 = YES OR ST03_10 = YES), GO TO ST04_1]
[IF ST02 ≥ 1 AND ST03_01 = NO AND ST03_2 = NO AND ST03_3 = NO AND ST03_4 = NO AND ST03_5 = NO AND ST03_6 = NO AND ST03_7 = NO AND ST03_8 = NO AND ST03_9 = NO AND ST03_10 = NO, CODE NO FOR STALKING VICTIMIZATION AND GO TO NEXT PERP, OR IF NO OTHERS, GO TO SH_INTRO]
[ST04]When this [FILL: RELATIONSHIP TYPE FROM ST_R3] did [this/these things] to you…
|
1 |
2 |
1. Did you feel afraid, threatened, or concerned for your safety or the safety of others? |
Yes |
No |
2. Did they make threats to physically harm you (even if you did not take the threat seriously)? |
Yes |
No |
3. Did you ever experience mental or emotional harm (for example, anxiety or depression) after [this/any of these things] happened to you? |
Yes |
No |
[PROGRAMMING NOTE: IF THE RESPONDENT ANSWERS YES TO BEING AFRAID (ST04_1) OR RECEIVING THREATS (ST04_2), THEN THEY ARE CODED AS A STALKING VICTIM FOR THAT PERPETRATOR; OTHERWISE, THEY ARE MARKED AS NO TO STALKING VICTIM FOR THAT PERPETRATOR]
[NOTE: ST03_13 IS A STALKING IMPACT; IT IS NOT PART OF THE CRITERIA FOR STALKING VICTIMIZATION; OK TO ASK EVEN IF ST03_1-2 = NO]
[FOR EACH PERPETRATOR: IF ST02 ≥ 1 AND (ST03_01 = YES OR ST03_2 = YES OR ST03_3 =YES OR ST03_4 = YES OR ST03_5 = YES OR ST03_6 = YES OR ST03_7 = YES OR ST03_8 = YES OR ST03_9 = YES OR ST03_10 = YES), THEN CODE YES AS STALKING VICTIM AND GO TO ST05; ELSE GO TO NEXT PERP, OR IF NO OTHERS GO TO SH_INTRO]
[ST05]
How old were you the first time this [FILL: RELATIONSHIP TYPE FROM ST_R3] did any of these things to you?
Age in years_________
[ST06]
Did this [FILL: RELATIONSHIP TYPE FROM ST_R3] do [this/any of these things] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF ST06 = NO, THEN GO TO NEXT PERP, OR IF NO OTHERS, GO TO SH_INTRO]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK ST_R1_12 – ST_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP ST_R1-12 AND FILL ST_R2_12 AND ST_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (e.g., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF ST_R3 = NON-INTIMATE PARTNER THEN SKIP ST_R1_12 AND FILL ST_R2_12 = ST_R2 AND FILL ST_R3_12 = ST_R3]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Contacted, followed, or spied: Person 1) ON THE SAME SCREEN] |
[ST_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM ST_R3] when they did [this/these things] in the past 12 months?
Yes 1
No 2
[IF ST_R1_12 = YES, THEN ST_R1_12 = RESPONSE FROM ST_R3; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO SH_INTRO]
[IF ST_R1_12 = NO, GO TO ST_R2_12]
[ST_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[ST_R3_12]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[REPEAT ST03 – ST_R3_12 FOR ADDITIONAL PERPS; IF NO OTHER PERPS, GO TO SH_INTRO]
[SEXUAL HARASSMENT, UNWANTED TOUCHING]
[SH_INTRO]
Next are some detailed questions about times in your life when you may have ever experienced unwanted sexual situations with anyone, including strangers or someone you knew such as a romantic or sexual partner, a family member, a friend, teacher, co-worker or supervisor, or someone you have known for only a short time. These questions are detailed and the language is explicit, which some people may find upsetting. It is important that the questions are asked this way so that you understand what we mean. Your answers will help us learn how often these things happen. You can skip questions you don’t want to answer and you can stop at any time.
The first questions are about unwanted sexual situations, including verbal harassment and unwanted touching.
To begin, think about unwanted sexual situations that might have happened to you at your place of work.
[SH01]
In your lifetime, has anyone from your WORKPLACE ever made unwanted sexual remarks or sexual jokes in your presence, or sexually offensive comments about your body or appearance? Please include people you work with or come into contact with through your job. This may have happened at work, or elsewhere with people connected to your workplace.
Yes 1
No 2
[IF SH01 = YES, THEN GO TO SH02]
[IF SH01 = NO, THEN GO TO SH03]
[SH02]
Has anyone from your WORKPLACE done this to you in the past 12 months? That is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
Now, think about unwanted sexual situations you might have experienced in a public place.
[SH03]
While you were in a PUBLIC place, has anyone ever verbally harassed you in a sexual way that made you feel uncomfortable?
Yes 1
No 2
[IF SH03=YES, THEN GO TO SH04]
[IF SH03 = NO, THEN GO TO TF_INTRO]
[SH04]
Has anyone done this to you in the past 12 months? That is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[GO TO TF_INTRO]
[TF_INTRO]
The next questions are about unwanted sexual situations that might have happened to you while using the internet, social media, text messages, or emails:
[TF01]
In your lifetime, has anyone ever sent you an unwanted sexually explicit message or image through the internet, social media, email, or text message without your consent?
Please do not include spam messages, phishing attempts, or messages that you think are from a Bot, that is, a computer program that imitates a human.
Examples of social media include Facebook, Twitter, Instagram, TikTok, SnapChat.
Yes 1
No 2
[IF TF01 = NO, THEN GO TO TF03]
[TF02]
Did this happen to you in the past 12 months? That is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[TF03]
To your knowledge, has anyone ever emailed, texted, or electronically posted a revealing or sexual photo or video of you without your consent?
Yes 1
No 2
[IF TF03 = NO, THEN GO TO UC_INTRO]
[TF04]
Did this happen to you in the past 12 months? That is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[GO TO UC_INTRO]
[UNWANTED SEXUAL CONTACT, NON-PENETRATIVE]
[UC_INTRO]
Thank you for your participation so far.
The next questions are about times when someone may have kissed or touched you in a sexual way when you did not want them to.
[UC01]
Has anyone ever kissed you in a sexual way when you did not want them to?
Yes 1
No 2
[UC02]
Has anyone ever…
fondled, groped, grabbed, or touched you in a sexual way when you did not want them to?
Yes 1
No 2
[GO TO UC_CHECK]
[UC_CHECK]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT ENDORSED ANY UNWANTED SEXUAL CONTACT; IF SO, THEN THEY GO TO PERP FOLLOW-UP; IF NOT, THEN THEY GO TO NEXT SECTION (SEXUAL COERCION)]
[IF UC01 = YES OR UC02 = YES, GO TO UC_REVIEW]
[IF UC01=NO AND UC02=NO, THEN GO TO SC_INTRO]
[UC_REVIEW]
You just answered that…
[IF UC05=YES, fill: Someone kissed you in a sexual way when you did not want them to.]
[IF UC06=YES, fill: Someone fondled, groped, grabbed, or touched you in a sexual way when you did not want them to.]
In total, how many DIFFERENT people did any of [this/these things] to you?
Number of people __________
[UNWANTED TOUCHING OR KISSING: PERSON 1/2/3/4/5]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Unwanted touching or kissing: Person 1) ON THE SAME SCREEN] |
[IF UC_REVIEW ≥ 1, ASK UC_R1]
[When looping through this section to ask about the 2nd or later perpetrator, show: Thank you for your participation. Your responses are very important to this study.]
Think about the [1st / 2nd / 3rd / 4th / 5th] person EVER did any of the following to you…
[SHOW ENDORSED BEHAVIORS ON SCREEN:
IF UC01 = YES: someone kissed you in a sexual way when you did not want them to.
IF UC02 = YES: someone fondled, groped, grabbed, or touched you in a sexual way when you did not want them to]
[UC_R1]
Was the person…?
Male 1
Female 2
Transgender 3
None of these 4
[UC_R2]
Please choose a category that best describes how you knew them at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if UC_R2=12]
[UC_R2_OTH] You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[UC_R3]
Specifically, was this person…?
[PROGRAMMER NOTE:
SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.]
|
[UC03]
How old were you the first time [FILL: RELATIONSHIP TYPE FROM UC_R3] touched or kissed you when you didn’t want them to?
Age in years __________
[UC04]
Did this [FILL: RELATIONSHIP TYPE FROM UC_R3] do [this/any of these things] to you in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
[SHOW ON SCREEN:]
[IF UC05=YES:] someone kissed you in a sexual way when you did not want them to.
[IF UC06=YES:] someone fondled, groped, grabbed, or touched you in a sexual way when you did not want them to]
Yes 1
No 2
[IF UC04 = YES, GO TO UC_R1_12]
[IF UC04 = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN GO TO SC_INTRO]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK UC_R1_12 – UC_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP UC_R1-12 AND FILL UC_R2_12 AND UC_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF UC_R3 = NON-INTIMATE PARTNER THEN SKIP UC_R1_12 AND FILL UC_R2_12 = UC_R2 AND FILL UC_R3_12 = ST_R3]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Unwanted touching or kissing: Person 1) ON THE SAME SCREEN] |
[UC_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM UC_R3] when they did [this/these things] in the past 12 months?
Yes 1
No 2
[IF UC_R1_12 = YES, THEN UC_R1_12 = RESPONSE FROM UC_R3; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO SC_INTRO]
[IF UC_R1_12 = NO, GO TO UC_R2_12]
[UC_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[UC_R3_12]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[REPEAT FOR ADDITIONAL PERPS; ELSE GO TO SC_INTRO]
[SEXUAL COERCION]
[SC_INTRO]
Sometimes unwanted sex happens after a person is pressured into it, such as through verbal and emotional pressure and other nonphysical kinds of pressure. The following questions are about times in your life when someone may have ever used verbal or other nonphysical pressure to make you have sex when you didn’t want to. This could be anyone, including strangers or someone you knew such as a romantic or sexual partner, a family member, a friend, teacher, co-worker or supervisor, or someone you have known for only a short time.
Have you had vaginal, oral, or anal sex with someone after they pressured you by doing any of the following….?
[SC01]
Telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you?
Yes 1
No 2
[SC02]
Wearing you down by repeatedly asking for sex, or showing they were unhappy?
Yes 1
No 2
[SC03]
Using their influence or authority over you, for example, your boss or your teacher?
Yes 1
No 2
[SC_CHECK1]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT ENDORSED ANY UNWANTED SEXUAL CONTACT; IF SO, THEN THEY GO TO PERP FOLLOW-UP; IF NOT, THEN THEY GO TO ATTENTION CHECK]
[IF SC01 = YES OR SC02 = YES OR SC03 = YES, THEN GO TO SC_REVIEW]
[IF SC01 = NO AND SC02 = NO AND SC03 = NO, THEN GO TO SAT1]
[SC_REVIEW]
You just answered that you have had vaginal, oral, or anal sex with someone after they pressured you…
[IF SC01 = YES, FILL: by telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you].
[IF SC02 = YES, FILL: by wearing you down by repeatedly asking for sex, or showing they were unhappy].
[IF SC03 = YES, FILL: by using their influence or authority over you].
In total, how many DIFFERENT people did any of these things to you?
Number of people __________
[COERCED SEX: PERSON 1/2/3/4/5]
[IF SC_REVIEW ≥ 1, GO TO SC_R1]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Unwanted sex you were pressured into: Person 1) ON THE SAME SCREEN WITH SC_R1.] |
[When looping through this section to ask about the 2nd or later perpetrator, show: Thank you for your participation. Your responses are very important to this study.]
Think about the [1st / 2nd / 3rd / 4th / 5th] person who EVER pressured you into having vaginal, oral, or anal sex with them by…
[SHOW ENDORSED BEHAVIORS]
[IF SC01 = YES: telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you]
or
[IF SC02 = YES: wearing you down by repeatedly asking for sex, or showing they were unhappy]
or
[IF SC03 = YES: using their influence or authority over you]
[SC_R1]
Was this person…?
Male 1
Female 2
Transgender 3
None of these 4
[SC_R2]
Please continue to think about the [1st / 2nd / 3rd / 4th / 5th] person who EVER pressured you into having vaginal, oral, or anal sex with them by…
[SHOW ENDORSED BEHAVIORS]
[IF SC01 = YES: telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you]
or
[IF SC02 = YES: wearing you down by repeatedly asking for sex, or showing they were unhappy]
or
[IF SC03 = YES: using their influence or authority over you]
Please choose a category that best describes how you knew them at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if SC_R2=12]
[SC_R2_OTH]
You selected “someone else.” Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[SC_R3]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[SC04]
How old were you the first time [FILL: RELATIONSHIP TYPE FROM SC_R3] did any of these things to you?
Age in years __________
[SC05]
Did this [FILL: RELATIONSHIP TYPE FROM SC_R3] do [this/any of these things] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Pressured you into having vaginal, oral, or anal sex with them by…
[SHOW ENDORSED BEHAVIORS]
[IF SC01 = YES: telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you]
or
[IF SC02 = YES: wearing you down by repeatedly asking for sex, or showing they were unhappy]
or
[IF SC03 = YES: using their influence or authority over you]
Yes 1
No 2
[IF SC05 = YES, GO TO SC_R1_12]
[IF SC05 = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN TO SC_CHECK (IMPACT)]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK SC_R1_12 – SC_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP SC_R1-12 AND FILL SC_R2_12 AND SC_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF SC_R3 = NON-INTIMATE PARTNER THEN SKIP SC_R1_12 AND FILL SC_R2_12 = SC_R2 AND FILL SC_R3_12 = SC_R3]
[PROGRAMMER NOTE: SHOW BURN LINE (Unwanted sex you were pressured into: Person 1).] |
[SC_R1_12]
Was this person [Fill the appropriate word: your/a/an] [FILL: RELATIONSHIP TYPE FROM SC_R3] when they did [Fill the appropriate word: this/these things] in the past 12 months?
Yes 1
No 2
[IF SC_R1_12 = YES, THEN SC_R1_12 = RESPONSE FROM SC_R3; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO SC_CHECK]
[IF SC_R1_12 = NO, GO TO SC_R2_12]
[SC_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[SC_R3_12]
Specifically, was this person…?
[PROGRAMMER NOTE:
SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.]
|
[GO TO SC_CHECK2]
[IMPACT FROM SEXUAL COERCION]
[SC_CHECK2]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT ENDORSED ANY UNWANTED SEXUAL CONTACT; IF SO, THEN THEY GO TO IMPACT QUESTIONS; IF NOT, THEN THEY GO TO ATTENTION CHECK. IMPACT QUESTIONS ARE ASKED AS A GROUP, NOT BY INDIVIDUAL PERPETRATORS]
[IF SC01 = YES OR SC02 = YES OR SC03 = YES, THEN GO TO SC_IMP]
[IF SC01 = NO AND SC02 = NO AND SC03 = NO, THEN GO TO SAT1]
[SC_IMP]
Next are a few follow-up questions.
You said that [a/an/your…] [fill relationships from SC_R3_12, one for each perpetrator] pressured you into having vaginal, oral, or anal sex with them by…
[SHOW ENDORSED BEHAVIORS]
[IF SC01 = YES: telling you lies, making promises about the future they knew were untrue, threatening to end your relationship, or threatening to spread rumors about you]
[IF SC02 = YES: wearing you down by repeatedly asking for sex, or showing they were unhappy]
[IF SC03 = YES: using their influence or authority over you]
Thinking about these experiences in your life…
[SC06]
Did you EVER get a sexually transmitted disease or other infection when [FILL: “this” / “any of these things”] happened? For example, did you get chlamydia, gonorrhea, HIV, or some other STD?
Yes 1
No 2
[PROGRAM NOTE: ONLY BIOLOGICAL FEMALES (SEX AT BIRTH = FEMALE) WILL ANSWER SC07 (ABOUT PREGNANCY)]
[IF RC01 = FEMALE, ASK SC07. ELSE GO TO SAT1]
[SC07]
Did you EVER get pregnant when [FILL: “this” / “any of these things”] happened?
Yes 1
No 2
[NOTE: THIS QUESTION IS TO CHECK TO SEE IF THE RESPONDENT IS PAYING ATTENTION]
[Skip this question if this session of the survey was accessed from CATI-CMS (TelMode=1), otherwise show it.]
[SAT1]
Paying attention and reading the instructions carefully is critical. If you are paying attention, please choose Silver below. [RANDOMIZE ORDER OF RESPONSES]
Red 1
Yellow 2
Blue 3
Green 4
Silver 5
Orange 6
[SAT1_ORDER] [After an option is selected in SAT1, record the order of options shown at the time the selection was made.]
[GO TO SV_INTRO1]
[COMPLETED RAPE AND MADE TO PENETRATE]
[SV_INTRO1]
This next section is about sexual contact that you did not consent to and that you did not want to happen.
Some people are threatened with harm or physically forced to have sex or sexual contact when they don’t want to. Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no. To be clear, the next questions are asking only about times in your life when sex was unwanted and you did not give consent.
Sometimes unwanted sex or sexual contact happens when a person is unable to consent to it or stop it from happening because they are too drunk, high, drugged, or passed out from alcohol, drugs, or medications. This can include times when they voluntarily consumed alcohol or drugs or times when they were given alcohol or drugs without their knowledge or consent.
These questions ask about unwanted sexual contact that might have occurred through physical force or when you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs.
You might or might not have ever been in this type of situation. Please remember that even if someone uses alcohol or drugs, what happens to them is not their fault. These questions use detailed and explicit language so that everyone is clear about what the questions are asking.
[PROGRAM NOTE: THIS INSTRUCTION SENDS RESPONDENTS TO THE MALE OR FEMALE QUESTIONS FOR RAPE AND MADE TO PENETRATE. IF BIRTH SEX AND GENDER IDENTITY MATCH THEN THEY GO TO THE CORRESPONDING SECTION (FEMALE OR MALE). IF BIRTH SEX AND GENDER IDENTITY DO NOT MATCH OR IF THEY SELECT TRANSGENDER FOR GENDER IDENTITY THEN THEY ARE ASKED TO SELECT THE SET OF QUESTIONS TO ANSWER (FEMALE OR MALE)]
[IF RC01 = 1 (MALE) AND RC02 = 1 (MALE), GO TO SV_M; IF RC01 = 2 (FEMALE) AND RC02 = 2 (FEMALE), GO TO SV_W]
[IF RC01 = 1 AND RC02 = 2, THEN GO TO Q_SELECT]
[IF RC01 = 2 AND RC02 = 1, THEN GO TO Q_SELECT]
[IF RC01 = 3 OR RC01 = 4, THEN GO TO Q_SELECT]
[IF RC02 = 3 (TRANSGENDER) OR RC02 = 4 (NONE OF THESE) GO TO Q_SELECT]
[QSELECT]
In this section you will be asked questions using specific language about victimization experiences related to one’s sexual anatomy. We have two sets of questions based on sex assigned at birth. In “male” set of questions, it is assumed that you have a penis. In the “female” set of questions, it is assumed that you have a vagina. We would like to give you the option to decide which set of questions best represents your experience. Would you prefer to answer the female or male set of questions?
Male set of questions (go to SV_M) 1
Female set of questions (go to SV_W) 2
[IF QSELECT = 1, GO TO SV_M; IF QSELECT = 2, GO TO SV_W]
[COMPLETED RAPE - WOMEN’S VERSION]
[SV_W] [Questions specifically for females start here.]
[SV_INTRO2]
In this section we are going ask about unwanted sex that actually occurred through physical force or during the use of alcohol or drugs when you were unable to consent. In a later section we will ask about times someone TRIED to have sex with you but sex did NOT happen.
In this section, please only include times when unwanted sex actually happened.
[SV01]
In your LIFETIME, has anyone EVER performed oral sex on you when you did NOT consent to it, and it was not wanted? By oral sex, we mean that someone put their mouth on your vagina.
Yes 1
No, this never happened to me 2
[IF SV01 = YES, GO TO SV01_a-b; ELSE SKIP TO SV02]
[SV01a]
Did this oral sex happen because the person used physical force or threats of physical harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Yes 1
No 2
[SV01b]
Did this oral sex happen because you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Yes 1
No 2
[SV02]
In your LIFETIME, has anyone EVER penetrated you by putting their fingers or an object in your vagina or anus when you did NOT consent to it, and it was not wanted?
Yes 1
No 2
[IF SV02 = YES, GO TO SV02_a-b; ELSE SKIP TO SV03]
[SV02a]
Did this unwanted penetration by fingers or an object happen because the person used physical force or threats of physical harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Yes 1
No 2
[SV02b]
Did this unwanted penetration by fingers or an object happen because you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Yes 1
No 2
[SV03]
In your LIFETIME, has anyone EVER have vaginal sex with you when you did NOT consent to it, and it was not wanted? By vaginal sex, we mean that someone put their penis in your vagina.
Yes 1
No, this never happened to me 2
[IF SV03 = YES, GO TO SV03_a-b; ELSE SKIP TO SV04]
[SV03a]
Did this vaginal sex happen because the person used physical force or threats of physical harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Yes 1
No 2
[SV03b]
Did this vaginal sex happen because you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Yes 1
No 2
[SV04]
In your LIFETIME, has anyone EVER penetrate you by putting their penis in your mouth or anus when you did NOT consent to it, and it was not wanted?
Yes 1
No, this never happened to me 2
[IF SV04 = YES, GO TO SV04_a-b]
[IF SV01 = NO AND SV02 = NO AND SV03 = NO AND SV04 = NO, GO TO FA_INTRO; ELSE GO TO PF_RAPE_CHECK ]
[SV04a]
Did this penetration of your mouth or anus happen because the person used physical force or threats of physical harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Yes 1
No 2
[SV04b]
Did this penetration of your mouth or anus happen because you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Yes 1
No 2
[GO TO PF_RAPE_CHECK]
[PHYSICALLY FORCED RAPE FOLLOW-UP]
[PF_RAPE_CHECK]
[CODING NOTE FOR WOMEN ONLY: SV01 = RAPE; SV02 = RAPE; SV03 = RAPE; SV04 = RAPE]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY PHYSICALLY FORCED RAPE; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO AD RAPE CHECK]
[IF (ANY PHYSICALLY FORCED RAPE IS ENDORSED) SV01a = YES OR SV02a = YES OR SV03a = YES OR SV04a = YES, THEN GO TO PF_RAPE_REVIEW]
[IF (ALL PHYSICALLY FORCED RAPE IS NO) SV01a = NO AND SV02a = NO AND SV03a = NO AND SV04a = NO, THEN GO TO AD_RAPE_CHECK]
[PF_RAPE_REVIEW]
You said that someone
[IF SV01 = YES, FILL: performed oral sex on you]
[IF SV02 = YES, FILL: penetrated you by putting their fingers or an object in your vagina or anus]
[IF SV03 = YES, FILL: had vaginal sex with you]
[IF SV04 = YES, FILL: penetrated you by putting their penis in your mouth or anus]
when you did NOT consent to it, and it was not wanted and they used physical force or threats of harm.
How many people in total, did these [this/any of these things] to you by using physical force or threats of harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Number of people: _____
[PROGRAM: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN PF_RAPE_REVIEW]
[IF PF_RAPE_REVIEW ≥ 1, GO TO PF_R1]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[FORCED RAPE: PERSON 1/2/3/4/5]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Penetrative sex by force: Person 1) ON THE SAME SCREEN] |
[PF_R1]
We would like to learn more about your experiences. Think about the [1st / 2nd / 3rd / 4th / 5th] person who did [this/any of these things] to you by using physical force or threats of harm, such as pinning or holding you down, using violence, or not stopping after you said no.
Was this person…
Male 1
Female 2
Transgender 3
None of these 4
[PF_R2]
Please choose a category that best describes how you knew them at the time that it happened.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if PF_R2=12]
[PF_R2_OTH] You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[PF_R3]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[PF04]
How old were you the FIRST TIME this [FILL: RELATIONSHIP NAMED IN PF_R3] did this to you?
Age in years_______
[PF05]
Did this [PERP 1: FILL RELATIONSHIP NAMED IN PF_R3] do [this/any of these things] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF PF05 = YES, THEN GO TO PF_R1_12]
[IF PF05 = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN GO TO AD_RAPE_CHECK]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK PF_R1_12 – PF_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP PF_R1-12 AND FILL PF_R2_12 AND PF_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF PF_R3 = NON-INTIMATE PARTNER THEN SKIP PF_R1_12 AND FILL PF_R2_12 = PF_R2 AND FILL PF_R3_12 = PF_R3]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Penetrative sex by force: Person 1) ON THE SAME SCREEN] |
[PF_R1_12]
Was this person [your/a/an] [PERP 1: FILL RELATIONSHIP CATEGORY NAMED IN PF_R3] when they did [this/these things] in the past 12 months?
Yes 1
No 2
[IF PF_R1_12 = YES, THEN PF_R1_12 = RESPONSE FROM PF_R3; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO AD_RAPE_CHECK]
[IF PF_R1_12 = NO, GO TO PF_R2_12]
[PF_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[PF_R3_12]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[REPEAT FOR EACH PHYSICALLY FORCED PERP (MAX = 5). THEN GO TO AD_RAPE_CHECK]
[ALCOHOL/DRUG-FACILITATED RAPE FOLLOW-UP]
[AD_RAPE_CHECK]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY A/D RAPE; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO ATTEMPTED RAPE SECTION]
[IF (ANY A/D RAPE IS ENDORSED) SV01b = YES OR SV02b = YES OR SV03b = YES OR SV04b = YES, THEN GO TO AD_RAPE_REVIEW]
[IF (ALL A/D RAPE IS NO) SV01b = NO AND SV02b = NO AND SV03b = NO AND SV04b = NO THEN GO TO FA_INTRO]
[AD_RAPE_REVIEW]
You said that someone
[IF SV01 = YES, FILL: performed oral sex on you]
[IF SV02 = YES, FILL: penetrated you by putting their fingers or an object in your vagina or anus]
[IF SV03 = YES, FILL: had vaginal sex with you]
[IF SV04 = YES, FILL: penetrated you by putting their penis in your mouth or anus]
when you did NOT consent, it was not wanted and you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs.
How many people in total, did [this/any of these things] to you when it was not wanted and you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Number of people: _____
[PROGRAM NOTE: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN AD_RAPE_REVIEW]
[IF AD_RAPE_REVIEW ≥ 1, GO TO AD_R1]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[A/D RAPE: PERSON 1/2/3/4/5]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Penetrative sex while drunk, high, drugged, or passed out: Person 1).] |
We would like to learn more about your experiences. Think about the [1st / 2nd / 3rd / 4th / 5th] person who did [this/any of these things] to you when it was not wanted and you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs.
[AD_R1]
Was this person…
Male 1
Female 2
Transgender 3
None of these 4
[AD_R2]
Please choose a category that best describes how you knew them at the time that it happened.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if AD_R2=12]
[AD_R2_OTH]
You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[AD_R3]
Specifically, was this person…?
[PROGRAMMER NOTE:
SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.]
|
[AD04]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM AD_R3] did this to you?
Age in years_______
[AD_GA]
When this happened with [FILL: RELATIONSHIP TYPE FROM AD_R3], do you think that you were ever given alcohol without your knowledge?
Yes 1
No 2
[AD_GD]
When this happened with [FILL: RELATIONSHIP TYPE FROM AD_R3], do you think that you were ever given other drugs without your knowledge?
Yes 1
No 2
[AD04]
Did this [FILL: RELATIONSHIP TYPE FROM AD_R3] do [this/any of these things] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF AD05 = YES, THEN GO TO AD_R1_12]
[IF AD05 = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN GO TO FA_INTRO]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK AD_R1_12 – AD_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP AD_R1-12 AND FILL AD_R2_12 AND AD_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF AD_R3 = NON-INTIMATE PARTNER THEN SKIP AD_R1_12 AND FILL AD_R2_12 = AD_R2 AND FILL AD_R3_12 = AD_R3]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Penetrative sex while drunk, high, drugged, or passed out: Person 1).] |
[AD_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM AD_R3] when [this/these things] happened in the past 12 months?
Yes 1
No 2
[IF AD_R1_12 = YES, THEN AD_R1_12 = RESPONSE FROM AD_R3; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO FA_INTRO]
[IF AD_R1_12 = NO, GO TO AD_R2_12]
[AD_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[AD_R3_12]
Specifically, was this person…?
[PROGRAMMER NOTE:
SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY]
|
[REPEAT FOR EACH A/D RAPE PERP. IF NO OTHERS, THEN GO TO FA_INTRO]
[ATTEMPTED PHYSICALLY FORCED RAPE - WOMEN’S VERSION]
[FA_INTRO]
The next set of questions are about times in your life when someone ever ATTEMPTED to have sex or sexual contact with you by using physical force or threats of harm but sex did NOT happen. Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no. To be clear, we are now asking only about times when sex was unwanted and you did not give consent, and sex was attempted but did not happen.
[FA01]
In your LIFETIME, has anyone EVER used physical force or threats of physical harm to TRY to put their penis in your vagina, mouth, or anus, but it did not happen?
Yes 1
No 2
[FA_RAPE_CHECK]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY ATTEMPTED RAPE; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO IMPACT CHECK (OT_CHECK)]
[IF FA01 = YES, GO TO FA_RAPE_REVIEW]
[IF FA01 = NO, GO TO OT_CHECK]
[FA_RAPE_REVIEW]
You said that someone used physical force or threats of physical harm to TRY to put their penis in your vagina, mouth, or anus, but it did not happen. Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no.
How many people in total, did this to you?
Number of people: _____
[PROGRAM NOTE: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN FA_RAPE_REVIEW]
[IF FA_RAPE_REVIEW ≥ 1, GO TO FA_R1]
[PROGRAM: DISPLAY THE BEHAVIOR THAT WAS ENDORSED (FA01) TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[ATTEMPTED RAPE: PERSON 1/2/3/4/5]
[PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex by Force: Person 1)]. |
[FA_R1]
[When looping through this section to ask about the 2nd or later perpetrator, show: Thank you for your participation. Your responses are very important to this study.]
Think about the [1st / 2nd / 3rd / 4th / 5th] person who did this to you.
Was this person…
[If TEMODE=1, fill in blue: Only read the grayed-out option if needed.]
Male 1
Female 2 [PROGRAMMER: GRAY OUT THIS OPTION]
Transgender 3
None of these 4
[FA_R2]
Please choose a category that best describes how you knew this person at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually
(other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if FA_R2=12]
[FA_R2_OTH]
You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[FA_R3]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A. |
[FA02]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM FA_R3] did this to you?
Age in years_______
[FA03]
Did this [FILL: RELATIONSHIP TYPE FROM FA_R3] do this to you in the past 12 months, that is, since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF FA03 = YES, THEN GO TO FA_R1_12]
[IF FA03 = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN GO TO OT_CHECK]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK FA_R1_12 – FA_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP FA_R1-12 AND FILL FA_R2_12 AND FA_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF FA_R3 = NON-INTIMATE PARTNER THEN SKIP FA_R1_12 AND FILL FA_R2_12 = FA_R2 AND FILL FA_R3_12 = FA_R3]
[PROGRAMMER NOTE: SHOW BURN LINE (Attempted Unwanted Sex by Force: Person 1)]. |
[FA_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM FA_R3] when they did this in the past 12 months?
Yes 1
No 2
[IF FA_R1_12 = YES, THEN FA_R1_12 = RESPONSE FROM FA_R3; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO OT_CHECK]
[IF FA_R1_12 = NO, GO TO FA_R2_12]
[FA_R2_12]
How did you know this person when they did this to you in the past 12 months?
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually
(other than an
ex-spouse) 4
[FA_R3_12]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[REPEAT FOR EACH PERPETRATOR; THEN GO TO OT_CHECK]
[COMPLETED RAPE & MADE TO PENETRATE: MEN’S VERSION]
[SV_INTRO2] [Questions specifically for males start here.]
In this section we are going to ask about unwanted sex that actually occurred through physical force or during the use of alcohol or drugs. In a later section we will ask about times someone TRIED to have sex with you but sex did NOT happen.
In this section, please only include times when unwanted sex actually happened.
[SV01]
In your LIFETIME, has anyone EVER performed oral sex on you when you did NOT consent to it, and it was not wanted? By perform oral sex, we mean that someone put their mouth on your penis or made you put your penis in their mouth.
Yes 1
No, this never happened to me 2
[IF SV01 = YES, GO ASK SV01_a-b; ELSE SKIP TO SV02]
[SV01a]
Did this oral sex happen because the person used physical force or threats of physical harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Yes 1
No 2
[SV01b]
Did this oral sex happen because you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Yes 1
No 2
[SV02]
In your LIFETIME, has anyone EVER penetrated you by putting their fingers or an object in your anus when you did NOT consent to it, and it was not wanted?
Yes 1
No, this never happened to me 2
[IF SV02 = YES, GO ASK SV02_a-b; ELSE SKIP TO SV03]
[SV02a]
Did this unwanted penetration by fingers or an object happen because the person used physical force or threats of physical harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Yes 1
No 2
[SV02b]
Did this unwanted penetration by fingers or an object happen because you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Yes 1
No 2
[SV03]
In your LIFETIME, has anyone EVER had vaginal sex with you when you did NOT consent to it, and it was not wanted? By vaginal sex, we mean that someone made you put your penis in their vagina.
Yes 1
No, this never happened to me 2
[IF SV03 = YES, GO ASK SV03_a-b; ELSE SKIP TO SV04]
[SV03a]
Did this vaginal sex happen because the person used physical force or threats of physical harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Yes 1
No 2
[SV03b]
Did this vaginal sex happen because you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Yes 1
No 2
[SV04]
In your LIFETIME, has anyone EVER penetrated you by putting their penis in your mouth or anus when you did NOT consent to it, and it was not wanted?
Yes 1
No, this never happened to me 2
[IF SV04 = YES, GO ASK SV04_a-b]
[IF SV01 = NO AND SV02 = NO AND SV03 = NO AND SV04 = NO, GO TO FA_INTRO]
[SV04a]
Did this penetration of your mouth or anus happen because the person used physical force or threats of physical harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Yes 1
No 2
[SV04b]
Did this penetration of your mouth or anus happen because you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Yes 1
No 2
[GO TO PF_MTP_CHECK]
[MEN: PHYSICALLY FORCED MADE TO PENETRATE FOLLOW-UP]
[PF_MTP_CHECK]
[SKIP PATTERN NOTE: ASK PHYSICALLY FORCED RAPE AND MTP FOLLOW-UP SEPARATELY SO WE CAN DISTINGUISH PERPETRATOR TYPES, AGE AT FIRST, ETC.]
[CODING NOTE FOR MEN ONLY: SV01 = MTP; SV02 = RAPE; SV03 = MTP; SV04 = RAPE]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY PHYSICALLY FORCED MTP; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO PHYSICALLY FORCED RAPE CHECK]
[IF (ANY PHYSICALLY FORCED MTP IS ENDORSED) SV01a = YES OR SV03a = YES, THEN GO TO PF_MTP_REVIEW]
[IF SV01a = NO AND SV03a = NO, THEN GO TO PF_RAPE REVIEW]
[PF_MTP_REVIEW]
You said that
[IF SV01 = YES, FILL: performed oral sex on you]
[IF SV03 = YES, FILL: had vaginal sex with you]
when you did NOT consent to it, and it was not wanted and they used physical force or threats of harm.
How many people in total, did [this/any of these things] to you by using physical force or threats of harm such as pinning or holding you down, using violence, or not stopping after you said no?
Number of people: _____
[PROGRAM: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN PF_MTP_REVIEW]
[IF PF_MTP_REVIEW ≥ 1, GO TO PF_R1]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[FORCED MTP: PERSON 1/2/3/4/5]
PROGRAMMER NOTE: DISPLAY BURN LINE (Made to penetrate someone by force: Person 1) ON THE SAME SCREEN |
[PF_R1_MTP]
We would like to learn more about your experiences. Think about the [1st / 2nd / 3rd / 4th / 5th] person who did [this/any of these things] to you by using physical force or threats of harm such as pinning or holding you down, using violence, or not stopping after you said no.
Was this person…
Male 1
Female 2
Transgender 3
None of these 4
[PF_R2_MTP]
Please choose a category that best describes how you knew them at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually
(other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if PF_R2=12]
[PF_R2_OTH] You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[PF_R3_MTP]
Specifically, was this person…?
[PROGRAMMER NOTE:
SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.]
|
[PF04_MTP]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM PF_R3] did this to you?
Age in years_______
[PF05_MTP]
Did this [FILL: RELATIONSHIP TYPE FROM PF_R3] do [this/any of these things] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF PF05 = YES, THEN GO TO PF_R1_12]
[IF PF05 = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN GO TO PF_RAPE_CHECK]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK PF_R1_12 – PF_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP PF_R1-12 AND FILL PF_R2_12 AND PF_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF PF_R3 = NON-INTIMATE PARTNER THEN SKIP PF_R1_12 AND FILL PF_R2_12 = PF_R2 AND FILL PF_R3_12 = PF_R3]
PROGRAMMER NOTE: DISPLAY BURN LINE (Made to penetrate someone by force: Person 1) ON THE SAME SCREEN |
[PF_R1_12_MTP]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM PF_R3] when they did [this/these things] in the past 12 months?
Yes 1
No 2
[IF PF_R1_12 = YES, THEN PF_R1_12 = RESPONSE FROM PF_R3; THEN GO TO PF_RAPE_CHECK]
[IF PF_R1_12 = NO, GO TO PF_R2_12]
[PF_R2_12_MTP]
Please choose a category that best describes how you knew the person when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually
(other than an
ex-spouse) 4
[PF_R3_12_MTP]
Specifically, was this person…?
[PROGRAMMER NOTE:
SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.]
|
[REPEAT FOR EACH PHYSICALLY FORCED MTP PERP. THEN GO TO PF_RAPE_CHECK]
[MEN: PHYSICALLY FORCED RAPE FOLLOW-UP]
[PF_RAPE_CHECK]
[SKIP PATTERN NOTE: ASK PHYSICALLY FORCED RAPE AND MTP FOLLOW-UP SEPARATELY SO WE CAN DISTINGUISH PERPETRATOR TYPES, AGE AT FIRST, ETC.]
[CODING NOTE FOR MEN ONLY: SV01 = MTP; SV02 = RAPE; SV03 = MTP; SV04 = RAPE]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY PHYSICALLY FORCED RAPE; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO ATTEMPTED RAPE/MTP SECTION]
[IF (ANY PHYSICALLY FORCED RAPE IS ENDORSED) SV02a = YES OR SV04a = YES, THEN GO TO PF_RAPE_REVIEW]
[IF SV02a = NO AND SV04a = NO, THEN GO TO FA_INTRO]
[PF_RAPE_REVIEW]
You said that
[IF SV02 = YES, FILL: penetrated you by putting their fingers or an object in your anus]
[IF SV04 = YES, FILL: penetrated you by putting their penis in your mouth or anus]
when you did NOT consent to it, and it was not wanted and they used physical force or threats of harm.
How many people in total, did these things to you by using physical force or threats of harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Number of people: _____
[PROGRAM: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN PF_RAPE_REVIEW]
[IF PF_RAPE_REVIEW ≥ 1, GO TO PF_R1]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[FORCED RAPE: PERSON 1/2/3/4/5]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Penetrative sex by force: Person 1) ON THE SAME SCREEN] |
[PF_R1]
We would like to learn more about your experiences. Think about the [1st / 2nd / 3rd / 4th / 5th] person who did [this/any of these things] to you by using physical force or threats of harm, such as pinning or holding you down, using violence, or not stopping after you said no.
Was this person…
Male 1
Female 2
Transgender 3
None of these 4
[PF_R2]
Please choose a category that best describes how you knew this person at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if PF_R2=12]
[PF_R2_OTH]
You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[PF_R3]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[PF04]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM PF_R3] did this to you?
Age in years_______
[PF05]
Did this [FILL: RELATIONSHIP TYPE FROM] do [this/any of these things] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF PF05 = YES, THEN GO TO PF_R1_12]
IF PF05 = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN GO TO AD_MTP_CHECK]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK PF_R1_12 – PF_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP PF_R1-12 AND FILL PF_R2_12 AND PF_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF PF_R3 = NON-INTIMATE PARTNER THEN SKIP PF_R1_12 AND FILL PF_R2_12 = PF_R2 AND FILL PF_R3_12 = PF_R3]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Penetrative sex by force: Person 1) ON THE SAME SCREEN] |
[PF_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM PF_R3] when they did [this/these things] in the past 12 months?
Yes 1
No 2
[IF PF_R1_12 = YES, THEN PF_R1_12 = RESPONSE FROM PF_R3; THEN GO TO PF_RAPE_CHECK]
[IF PF_R1_12 = NO, GO TO PF_R2_12]
[PF_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[PF_R3_12]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[REPEAT FOR EACH PHYSICALLY FORCED RAPE PERP. THEN GO TO AD_MTP_CHECK]
[MEN: ALCOHOL/DRUG-FACILITATED MADE TO PENETRATE FOLLOW-UP]
[AD_MTP_CHECK]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY A/D MADE TO PENETRATE; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO A/D RAPE CHECK]
[CODING NOTE FOR MEN ONLY: SV01 = MTP; SV02 = RAPE; SV03 = MTP; SV04 = RAPE]
[IF (ANY A/D MTP IS ENDORSED) SV01b = YES OR SV03b = YES, THEN GO TO AD_MTP_REVIEW]
[IF (ALL A/D MTP IS NO) SV01b = NO AND SV03b = NO, THEN GO TO AD_RAPE_CHECK]
[AD_MTP_REVIEW]
You said that
[IF SV01 = YES, FILL: performed oral sex on you]
[IF SV03 = YES, FILL: had vaginal sex with you]
when you did NOT consent to it, it was not wanted, and you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs.
How many people in total, did these things to you when it was not wanted and you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Number of people: _____
[PROGRAM: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN AD_MTP_REVIEW]
[IF AD_MTP_REVIEW ≥ 1, GO TO AD_R1_MTP]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[AD MTP: PERSON 1/2/3/4/5]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Made to penetrate someone while drunk, high, drugged, or passed out: Person 1) ON THE SAME SCREEN] |
We would like to learn more about your experiences. Think about the [1st / 2nd / 3rd / 4th / 5th] person who did [this/any of these things] to you when it was not wanted and you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs.
[AD_R1_MTP]
Was this person…
Male 1
Female 2
Transgender 3
None of these 4
[AD_R2_MTP]
Please choose a category that best describes how you knew this person at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if AD_R2_MTP=12]
[AD_R2_MTP _OTH] You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[AD_R3_MTP]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[AD04_MTP]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM AD_R3_MTP] did this to you?
Age in years_______
[AD_GA_MTP]
When this happened with [FILL: RELATIONSHIP TYPE FROM AD_R3_MTP], do you think that you were ever given alcohol without your knowledge?
Yes 1
No 2
[AD_GD_MTP]
When this happened with [FILL: RELATIONSHIP TYPE FROM AD_R3_MTP], do you think that you were ever given other drugs without your knowledge?
Yes 1
No 2
[AD05_MTP]
Did this [FILL: RELATIONSHIP TYPE FROM AD_R3_MTP] do [this/any of these things] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF AD05_MTP = YES, THEN GO TO AD_R1_12_MTP]
[IF AD05_MTP = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN GO TO AD_RAPE_CHECK]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK AD_R1_12_MTP – AD_R3_12_MTP. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP AD_R1-12_MTP AND FILL AD_R2_12_MTP AND AD_R2_12_MTP WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF AD_R3_MTP = NON-INTIMATE PARTNER THEN SKIP AD_R1_12_MTP AND FILL AD_R2_12_MTP = AD_R2_MTP AND FILL AD_R3_12_MTP = AD_R3_MTP]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Made to penetrate someone while drunk, high, drugged, or passed out: Person 1) ON THE SAME SCREEN] |
[AD_R1_12_MTP]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM AD_R3_MTP] when [this/these things] happened in the past 12 months?
Yes 1
No 2
[IF AD_R1_12_MTP = YES, THEN AD_R1_12_MTP = RESPONSE FROM AD_R3_MTP; THEN GO TO NEXT PERP OR IF NO OTHERS, THEN GO TO AD_RAPE_CHECK]
[IF AD_R1_12_MTP = NO, GO TO AD_R2_12_MTP]
[AD_R2_12_MTP]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[AD_R3_12_MTP]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[REPEAT FOR EACH A/D MTP PERP. IF NO OTHERS, THEN GO TO AD_RAPE_CHECK]
[MEN: ALCOHOL/DRUG-FACILITATED RAPE FOLLOW-UP]
[AD_RAPE_CHECK]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY A/D RAPE; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO ATTEMTPED RAPE/MTP SECTION]
[CODING NOTE FOR MEN ONLY: SV01 = MTP; SV02 = RAPE; SV03 = MTP; SV04 = RAPE]
[IF (ANY A/D RAPE IS YES) SV02b = YES OR SV04b = YES, THEN GO TO AD_RAPE_REVIEW]
[IF (ALL A/D RAPE IS NO) SV02b = NO AND SV04b = NO, THEN GO TO FA_INTRO]
[AD_RAPE_REVIEW]
You said that
[IF SV02 = YES, FILL: penetrated you by putting their fingers or an object in your anus]
[IF SV04 = YES, FILL: penetrated you by putting their penis in your mouth or anus]
when you did NOT consent to it, and it was not wanted and [you unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs.]
How many people in total, did these things to you when it was not wanted and you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs?
Number of people: _____
[PROGRAM: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN AD_RAPE_REVIEW]
[IF AD_RAPE_REVIEW ≥ 1, GO TO AD_R1]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[AD RAPE: PERSON 1/2/3/4/5]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Penetrative sex while drunk, high, drugged, or passed out: Person 1) ON THE SAME SCREEN] |
We would like to learn more about your experiences. Think about the [1st / 2nd / 3rd / 4th / 5th] person who did [this/any of these things] to you when it was not wanted and you were unable to consent to sex or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol or drugs.
[AD_R1]
Was this person…
Male 1
Female 2
Transgender 3
None of these 4
[AD_R2]
Please choose a category that best describes how you knew this person at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if AD_R2=12]
[AD_R2_OTH]
You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[AD_R3]
Specifically, was this person…?
[PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.] |
[AD04]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM AD_R3] did this to you?
Age in years_______
[AD_GA]
When this happened with [FILL: RELATIONSHIP FROM AD_R3], do you think that you were ever given alcohol without your knowledge?
Yes 1
No 2
[AD_GD]
When this happened with [PERP 1: FILL RELATIONSHIP FROM AD_R3], do you think that you were ever given other drugs without your knowledge?
Yes 1
No 2
[AD05]
Did this [PERP 1: FILL RELATIONSHIP FROM AD_R3] do [this/any of these things] in the past 12 months, that is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF AD05 = YES, THEN GO TO AD_R1_12]
[IF AD05 = NO, THEN SKIP TO NEXT PERPETRATOR, OR IF NO OTHERS, THEN GO TO FA_INTRO]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK AD_R1_12 – AD_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP AD_R1-12 AND FILL AD_R2_12 AND AD_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF AD_R3 = NON-INTIMATE PARTNER THEN SKIP AD_R1_12 AND FILL AD_R2_12 = AD_R2 AND FILL AD_R3_12 = AD_R3]
[PROGRAMMER NOTE: DISPLAY BURN LINE (Penetrative sex while drunk, high, drugged, or passed out: Person 1) ON THE SAME SCREEN] |
[AD_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM AD_R3] when [this/these things] happened in the past 12 months?
Yes 1
No 2
[IF AD_R1_12 = YES, THEN AD_R1_12 = RESPONSE FROM AD_R3; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO FA_INTRO]
[IF AD_R1_12 = NO, GO TO AD_R2_12]
[AD_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[AD_R3_12]
Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A. |
[REPEAT FOR EACH A/D RAPE PERP. IF NO OTHERS, THEN GO TO FA_INTRO]
[ATTEMPTED PHYSICALLY FORCED RAPE & MADE TO PENETRATE: MEN’S VERSION]
[FA_INTRO]
The next set of questions are about times in your life when someone ever ATTEMPTED to have sex or sexual contact with you by using physical force or threats of harm but sex did NOT happen. Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no. To be clear, we are now asking only about times when sex was unwanted and you did not give consent, and sex was attempted but did not happen.
[FA01]
In your lifetime, has anyone EVER used physical force or threats of physical harm to TRY to put their mouth on your penis, or TRY to make you put your penis in their mouth, but it did not happen?
Yes 1
No, this never happened to me 2
[FA02]
In your lifetime, has anyone EVER used physical force or threats of physical harm to TRY to make you put your penis in their vagina, but it did not happen?
Yes 1
No, this never happened to me 2
[FA03]
In your lifetime, has anyone EVER used physical force or threats of physical harm to TRY to put their penis in your mouth or anus, but it did not happen?
Yes 1
No, this never happened to me 2
[IF FA01 = NO AND FA02 = NO AND FA03 = NO, THEN GO TO OT_CHECK; ELSE GO TO NEXT QUESTION]
[MEN: ATTEMPTED MADE TO PENETRATE FOLLOW-UP]
[FA_MTP_CHECK]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY ATTEMPTED MADE TO PENETRATE; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO ATTEMTPED RAPE CHECK SECTION]
[CODING NOTE FOR MEN ONLY: FA01 = MTP; FA02 = MTP; FA03 = RAPE]
[IF (ANY A/D MTP IS YES) FA01 = YES OR FA02 = YES, THEN GO TO FA_MTP_REVIEW]
[IF (ALL A/D MTP IS NO) FA01 = NO AND FA02 = NO, THEN GO TO FA_RAPE_CHECK]
[FA_MTP_REVIEW]
You said that someone used physical force or threats of physical harm to
[IF FA01 = YES, FILL: TRY to put their mouth on your penis, or TRY to make you put your penis in their mouth but it did not happen]
[IF FA02 = YES, FILL: TRY to make you put your penis in their vagina but it did not happen]
Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no.
[FA04_MTP]
How many people in total, did these things to you by using physical force or threats of harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Number of people: _____
[PROGRAM: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN FA04_MTP]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[ATTEMPTED MTP: PERSON 1/2/3/4/5]
PROGRAMMER NOTE: SHOW BURN LINE (Attempt to make you penetrate someone using force: Person 1). |
We would like to learn more about your experiences. Think about the [1st / 2nd / 3rd / 4th / 5th] person who did [this/any of these things] to you.
[FA_R1_MTP]
Think about the [1st / 2nd / 3rd / 4th / 5th] person who did [this/any of these things] to you by using physical force or threats of harm, such as pinning or holding you down, using violence, or not stopping after you said no.
Was this person…
Male 1
Female 2
Transgender 3
None of these 4
[FA_R2_MTP]
Please choose a category that best describes how you knew this person at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if FA_R2_MTP=12]
[FA_R2_MTP_OTH]
You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[FA_R3_MTP]
Specifically, was this person…?
PROGRAMMER NOTE:
SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.
|
[FA04_MTP]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM FA_R3_MTP] did this to you?
Age in years_______
[FA05_MTP]
Did this [FILL: RELATIONSHIP TYPE FROM FA_R3_MTP] do this to you in the past 12 months, that is, since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
(IF FA05_MTP = NO, SKIP TO NEXT ATTEMPTED RAPE PERPETRATOR, OR IF NO OTHERS, THEN GO TO OT_CHECK)
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK FA_R1_12_MTP – FA_R3_12_MTP. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP FA_R1-12_MTP AND FILL FA_R2_12_MTP AND FA_R2_12_MTP WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF FA_R3_MTP = NON-INTIMATE PARTNER THEN SKIP FA_R1_12_MTP AND FILL FA_R2_12_MTP = FA_R2_MTP AND FILL FA_R3_12_MTP = FA_R3_MTP]
PROGRAMMER NOTE: SHOW BURN LINE (Attempt to make you penetrate someone using force: Person 1). |
[FA_R1_12_MTP]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM AD_R3_MTP] when [this/these things] happened in the past 12 months?
Yes 1
No 2
[IF FA_R1_12_MTP = YES, THEN FA_R1_12_MTP = RESPONSE FROM FA_R3_MTP; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO FA_RAPE_CHECK]
[IF FA_R1_12_MTP = NO, GO TO FA_R2_12_MTP]
[FA_R2_12_MTP]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[FA_R3_12_MTP]
Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A. |
[REPEAT FOR ADDITIONAL PERPS, OR IF NONE, GO TO FA_RAPE_CHECK]
[MEN: ATTEMPTED RAPE FOLLOW-UP]
[FA_RAPE_CHECK]
[NOTE: THIS INSTRUCTION CHECKS TO SEE IF RESPONDENT HAD ANY ATTEMPTED RAPE; IF SO, THEN THEY WILL ANSWER THE FOLLOW-UP QUESTIONS. IF NOT, THEY WILL SKIP TO RAPE/MTP IMPACT SECTION]
[CODING NOTE FOR MEN ONLY: FA01 = MTP; FA02 = MTP; FA03 = RAPE]
[IF (ATTEMPTED RAPE IS YES) FA03 = YES, THEN GO TO FA_RAPE_REVIEW]
[IF (ATTEMPTED RAPE IS NO) FA03 = NO, THEN GO TO OT_CHECK]
[FA_RAPE_REVIEW]
You said that used someone used physical force or threats of physical harm to TRY to put their penis in your mouth or anus, but it did not happen?
Examples of physical force are being pinned or held down, using violence or threats of violence, or not physically stopping after you said no.
[FA04]
How many people in total, did these things to you by using physical force or threats of harm, such as pinning or holding you down, using violence, or not stopping after you said no?
Number of people: _____
[PROGRAM NOTE: FOLLOW UP ON THE NUMBER OF PEOPLE GIVEN IN FA04]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[ATTEMPTED RAPE: PERSON 1/2/3/4/5]
PROGRAMMER NOTE: SHOW BURN LINE (Attempt to make you penetrate someone while drunk, high, drugged, or passed out: Person 1). |
[FA_R1]
We would like to learn more about your experiences. Think about the [1st / 2nd / 3rd / 4th / 5th] person who did this to you by using physical force or threats of harm, such as pinning or holding you down, using violence, or not stopping after you said no.
Was this person…
Male 1
Female 2 [PROGRAMMER: GREY OUT THIS OPTION]
Transgender 3
None of these 4
[FA_R2]
Please choose a category that best describes how you knew this person at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
A family member 5
A friend 6
Acquaintance, for example, a neighbor, roommate, classmate, friend of a friend, etc. 7
Someone I knew through work, for example, a co-worker, boss/supervisor, client,
customer, patient, etc. 8
A person of authority, for example, a teacher, doctor, police officer, etc. 9
Someone I knew less than 24 hours, for example, a taxi driver, someone met
at party/bar 10
A complete stranger 11
Someone else 12
[Show if FA_R2=12]
[FA_R2_OTH]
You selected “someone else”. Please specify the category that best describes how you knew them at the time they did this to you.
___________ [allow up to 40 characters]
[FA_R3]
Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A. |
[FA05]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM FA_R3] did this to you?
Age in years_______
[FA06]
Did this [FILL: RELATIONSHIP TYPE FROM FA_R3] do this to you in the past 12 months, that is, since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF FA06 = NO, SKIP TO NEXT ATTEMPTED RAPE PERPETRATOR, OR IF NO OTHERS, THEN GO TO OT_CHECK]
[NOTE: THIS INSTRUCTION IS FOR THE 12M RELATIONSHIP QUESTIONS. IF THE PERP IS AN INTIMATE PARTNER, THEN ASK FA_R1_12 – FA_R3_12. IF THE PERP IS A NON-INTIMATE PARTNER THEN SKIP FA_R1-12 AND FILL FA_R2_12 AND FA_R2_12 WITH RESPONSES TO THE PREVIOUS RELATIONSHIP TYPE QUESTIONS (THE ASSUMPTION IS THAT THE RELATIONSHIP TYPE WILL NOT HAVE CHANGED); HOWEVER, AN INTIMATE PARTNER COULD CHANGE (E.G., FROM CURRENT TO AN EX)].
[PROGRAMMING: IF FA_R3 = NON-INTIMATE PARTNER THEN SKIP FA_R1_12 AND FILL FA_R2_12 = FA_R2 AND FILL FA_R3_12 = FA_R3]
PROGRAMMER NOTE: SHOW BURN LINE (Attempt to make you penetrate someone while drunk, high, drugged, or passed out: Person 1). |
[FA_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM AD_R3] when [this/these things] happened in the past 12 months?
Yes 1
No 2
[IF FA_R1_12 = YES, THEN FA_R1_12 = RESPONSE FROM FA_R3; THEN GO TO NEXT PERP OR IF NO OTHERS, GO TO OT_CHECK]
[IF FA_R1_12 = NO, GO TO FA_R2_12]
[FA_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[FA_R3_12]
Specifically, was this person…?
PROGRAMMER NOTE:
SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A.
|
[REPEAT FOR ADDITIONAL ATTEMPTED MTP PERPS THEN GO TO OT_CHECK]
[OUTCOMES OF RAPE AND MADE TO PENETRATE: BOTH WOMEN AND MEN]
[OT_CHECK]
[PROGRAM NOTE: THIS SECTION IS THE FOLLOW-UP FOR ANYONE WHO ENDORSED A COMPLETED OR ATTEMPTED PHYSICALLY FORCED RAPE OR MTP OR ALCOHOL/DRUG-FACILITATED RAPE OR MTP. FOR MEN, THE QUESTIONS ARE ASKED OF ALL RAPE AND MTP COMBINED (NOT SEPARATELY FOR RAPE AND MTP]
[WOMEN: IF SV01a = YES OR SV01b = YES OR SV02a = YES OR SV02b = YES OR SV03a = YES OR SV03b = YES OR SV04a = YES OR SV04b = YES OR FA01 = YES, THEN GO TO OT_INTRO]
[WOMEN: SV01 = NO AND SV02 = NO AND SV03 = NO AND SV04 = NO AND FA01 = NO, GO TO PA_INTRO]
[MEN: IF SV01a = YES OR SV01b = YES OR SV02a = YES OR SV02b = YES OR SV03a = YES OR SV03b = YES OR SV04a = YES OR SV04b = YES OR FA01 = YES OR FA02 = YES OR FA03 = YES, THEN GO TO OT_INTRO]
[MEN: IF SV01 = NO AND SV02 = NO AND SV03 = NO AND SV04 = NO AND FA01 = NO AND FA02 = NO AND FA03 = NO, GO TO PA_INTRO
[OT_INTRO]
Next are a few follow-up questions.
You said that [a/an/your] [FILL ENDORSED RELATIONSHIP TYPES FROM R3] …
[FILL: previous completed rape/MTP attempted rape/MTP questions/context that were endorsed; show on screen]
DISPLAY BELOW FOR FEMALE RESPONDENTS AND THOSE WHO CHOSE FEMALE TRACK]
[IF SV01 = YES AND SV01a = YES, FILL: performed oral sex on you by using physical force or threats]
[IF SV01 = YES AND SV01b = YES, FILL: performed oral sex on you when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs]
[IF SV02 = YES AND SV02a = YES, FILL: penetrated you by putting their fingers or an object in your vagina or anus by using physical force or threats]
[IF SV02 = YES AND SV02b = YES, FILL: penetrated you by putting their fingers or an object in your vagina or anus when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs]
[IF SV03 = YES AND SV03a = YES, FILL: had vaginal sex with you by using physical force or threats]
[IF SV03 = YES AND SV03b = YES, FILL: had vaginal sex with you when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs]
[IF SV04 = YES AND SV04a = YES, FILL: penetrated you by putting their penis in your mouth or anus by using physical force or threats]
[IF SV04 = YES AND SV04b = YES, FILL: penetrated you by putting their penis in your mouth or anus when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs]
[IF FA01 = YES, FILL: You said that someone used physical force or threats of physical harm to TRY to put their penis in your vagina, mouth, or anus, but it did not happen]
[DISPLAY BELOW FOR MALE RESPONDENTS AND THOSE WHO CHOSE MALE TRACK]
[IF SV01 = YES AND SV01a = YES, FILL: performed oral sex on you by using physical force or threats]
[IF SV01 = YES AND SV01b = YES, FILL: performed oral sex on you when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs]
[IF SV02 = YES AND SV02a = YES, FILL: penetrated you by putting their fingers or an object in your anus by using physical force or threats]
[IF SV02 = YES AND SV02b = YES, FILL: penetrated you by putting their fingers or an object in your anus when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs]
[IF SV03 = YES AND SV03a = YES, FILL: had vaginal sex with you by using physical force or threats]
[IF SV03 = YES AND SV03b = YES, FILL: had vaginal sex with you when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs]
[IF SV04 = YES AND SV04a = YES, FILL: penetrated you by putting their penis in your mouth or anus by using physical force or threats]
[IF SV04 = YES AND SV04b = YES, FILL: penetrated you by putting their penis in your mouth or anus when you were unable to consent to sex or stop it from happening, because you were too drunk, high, drugged, or passed out from alcohol or drugs]
[IF FA01 = YES, FILL: someone used physical force or threats of physical harm to TRY to put their mouth on your penis, or TRY to make you put your penis in their mouth but it did not happen]
[IF FA02 = YES, FILL: someone used physical force or threats of physical harm to TRY to make you put your penis in their vagina but it did not happen]
Thinking about these experiences in your entire lifetime.
When [FILL: this/any of these things] happened…
[OT01]
Did you file a police report?
Yes 1
No 2
[OT02]
Were you EVER physically injured when [this/any of these things] happened? For example, did you have bruises, [IF RC01 = 2 (FEMALE) OR QSELECT = 2 (FEMALE QUESTIONS) FILL: vaginal or] anal tears, or other internal or external injuries?
Yes 1
No 2
[OT02a]
A concussion is when a blow to the head caused you to have one or more symptoms such as blurred or double vision, sensitivity to light or noise, headaches, dizziness or balance problems, nausea, being dazed or confused, difficulty remembering, difficulty concentrating, or being knocked out.
Did you ever experience a concussion when [this/any of these things] happened?
Do not include situations where you were hurt accidentally.
Yes 1
[OT03]
Did you EVER get a sexually transmitted disease (STD) or other infection when [this/any of these things] happened? For example, did you get chlamydia, gonorrhea, HIV, or some other STD?
Yes 1
No 2
[IF RC01 = FEMALE OR QSELECT = 2 (FEMALE QUESTIONS) AND SV03 (VAGINAL RAPE) = YES, AND EITHER OF THESE 2 CONDITIONS: (1) SV03a = YES AND PF05 = YES (2) SV03b = YES, AND AD04 = YES. GO TO OT04a. ELSE GO TO OT05]
[OT04a] [FEMALES ONLY]
Did you EVER get pregnant when [this/any of these things] happened?
Yes 1
[IF OT04A = YES, GO TO OT04b]
[PROGRAMMING INSTRUCTION: FEMALE RESPONDENT REPORTED VAGINAL RAPE IN LIFETIME THROUGH EITHER PHYSICAL FORCE OR A/D FACILITATION, AND REPORTED THAT SV OCCURRED IN PAST 12 MONTHS]
[IF OT04A = YES AND RC01 = 2 (FEMALE) AND SV03 (VAGINAL RAPE) = YES, AND EITHER OF THESE 2 CONDITIONS: (1) SV03a = YES AND PF05 = YES (2) SV03b = YES, AND AD04 = YES. AND, THEN GO TO OT04b]
[OT04b] [FEMALES ONLY]
Did you get pregnant when [this/any of these things] happened in the PAST 12 MONTHS, that is, since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[OT05]
When [this/any of these things] happened, were you ever concerned for your safety?
Yes 1
No 2
[OT06]
When
[this/any
of these things]
happened, were you ever fearful for yourself or someone close to you?
Yes 1
No 2
[OT07]
Did you ever experience mental or emotional harm (for example, anxiety or depression) after [this/any of these things] happened to you?
Yes 1
No 2
[PSYCHOLOGICAL AGGRESSION BY AN INTIMATE PARTNER]
[PA_INTRO]
The next questions ask more generally about experiences you may have had in your life with your current or ex-romantic or sexual partners. Examples of romantic or sexual partners include: spouses, partners, boyfriends, girlfriends, people you have dated, or people you were seeing romantically.
Do NOT include first dates or one-time hook-up situations.
[PA01]
In your lifetime, has a current or ex-romantic or sexual partner ever done any of the following things to you on purpose?
[PROGRAMMING: SHOW THE LIST OF EXAMPLES ON ONE SCREEN]
Kept
you from having your own money
Tried
to keep you from seeing or talking to your family or friends
Kept
track of you by demanding to know where you were and what you were
doing
Made
threats to physically harm you
Threatened
to hurt themselves or commit suicide because they were upset with
you
Made
decisions that should have been yours to make
Destroyed
something that was important to you
Insulted
or humiliated you in front of others
Yes 1
No, none of these ever happened to me 2
[IF PA01 = YES, GO TO PA02; ELSE GO TO RC_INTRO]
[PA02]
In total, how many DIFFERENT current or ex-romantic or sexual partners did any of these things to you?
Number of people______________
[IF PA02 ≥ 1, GO TO PA_R1]
[IF PA02 = 0, GO TO RC_INTRO]
[PSYC AGGRESSION: PERSON 1/2/3/4/5]
PROGRAMMER NOTE: DISPLAY BURN LINE (Insulted, humiliated, controlled, threatened: Person 1) ON THE SAME SCREEN |
[PA_R1]
[When looping through this section to ask about the 2nd or later perpetrator, show: Thank you for your participation. Your responses are very important to this study.]
We would like to learn more about your experience. You said [FILL: NUMBER FROM PA02] people insulted, humiliated, controlled, or threatened you.
Think about the [1st / 2nd / 3rd / 4th / 5th] person who did those things to you.
Was this person male or female?
Male 1
Female 2
Transgender 3
None of these 4
[PA_R2]
How did you know this person who insulted, humiliated, controlled, or threatened you? Please choose a category that best describes how you knew them at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[PA_R3]
Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A. |
[PA03]
Still thinking about this person, please answer the following questions. Did this [FILL: RELATIONSHIP TYPE FROM PA_R3]….
|
1 |
2 |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
[IF PA03_1 = YES OR PA03_2 = YES OR PA03_3 = YES OR PA03_4 = YES OR PA03_5 = YES OR PA03_6 = YES OR PA03_7 = YES OR PA03_8 = YES, THEN GO TO PA04]
[PA04]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM PA_R3] did [this/any of these things] to you?
[SHOW ENDORSED PA BEHAVIORS]
Age in years_______
[PA05]
Did this [FILL: RELATIONSHIP TYPE FROM PA_R3] do [this/any of these things] to you in the past 12 months, that is, since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF PA05=NO, SKIP TO NEXT SECTION (RC_INTRO). ELSE GO TO NEXT QUESTION]
PROGRAMMER NOTE: DISPLAY BURN LINE (Insulted, humiliated, controlled, threatened: Person 1) ON THE SAME SCREEN |
[PA_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM PA_R3] when they did [this/these things] in the past 12 months?
Yes 1 (Programming: fill response from PAR3 into PA_R2_12)
No 2 (go to PA_R2_12)
[PA_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[PA_R3_12]
Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY IN APPENDIX A. |
[REPEAT PA_R1 – PA_R3_12 FOR EACH PERP. THEN GO TO RC_INTRO]
[REPRODUCTIVE COERCION BY AN INTIMATE PARTNER]
[RC_INTRO]
The next few questions are related to other experiences you may have had with a current or ex-romantic or sexual partner. Examples of romantic or sexual partners include: spouses, partners, boyfriends, girlfriends, people you have dated, or people you were seeing romantically.
[PROGRAM NOTE: ONLY BIOLOGICAL FEMALES (SEX AT BIRTH = FEMALE) WILL BE ASKED QUESTIONS ABOUT PREGNANCY]
[IF RC01 = FEMALE, ASK RC12; IF RC01 = MALE, SKIP TO RC13; ELSE SKIP TO RC13]
[RC12] [FEMALE ONLY]
Has a current or ex-partner EVER tried to keep you from using your birth control so that you would get pregnant when you didn’t want to? For example, did they hide your birth control, throw it away or do anything else to keep you from using it?
Yes 1
No, this never happened to me 2
[IF RC12 = YES, GO TO RC12a]
[IF RC12 = NO, GO TO RC13]
[RC12a] [FEMALE ONLY]
Has a current or ex-partner done this to you in the past 12 months? That is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[RC12b] [FEMALE ONLY]
Did you EVER actually get pregnant because a current or ex- stopped you from using birth control?
Yes 1
No 2
[RC13] [FEMALE ONLY]
Has a current or ex-partner ever threatened to hurt you if you did not become pregnant when you did not want to become pregnant?
Yes 1
No, this never happened to me 2
[IF RC13 = YES, GO TO RC13a]
[IF RC13 = NO, GO TO RC14]
[RC13a] [FEMALE ONLY]
Has a current or ex-partner done this to you in the past 12 months? That is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[RC13b] [FEMALE ONLY]
Did you EVER actually get pregnant because a current or ex-partner threatened to hurt you if you did not become pregnant even when you didn’t want to?
Yes 1
No 2
[RC14] [FEMALE ONLY]
Has a current or ex-partner EVER refused to use a condom, intentionally broken a condom, or removed a condom while having sex when you wanted them to use one, to get you pregnant?
Yes 1
No, this never happened to me 2
[IF RC14 = YES, GO TO RC14a]
[IF RC14 = NO, GO TO PV_INTRO]
[RC14a] [FEMALE ONLY]
Has a current or ex-partner done this to you in the past 12 months? That is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
Did you EVER actually get pregnant because a current or ex-partner refused to use a condom, intentionally broke a condom, or removed a condom when you wanted them to use one?
Yes 1
No 2
[GO TO PV_INTRO]
Has a current or ex-partner EVER tried to get pregnant when you didn’t want them to get pregnant or tried to stop you from using a condom or other birth control so they would get pregnant?
Yes 1
No, this never happened to me 2
[IF RC15 = YES, GO TO RC15a]
[IF RC15 = NO, GO TO PV_INTRO]
[RC15a] [MALE ONLY]
Has a current or ex-partner done this to you in the past 12 months? That is since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[RC15b] [MALE ONLY]
Did your current or ex-partner EVER get pregnant because she stopped you from using a condom or other birth control?
Yes 1
No 2
[GO TO PV_INTRO]
[PHYSICAL VIOLENCE BY AN INTIMATE PARTNER]
[PV_INTRO]
The next questions are related to physical acts you may have experienced with your current or ex-romantic or sexual partners, such as being. Examples of romantic or sexual partners include: spouses, partners, boyfriends, girlfriends, people you have dated, or people you were seeing romantically.
Do NOT include first dates or one-time hook-up situations.
[PV01]
In your lifetime, has a current or ex-romantic or sexual partner ever done any of the following things to you on purpose?
[PROGRAMMING: SHOW THE LIST OF EXAMPLES ON ONE SCREEN]
Slapped,
pushed, or shoved you
Hit
you with a fist or something hard
Kicked
or stomped you
Hurt
you by pulling your hair
Slammed
you against something to hurt you
Tried
to hurt you by choking or suffocating you
Used
or threatened you with a knife
Used
or threatened you with a gun, such as pistols, revolvers, shotguns,
and rifles (but not BB guns or paint ball guns).
Yes 1
No, none of these ever happened to me 2
[IF PV01 = YES, GO TO PV02; ELSE GO TO CQ_CHECK]
[PROGRAM: DISPLAY THE BEHAVIORS THAT WERE ENDORSED TO REMIND PARTICIPANT OF WHAT WE’RE ASKING THEM ABOUT]
[PV02]
In total, how many DIFFERENT current or ex-romantic or sexual partners did any of these things to you in your lifetime?
Number of people______________
[IF PV02 ≥ 1, GO TO PV_R1]
[IF PV02 = 0, GO TO CQ_CHECK]
[PHYSICAL VIOLENCE: PERSON 1/2/3/4/5]
PROGRAMMER NOTE: DISPLAY BURN LINE (Physically hurt you on purpose: Person 1) ON THE SAME SCREEN |
[PV_R1]
We would like to learn more about your experience. You said [FILL: NUMBER FROM PV02] people physically hurt you on purpose.
Think about the [1st / 2nd / 3rd / 4th / 5th] person who did those things to you.
Was this person male or female?
Male 1
Female 2
Transgender 3
None of these 4
[PV_R2]
How did you know this person who physically hurt you on purpose? Please choose a category that best describes how you knew them at the time they did this to you.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[PV_R3]
Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
[PV03]
Still thinking about this person, please answer the following questions. Did this [FILL: RELATIONSHIP TYPE FROM PV_R3]….
|
1 |
2 |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
[IF PV03_1 = YES OR PV03_2 = YES OR PV03_3 = YES OR PV03_4 = YES OR PV03_5 = YES OR PV03_6 = YES OR PV03_7 = YES OR PV03_8 = YES, THEN GO TO PV04]
[IF PV03_1 = NO AND PV03_2 = NO AND PV03_3 = NO AND PV03_4 = NO AND PV03_5 = NO AND PV03_6 = NO AND PV03_7 = NO AND PV03_8 = NO THEN GO TO NEXT PERP, OR IF NO OTHERS, GO TO CQ_CHECK]
[PV04]
How old were you the FIRST TIME this [FILL: RELATIONSHIP TYPE FROM PV_R3] did [this/any of these things] to you?
[SHOW ENDORSED PV BEHAVIORS]
Age in years_______
[PV05]
Did this [FILL: RELATIONSHIP TYPE FROM PV_R3] do [this/any of these things] to you in the past 12 months, that is, since [FILL: DATE 12 MONTHS AGO]?
Yes 1
No 2
[IF PV05=NO, SKIP TO NEXT SECTION (CQ_CHECK). ELSE GO TO NEXT QUESTION]
PROGRAMMER NOTE: DISPLAY BURN LINE (Physically hurt you on purpose: Person 1) ON THE SAME SCREEN |
[PV_R1_12]
Was this person [your/a/an] [FILL: RELATIONSHIP TYPE FROM PV_R3] when they did [this/these things] in the past 12 months?
Yes 1 (Programming: fill response from PV_R3 into PV_R2_12)
No 2 (go to PV_R2_12)
[PV_R2_12]
Please choose a category that best describes how you knew them when they did this to you in the past 12 months.
My spouse (husband or wife) 1
My ex-spouse (ex-husband or ex-wife) 2
Someone I was involved with romantically or sexually (other than a spouse) 3
Someone I used to be involved with romantically or sexually (other than an
ex-spouse) 4
[PV_R3_12]
Specifically, was this person…?
PROGRAMMER NOTE: SHOW SUBCATEGORIES AS RESPONSE OPTIONS BASED ON SEX AND BROAD RELATIONSHIP CATEGORY. |
[REPEAT PV_R1 – PV_R3_12 FOR EACH PERP. THEN GO TO CQ_CHECK]
[CQ_CHECK]
[PROGRAMMING
INSTRUCTION: IF RESPONDENT REPORTED ANY VIOLENCE BY AN INTIMATE
PARTNER (STALKING, UNWANTED SEXUAL CONTACT, SEXUAL COERCION,
COMPLETED RAPE OR MADE TO PENETRATE, ATTEMPTED RAPE OR MADE TO
PENETRATE, PSYCHOLOGICAL AGGRESSION, REPRODUCTIVE COERCION, OR
PHYSICAL VIOLENCE) GO TO CQ_INTRO; IF NONE GO TO [INCENTIVE]]
]
[NOTE: RESPONDENTS ANSWER IMPACT QUESTIONS THINKING ABOUT ALL INTIMATE PARTNER PERPETRATORS, NOT BY INDIVIDUAL INTIMATE PARTNER PERPS]
[CQ_INTRO]
This is the final set of questions. The next questions ask about the consequences of the experiences that you have shared with us involving a current or ex-romantic or sexual partner.
[CQ_REVIEW]
You said previously that a current or ex-romantic or sexual partner …
[PROGRAMMING INSTRUCTION: SHOW ENDORSED BEHAVIORS (SHORTHAND PHRASES) FROM ALL SECTIONS WHERE AN INTIMATE PARTER WAS THE PERPETRATOR]
[IF STALKING: followed, contacted, tracked, or spied on you in a way and made you feel afraid, concerned for your safety, or threatened]
[IF UNWANTED CONTACT: kissed, fondled, or touched you in a sexual way when you did not want it to happen]
[IF SEXUAL COERCION: verbally pressured you into unwanted sex]
[IF COMPLETED FORCED RAPE: used physical force or threats of harm to have unwanted sex with you]
[IF COMPLETED A/D RAPE: had unwanted sex with you when you were too drunk, high, drugged, or passed out from alcohol or drugs and unable to consent]
[IF COMPLETED FORCED MTP: used physical force or threats of harm to have unwanted sex with you]
[IF COMPLETED A/D MTP: had unwanted sex with you when you were too drunk, high, drugged, or passed out from alcohol or drugs and unable to consent]
[IF ATTEMTPED RAPE: tried to have sex or sexual contact with you by using physical force or threats of harm but sex did NOT Happen]
[IF ATTEMPTED MTP: tried to have sex or sexual contact with you by using physical force or threats of harm but sex did NOT happen]
[IF PSYCHOLOGICAL AGGRESSION: insulted, humiliated, controlled, or threatened you]
[IF REPRODUCTIVE COERCION: IF FEMALE: tried to get you pregnant when you didn’t want to, stopped you from using birth control, threatened to hurt you if you didn’t become pregnant, or refused to use, intentionally broke, or removed a condom to get you pregnant. IF MALE: tried to get pregnant when you didn’t want them to, tried to stop you from using birth control, or refused to use a condom]
[IF PHYSICAL VIOLENCE: physically hurt you on purpose]
[CQ01]
Were you ever concerned for your safety because of what happened to you?
Yes 1
No 2
[IF CQ01=YES, ASK CQ02. ELSE GO TO CQ03]
[CQ02]
In the past 12 months, were you concerned for your safety because of what happened to you?
Yes 1
No 2
[CQ03]
Were
you ever fearful for yourself or someone close to you because of what
happened to you?
Yes 1
No 2
[IF CQ03=YES, GO TO CQ04]
[IF CQ03 = NO, GO TO CQ05]
[CQ04]
In the past 12 months, that is since [FILL: DATE 12 MONTHS AGO], were you fearful because of what happened to you?
Yes 1
No 2
[CQ05]
Thinking back to the unwanted physical acts, sexual situations, or repeated contacting, following, or spying on you by a current or ex-romantic or sexual partner …
did you ever have nightmares because of what a current or ex-partner did to you?
Yes 1
No 2
[CQ06]
(Thinking back to the unwanted physical acts, sexual situations, or repeated contacting, following, or spying on you by a current or ex-romantic or sexual partner …)
did you ever try hard not to think about or go out of your way to avoid being reminded of the things that were done to you because of what a current or ex-partner did to you?
Yes 1
No 2
[CQ07]
(Thinking back to the unwanted physical acts, sexual situations, or repeated contacting, following, or spying on you by a current or ex-romantic or sexual partner …)
did you ever feel like you were constantly on guard, watchful, or easily startled because of what a current or ex-partner did to you?
Yes 1
No 2
[CQ08]
(Thinking back to the unwanted physical acts, sexual situations, or repeated contacting, following, or spying on you by a current or ex-romantic or sexual partner …)
did you ever feel numb or detached from others, your activities, or your surroundings because of what a current or ex-partner did to you?
Yes 1
No 2
[IF CQ05=YES OR CQ06=YES OR CQ07=YES OR CQ08=YES, ASK CQ09. ELSE GO TO CQ10.]
[CQ09_INTRO]
You said earlier that you…
[IF CQ05 = YES, FILL: had nightmares]
[IF CQ06 = YES, FILL: tried not to think about things done to you]
[IF CQ07 = YES, FILL: felt constantly on guard or easily startled]
[IF CQ08 = YES, FILL: felt numb or detached]
because of what a current or ex-partner did to you.
[CQ09]
In the past 12 months, that is since [FILL: DATE 12 MONTHS AGO] did you ever feel this way because of what happened to you?
Yes 1
No 2
[IF RESPONDENT ENDORSED ONLY PSYCHOLOGICAL AGGRESSION AND NO OTHER IPV, THEN SKIP TO CQ18]
Here is a list of possible injuries. Please indicate which of these you have experienced because of the things that a current or ex-partner of the things did to you.
[PROGRAMMING INSTRUCTION: SHOW ENDORSED BEHAVIORS (SHORTHAND PHRASES) FROM ALL SECTIONS WHERE AN INTIMATE PARTER WAS THE PERPETRATOR]
[IF STALKING: followed, contacted, tracked, or spied on you in a way and made you feel afraid, concerned for your safety, or threatened]
[IF UNWANTED CONTACT: kissed, fondled, or touched you in a sexual way when you did not want them to]
[IF SEXUAL COERCION: verbally pressured you into unwanted sex]
[IF COMPLETED FORCED RAPE: used physical force or threats of harm to have unwanted sex with you]
[IF COMPLETED A/D RAPE: had unwanted sex with you when you were too drunk, high, drugged, or passed out from alcohol or drugs and unable to consent]
[IF COMPLETED FORCED MTP: used physical force or threats of harm to make you penetrate someone]
[IF COMPLETED A/D MTP: made you penetrate someone when you were too drunk, high, drugged, or passed out from alcohol or drugs and unable to consent]
[IF ATTEMTPED RAPE: tried to have sex with you by using physical force or threats of harm but sex did NOT Happen]
[IF ATTEMPTED MTP: tried to make you penetrate someone by using physical force or threats of harm but sex did NOT Happen]
[IF PSYCHOLOGICAL AGGRESSION: insulted, humiliated, controlled, or threatened you]
[IF REPRODUCTIVE COERCION: IF FEMALE: tried to get you pregnant when you didn’t want to, stopped you from using birth control, threatened to hurt you if you didn’t become pregnant, or refused to use, intentionally broke, or removed a condom to get you pregnant. IF MALE: tried to get pregnant when you didn’t want them to, tried to stop you from using birth control, or refused to use a condom]
[IF PHYSICAL VIOLENCE: physically hurt you on purpose]
[CQ10]
Did you ever experience …
minor bruises or scratches?
Yes 1
No 2
[CQ11]
Did you ever experience …
cuts, major bruises, or black eyes?
Yes 1
No 2
[CQ12]
Did you ever experience …
injury to any ligaments, muscles or tendons?
Yes 1
No 2
[CQ13]
(Did you ever experience …)
broken bones or teeth?
Yes 1
No 2
[CQ14]
(Did you ever experience …)
back or neck injury?
Yes 1
No 2
[CQ15]
(Did you ever experience …)
being knocked out after getting hit, slammed against something or choked?
Yes 1
No 2
[CQ16]
A concussion is when a blow to the head caused you to have one or more symptoms such as blurred or double vision, sensitivity to light or noise, headaches, dizziness or balance problems, nausea, being dazed or confused, difficulty remembering, difficulty concentrating, or being knocked out.
Did you ever experience a concussion because of what a current or ex-partner did to you?
Do not include situations where you were hurt accidentally.
Yes 1
No 2
[CQ17]
In the past 12 months, that is since [FILL: DATE 12 MONTHS AGO], were you physically injured because of the things a current or ex-partner did to you?
Yes 1
No 2
[CQ18]
Did you ever experience mental or emotional harm (for example, anxiety or depression) because of what a current or ex-partner did to you?
Yes 1
No 2
[CQ19]
Did you ever need medical care because of what a current or ex-partner did to you?
Yes 1
No 2
[IF CQ19=YES, ASK C20. ELSE GO TO CQ21]
[CQ20]
In the past 12 months, that is since [FILL: DATE 12 MONTHS AGO] did you need medical care because of what a current or ex-partner did to you?
Yes 1
No 2
[CQ21_INTRO]
Thank you for your participation. Only a few final questions remain.
In the next few questions, we will ask about services and assistance you might have needed because of what a current or ex-romantic or sexual partner did to you.
[CQ21]
Have you ever talked to a crisis hotline operator?
Yes 1
No 2
[CQ22]
Did you ever need housing services?
Yes 1
No 2
[CQ23]
Did you ever need victim’s advocate services?
Yes 1
No 2
[CQ24]
Did you ever need legal services or the advice of an attorney?
Yes 1
No 2
[CQ25]
Did you ever file a police report because of the things that a current or ex-partner did to you?
Yes 1
No 2
[IF CQ25=YES, ASK CQ26. ELSE GO TO CQ27]
[CQ26]
In the past 12 months, that is since [FILL: DATE 12 MONTHS AGO] did you file a police report because of the things that a current or ex-partner did to you?
Yes 1
No 2
[CQ27]
Did you ever miss days of work because of the things that a current or ex-partner did to you?
Yes 1
No 2
[IF CQ27 = YES, GO TO CQ28. ELSE GO TO CQ29]
[CQ28]
In the past 12 months, that is since [FILL: DATE 12 MONTHS AGO] did you miss days of work because of the things that a current or ex-partner did to you?
Yes 1
No 2
[CQ29]
Did you ever miss days of school because of the things that a current or ex-partner did to you?
Yes 1
No 2
[IF CQ29 = YES, GO TO CQ30; ELSE GO TO INCENTIVE]
[CQ30]
In the past 12 months, that is since [FILL: DATE 12 MONTHS AGO] did you miss days of school because of the things that a current or ex-partner did to you?
Yes 1
No 2
[GO TO INCENTIVE]
[END OF SURVEY]
[INCENTIVE]
That completes the survey. As a token of appreciation, we would like to give you [If Phase=1, fill $15; If Phase=2, fill $40].
Would you like us to send that to you instantly by email as a VISA gift card or would you prefer to receive it in the mail, as a check?
By email 1
By mail as a check 2
Don’t want the [If Phase=1, fill $15; If Phase=2, fill $40] 3
[Show if INCENTIVE=1]
[INCENT_EMAIL]
Please provide the email address to which we should send your you [If Phase=1, fill $15; If Phase=2, fill $40].
Email address ([email protected]): [only allow valid email address formats]
Retype email address ([email protected]): [only allow valid email address formats]
[If the email addresses provided do not match, show in red: “The email addresses you typed do not match. Please enter them both again.]
[If either of email addresses is invalid, show in red: “Email address is invalid. Please provide a valid email address ([email protected]).]
[Show if INCENTIVE=2]
[INCENT_NAME]
Please provide your first and last name, as it should appear on your check.
First name: [INCENT_NAMEF]
Last name: [INCENT_NAMEL]
[IF R MOVES FORWARD WITHOUT PROVIDING BOTH A FIRST NAME AND A LAST NAME, DISPLAY A 508-COMPLIANT MESSAGE IN RED TO PROMPT FOR A RESPONSE.]
[FINAL SCREEN]
Thank you for participating in CDC’s survey of health and injuries. We realize that some of the topics covered are quite personal and can be difficult to think and talk about. We appreciate your willingness to be a part of this study and want you to know that we recognize the important contribution you have made. Sometimes when people have participated in a study like this, they realize that they are interested in following up on some of the issues that they have been asked about in the study with someone who is professionally trained to deal with these kinds of issues.
Below are some toll-free numbers of resources that you can use now or in the future if you want to speak further with someone.
You can reach the National Domestic Violence Hotline at 1-800-799-SAFE (7233).
You can reach the National Sexual Assault Hotline at 1-800-656-HOPE (4673).
You can reach the National Child Abuse Hotline at 1-800-4-A-Child (422-4453).
You can reach the National Suicide Prevention Lifeline at 988.
[PROGRAMMER: INCLUDE “SUBMIT” BUTTON ON THIS FINAL SCREEN. WHEN R CLICKS BUTTON, LAND ON RECEIPT PAGE WHICH WILL READ:]
You have reached the end of the survey, you may now close your browser.
Appendix A. Relationship Codes and Categories
|
Subcategories shown when perp sex is male |
Subcategories shown when perp sex is female |
Subcategories shown when perp sex is transgender or none of these |
|||
Broad Category |
Code |
Subcategory |
Code |
Subcategory |
Code |
Subcategory |
INTIMATE PARTNER |
100 |
Male intimate partner |
150 |
Female intimate partner |
170 |
Transgender intimate partner |
My spouse (husband or wife) |
101 |
Husband |
151 |
Wife |
171 |
Spouse |
My ex-spouse (husband or wife) |
102 |
Ex-husband /divorced /separated |
152 |
Ex-wife /divorced /separated |
172 |
Ex-spouse |
Someone I was currently involved with romantically or sexually (other than a spouse) |
103 |
Partner/Significant other/Fiancé |
153 |
Partner/Significant other/Fiancé |
173 |
Partner/Significant other/Fiancé |
104 |
Boyfriend/Dating partner |
154 |
Girlfriend/Dating partner |
174 |
Dating partner |
|
105 |
Someone I was having sex with |
155 |
Someone I was having sex with |
175 |
Someone I was having sex with |
|
106 |
Child’s father |
156 |
Child’s mother |
176 |
Child's parent |
|
107 |
Other |
157 |
Other |
177 |
Other |
|
Someone I used to be involved with romantically or sexually (other than an ex-spouse) |
108 |
Ex-Partner/Ex-Significant other/Ex-Fiancé |
158 |
Ex-Partner/Ex-Significant other/Ex-Fiancée |
178 |
Ex-Partner/Ex-Significant other/Ex-Fiancé |
109 |
Ex-boyfriend/Ex-dating partner |
159 |
Ex-girlfriend/Ex-dating partner |
179 |
Ex-dating partner |
|
110 |
Someone I had sex with |
160 |
Someone I had sex with |
180 |
Someone I had sex with |
|
111 |
Child’s father |
161 |
Child’s mother |
181 |
Child's parent |
|
112 |
Other |
162 |
Other |
182 |
Other |
|
FAMILY MEMBER |
200 |
Male family member |
250 |
Female family member |
270 |
Transgender family member |
A family member |
201 |
Father (includes Father/ Step-Father/Foster father/ Father-in-law) |
251 |
Mother (includes Mother/Step-Mother/Foster mother/Mother-in-law) |
271 |
Parent |
202 |
Brother (includes Step, Half, Adopted, Foster, and -in-Law) |
252 |
Sister (includes Step, Half, Adopted, Foster, and -in-Law) |
272 |
Sibling |
|
203 |
Grandfather |
253 |
Grandmother |
273 |
Grandparent |
|
204 |
Uncle/Godfather |
254 |
Aunt/Godmother |
274 |
Aunt/Uncle/Godparent |
|
205 |
Son (includes Step, Foster, and in-Law) |
255 |
Daughter (includes Step, Foster, and in-Law) |
275 |
Child, offspring |
|
206 |
Nephew |
256 |
Niece |
276 |
Nephew/Niece |
|
207 |
Cousin |
257 |
Cousin |
277 |
Cousin |
|
208 |
Grandson (includes Step Grandson) |
258 |
Granddaughter (includes Step Granddaughter) |
278 |
Grandchild |
|
209 |
Other |
259 |
Other |
279 |
Other |
|
FRIEND |
300 |
Male friend |
350 |
Female friend |
370 |
Transgender friend |
A friend |
301 |
Friend |
351 |
Friend |
371 |
Friend |
302 |
Family friend |
352 |
Family friend |
372 |
Family friend |
|
303 |
Other |
353 |
Other |
373 |
Other |
|
ACQUAINTANCE |
400 |
Male acquaintance |
450 |
Female acquaintance |
470 |
Transgender Acquaintance |
Acquaintance (e.g., neighbor, roommate, classmate, friend of a friend, etc.) |
401 |
Acquaintance/Friend of a friend |
451 |
Acquaintance/Friend of a friend |
471 |
Acquaintance/Friend of a friend |
402 |
Neighbor |
452 |
Neighbor |
472 |
Neighbor |
|
403 |
Roommate |
453 |
Roommate |
473 |
Roommate |
|
404 |
Classmate/Schoolmate/Student |
454 |
Classmate/Schoolmate/Student |
474 |
Classmate/Schoolmate/Student |
|
405 |
Drug dealer |
455 |
Drug dealer |
475 |
Drug dealer |
|
406 |
Enemy |
456 |
Enemy |
476 |
Enemy |
|
407 |
Other |
457 |
Other |
477 |
Other |
|
KNOWN THROUGH WORK |
500 |
Male work relationship |
550 |
Female work relationship |
570 |
Transgender work relationship |
Someone I knew through work (e.g., co-worker, boss/supervisor, client/customer/ patient, etc.) |
501 |
Client/Customer/Patient |
551 |
Client/Customer/Patient |
571 |
Client/Customer/Patient |
502 |
Co-worker |
552 |
Co-worker |
572 |
Co-worker |
|
503 |
Boss/Manager/Supervisor/Superior in command |
553 |
Boss/Manager/Supervisor/Superior in command |
573 |
Boss/Manager/Supervisor/Superior in command |
|
504 |
Someone who was working for me |
554 |
Someone who was working for me |
574 |
Someone who was working for me |
|
505 |
Other |
555 |
Other |
575 |
Other |
|
PERSON OF AUTHORITY |
600 |
Male person of authority |
650 |
Female person of authority |
670 |
Transgender person of authority |
Person of authority (e.g., teacher, doctor, police officer, etc.) |
601 |
Professor/Teacher/Teaching Assistant |
651 |
Professor/Teacher/Teaching Assistant |
671 |
Professor/Teacher/Teaching Assistant |
602 |
Coach / Camp counselor |
652 |
Coach / Camp counselor |
672 |
Coach / Camp counselor |
|
603 |
Doctor/Dentist/Nurse/Therapist |
653 |
Doctor/Dentist/Nurse/Therapist |
673 |
Doctor/Dentist/Nurse/Therapist |
|
604 |
Caregiver/Babysitter |
654 |
Caregiver/Babysitter |
674 |
Caregiver/Babysitter |
|
605 |
Landlord |
655 |
Landlord |
675 |
Landlord |
|
606 |
Police officer/Security guard |
656 |
Police officer/Security guard |
676 |
Police officer/Security guard |
|
607 |
Clergy member |
657 |
Clergy member |
677 |
Clergy member |
|
608 |
Other |
658 |
Other |
678 |
Other |
|
BRIEFLY KNOWN |
700 |
Male briefly known |
750 |
Female briefly known |
770 |
Transgender briefly known |
Someone I knew less than 24 hours (e.g., taxi driver, someone met at party/bar) |
701 |
Someone just met (e.g.: at a party, a bar, blind date)/Known for less than 24 hours |
751 |
Someone just met (e.g.: at a party, a bar, blind date)/Known for less than 24 hours |
771 |
Someone just met (e.g.: at a party, a bar, blind date)/Known for less than 24 hours |
702 |
Someone met online |
752 |
Someone met online |
772 |
Someone met online |
|
703 |
Someone in the neighborhood / Known by sight |
753 |
Someone in the neighborhood / Known by sight |
773 |
Someone in the neighborhood / Known by sight |
|
704 |
Maintenance/Service provider/Delivery person |
754 |
Maintenance/Service provider/Delivery person |
774 |
Maintenance/Service provider/Delivery person |
|
705 |
Clerk/Sales person |
755 |
Clerk/Sales person |
775 |
Clerk/Sales person |
|
706 |
Taxi/Cab/Uber/Lyft driver/Bus driver |
756 |
Taxi/Cab/Uber/Lyft driver/Bus driver |
776 |
Taxi/Cab/Uber/Lyft driver/Bus driver |
|
707 |
Other |
757 |
Other |
777 |
Other |
|
A COMPLETE STRANGER |
800 |
Male stranger |
850 |
Female stranger |
870 |
Transgender stranger |
SOMEONE ELSE (SPECIFY) |
900 |
Male, someone else |
950 |
Female, someone else |
970 |
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Mina Muller |
| File Modified | 0000-00-00 |
| File Created | 2023-11-10 |
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