O
MB
No.:
Expiration Date:
Building Strong Families: 36 Month Follow-Up Survey
Shannon Monahan
Robert Wood
Sheena McConnell
Shawn Marsh
Submitted to:
U.S. Department of Health and Human Services Administration for Children and Families Office of Planning, Research, and Evaluation 7th Fl., West, Aerospace Center Bldg. 370 L’ Enfant Promenade, SW Washington, DC 20447
Project Officer: |
Submitted by:
Mathematica Policy Research, Inc. P.O. Box 2393 Princeton, NJ 08543-2393 Telephone: (609) 799-3535 Facsimile: (609) 799-0005
Alan Hershey
Survey Director: Shawn Marsh |
OMB No.:
Expiration Date:
The Building Strong Families Evaluation
Thirty-Six Month Follow-Up Survey
Items CO1.a - CO1.j: Adapted and reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16204 North Florida Avenue, Lutz, Florida 33549, from the Parenting Alliance Measure by Richard Abidin, EdD and Timothy R Konold, PhD. Copyright 1999 by PAR, Inc. Further reproduction is prohibited without permission from PAR, Inc.
Items RR14.a – RR14.l: CTS2 copyright © 2003 by Western Psychological Services. Adapted for use in specific scholarly application by Mathematica Policy Research, Inc., under limited-use license from the publisher, Western Psychological Services, 12031 Wilshire Boulevard, Los Angeles, California 90025-1251, U.S.A. All rights reserved. No additional reproduction may be made, whether in whole or in part, without the prior, written authorization of Western Psychological Services (rights@wpspublish.com).
COPYRIGHT FOR BPI |
COPYRIGHT FOR CTSPC |
COPYRIGHT FOR PKBS |
[NEED OMB CONTROL NUMBER]
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. The time required to complete this information collection is estimated to average 45 minutes per respondent, including the time to review instructions, gather the data needed, and complete and review the information collected. |
CONTENTS
Section Page
IN INTRODUCTION 1
FS FAMILY STRUCTURE 6
CO INVOLVEMENT WITH CHILD 35
CH CHILD OUTCOMES 43
RR RELATIONSHIP 51
WB PARENTAL WELL BEING (I) 64
SE RECEIPT OF SERVICES 69
PA PATERNITY AND CHILD SUPPORT 70
WW FAMILY SELF-SUFFICIENCY 76
WB PARENTAL WELL BEING (II) 93
BP COUNTRY OF ORIGIN AND BIOLOGICAL PARENTS 100
LO LOCATING INFORMATION 105
QUESTIONNAIRE FORMAT EXPLANATION
The purpose of this page is to illustrate the layout of questions in this instrument and help the reader to interpret the formatting and instructions, so they can follow the flow of the questions. This format was designed for ease of use by those who will be programming the computer-aided telephone interviewing (CATI) survey instrument. If this questionnaire was administered in a paper and pencil version, the formatting would be changed; however, the skip logic would remain the same.
Line
2: This box indicates if a previously answered question affects
whether this question is asked or which part of the question is
asked, and if so, the specific responses to the earlier question
that trigger this question or a specific part of it.
FS42.2 |
IF FS42=most of the time (2), some of the time (3), OR none of the time (4) |
h |
(
IF
FS42 =2 or 3)
When [he/she] is not living with you,
Question Text
(W/w)ho does [CHILD] live with?
These
are skip instructions to the next question asked. You should follow
the lowest number skip to the next question, to see if that question
is appropriate. Instructions at those questions will tell you how
to proceed.
F |
1 |
F |
GRANDPARENT(S) |
2 |
|
OTHER RELATIVES(S) |
3 |
|
ADOPTIVE PARENTS |
4 |
|
FOSTER PARENTS |
5 |
|
FRIEND(S) |
6 |
|
SOMEONE ELSE |
7 |
FS42.2.1 |
DK |
d |
FS42.3 OR FS43 |
REF |
r |
IN1 |
ALL |
May I please speak with [SAMPLE MEMBER]? My name is [NAME] and I’m calling from Mathematica Policy Research, Inc., a research company in Princeton, New Jersey.
SAMPLE MEMBER AVAILABLE |
1 |
IN3a if 15 MO = 0, IN3b if 15 MO = 1 |
SAMPLE MEMBER NOT AVAILABLE |
2 |
IN2 |
SAMPLE MEMBER DECEASED |
3 |
IN8 |
IN2 |
IN1=2 |
(When would be a good time to reach [SAMPLE MEMBER]?/ When would be a good time to do the interview?)
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
INSTRUCTION: MAKE AN APPOINTMENT USING THE PARALLEL BLOCK.
INSTRUCTION: USE THE ‘APPOINTMENT’ TAB OR PRESS <CTRL-S> TO INVOKE THE APPOINTMENT MAKING DIALOG.
CALL BACK INFO |
STRING OF 20 |
END |
IN3a |
IN1=1 and 15 Mo = 0 |
(Hello, my name is [NAME] and I’m calling from Mathematica Policy Research, Inc., a research company in Princeton, New Jersey.) I’m calling you about the Building Strong Families study you joined about three years ago. You may have received a letter recently to let you know that we would be calling you.
We last spoke with you on [RA DATE]. At that time, we told you that we would be contacting you again to learn how you are doing.
The interview will take about 45 50 minutes and you will receive $25 for completing the interview. Everything that you tell me is confidential and your privacy will be protected to the extent allowable by law. Your participation in the survey is voluntary and will not affect any benefits or services you or your family receive now or in the future. You do notn’t have to answer any questions that make you uncomfortable.
Because we want to get your opinion, it is important that you answer the questions without help from anyone else. Of course, you can share what you said with others after we have completed the interview.
This interview may be taped so my supervisor can monitor the interview and make sure that the questions are asked correctly.
Is now a good time to start?
OK TO CONTINUE |
1 |
IN5 |
NOT A GOOD TIME |
2 |
IN4 |
FOR THOSE WITH 15MONTH (PRELOADED)
IN3b |
IN1=1 and 15 Mo=1 |
(Hello, my name is [NAME] and I’m calling from Mathematica Policy Research, Inc., a research company in Princeton, New Jersey.) I’m calling you about the Building Strong Families study you joined about three years ago. We spoke with you several years ago to see how you were doing and now we’d like to talk with you again and see how things are going for you. You may have received a letter recently to let you know that we would be calling you.
The interview will take about 50 minutes and you will receive $25 for completing the interview. Everything that you tell me is confidential and your privacy will be protected to the extent allowable by law. Your participation in the survey is voluntary and will not affect any benefits or services you or your family receive now or in the future. You do not have to answer any questions that make you uncomfortable.The interview will take about 45 minutes and you will receive $25 for completing the interview. Everything that you tell me is confidential. You don’t have to answer any questions that make you uncomfortable.
Because we want to get your opinion, it is important that you answer the questions without help from anyone else. Of course, you can share what you said with others after we have completed the interview.
This interview may be taped so my supervisor can monitor the interview and make sure that the questions are asked correctly.
Is now a good time to start?
OK TO CONTINUE |
1 |
IN5 |
NOT A GOOD TIME |
2 |
IN4 |
IN4 |
IN3a=2 or IN3b=2 |
When would be a good time to do the interview?
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
INSTRUCTION: MAKE AN APPOINTMENT USING THE PARALLEL BLOCK.
INSTRUCTION: USE THE ‘APPOINTMENT’ TAB OR PRESS <CTRL-S> TO INVOKE THE APPOINTMENT MAKING DIALOG.
CALL BACK INFO |
STRING OF 20 |
END |
IN5 |
IN3a=1 or IN3b=1 |
I just need to verify that I am speaking with the correct person. What is your date of birth?
RESP. BIRTHDAY |
MM/DD/YYYY |
FS1 |
DK |
d |
IN6 |
REF |
r |
IN6 |
BIRTHDAY INCORRECT |
MM/DD/YYYY |
IN6 |
IN6 |
IN5=BIRTHDATE INCORRECT, d OR r |
And what are the last 4-digits of your Social Security Number?
RESP. 4-DIGIT SSN |
FF |
FS1 |
DK |
d |
IN6a |
REF |
r |
IN6a |
SSN INCORRECT |
FF |
IN6a |
IN6a |
IN6=SSN INCORRECT, d OR r |
Can you tell me the name of the street that you lived on when you first enrolled in the program on [RA DATE]?
RESP. ADDRESS CORRECT |
1 |
FS1 |
DK |
d |
IN7 |
REF |
r |
IN7 |
RESP. ADDRESS INCORRECT |
0 |
IN7 |
IN7 |
IN6a = 0, d OR r |
I’m sorry. I need to check my records before I can interview you. Is this the best time to reach you in the future?
INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.
YES |
1 |
END |
NO, CALL BACK INFO |
STRING OF 20 |
END |
IN8 |
IN1 = 3 |
Thank you for taking time to speak with me. Good-bye.
|
|
END |
FS1 |
ALL |
Before we get started I would like to make sure we have your name recorded correctly.
What is your first name?
PROBE: Can you spell that for me please?
FIRST NAME OF RESPONDENT |
STRING OF 20 |
FS2 |
FS2 |
ALL |
And a middle name please?
PROBE: Can you spell that for me please?
MIDDLE NAME OF RESPONDENT |
STRING OF 20 |
FS3 |
FS3 |
ALL |
And a last name please?
PROBE: Can you spell that for me please?
LAST NAME OF RESPONDENT |
STRING OF 20 |
FS4 |
FS4 |
ALL |
Are you usually called [RESP FIRST NAME] or do you go by another name?
INSTRUCTION: IF SAME JUST HIT ENTER.
INSTRUCTION: IF DIFFERENT NAME, CHANGE TO USUAL NAME WHICH WILL BE USED AS FILL IN THE REMAINDER OF SURVEY.
PROBE: Can you spell that for me please?
FATHER/MOTHER USUAL FIRST NAME |
STRING OF 20 |
FS5a (if 15 Mo=0 and NOTPREG) FS7 (if 15 Mo=0 and PREG) FS5b (if 15 Mo=1 and 15MO_FS5=1 or 3) BOX 1 (if 15 Mo=1 and 15MO_FS5=2 or 4) |
FS5a |
If not pregnant at baseline (NOTPREG) and 15 Mo = 0 |
FATHER NAME IF FEMALE/MOTHER NAME IF MALE |
Our records indicate that you and [FATHER NAME/MOTHER NAME] had a baby on [BASELINE CHILD BDATE]. Is that correct?
INSTRUCTION: IF RESPONDENT REPORTS MULTIPLE BIRTHS, ENTER “YES.”
YES |
1 |
FS6.1 |
YES, BUT BABY DIED |
2 |
BOX 1 |
NO, OTHER DATE |
3 |
FS6 |
NO, BABY DIED |
4 |
BOX 1 |
DENY BABY EXISTS |
5 |
BOX 1 |
FS5b |
15 Mo=1 and 15 Mo_FS5=1, OR 15 Mo_FS7=1 OR 15 Mo_FS8=1 |
FATHER NAME IF FEMALE/MOTHER NAME IF MALE |
When we interviewed you on [15MO SURVDATE], we asked you some questions about your child, [CHILD]. [CHILD] is around 3 years old now. Is that correct?
INSTRUCTION: IF RESPONDENT REPORTS MULTIPLE BIRTHS, ENTER “YES.”
YES |
1 |
FS19 |
NO, CHILD DIED |
2 |
BOX 1 |
NO, DENY CHILD EXISTS |
3 |
|
DK |
d |
|
REF |
r |
FS6 |
IF 15 MO=0 AND NOTPREG AND FS5a=NO, OTHER DATE |
When did you and [FATHER NAME/MOTHER NAME] have the baby?
CHILD BIRTHDAY |
MM/DD/YYYY |
FS6.1 |
FS6.1 |
IF 15 MO=0 AND NOTPREG AND FS5a=1 |
FATHER NAME IF MALE/MOTHER NAME IF FEMALE |
INSTRUCTION: ENTER WITHOUT ASKING IF ALREADY KNOWN.
And you and [FATHER NAME/MOTHER NAME] had just one baby on [CHILD BDATE]?
INSTRUCTION: IF “NO” PROBE FOR NUMBER OF BABIES.
INSTRUCTION: IF “YES” ENTER ONE.
NUMBER OF BABIES |
FF |
FS10 |
DK |
d |
|
REF |
r |
FS7 |
If 15 Mo=0 AND pregnant at baseline (PREG) |
FATHER NAME IF FEMALE/MOTHER NAME IF MALE |
Our records indicate that you and [FATHER NAME/MOTHER NAME] were expecting a baby around [BASELINE CHILD EXPECTED DELIVERY DATE].
Did you have a baby around that time?
INSTRUCTION: IF RESPONDENT REPORTS DATE OF BIRTH, ANSWER “YES” AND ENTER DATE OF BIRTH ON NEXT SCREEN.
INSTRUCTION: IF RESPONDENT REPORTS MULTIPLE BIRTHS, ENTER “YES.” YOU WILL ENTER NUMBER OF BABIES ON ANOTHER SCREEN.
IF RESPONDENT ANSWERS NO, PROBE: I’m sorry. What happened?
YES |
1 |
FS8 |
YES, BUT BABY DIED |
2 |
BOX 1 |
NO, MISCARRIAGE |
3 |
|
NO, ABORTION |
4 |
|
NO, BABY DIED |
5 |
|
NO, DENY PREGNANCY |
6 |
|
DK |
d |
|
REF |
r |
BOX 1: IF FS5a=2, 4, 5 OR FS5b=2, 3 OR FS7=2,3,4,5, d OR r OR 15MO_FS5=2 OR 4 |
DO NOT ASK UNLESS OTHERWISE INDICATED |
FS8 to FS17.6 AND FS42 TO FS46.1 |
CO1 TO CO4 |
WB0 (IF NO OTHER CHILDREN) |
CHI-CH12 (SKIPPING ENTIRE CH SECTION) |
PA1 TO PA12 |
FS8 |
IF 15 MO=0 AND PREG AND FS7=1 |
FATHER NAME IF MALE/MOTHER NAME IF FEMALE |
On what date was the baby born?
INSTRUCTION: ENTER RESPONSE WITHOUT ASKING IF KNOWN.
BIRTHDAY |
MM/DD/YYYY |
FS9 |
BABY DIED |
2 |
FS19 |
FS9 |
IF 15 MO=0 AND PREG AND FS7=1 |
FATHER NAME IF FEMALE/MOTHER NAME IF MALE |
INSTRUCTION: ENTER WITHOUT ASKING IF ALREADY KNOWN.
And you and [FATHER NAME/MOTHER NAME] had just one baby on [CHILD BDATE]?
INSTRUCTION: IF “NO” PROBE FOR NUMBER OF BABIES.
INSTRUCTION: IF “YES” ENTER ONE.
NUMBER OF BABIES |
FF |
FS10 |
DK |
d |
|
REF |
r |
FS10 |
ALL |
oldest or first born IF FS9>1 or FS6.1>1 |
What is the first name of this baby?
FIRST NAME OF CHILD |
STRING OF 20 |
FS12 |
FS12 |
ALL |
And a middle name please?
PROBE: Can you spell that for me please?
MIDDLE NAME OF CHILD |
STRING OF 20 |
FS13 |
FS13 |
ALL |
And a last name please?
PROBE: Can you spell that for me please?
LAST NAME OF CHILD |
STRING OF 20 |
FS17 |
FS17 |
ALL |
INSTRUCTION: DO NOT ASK IF ALREADY KNOWN.
Is [CHILD] male or female?
MALE |
1 |
FS17.1 |
FEMALE |
2 |
FS17.1 |
ALL |
him IF FS17=CMALE; her IF FS17=CFEMALE |
I want to make sure that we use [CHILD]’s correct first name. Do you call [him/her] [CHILD] or do you usually call [him/her] by a different name?
INSTRUCTION: IF DIFFERENT NAME, CHANGE TO USUAL NAME WHICH WILL BE USED AS FILL IN THE REMAINDER OF SURVEY.
USUAL FIRST NAME OF [CHILD] |
STRING OF 20 |
FS17.3 |
FS17.3 |
IF FEMALE |
he if CMALE; she if CFEMALE |
At the time [he/she] was born, how much did [CHILD] weigh?
PROBE: You can tell me in pounds and ounces or in kilograms.
INSTRUCTION: FIRST ENTER IF ANSWER IS IN POUNDS AND OUNCES OR KILOGRAMS. YOU WILL ENTER THE WEIGHT ON THE NEXT SCREEN.
POUNDS AND OUNCES |
1 |
FS17.4 |
KILOGRAMS |
2 |
FS17.6 |
DK |
d |
FS19 |
REF |
r |
FS17.4 |
IF FS17.3=1 (pounds and ounces) |
INSTRUCTION: ENTER NUMBER OF POUNDS.
POUNDS |
FF |
FS17.5 |
FS17.5 |
IF FS17.3=1 (pounds and ounces) |
INSTRUCTION: ENTER NUMBER OF OUNCES.
OUNCES |
FF |
FS19 |
FS17.6 |
IF FS17.3=2 (kilograms) |
INSTRUCTION: ENTER NUMBER OF KILOGRAMS.
KILOGRAMS |
FF |
FS19 |
FS19 |
ALL (IF BSF_PARTNER=DECEASED FROM 15 MO, THEN BOX 2) |
he IF FEMALE; she IF MALE |
father’s IF FEMALE; mother’s IF MALE |
(IF FS5a=2 or 4 OR FS5b=2 OR FS7=2, 3 or 5) I am very sorry to hear that. Our condolences for your loss. If you don’t mind…
I’d like to ask you a few questions about [FIRST NAME OF FATHER/MOTHER].
I also want to make sure that I use [FIRST NAME OF FATHER NAME/MOTHER NAME]’s correct first name. Is [he/she] usually called [FIRST NAME OF FATHER NAME/MOTHER NAME] or does [he/she] go by a different first name?
INSTRUCTION: IF DIFFERENT NAME, CHANGE TO USUAL NAME WHICH WILL BE USED AS FILL IN THE REMAINDER OF SURVEY.
INSTRUCTION: IF RESPONDENT REPORTS THAT FATHER DIED CODE ’3’
YES, CORRECT NAME |
1 |
FS25 |
NO, IS NOT CORRECT NAME |
0 |
FS19.Fn |
NO, DIED |
3 |
BOX 2 |
DK |
d |
FS25 |
REF |
r |
FS19.Fn |
if FS19=NO |
What name does he/she usually go by?
ENTER USUAL FIRST NAME
USUAL FIRST NAME OF [FATHER/MOTHER] |
STRING OF 20 |
FS25 (IF ‘98’ BOX 2) |
FS25 |
IF FS19<>3 OR BSF_PARTNER NOT DECEASED FROM 15 MO |
FATHER IF FEMALE; MOTHER IF MALE |
The next questions are about you and [FATHER/MOTHER].
Are you and [FATHER/MOTHER]…
Married, |
1 |
FS33 |
Divorced, |
2 |
FS26 |
Separated, or |
3 |
FS26 |
Have you never been married to each other? |
4 |
FS26 |
MARRIAGE ANNULLED |
5 |
FS26 |
WIDOWED |
6 |
BOX 2 |
PARTNER DIED (NEVER MARRIED) |
7 |
|
DK |
d |
FS26 |
REF |
r |
BOX 2: IF FS19=3 OR FS25=6 OR FS25=7 (FATHER/MOTHER died) OR 15MO_FS19=3 OR 15MO_FS25=6 OR 7 |
DO NOT ASK UNLESS OTHERWISE INDICATED |
FS26 TO FS33.2.3 |
FS43.1 TO FS46.1 |
RR1 TO RR11 |
PA11.2 TO PA12 |
FS26 |
if FS25<>1 |
FATHER IF FEMALE; MOTHER IF MALE |
Which of the following statements best describes your current relationship with [FATHER/MOTHER]?
We are romantically involved on a steady basis, |
1 |
FS27 |
We are involved in an on-again and off-again relationship, or |
2 |
|
We are not in a romantic relationship. |
3 |
FS26.1 |
DK |
d |
FS27 |
REF |
r |
FS26.1 |
IF FS26=3 (no relationship) AND 15MO_FS26=3 then Go to FS27 |
FATHER IF MALE/MOTHER IF FEMALE |
When did your romantic relationship with [FATHER/MOTHER] end?
PROBE: Just the month and year is fine.
INTERVIEWER: CODE 13 IF RESPONDENT ANSWERS THAT THEY WERE NEVER IN A RELATIONSHIP.
DATE END RELATIONSHIP |
MM/YYYY |
FS26.2 |
FS26.2 |
IF FS26=3 (no relationship) AND 15MO_FS26=3 then Go to FS27 |
him IF FEMALE; her IF MALE |
I am going to read you a list of reasons that people give for why their relationships ended. For each reason, tell me if this is why your relationship with [FATHER/MOTHER] ended.
(For a thru f) Was it because you, [FATHER/MOTHER], or both of you…
(For g through i) Was it because…
|
|
|
|
(IF YES FOR A THRU F) |
|
|
|
|
|
Was that you, [FATHER/MOTHER] or both of you? |
|
a |
Cheated or were unfaithful? |
YES |
1 |
YOU |
1 |
[FATHER/MOTHER] |
2 |
||||
BOTH OF YOU |
3 |
||||
NO |
0 |
|
|||
b |
Went to jail or prison? |
YES |
1 |
YOU |
1 |
[FATHER/MOTHER] |
2 |
||||
BOTH OF YOU |
3 |
||||
NO |
0 |
|
|||
c |
Were abusive or violent? |
YES |
1 |
YOU |
1 |
[FATHER/MOTHER] |
2 |
||||
BOTH OF YOU |
3 |
||||
NO |
0 |
|
|||
d |
Used drugs or alcohol? |
YES |
1 |
YOU |
1 |
[FATHER/MOTHER] |
2 |
||||
BOTH OF YOU |
3 |
||||
NO |
0 |
|
|||
e |
Could not keep a job or contribute enough financially to the family? |
YES |
1 |
YOU |
1 |
[FATHER/MOTHER] |
2 |
||||
BOTH OF YOU |
3 |
||||
NO |
0 |
|
|||
f |
Were not a good parent or role model? |
YES |
1 |
YOU |
1 |
[FATHER/MOTHER] |
2 |
||||
BOTH OF YOU |
3 |
||||
NO |
0 |
|
|||
g |
The two of you were not communicating well or were arguing too much? |
YES |
1 |
|
|
|
|
NO |
0 |
|
|
h |
Of lack of support from family members? |
YES |
1 |
|
|
|
|
NO |
0 |
|
|
i |
You and [FATHER/MOTHER] were living too far apart? |
YES |
1 |
|
|
|
|
NO |
0 |
|
|
j |
Were there any other reasons why your romantic relationship ended? |
YES |
1 |
FS26.3 |
|
|
|
NO |
0 |
FS27 OR FS33 |
FS26.3 |
IF FS26.2J=1 AND 15MO_FS26=3 then Go to FS27 |
What were those other reasons?
INSTRUCTION: RECORD RESPONSE VERBATIM
REASONS RELATIONSHIP ENDED |
STRING OF 100 |
FS27 OR FS33 |
FS27 |
IF FS25=4 (never been married to each other) |
FATHER IF FEMALE; MOTHER IF MALE |
What do you think the chances are you will marry [FATHER/MOTHER] in the future…
No chance, |
0 |
FS33 |
A little chance, |
1 |
FS28 |
A 50-50 chance, |
2 |
|
A pretty good chance, or |
3 |
|
An almost certain chance? |
4 |
|
DK |
d |
|
REF |
r |
FS28 |
IF FS27<>0, DK |
FATHER IF FEMALE; MOTHER IF MALE |
YES |
1 |
FS29 |
NO |
0 |
FS33 |
DK |
d |
|
REF |
r |
FS29 |
IF FS28=YES |
INSTRUCTION: ENTER 13 IF NO DATE HAS BEEN SET
DATE OF PLANNED WEDDING |
MM/YYYY |
FS33 |
DK/NO DATE YET |
d |
|
REF |
r |
FS33 |
ALL |
FATHER IF FEMALE; MOTHER IF MALE |
Do you currently live with [FATHER/MOTHER] in the same household…
All of the time, |
1 |
FS42 |
Most of the time, |
2 |
|
Some of the time, or |
3 |
FS33.2 |
None of the time? |
4 |
|
DK |
d |
|
REF |
r |
FS33.2 |
IF FS33>2 |
FATHER IF FEMALE; MOTHER IF MALE |
How often do you and [FATHER/MOTHER] see or talk to each other? Is it…
Every day or almost every day, |
1 |
FS42 OR FS37 |
A few times a week, |
2 |
|
A few times a month, |
3 |
|
About once a month, |
4 |
FS33.2.1 OR FS37 |
Only a few times in the past year, or |
5 |
|
Hardly ever or never? |
6 |
|
DK |
d |
|
REF |
r |
FS33.2.1 |
OPTION 1: FS33=4 (not living together at all) AND FS25=1 (married)
OPTION 2: IF FS26=1,2 (romantically involved) AND FS33.2=4,5,6 (seeing each less than a few times) |
FATHER IF FEMALE; MOTHER IF MALE |
IF OPTION 1: Are you and [FATHER/MOTHER] not living together because you are not getting along or is there another reason?
IF OPTION 2: Are you and [FATHER/MOTHER] not seeing each other very much because you are not getting along or is there another reason?
NOT GETTING ALONG |
1 |
FS37 |
ANOTHER REASON |
2 |
FS33.2.2 |
DK |
d |
FS42 |
REF |
r |
FS33.2.2 |
FS33.2.1=2 AND OPTION 1: FS33=4 (not living together at all) AND FS25=1 (married)
OPTION 2: IF FS26=1,2 (romantically involved) AND FS33.2=4,5,6 (seeing each less than a few times) |
FATHER IF FEMALE; MOTHER IF MALE |
IF OPTION 1: Why are you and [FATHER/MOTHER] not living together now?
IF OPTION 2: Why are you and [FATHER/MOTHER] not seeing each other very much?
INSTRUCTION: PROBE FOR MORE THAN ONE ANSWER.
1 |
PARTNER IS INCARCERATED |
YES |
NO |
FS42 |
2 |
RESPONDENT INCARCERATED |
YES |
NO |
|
3 |
PARTNER IN MILITARY |
YES |
NO |
|
4 |
RESPONDENT IN MILITARY |
YES |
NO |
|
5 |
PARTNER’S WORK |
YES |
NO |
|
6 |
RESPONDENT’S WORK |
YES |
NO |
|
7 |
OTHER REASON |
YES |
NO |
FS33.2.3 |
|
DK |
d |
FS42 |
|
|
REF |
r |
FS33.2.3 |
IF FS33.2.2=7 |
INSTRUCTION: |
SPECIFY OTHER REASON |
FS42 |
FS37 |
IF FS25<>(1) (not married) and FS26<>(1,2) (not romantically involved) OR (IF FS33.2.1=1) OR IF FS19=3 |
someone other than [FATHER/MOTHER] IF FS25<>6,7; with someone else IF FS25=6,7 OR IF FS19=3 |
FATHER IF FEMALE; MOTHER IF MALE |
(IF FS19=3 or FS25=6 or 7) I am very sorry to hear that. If you don’t mind, I have a few more questions to ask.
Are you currently involved in a romantic relationship with [someone other than [FATHER/MOTHER]/someone else]?
YES |
1 |
FS38 |
NO |
0 |
FS42 |
DK |
d |
|
REF |
r |
FS38 |
IF FS37=YES |
Just to be able to refer to your current partner by name in this interview, what is your current partner’s first name?
INSTRUCTION: IF RESPONDENT INDICATES MORE THAN ONE CURRENT PARTNER, PROBE FOR NAME OF MAIN OR PRIMARY CURRENT PARTNER.
FIRST NAME OF PARTNER |
STRING OF 20 |
FS38.1 |
FS38.1 |
IF FS37=YES AND FS25<>1,3 (if not married or not separated) |
YES |
1 |
FS40 |
NO |
0 |
|
DK |
d |
|
REF |
r |
FS40 |
IF FS37=YES |
All of the time, |
1 |
FS41 |
Most of the time, |
2 |
|
Some of the time, or |
3 |
|
None of the time? |
4 |
|
DK |
d |
|
REF |
r |
FS41 |
IF FS37=1 |
Taking all things together, on a scale from 0 to 10, where 0 is not at all happy and 10 is completely happy, how happy would you say your relationship with [CURRENT PARTNER] is? You can pick any number from 0 to 10.
COMPLETELY HAPPY |
10 |
FS42 |
|
9 |
|
|
8 |
|
|
7 |
|
|
6 |
|
|
5 |
|
|
4 |
|
|
3 |
|
|
2 |
|
|
1 |
|
NOT AT ALL HAPPY |
0 |
|
DK |
d |
|
REF |
r |
FS42 |
ALL |
Next, I have some questions about [CHILD].
Do you currently live with [CHILD] in the same household…
All of the time, |
1 |
FS43 |
Most of the time, |
2 |
FS42.2 |
Some of the time, or |
3 |
|
None of the time? |
4 |
|
DK |
d |
|
REF |
r |
FS42.2 |
IF FS42=most of the time (2), some of the time (3), OR none of the time (4) |
he if CMALE; she if CFEMALE |
(IF FS42=2 or 3) When [he/she] is not living with you,
(W/w)ho does [CHILD] live with?
FATHER/MOTHER |
1 |
FS42.3 OR FS43 |
GRANDPARENT(S) |
2 |
|
OTHER RELATIVES(S) |
3 |
|
ADOPTIVE PARENTS |
4 |
|
FOSTER PARENTS |
5 |
|
FRIEND(S) |
6 |
|
SOMEONE ELSE |
7 |
FS42.2.1 |
DK |
d |
FS42.2 OR FS43 |
REF |
r |
FS42.2.1 |
IF FS42.2=7 |
INSTRUCTION: PROBE FOR RELATIONSHIP OF THIS PERSON TO CHILD.
DESCRIBE OTHER PERSON |
STRING OF 501 |
FS42.3 OR FS43 |
FS42.3 |
FS42=None of the time (4) |
YES |
1 |
FS43 |
NO |
0 |
FS45 |
DK |
d |
|
REF |
r |
FS43 |
If FS42=all, most, some of the time (1,2,3) OR IF FS42.3=YES |
him IF FS17=MALE; her if FS17=FEMALE |
Since [CHILD] was born, did you live with [him/her] in the same household…
All the time, |
1 |
FS43.1 |
Most of the time |
2 |
|
Some of the time, or |
3 |
|
None of the time? |
4 |
|
DK |
d |
|
REF |
r |
PROGRAMMER: IF FS42<>4 THEN FS43<>5 |
FS43.1 |
If FS42=all, most, some of the time (1,2,3) OR IF FS42.3=YES |
him IF FS17=CMALE; her if FS17=FEMALE |
Since [CHILD] was born, did you live in the same household with both [him/her] and [FATHER/MOTHER]…
All the time, |
1 |
FS45 OR FS46.1 OR FS50 |
Most of the time |
2 |
|
Some of the time, or |
3 |
|
None of the time? |
4 |
|
DK |
d |
|
REF |
r |
FS45 |
IFS42=3, 4 (living with child some or none of the time) |
Have you seen [CHILD] in the past month?
YES |
1 |
FS46.1 OR FS50 |
NO |
0 |
|
DK |
d |
|
REF |
r |
FS46.1 |
FS42.2<>1 OR NOT (FS33=1 AND FS42=1) (skip if respondent lives with mother/father and also child) |
Has [FATHER/MOTHER] seen [CHILD] in the past month?
YES |
1 |
FS50 |
NO |
0 |
|
DK |
d |
|
REF |
r |
FS50 |
ALL |
had IF FEMALE; fathered IF MALE |
(IF FS5a=2 OR FS5b=2 OR FS7=2 OR FS8=2) Since the baby that died, have you [had/fathered] another baby or are you expecting another baby?
(IF FS5a=4 OR FS5b=4 OR FS7=5) Since your baby died, have you [had/fathered] another baby or are you expecting a baby now?
(IF FS7=4) Since the abortion, have you [had/fathered] a baby or are you expecting a baby now?
(IF FS7=3) Since the miscarriage, have you [had/fathered] another baby or are you expecting a baby now?
(ELSE) Since [CHILD] was born, have you [had/fathered] another baby or are you expecting a baby now?
(ALL) This can be a baby you had or are expecting with [FATHER/ MOTHER] or someone else.
(IF FS6.1>1 OR FS9>1) Don’t count the other babies born at the same time as [CHILD].
YES, HAD ANOTHER BABY/HAD OTHER BABIES |
1 |
FS51 |
YES, EXPECTING A BABY NOW |
2 |
FS51.1 |
YES, HAD ANOTHER BABY AND IS EXPECTING A BABY |
3 |
FS51 |
NO |
4 |
FS53 |
MISCARRIAGE/STILL BIRTH/ABORTION/ VOLUNTEERED |
5 |
|
DK |
d |
|
REF |
r |
FS51 |
IF FS50=YES (1,3) |
have IF FEMALE; father IF MALE |
How many babies have you [had/fathered] since then?
NUMBER OF BABIES |
FF |
FS52 OR FS51.1 |
DK |
d |
|
REF |
r |
FS51.1 |
IF FS50=(2,3) |
Are you expecting just one baby now?
YES |
1 |
FS52 |
NO |
0 |
FS51.2 |
DK |
d |
FS52 |
REF |
r |
FS51.2 |
IF FS51.1=YES |
How many babies are you expecting?
NUMBER OF BABIES |
FF |
FS52 |
DK |
d |
|
REF |
r |
FS52 |
IF FS50=1, 2, or 3 |
this baby IF FS51=1 OR FS51.1=YES AND FS50<>3; of these babies IF FS51>1 OR FS51.1=NO OR FS50<>3 |
FATHER IF FEMALE; MOTHER IF MALE |
mother IF MALE; father IF FEMALE |
Is [FATHER/MOTHER] the [father/mother] of [this baby/of these babies]?
PROBE: We are interested in babies you are expecting or were born since [CHILD].
YES |
1 |
FS53 |
YES, BUT NOT OF ALL BABIES |
2 |
|
NO |
0 |
|
DK |
d |
|
REF |
r |
FS53 |
ALL |
Now I have some questions about people in your household.
Altogether, how many children under 18 live with you all or most of the time? Include all children, even if they are not your own.
(IF FS42>1,2 AND FS5a<>2 OR 4 OR FS5b<>2 OR 4 OR FS7=1) Please include [CHILD] in your answer.
PROBE: All or most of the time should include anyone who sleeps in your house more than 4 nights a week.
NUMBER OF CHILDREN |
FF |
FS54 |
DK |
d |
FS55 54_1 |
REF |
r |
FS55 54_1 |
PROGRAMMER CHECK: FS53 CAN’T=0 IF FS42=1 OR 2
FS54 |
IF FS53>0 |
(or [FATHER/MOTHER/CURRENT PARTNER]) IF FS33=1,2 OR FS 40=1,2 |
FATHER/MOTHER IF FS33=1,2; CURRENT PARTNER IF FS40=1,2 |
FATHER IF FEMALE; MOTHER IF MALE |
(IF FS53>1) How many of these [ANSWER IN FS53] children are you [or [FATHER/MOTHER/CURRENT PARTNER] primarily responsible for?
(IF FS53=1) Are you [or [FATHER/MOTHER/CURRENT PARTNER] the adult(s) who (is/are) primarily responsible for this child?
(IF FS53=1) INSTRUCTION: IF ‘YES’ ENTER 1 AND IF NO ENTER ‘0’.
NUMBER OF CHILDREN |
FF |
FS54.1 |
DK |
d |
|
REF |
r |
FS54.1 |
IF FS42=1 or 2 (respondent living with child all or most of the time) |
Besides FATHER/MOTHER are, IF FS33=1,2 |
Besides CURRENT PARTNER are, IF FS40=1,2 |
Are IF FS33<>1,2 OR FS40<>1,2 |
[Besides [FATHER/MOTHER/CURRENT PARTNER are,] [Are] other adults living with you who are related to [CHILD]?
YES |
1 |
FS54.2 |
NO |
0 |
FS55 |
DK |
d |
|
REF |
r |
FS54.2 |
IF FS54.1=YES |
Are any of these other adults employed?
YES |
1 |
FS55 |
NO |
0 |
|
DK |
d |
|
REF |
r |
FS55 |
IF FS25<>7 |
Next, I have some questions about marriage.
CONTINUE |
FS56 OR FS66 |
SKIP IF FS25=4 OR 15MO_FS56=DATE
FS56 |
IF FS25=1,2,3,5,6 (married, separated, divorced, annulled, widowed) |
FATHER IF FEMALE; MOTHER IF MALE |
You previously told me that you [are/had been] married to [FATHER/MOTHER].
When did you get married to [FATHER/MOTHER]?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR.
DATE OF MARRIAGE |
MM//YYYY |
FS59, FS56.1 OR FS66 |
DK |
d |
|
REF |
r |
SKIP IF 15MO_FS25=3
FS56.1 |
IF FS25=3 (separated) |
FATHER IF FEMALE; MOTHER IF MALE |
When did you get separated from [FATHER/MOTHER]?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR.
DATE OF SEPARATION |
MM//YYYY |
FS59 OR FS66 |
DK |
d |
|
REF |
r |
SKIP IF 15MO_FS25=2,5,6, or 7 OR 15MO_FS19=3
FS59 |
IF FS25=divorced (2) OR FS25=annulled (5) OR FS25=6 (widowed) OR FS25=7 (partner died) OR FS19=3 |
FATHER IF FEMALE; MOTHER IF MALE |
(IF FS25=2) When did the divorce from [FATHER/MOTHER] become final?
(IF FS25=5) When did the annulment of your marriage to [FATHER/MOTHER] take place?
(IF FS25=6 or 7 OR FS19=3) When did [FATHER/MOTHER] pass away?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR.
DATE OF END OF MARRIAGE |
MM/YYYY |
FS66 OR FS60 |
DK |
d |
|
REF |
r |
FS60 |
IF FS38.1=YES |
You previously told me that you are married to [CURRENT PARTNER].
When did you get married to [CURRENT PARTNER]?
INTERVIEWER INSTRUCTION: RECORD ONLY MONTH AND YEAR.
DATE OF MARRIAGE |
MM//YYYY |
FS66 |
DK |
d |
|
REF |
r |
FS66 |
ALL |
to someone else besides [FATHER/MOTHER] IF FS25=1,2,3,5,6 or FS38.1=YES |
FATHER IF FEMALE |
MOTHER IF MALE |
and IF FS25=1,2,3,5,6 AND FS38.1=YES |
Your current partner, [CURRENT PARTNER] IF FS38.1=YES |
IF DID NOT HAVE A 15MO INTERVIEW: Have you ever been married [to someone else besides [FATHER/MOTHER] [and] [your current partner, [CURRENT PARTNER]?
IF DID HAVE A 15MO INTERVIEW: Since [15MO SURVDATE] have you been married [to someone else besides [FATHER/MOTHER] [and] [your current partner, [CURRENT PARTNER]?
YES |
1 |
FS67 |
NO |
0 |
NEXT SECTION |
DK |
d |
|
REF |
r |
FS67 |
IF FS66=YES |
to someone else besides [FATHER/MOTHER] IF FS25=1,2,3,5,6 or FS38.1=YES |
FATHER IF FEMALE |
MOTHER IF MALE |
and IF FS25=1,2,3 AND FS38.1=YES |
your current partner, [CURRENT PARTNER] IF FS38.1=YES |
IF DID NOT HAVE A 15MO INTERVIEW: How many times have you been married [to someone else besides [FATHER/MOTHER] [and] [your current partner, [CURRENT PARTNER]?
IF DID HAVE A 15MO INTERVIEW: Since [15MO SURVDATE] how many times have you been married [to someone else besides [FATHER/MOTHER] [and] [your current partner, [CURRENT PARTNER]?
NUMBER OF MARRIAGES |
FF |
FS68 |
DK |
d |
|
REF |
r |
[RANGE 2<SOFT CHECK]
LOOP FOR EACH MARRIAGE IN FS67 |
FS68 |
IF FS66=YES |
(to someone else) IF FS25=1,2,3,5,6 OR FS38.1=YES |
COUNTER=NUMBER IN LOOP (first, second, third, etc.) IF FS67>1 |
Thinking about the [COUNTER] marriage IF FS67>1 |
a |
Thinking about the [COUNTER] marriage (to someone else), when did you get married? |
DATE OF MARRIAGE |
MM/YYYY |
FS68-b OR FS68-c |
DK |
d |
|||
REF |
r |
|||
b |
(IF FS25<>1,3 OR FS38.1=NO**) Are you still married to this person? |
YES |
1 |
NEXT IN LOOP OR NEXT SECTION |
NO |
0 |
FS68-c |
||
c |
Did this marriage end through divorce or annulment, or did your spouse pass way? |
DIVORCE |
1 |
FS68-d |
ANNULMENT |
2 |
|||
SPOUSE DIED |
3 |
|||
DK |
d |
|||
REF |
r |
|||
d |
(IF FS68c=1) When did the divorce become final? (IF FS68c=2) When did the annulment take place? (IF FS68c=3) When did your spouse pass away? (IF FS68c=DK or R) When did this marriage end? |
DATE MARRIAGE ENDED |
MM/YYYY |
NEXT IN LOOP OR NEXT SECTION |
**Questions should also be skipped if previous answer in b=yes |
END LOOP FOR EACH MARRIAGE |
CO1 |
IF FS19<>3 OR FS25<>6,7 (father/mother alive) |
FATHER IF FEMALE; MOTHER IF MALE |
father IF FEMALE; mother IF MALE |
he if CMALE; she IF CFEMALE |
Now, I would like to talk about you and [FATHER/MOTHER] as parents.
The following statements are about [FATHER/MOTHER]’s and your involvement in the care of [CHILD].
For each statement, please answer if you strongly agree, agree, are not sure, disagree, or strongly disagree.
[STATEMENT a to o] Do you strongly agree, agree, are not sure, disagree, or strongly disagree with this statement?
|
|
STRONGLY AGREE |
AGREE |
NOT SURE |
DISAGREE |
STRONGLY DISAGREE |
DK |
REF |
a |
I believe [FATHER/MOTHER] is a good parent. |
1 |
2 |
3 |
4 |
5 |
d |
r |
b |
[FATHER/MOTHER] and I communicate well about [CHILD]. |
1 |
2 |
3 |
4 |
5 |
d |
r |
c |
I feel good about [FATHER/MOTHER]’s judgment about what is right for [CHILD]. |
1 |
2 |
3 |
4 |
5 |
d |
r |
d |
[FATHER/MOTHER] makes my job of being a parent easier. |
1 |
2 |
3 |
4 |
5 |
d |
r |
e |
[FATHER/MOTHER] and I are a good team. |
1 |
2 |
3 |
4 |
5 |
d |
r |
f |
[FATHER/MOTHER] knows how to handle children well. |
1 |
2 |
3 |
4 |
5 |
d |
r |
g |
When there is a problem with [CHILD], FATHER/MOTHER] and I work out a good solution together. |
1 |
2 |
3 |
4 |
5 |
d |
r |
h |
[FATHER/MOTHER] is willing to make personal sacrifices to help take care of [CHILD]. |
1 |
2 |
3 |
4 |
5 |
d |
r |
i |
Talking to [FATHER/MOTHER] about [CHILD] is something I look forward to. |
1 |
2 |
3 |
4 |
5 |
d |
r |
j |
[FATHER/MOTHER] pays a great deal of attention to [CHILD]. |
1 |
2 |
3 |
4 |
5 |
d |
r |
k |
I am satisfied with the responsibility [FATHER/MOTHER] takes for raising [CHILD]. |
1 |
2 |
3 |
4 |
5 |
d |
r |
l |
[FATHER/MOTHER] is committed to being there for [CHILD]. |
1 |
2 |
3 |
4 |
5 |
d |
r |
m |
[CHILD] needs [FATHER/MOTHER] just as much as [he/she] needs me. |
1 |
2 |
3 |
4 |
5 |
d |
r |
n |
No matter what might happen between [FATHER/MOTHER] and me, when I think of [CHILD]’s future, it includes [FATHER/MOTHER]. |
1 |
2 |
3 |
4 |
5 |
d |
r |
o |
[FATHER/MOTHER] is the type of [father/mother] I want for [CHILD]. |
1 |
2 |
3 |
4 |
5 |
d |
r |
LOOP FOR CO2 |
|
you IF RESPONDENT; FATHER FEMALE ABOUT MALE; |
have IF RESPONDENT; has IF FEMALE ABOUT MALE |
(IF COUNTER=1) The next question is about time spent with [CHILD].
In the past month, how often [have/has] [you/FATHER] spent one or more hours a day with [CHILD]? Was it…
Everyday or almost every day, |
1 |
CO3 |
A few times a week, |
2 |
|
A few times in the past month, |
3 |
|
Once or twice, or |
4 |
|
Never? |
5 |
|
DK |
d |
|
REF |
r |
END LOOP CO2 |
CO3 |
FS45<> NO (contact with child in past month) IF FEMALE ONLY, ASK a THRU d. |
him If CMALE; her IF CFEMALE |
The next questions are about things you may have done with [CHILD] in the past month.
In the past month, how often have you [STATEMENT a to l]? Was it more than once a day, about once a day, a few times a week, a few times a month, rarely, or not at all?
|
|
MORE THAN ONCE A DAY |
ABOUT ONCE A DAY |
A FEW TIMES A WEEK |
A FEW TIMES A MONTH |
RARELY |
NOT AT ALL |
DK |
REF |
a |
Sung songs with [CHILD]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
b |
Read or looked at books with [CHILD]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
c |
Told stories to [CHILD]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
d |
Played with games or toys with [CHILD]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
e |
Helped [CHILD] to get dressed. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
f |
Changed [CHILD]’s diapers or helped [him/her] use the toilet. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
g |
Fed [CHILD] or gave [him/her] something to eat. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
h |
Rolled a ball, tossed a ball, or played games with a ball with [CHILD]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
i |
Taken [CHILD] for a ride on your shoulders or back. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
j |
Turned [CHILD] upside down or tossed (her or him) up in the air |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
k |
Played chasing games with [CHILD]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
l |
Played outside in the yard, a park, or a playground with [CHILD]. |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
|
CO3.1 |
CO3.1 |
FS45<> NO (contact with child in past month) |
The next questions are about times you have spent with [CHILD] in the past month.
In the past month, how often would you say that [STATEMENT a to c]? Is that often, sometimes, rarely, or never?
|
|
OFTEN |
SOMETIMES |
RARELY |
NEVER |
DK |
REF |
a |
[CHILD] and you have warm close times together |
1 |
2 |
3 |
4 |
d |
r |
b |
You feel that [CHILD] likes you and wants to be near you |
1 |
2 |
3 |
4 |
d |
r |
c |
When you’re in a bad mood, you still show [CHILD] love |
1 |
2 |
3 |
4 |
d |
r |
CO5 |
|
FATHER IF FEMALE AND IF FS46.1<>0 (contact with child in the past month)/MOTHER IF MALE AND IF FS46.1<>0 (contact with child in the past month) |
CURRENT PARTNER IF FS37=YES (respondent has current partner) |
FATHER IF FEMALE; MOTHER IF MALE |
Children often do things that are wrong, disobey, or make their parents angry. We would like to know what you (or [FATHER/MOTHER] or [CURRENT PARTNER]) have done when [CHILD] did something wrong or made you upset or angry.
In the past month, did you (or [FATHER/MOTHER (or [CURRENT PARTNER])) [STATEMENT a to j)?
|
YES |
NO |
(IF YES AND IF HAVE A CURRENT PARTNER OR BSF PARTNER IS LIVING) Was that you, [or FATHER/MOTHER] [or CURRENT PARTNER]? |
DK |
REF |
|||
a |
Put [CHILD] in time out or send (him/her) to (his/her) room |
1 |
0 |
ME (respondent) |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
b |
Shout, yell or scream at [CHILD] |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
c |
Spank [CHILD] on the bottom with a bare hand |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
d |
Hit [CHILD] on the bottom with a belt, hairbrush, or stick |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
e |
Threaten to spank or hit [CHILD] but did not actually do it |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
f |
Give [CHILD] something to do instead of what (he/she) was doing wrong? |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
g |
Swear or curse at [CHILD] |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
h |
Slap [CHILD] on the hand, arm, or leg |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
i |
Slap [CHILD] on the face, head, or ears |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
||||
j |
Explain to [CHILD] why something was wrong |
1 |
0 |
ME |
YES |
NO |
d |
r |
[FATHER/MOTHER], |
YES |
NO |
d |
r |
||||
[CURRENT PARTNER], |
YES |
NO |
d |
r |
||||
|
|
|
|
|
FOR THIS ENTIRE SECTION - ASK QUESTION OF
|
Now, I’d like to ask you some questions about [CHILD].
We will start with questions about [CHILD]’s health.
CH1 |
ALL |
In general, would you say [CHILD]’s health is...
Excellent, |
1 |
CH2 |
Very good, |
2 |
|
Good, |
3 |
|
Fair, or |
4 |
|
Poor? |
5 |
|
DK |
d |
|
REF |
r |
CH2 |
ALL |
In the past month did [CHILD] have a cold, flu or fever that limited (his/her) ability to participate in (his/her) usual activities?
YES |
1 |
CH3 |
NO |
0 |
|
DK |
d |
|
REF |
r |
CH3 |
ALL |
Has a doctor or other health professional ever told you that [CHILD] has asthma?
YES |
1 |
CH4
|
NO |
0 |
CH5 |
DK |
d |
|
REF |
r |
CH4 |
IF CH3=YES |
Since [CHILD] was born, did [CHILD] have to visit an emergency room or urgent care center because of asthma?
YES |
1 |
CH5 |
NO |
0 |
|
DK |
d |
|
REF |
r |
CH5 |
ALL |
Next, I have some questions about [CHILD’S] behavior. For each behavior I read to you, I’d like you to tell me how often you saw [CHILD] behave in this way in the last three months: never, rarely, sometimes or often.
During the last three months, how often was this like [CHILD]...
[CHILD] [STATEMENT A to I]? Was that never, rarely, sometimes, or often?
|
|
never |
rarely |
sometimes |
often |
DK |
REF |
A |
Tried to understand another child’s behavior (for example, [CHILD] asked “Why are you crying?”) |
1 |
2 |
3 |
4 |
d |
r |
B |
Participated in family or classroom discussions |
1 |
2 |
3 |
4 |
d |
r |
C |
Asked for help from adults when needed |
1 |
2 |
3 |
4 |
d |
r |
D |
Comforted other children who were upset |
1 |
2 |
3 |
4 |
d |
r |
E |
Invited other children to play |
1 |
2 |
3 |
4 |
d |
r |
F |
Sought comfort from an adult when hurt |
1 |
2 |
3 |
4 |
d |
r |
G |
Apologized for accidental behavior that may upset others |
1 |
2 |
3 |
4 |
d |
r |
H |
Was sensitive to adult problems (for example, [CHILD] asked “Are you sad?”) |
1 |
2 |
3 |
4 |
d |
r |
I |
Showed affection for other children |
1 |
2 |
3 |
4 |
d |
r |
CH6 |
ALL |
For each statement that I read, please answer if the statement is never true, sometimes true, or often true of [CHILD]’s behavior.
[CHILD] [STATEMENT A to Z]? Is that never true, sometimes true or often true of [CHILD’s] behavior?
|
|
never true |
sometimes true |
often true |
DK |
REF |
A |
Has sudden changes in mood or feeling. |
1 |
2 |
3 |
d |
r |
B |
Feels or complains that no one loves (him/her). |
1 |
2 |
3 |
d |
r |
C |
Is rather high strung, tense and nervous |
1 |
2 |
3 |
d |
r |
D |
Cheats or tells lies. |
1 |
2 |
3 |
d |
r |
E |
Is too fearful or anxious. |
1 |
2 |
3 |
d |
r |
F |
Argues too much. |
1 |
2 |
3 |
d |
r |
G |
Has difficulty concentrating, cannot pay attention for long. |
1 |
2 |
3 |
d |
r |
H |
Is easily confused, seems to be in a fog. |
1 |
2 |
3 |
d |
r |
I |
Bullies or is cruel or mean to others. |
1 |
2 |
3 |
d |
r |
J |
Is disobedient. |
1 |
2 |
3 |
d |
r |
K |
Does not seem to feel sorry after (he/she) misbehaves. |
1 |
2 |
3 |
d |
r |
L |
Has trouble getting along with children (his/her) age. |
1 |
2 |
3 |
d |
r |
M |
Is impulsive, or acts without thinking. |
1 |
2 |
3 |
d |
r |
N |
Feels worthless or inferior. |
1 |
2 |
3 |
d |
r |
O |
Is not liked by other children (his/her) age. |
1 |
2 |
3 |
d |
r |
P |
Has a lot of difficulty getting (his/her) mind off certain thoughts. |
1 |
2 |
3 |
d |
r |
Q |
Is restless or overly active, cannot sit still |
1 |
2 |
3 |
d |
r |
R |
Is stubborn, sullen, or irritable. |
1 |
2 |
3 |
d |
r |
S |
Has a very strong temper and loses it easily. |
1 |
2 |
3 |
d |
r |
T |
Is unhappy, sad or depressed. |
1 |
2 |
3 |
d |
r |
U |
Is withdrawn, does not get involved with others. |
1 |
2 |
3 |
d |
r |
V |
Breaks things on purpose or deliberately destroys (his/her) own or another's things. |
1 |
2 |
3 |
d |
r |
W |
Cries too much. |
1 |
2 |
3 |
d |
r |
X |
Demands a lot of attention. |
1 |
2 |
3 |
d |
r |
Y |
Is too dependent on others. |
1 |
2 |
3 |
d |
r |
Z |
Worries too much. |
1 |
2 |
3 |
d |
r |
CH7 |
ALL |
My next questions are about some of the usual routines in your household.
(IF FS46.1≠0) In a typical week, please tell me the total number of days [CHILD] eats the evening meal with either you or [MOTHER/FATHER].
(IF FS46.1 = 0) In a typical week, please tell me the number of days [CHILD] eats the evening meal with you.
NUMBER OF DAYS |
FF |
CH8 |
DK |
d |
|
REF |
r |
CH8 |
ALL |
When is [CHILD]’s regular bedtime? We are interested in what time (he/she) goes to bed, not what time (he/she) actually falls asleep.
PROBE: ‘On average?’
| | |:| | | P.M. GOTO CH9
| | |:| | | A.M. GOTO CH9
NO USUAL TIME 0 GOTO CH12
DON’T KNOW d GOTO CH10
REFUSED r GOTO CH10
CH9 |
ALL |
How many times in the last week, Monday through Friday, was [CHILD] put to bed at that time?
NUMBER OF DAYS |
FF |
CH10 |
DK |
d |
|
REF |
r |
CH10 |
ALL |
Some families have a routine of things they do when it is time to put a child to bed. Is there a regular routine of things done with [CHILD] to put (him/her) to bed?
YES |
1 |
CH11 |
NO |
0 |
CH12 |
DK |
d |
|
REF |
r |
CH11 |
IF CH10=1 |
How many times in the last week, Monday through Friday, was this bedtime routine for [CHILD] able to be followed?
NUMBER OF DAYS |
FF |
CH12 |
DK |
d |
|
REF |
r |
NOTE: NUMBER OF DAYS MUST BE IN THE RANGE 1-5.
CH12-SIMS |
IF FS25=married (1) OR FS26=romantically involved (1) or on-again-off-again relationship (2) OR FS33=1 or 2 (live together all or most of the time) OR FS33.2=1, 2, or 3 (see each other at least a few times a month) |
Next, I am going to ask you to describe [CHILD]’s reactions to seeing arguments and disagreements between you and [MOTHER/FATHER] during the past month. Tell me if [CHILD] reacts to witnessing arguments and disagreements in this way often, sometimes, rarely, or never.
[CHILD] [STATEMENT a to j]
|
|
Often |
Sometimes |
Rarely |
Never |
DK |
REF |
a |
Yells at family members. |
1 |
2 |
3 |
4 |
d |
r |
b |
Starts hitting, kicking, slapping, or throwing things at family members. |
1 |
2 |
3 |
4 |
d |
r |
c |
Appears angry. |
1 |
2 |
3 |
4 |
d |
r |
d |
Appears frightened. |
1 |
2 |
3 |
4 |
d |
r |
e |
Appears sad. |
1 |
2 |
3 |
4 |
d |
r |
f |
Still seems upset after we argue. |
1 |
2 |
3 |
4 |
d |
r |
g |
Can’t seem to calm down after we argue. |
1 |
2 |
3 |
4 |
d |
r |
h |
Causes trouble. |
1 |
2 |
3 |
4 |
d |
r |
i |
Appears upset. |
1 |
2 |
3 |
4 |
d |
r |
j |
Takes a while after the argument to act like (him/her) self again. |
1 |
2 |
3 |
4 |
d |
r |
End section
RR0 |
R=ALL |
Next, I would like to have your opinion on a few statements about marriage. Tell me if you strongly agree, agree, disagree, or strongly disagree with the following statements…
|
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DK |
REF |
A |
A single parent can bring up a child just as well as a married couple. |
1 |
2 |
3 |
4 |
d |
r |
B |
It is better for a couple to be married than to just live together. |
1 |
2 |
3 |
4 |
d |
r |
C |
There are very few people who have good and happy marriages. |
1 |
2 |
3 |
4 |
d |
r |
D |
When a couple is committed to each other, it makes no difference whether they are married or living together. |
1 |
2 |
3 |
4 |
d |
r |
E |
It is better for children if their parents are married. |
1 |
2 |
3 |
4 |
d |
r |
|
|
RR0.1 |
RR0.1 |
ALL |
Now I would like to ask you about your friends.
Do you strongly agree, agree, disagree, or strongly disagree with the following statement:
Most of my friends are not ready to settle down.
STRONGLY AGREE |
1 |
RR1 or RR2 or RR8 |
AGREE |
2 |
|
DISAGREE |
3 |
|
STRONGLY DISAGREE |
4 |
|
DK |
d |
|
REF |
r |
RR1 |
IF FS25=married (1) OR FS26=romantically involved (1) or on-again-off-again relationship (2) |
FATHER IF FEMALE; MOTHER IF MALE |
Now I would like to ask about your relationship with [FATHER/MOTHER]. Taking all things together, on a scale from 0 to 10, where 0 is not at all happy and 10 is completely happy, how happy would you say your relationship with [FATHER/MOTHER] is? You can pick any number from 0 to 10.
COMPLETELY HAPPY |
10 |
RR1.1 |
|
9 |
|
|
8 |
|
|
7 |
|
|
6 |
|
|
5 |
|
|
4 |
|
|
3 |
|
|
2 |
|
|
1 |
|
NOT AT ALL HAPPY |
0 |
|
DK |
d |
|
REF |
r |
RR1.1 |
IF FS25=married (1) OR FS26=romantically involved (1) or on-again-off-again relationship (2) |
FATHER IF FEMALE; MOTHER IF MALE |
In the past month, about how many times did you and [FATHER/MOTHER] go out together—just the two of you—to do something fun?
NUMBER OF TIMES |
XX |
RR2 |
DK |
d |
|
REF |
r |
RR2 |
IF FS25=1 (married) OR FS26=1 (romantically involved) OR 2 (on-again-off-again relationship) OR FS33=1 OR 2 (live together all or most of the time) OR FS33.2=1,2,3 (see each other at least a few times a month) |
FATHER IF FEMALE; MOTHER IF MALE |
Now, I am going to read you some statements about things couples may experience when they are together. Tell me if this often happens, sometimes happens, rarely happens or never happens.
[STATEMENT a-dd] Does this happen often, sometimes, rarely, or never?
|
|
OFTEN |
SOMETIMES |
RARELY |
NEVER |
DK |
REF |
a |
When I have problems, [FATHER/MOTHER] really understands what I’m going through. |
1 |
2 |
3 |
4 |
d |
r |
b |
[FATHER/MOTHER] blames me for things that go wrong. |
1 |
2 |
3 |
4 |
d |
r |
e |
I feel appreciated by [FATHER/MOTHER]. |
1 |
2 |
3 |
4 |
d |
r |
j |
I feel respected even when we disagree. |
1 |
2 |
3 |
4 |
d |
r |
x |
Even when arguing we can keep a sense of humor. |
1 |
2 |
3 |
4 |
d |
r |
m |
When we discuss something, [FATHER/MOTHER] acts as if I am totally wrong. |
1 |
2 |
3 |
4 |
d |
r |
n |
We are good at solving our differences. |
1 |
2 |
3 |
4 |
d |
r |
q |
When we argue, one of us is going to say something we will regret. |
1 |
2 |
3 |
4 |
d |
r |
v |
When we argue, I feel personally attacked by [FATHER/MOTHER]. |
1 |
2 |
3 |
4 |
d |
r |
4w |
During arguments, we are good at taking breaks when we need them. |
1 |
2 |
3 |
4 |
d |
r |
s |
When we argue, I get very upset. |
1 |
2 |
3 |
4 |
d |
r |
y |
We are pretty good listeners, even when we have different positions on things. |
1 |
2 |
3 |
4 |
d |
r |
z |
[FATHER/MOTHER] is good at calming me when I get upset. |
1 |
2 |
3 |
4 |
d |
r |
aa |
Little arguments turn into ugly fights with accusations, criticisms, name calling or bringing up past hurts. |
1 |
2 |
3 |
4 |
d |
r |
bb |
[FATHER/MOTHER] puts down my opinions, feelings or desires. |
1 |
2 |
3 |
4 |
d |
r |
cc |
[FATHER/MOTHER] seems to view my words or actions more negatively than I mean them to be. |
1 |
2 |
3 |
4 |
d |
r |
dd |
When we argue, one of us withdraws and refuses to talk about it any more. |
1 |
2 |
3 |
4 |
d |
r |
|
|
RR4 |
RR4 |
IF FS25=1 (married) OR FS26=1 (romantically involved) OR FS26=2 (on-again-off-again relationship) ASK: ALL ITEMS
IF FS25<>1 OR FS26<>1,2, ONLY ASK: RRi, RRj, RRn, RRq, RRr, RRt |
FATHER IF FEMALE; MOTHER IF MALE |
him IF FEMALE; her IF MALE |
FATHER IF FEMALE; MOTHER IF MALE |
Tell me whether you strongly agree, agree, disagree, or strongly disagree with the following statements.
[STATEMENT B-Z] Do you strongly agree, agree, disagree, or strongly disagree?
|
|
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
DK |
REF |
B |
[FATHER/MOTHER] and I often talk about things that happen to each of us during the day. |
1 |
2 |
3 |
4 |
d |
r |
C |
[FATHER/MOTHER] and I enjoy doing even ordinary, day-to-day things together. |
1 |
2 |
3 |
4 |
d |
r |
I |
[FATHER/MOTHER] is honest and truthful with me. |
1 |
2 |
3 |
4 |
d |
r |
J |
I can trust [FATHER/MOTHER] completely. |
1 |
2 |
3 |
4 |
d |
r |
N |
[FATHER/MOTHER] can be counted on to help me. |
1 |
2 |
3 |
4 |
d |
r |
O |
I may not want to be with [FATHER/ MOTHER] a few years from now. |
1 |
2 |
3 |
4 |
d |
r |
P |
My relationship with [FATHER/MOTHER] is more important to me than almost anything else in my life. |
1 |
2 |
3 |
4 |
d |
r |
Q |
[FATHER/MOTHER] knows and understands me. |
1 |
2 |
3 |
4 |
d |
r |
R |
[FATHER/MOTHER] listens to me when I need someone to talk to. |
1 |
2 |
3 |
4 |
d |
r |
T |
[FATHER/MOTHER] respects me. |
1 |
2 |
3 |
4 |
d |
r |
V |
I want this relationship to stay strong no matter what rough times we may have. |
1 |
2 |
3 |
4 |
d |
r |
W |
[FATHER/MOTHER] encourages or helps me to do things that are important to me. |
1 |
2 |
3 |
4 |
d |
r |
X |
[FATHER/MOTHER] shows love and affection for me. |
1 |
2 |
3 |
4 |
d |
r |
Y |
I am satisfied with my sexual relationship with [FATHER/MOTHER]. |
1 |
2 |
3 |
4 |
d |
r |
Z |
My friends and relatives support my relationship with [FATHER/MOTHER] |
1 |
2 |
3 |
4 |
d |
r |
|
|
RR8 |
RR8 |
ALL |
FATHER IF FEMALE; MOTHER IF MALE |
IF STILL TOGETHER: (IF FS25=1 OR IF FS26 = 1 OR 2) Sometimes couples are not always faithful to each other. Since [RA DATE] has FATHER/MOTHER cheated on you with someone else? Is that…
IF NOT STILL TOGETHER: (IF FS25<>1 OR IF FS26<>1 OR 2) Sometimes couples are not always faithful to each other. Please think only about the time after [RA DATE] and before your romantic relationship with [FATHER/MOTHER] ended. Did FATHER/MOTHER cheat on you with someone else? Is that…
PROBE: (IF FS26 NOT EQUAL TO 1 OR 2) Please think only about the time after [RA DATE] and before your romantic relationship with [FATHER/MOTHER] ended.
INSTRUCTION: IF RESPONDENT ANSWERS ‘DK’ DO NOT PROBE.
Definitely yes, |
1 |
RR9 |
Probably yes, |
2 |
|
Probably no, or |
3 |
|
Definitely no? |
4 |
|
DK |
d |
|
REF |
r |
RR9 |
ALL |
FATHER IF FEMALE; MOTHER IF MALE |
man IF FEMALE; woman IF MALE |
IF STILL TOGETHER: (IF FS26 = 1 OR 2) Since [RA DATE], have you cheated on [FATHER/MOTHER] with someone else?
IF NOT STILL TOGETHER: (IF FS26 NOT EQUAL TO 1 OR 2) Did you cheat on [FATHER/MOTHER] with someone else? Please think only about the time after [RA DATE] and before your romantic relationship with [FATHER/MOTHER] ended.
YES |
1 |
RR10 or RR14 |
NO |
0 |
|
DK |
d |
|
REF |
r |
RR10 |
IF FS25=1 (married) OR FS26=1 (romantically involved) OR 2 (on-again-off-again relationship) |
FATHER IF FEMALE; MOTHER IF MALE |
Do you think [FATHER/MOTHER] will cheat on you in the future? Is that…
Definitely yes, |
1 |
RR11 |
Probably yes, |
2 |
|
Probably no, or |
3 |
|
Definitely no? |
4 |
|
DK |
d |
|
REF |
r |
RR11 |
IF FS25=1 (married) OR FS26=1 (romantically involved) OR 2 (on-again-off-again relationship) |
FATHER IF FEMALE; MOTHER IF MALE |
Do you think you will cheat on [FATHER/MOTHER] in the future? Would you say…
Definitely yes, |
1 |
RR14 |
Probably yes, |
2 |
|
Probably no, or |
3 |
|
Definitely no? |
4 |
|
DK |
d |
|
REF |
r |
RR14 |
ALL |
FATHER IF FEMALE IF FS19<>3 OR FS25<>6,7/MOTHER IF MALE AND IF FS19<>3 OR FS25<>6,7 |
CURRENT PARTNER IF FS37=YES (respondent has current partner) |
FATHER IF FEMALE; MOTHER IF MALE |
Next I’m going to read a list of things that might have happened to you in the past year. In the past year, did [FATHER/MOTHER/CURRENT PARTNER] or another partner you were involved with…
|
|
(IF YES and SITENAME <> ATLANTA) How often did [FATHER/MOTHER], [CURRENT PARTNER], [this other partner] do this in the past year? Was it… (IF YES AND SITENAME = ATLANTA)How often did this happen to you in the past year? |
|
|
|||||||||||
|
YES |
NO |
(IF YES and SITENAME <> ATLANTA) Was it [FATHER/MOTHER], [CURRENT PARTNER], or another partner who did that to you? |
Once |
twice |
3-5 times |
6-10 times |
11-20 times |
More than 20 times |
DK |
REF |
||||
a |
Throw something at you that could hurt? |
1 |
0 |
[FATHER/MOTHER], |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
[CURRENT PARTNER], |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
b |
Twist your arm or hair? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
c |
Push or shove you? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
d |
Grab you? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
e |
Slap you? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
f |
Use a knife or gun on you? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
g |
Punch or hit you with something that could hurt? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
h |
Choke you? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Some other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
i |
Slam you against the wall?
|
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
j |
Kick you? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
k |
Beat you up? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
l |
Burn or scald you on purpose? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
m |
Use threats or force to make you have sex or do sexual things you didn’t want to do? |
1 |
0 |
[FATHER/MOTHER] |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|
CURRENT PARTNER |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
Other partner |
YES |
NO |
1 |
2 |
3 |
4 |
5 |
6 |
d |
r |
|||||
|
|
|
|
|
RR15 |
RR15 |
ALL |
FATHER IF FEMALE IF FS19<>3 OR FS25<>6,7; MOTHER IF MALE IF FS19<>3 OR FS25<>6,7 |
CURRENT PARTNER IF FS37=YES (respondent has current partner) |
In the past year, did you need to see a doctor because of a fight with [MOTHER/FATHER], [CURRENT PARTNER] or another partner you were involved with? Please include times when you needed to see a doctor, even if you didn’t go.
YES |
1 |
RR15.1
|
NO |
0 |
NEXT SECTION |
DK |
d |
|
REF |
r |
RR15.1 |
IF RR15=YES AND SITENAME <> ATLANTA |
FATHER IF FEMALE AND IF FS19<>3 AND FS25<>6,7; MOTHER IF MALE IF FS19<>3 AND FS25<>6,7 |
CURRENT PARTNER IF FS37=YES (respondent has current partner) |
Was that because of a fight with [FATHER/MOTHER], [CURRENT PARTNER], or another partner?
FATHER/MOTHER |
YES |
NO |
WB1.1
|
CURRENT PARTNER |
YES |
NO |
|
OTHER PARTNER |
YES |
NO |
|
DK |
d |
||
REF |
r |
WB1.1 |
ALL |
The next questions are mostly about you.
In the past year, about how often have you attended a religious service? Was it…
Never |
1 |
WB1.2 |
A few times a year, |
2 |
|
A few times a month, or |
3 |
|
Once a week or more? |
4 |
|
DK |
d |
|
REF |
r |
WB1.2 |
IF BASELINE Q20 PLUS BASELINE Q21 PLUS (FS9 minus 1) PLUS (FS6.1 minus 1) PLUS 1 (IF FS50=1 OR 3) MINUS 1 (IF FS5=3 OR FS7=2,3,4) >0 |
children IF BASELINE Q20 PLUS BASELINE Q21 PLUS (FS9 minus 1) PLUS (FS6.1 minus 1) PLUS 1 (IF FS50=1 OR 3) MINUS 1 (IF FS5=3 OR FS7=2,3,4) >1; child IF BASELINE Q20 PLUS BASELINE Q21 PLUS (FS9 minus 1) PLUS (FS6.1 minus 1) PLUS 1 (IF FS50=1 OR 3) MINUS 1 (IF FS5=3 OR FS7=2,3,4)=1 |
Now, I am going to read you a list of ways you might have felt in the past month about being a parent.
During the past month, how often have you…
[STATEMENT a to d] Was it all of the time, most of the time, some of the time, or none of the time?
|
|
ALL OF THE TIME |
MOST OF THE TIME |
SOME OF THE TIME |
NONE OF THE TIME |
DK |
REF |
a |
Felt your (child/children) [is/are] much harder to care for than most? |
1 |
2 |
3 |
4 |
d |
r |
b |
Felt your (child does/children do) things that really bother you? |
1 |
2 |
3 |
4 |
d |
r |
c |
Felt you are giving up more of your life to meet your (child’s/children’s) needs than you ever expected? |
1 |
2 |
3 |
4 |
d |
r |
d |
Felt angry with your (child/children)? |
1 |
2 |
3 |
4 |
d |
r |
|
|
WB1.3 |
WB1.3 |
ALL |
Now, I am going to read you a list of ways you might have felt or behaved during the past week. For each item on the list I will ask you how often you felt this way.
During the past week… [STATEMENT A-T] Would you say that happened rarely or none of the time; some of the time; a moderate amount of time; or most or all of the time?
PROBE: Rarely or none of the time” would mean less than 1 day in the past week; “some of the time” would mean 1 or 2 days in the past week; “a moderate amount of time” would mean 3 or 4 days in the past week; and “most of or all of the time” would mean 5 to 7 days in the past week.
STATEMENT |
RARELY OR NONE OF THE TIME |
SOME OF THE TIME |
A MODERATE AMOUNT OF TIME |
MOST OR ALL OF THE TIME |
DK |
REF |
|
A |
I was bothered by things that usually don't bother me. |
1 |
2 |
3 |
4 |
d |
r |
B |
I did not feel like eating; my appetite was poor. |
1 |
2 |
3 |
4 |
d |
r |
C |
I felt that I could not shake off the blues even with help from my family or friends. |
1 |
2 |
3 |
4 |
d |
r |
E |
I had trouble keeping my mind on what I was doing. |
1 |
2 |
3 |
4 |
d |
r |
F |
I felt depressed. |
1 |
2 |
3 |
4 |
d |
r |
G |
Everything I did felt like an effort. |
1 |
2 |
3 |
4 |
d |
r |
J |
I felt fearful. |
1 |
2 |
3 |
4 |
d |
r |
K |
My sleep was restless. |
1 |
2 |
3 |
4 |
d |
r |
M |
I talked less than usual. |
1 |
2 |
3 |
4 |
d |
r |
N |
I felt lonely. |
1 |
2 |
3 |
4 |
d |
r |
R |
I felt sad. |
1 |
2 |
3 |
4 |
d |
r |
T |
I could not get “going.” |
1 |
2 |
3 |
4 |
d |
r |
|
IF 2 OR MORE ANSWERS IN A THRU T >1 WB2 ELSE WB4 |
WB2 |
IF 2 OR MORE ANSWERS IN A THRU T >1 IN WB1 |
In the past week, how difficult did these feelings or problems make it for you to do your work or take care of things at home? Has it been…
Not at all difficult, |
1 |
WB3 |
Somewhat difficult, |
2 |
|
Very difficult, or |
3 |
|
Extremely difficult? |
4 |
|
DK |
d |
|
REF |
r |
WB3 |
IF 2 OR MORE ANSWERS IN A THRU T >1 IN WB1 |
And in the past week, how difficult have these feelings or problems made it for you to get along with other people?
Not at all difficult, |
1 |
WB4 |
Somewhat difficult, |
2 |
|
Very difficult, or |
3 |
|
Extremely difficult? |
4 |
|
DK |
d |
|
REF |
r |
WB4 |
ALL |
4 = AMOUNT IF FEMALE; 5 = AMOUNT IF MALE |
The next question is about drinking alcoholic beverages. By a “drink” we mean either a bottle of beer, a wine cooler, a glass of wine, a shot of liquor, or a mixed drink.
In the past year, how many times have you had [AMOUNT] or more drinks of alcohol in one day?
NUMBER OF TIMES |
FF |
WB5 |
DK |
d |
|
REF |
r |
WB5 |
ALL |
In the past year, did you have any problems keeping a job or getting along with family or friends because of your alcohol or drug use?
YES |
1 |
WB6 OR NEXT SECTION |
NO |
0 |
|
DK |
d |
|
REF |
r |
WB6 |
IF FS19<>3 OR FS25<>6,7 |
FATHER IF FEMALE; MOTHER IF MALE |
his IF FEMALE; her IF MALE |
And what about [FATHER/MOTHER]? In the past year, did [FATHER/MOTHER] have any problems keeping a job or getting along with family or friends because of [his/her] alcohol or drug use?
YES |
1 |
NEXT SECTION |
NO |
0 |
|
DK |
d |
|
REF |
r |
SE1 |
ALL |
FATHER IF FEMALE; MOTHER IF MALE |
(IF 15MO=1) Next I am going to ask you about programs you may have participated in since [15M SURVEY DATE]; that is about [NUMBER OF MONTHS SINCE 15M SURVEY DATE] months ago. Since [15M SURVEY DATE] did you and [FATHER/MOTHER] attended any classes, workshops, or group sessions to help your relationship? These sessions would have included other couples, not just you and [FATHER/MOTHER].
(IF 15MO=0) Next I am going to ask you about programs you may have participated in since [RA DATE]; that is about three years ago. Since [RA DATE] did you and [FATHER/MOTHER] attend any classes, workshops, or group sessions to help your relationship? These sessions would have included other couples, not just you and [FATHER/MOTHER].
YES |
1 |
SE1.1 |
NO |
0 |
NEXT SECTION |
DK |
d |
|
REF |
r |
SE1.1 |
SE1=1 AND 15MO=0 |
FATHER IF FEMALE; MOTHER IF MALE |
Have you participated in any of these classes since [RA DATE + 15 MONTHS]?
PROBE: That’s about 2 years ago.
YES |
1 |
NEXT SECTION |
NO |
0 |
|
DK |
d |
|
REF |
r |
PA1 |
NOT MARRIED AT BIRTH AND (15MO=0 OR 15MO_PA1=0, dk) |
you IF MALE; FATHER IF FEMALE |
are IF MALE; is IF FEMALE |
My next questions are about the legal arrangements you and [MOTHER/FATHER] have regarding [CHILD].
Did you and [MOTHER/FATHER] ever sign a birth certificate or document that identifies [you/FATHER] as the legal father of [CHILD]? Or, has a court ruled that [you/FATHER] [are/is] [CHILD]’s father?
PROBE: You usually sign a birth certificate in the hospital shortly after the baby is born or sometimes a little bit later.
YES |
1 |
PA1.1 |
NO |
0 |
PA2 OR PA11.2 OR PA12 |
DK |
d |
PA1.1 |
REF |
r |
PA1.1 |
PA1.1 |
IF PA1=1 |
you IF MALE; FATHER IF FEMALE |
Did you and [MOTHER/FATHER] voluntarily sign a document establishing [you/FATHER] as [CHILD]’s legal father? Or did this get handled through the courts?
VOLUNTARILY SIGNED DOCUMENT |
1 |
PA2 OR PA11.2 OR PA12 |
HANDLED THROUGH THE COURT |
2 |
|
DK |
d |
|
REF |
r |
PA2 |
FS42<>1,2 (not live with child all or most of the time) |
Next I have some questions about the financial contribution you might make to support [CHILD].
Do you have a legal agreement or child support order that requires you to provide financial support for [CHILD]?
YES |
1 |
PA7 |
NO |
0 |
PA9 |
DK |
d |
|
REF |
r |
PA7 |
IF PA2=YES |
In the past month, how much were you supposed to pay in child support for [CHILD] under this order?
PROBE: If your support order covers more than one child, tell me the total amount you were supposed to pay last month.
PROBE: Your best estimate is fine.
AMOUNT IN DOLLARS |
FF |
PA8 OR PA9 |
DK |
d |
|
REF |
r |
PA8 |
IF PA7<>0 |
And in the past month, how much of that amount did you actually pay in child support?
PROBE: Your best estimate is fine.
AMOUNT IN DOLLARS |
FF |
PA9 OR PA12 |
DK |
d |
|
REF |
r |
PA9 |
IF FS42<> 1,2 (not live with child all or most of the time) |
extra IF PA8>0 |
(IF PA8>0) Not counting the child support you already told me about,
[In/in] the past month, did you give extra money to help out with the cost of raising [CHILD]?
YES |
1 |
PA10 |
NO |
0 |
PA11 |
DK |
d |
|
REF |
r |
PA10 |
IF PA9=YES |
extra IF PA8>0 |
How much extra money did you provide in the past month to help support [CHILD]?
PROBE: Your best estimate is fine.
AMOUNT IN DOLLARS |
FF |
PA11 |
DK |
d |
|
REF |
r |
PA11 |
IF FS42<>1,2 (not live with child all or most of the time) |
his IF CMALE; her IF CFEMALE |
In the past month, did you buy things for [CHILD] that [he/she] needed like clothes, diapers, or medicine?
YES |
1 |
PA11.2 OR PA12 |
NO |
0 |
|
DK |
d |
|
REF |
r |
PA11.2 |
IF FS33<>1,2 (not live together with other parent all or most of the time) AND FS42=1,2 (live with child all or most of the time) |
FATHER IF FEMALE; MOTHER IF MALE |
Do you have a legal agreement or child support order that requires [FATHER/MOTHER] to provide financial support for [CHILD]?
YES |
1 |
PA11.7 |
NO |
0 |
PA11.9 |
DK |
d |
|
REF |
r |
PA11.7 |
IF PA11.2=YES |
FATHER IF FEMALE; MOTHER |
In the past month, how much was [FATHER/MOTHER] supposed to pay in child support for [CHILD] under that order?
PROBE: If the support order covers more than one child, tell me the total amount [he/she] was supposed to pay last month for all your children.
AMOUNT IN DOLLARS |
FF |
PA11.8 OR PA11.9 |
DK |
d |
|
REF |
r |
PA11.8 |
IF PA11.7<>0 |
FATHER IF FEMALE; MOTHER IF MALE |
And in the past month, how much did [FATHER/MOTHER] actually pay in child support?
AMOUNT IN DOLLARS |
FF |
PA11.9 |
DK |
d |
|
REF |
r |
PA11.9 |
IF FS33<>1,2 (not live together with other parent all of the time) AND FS42=1,2 (live with child all or most of the time) |
FATHER IF FEMALE; MOTHER IF MALE |
extra IF PA11.8>0 |
(IF PA11.8>0) Not counting the child support you already told me about, in the past month, did [FATHER/MOTHER] give you [extra] money to help out with the cost of raising [CHILD]?
YES |
1 |
PA11.10 |
NO |
0 |
PA11.11 |
DK |
d |
|
REF |
r |
PA11.10 |
IF PA11.9=YES |
FATHER IF FEMALE; MOTHER IF MALE |
extra IF PA8>0 |
How much extra money did [FATHER/MOTHER] pay you in the past month to help support [CHILD]?
AMOUNT IN DOLLARS |
FF |
PA11.11 |
DK |
d |
|
REF |
r |
PA11.11 |
IF FS33<>1,2 (not live with other parent together all or most of the time) AND FS42=1,2 (live with child all or most of the time) |
FATHER IF FEMALE; MOTHER IF MALE |
he IF CMALE; she IF CFEMALE |
In the past month, did [FATHER/MOTHER] buy things for [CHILD] that [he/she] needed like clothes, diapers, or medicine?
YES |
1 |
PA12 |
NO |
0 |
|
DK |
d |
|
REF |
r |
PA12 |
ONLY ASK IF FEMALE IS RESPONDENT |
his IF CMALE; her IF CFEMALE |
him IF CMALE; her IF CFEMALE |
Parents deal with meeting the expenses of raising a child in different ways. When answering the next question, I’d like you to think about all the expenses associated with raising [CHILD] such as [his/her] food, clothing, medical expenses, diapers, and any other costs of raising [him/her].
How much of the cost of raising [CHILD] does [FATHER] cover? Would you say its…
All or almost all, |
1 |
END OF SECTION |
More than half, |
2 |
|
About half, |
3 |
|
Less than half, or |
4 |
|
Little or none? |
5 |
|
DK |
d |
|
REF |
r |
WW1 |
ALL |
The next questions are about your work.
Have you worked for pay at any time during the past 12 months? Please include odd jobs and temporary jobs.
PROBE: You can include odd jobs, temporary jobs, self-employment, military service, or any other type of paid work.
YES |
1 |
WW2 |
NO |
0 |
WW13 OR WW8 |
DK |
d |
|
REF |
r |
WW2 |
IF WW1=YES |
How many months did you work for pay in the past 12 months?
INSTRUCTION: IF LESS THAN 1 MONTH, ENTER 1 MONTH.
NUMBER OF MONTHS |
FF (1 TO 12) |
1 to 11=WW3
12=WW4 |
DK |
d |
|
REF |
r |
WW3 |
IF WW2<>12 |
Did you work for pay in the past month?
PROBE: You can include odd jobs, temporary jobs, self-employment, military service, or any other type of paid work.
YES |
1 |
WW4 |
NO |
0 |
WW7 |
DK |
d |
|
REF |
r |
WW4 |
IF WW3=1 OR WW2=12 |
What were your total earnings in the past month before taxes and other deductions? Please include tips, commissions, and overtime pay.
PROBE: If you held more than one job, include your total earnings from all your jobs during the past month.
PROBE: I can help you add it up if you want to think out loud.
INSTRUCTION: IF RESPONDENT CAN ONLY REPORT EARNINGS AFTER TAXES, ENTER THAT AMOUNT.
AMOUNT |
FFF,FFF.FF |
WW5.2 |
DK |
d |
WW5.1 |
REF |
r |
WW6 |
WW5.1 |
IF WW4=DK |
I just need to know a range. Can you tell me if it was…
INSTRUCTION: YOU CAN STOP READING WHEN RESPONDENT PROVIDES RANGE.
Less than $500, |
1 |
WW5.2 |
Between $500 and $750, |
2 |
|
Between $750 and $1000, |
3 |
|
Between $1000 and $1250, |
4 |
|
Between $1250 and $1500, |
5 |
|
Between $1500 and $1750, |
6 |
|
Between $1750 and $2000, |
7 |
|
Between $2000 and $2500, |
8 |
|
Between $2500 and $3000, |
9 |
|
Between $3000 and $3500, |
10 |
|
Between $3500 and $4000, |
11 |
|
Between $4000 and $4500, |
12 |
|
Between $4500 and $5000, |
13 |
|
Between $5500 and $6000, |
14 |
|
$6000 or more? |
15 |
|
DK |
d |
WW6 |
REF |
r |
WW5.2 |
IF WW4>0 OF IF WW5.1<>DK OR REF |
PLEASE ENTER IF RESPONDENT PROVIDED THE AMOUNT…
BEFORE TAXES WITHOUT PROBING |
1 |
WW6 |
BEFORE TAXES AFTER PROBING |
2 |
|
AFTER TAXES |
3 |
|
NOT SURE |
4 |
WW6 |
IF WW3=1 OR WW2=12 |
How many hours per week did you typically work last month?
AMOUNT OF HOURS |
FFF |
WW13 OR WW8 |
DK |
d |
|
REF |
r |
WW7 |
IF WW3=NO |
Thinking about the last month that you did work, what were your total earnings during that month before taxes and other deductions? Please include tips, commissions, and overtime pay.
PROBE: If you held more than one job during that month, include your total earnings from all your jobs you held that month.
PROBE: I can help you add it up if you want to think out loud.
INSTRUCTION: IF RESPONDENT CAN ONLY REPORT EARNINGS AFTER TAXES, ENTER THAT AMOUNT.
AMOUNT |
FFF,FFF.FF |
WW7.2 |
DK |
d |
WW7.1 |
REF |
r |
WW13 OR WW8 |
WW7.1 |
IF WW7=DK |
I just need to know a range. Can you tell me if it was…
INSTRUCTION: YOU CAN STOP READING WHEN RESPONDENT PROVIDES RANGE.
Less than $500, |
1 |
WW7.2 |
Between $500 and $750, |
2 |
|
Between $750 and $1000, |
3 |
|
Between $1000 and $1250, |
4 |
|
Between $1250 and $1500, |
5 |
|
Between $1500 and $1750, |
6 |
|
Between $1750 and $2000, |
7 |
|
Between $2000 and $2500, |
8 |
|
Between $2500 and $3000, |
9 |
|
Between $3000 and $3500, |
10 |
|
Between $3500 and $4000, |
11 |
|
Between $4000 and $4500, |
12 |
|
Between $4500 and $5000, |
13 |
|
Between $5500 and $6000, |
14 |
|
$6000 or more? |
15 |
|
DK |
d |
WW8 OR WW13 |
REF |
r |
WW7.2 |
IF WW7>0 OR WW7.1 <>DK, REF |
PLEASE ENTER IF RESPONDENT PROVIDED THE AMOUNT…
BEFORE TAXES WITHOUT PROBING |
1 |
WW13 OR WW8 |
BEFORE TAXES AFTER PROBING |
2 |
|
AFTER TAXES |
3 |
|
NOT SURE |
4 |
WW8 |
IF FS25=1 OR FS33<3 OR FS40<3 |
he IF FEMALE; she IF MALE |
FATHER IF FEMALE and FS33<3; MOTHER IF MALE and FS33<3; CURRENT PARTNER IF FS40<3 OR FS38.1=1 |
he IF FEMALE; she IF MALE |
The next questions are about jobs [FATHER/MOTHER/CURRENT PARTNER] had in the past month. Has [he/she] worked for pay in the past month?
PROBE: You can include odd jobs, temporary jobs, self-employment, military service, or any other type of paid work.
YES |
1 |
WW8.1 |
NO |
0 |
WW13 |
DK |
d |
|
REF |
r |
WW8.1 |
IF WW8=1 |
her IF FEMALE; his IF MALE |
he IF FEMALE; she IF MALE |
What were [his/her] total earnings in the past month before taxes and other deductions? Please include tips, commissions, and overtime pay.
PROBE: If [he/she] held more than one job, include total earnings from all [his/her] jobs during the past month.
PROBE: I can help you add it up if you want to think out loud.
INSTRUCTION: IF RESPONDENT CAN ONLY REPORT EARNINGS AFTER TAXES, ENTER THAT AMOUNT
AMOUNT |
FFF,FFF.FF |
WW8.3 |
DK |
d |
WW8.2 |
REF |
r |
WW13 |
WW8.2 |
IF WW8.1=DK |
I just need to know a range. Can you tell me if it was…
INSTRUCTION: YOU CAN STOP READING WHEN RESPONDENT PROVIDES RANGE.
Less than $500, |
1 |
WW8.3 |
Between $500 and $750, |
2 |
|
Between $750 and $1000, |
3 |
|
Between $1000 and $1250, |
4 |
|
Between $1250 and $1500, |
5 |
|
Between $1500 and $1750, |
6 |
|
Between $1750 and $2000, |
7 |
|
Between $2000 and $2500, |
8 |
|
Between $2500 and $3000, |
9 |
|
Between $3000 and $3500, |
10 |
|
Between $3500 and $4000, |
11 |
|
Between $4000 and $4500, |
12 |
|
Between $4500 and $5000, |
13 |
|
Between $5500 and $6000, |
14 |
|
$6000 or more? |
15 |
|
DK |
d |
WW13 |
REF |
r |
WW8.3 |
IF WW8.1>0 OR WW8.2<> DK, REF |
PLEASE ENTER IF RESPONDENT PROVIDED THE AMOUNT…
BEFORE TAXES WITHOUT PROBING |
1 |
WW13 |
BEFORE TAXES AFTER PROBING |
2 |
|
AFTER TAXES |
3 |
|
NOT SURE |
4 |
WW13 |
ALL |
FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; CURRENT PARTNER IF FS40<3 OR FS38.1=1 |
LOCAL NAME FOR TANF: NEEDS SITE SPECIFIC FILL |
Now I’m going to read a list of income sources. For each, tell me whether you, [FATHER/MOTHER/CURRENT PARTNER], or the children who live with you received income from this source in the past month:
PROBE: Did you, [FATHER/MOTHER/CURRENT PARTNER], or the children who live with you receive income from this source in the past month?
|
|
|
(IF YES) How much did you receive in [FILL INCOME SOURCE] in the past month? |
Cash welfare which is also known as TANF, or [LOCAL NAME OF TANF]? |
YES |
1 |
FF,FFF.FF |
DK |
|||
REF |
|||
NO |
0 |
|
|
Food stamp benefits |
YES |
1 |
FF,FFF.FF |
DK |
|||
REF |
|||
NO |
0 |
|
|
Disability insurance such as Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI)? |
YES |
1 |
FF,FFF.FF |
DK |
|||
REF |
|||
NO |
0 |
|
|
Unemployment Insurance Benefits or UI |
YES |
1 |
FF,FFF.FF |
DK |
|||
REF |
|||
NO |
0 |
|
|
Child support? |
YES |
1 |
FF,FFF.FF |
DK |
|||
REF |
|||
NO |
0 |
|
|
Money from friends or relatives? |
YES |
1 |
FF,FFF.FF |
DK |
|||
REF |
|||
NO |
0 |
|
|
|
WW28 |
WW28 |
ALL |
or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; or CURRENT PARTNER IF FS40<3 OR FS38.1=1 |
In the past month did you (or [FATHER/MOTHER/CURRENT PARTNER]) receive money from any other source, such as rent from boarders, other government benefits, or any other income we have not already talked about?
YES |
1 |
WW30 |
NO |
0 |
WW32 |
DK |
d |
|
REF |
r |
WW30 |
IF WW28=YES |
or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; or CURRENT PARTNER IF FS40<3 OR FS38.1=1 |
How much money from these other sources did you (or [FATHER/MOTHER/CURRENT PARTNER]) receive in the past month?
AMOUNT |
FFF,FFF.FF |
WW32 |
DK |
d |
|
REF |
r |
WW32 |
ALL |
and FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; and MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; and CURRENT PARTNER IF FS40<3 OR FS38.1=1 |
or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; or CURRENT PARTNER IF FS40<3 |
The next questions are about bank accounts.
Do you (or [FATHER/MOTHER/CURRENT PARTNER]) have any bank accounts?
YES |
1 |
WW33 |
NO |
0 |
WW36 |
DK |
d |
|
REF |
r |
WW33 |
IF WW32=YES AND ((IF FS25=1) OR (IF FS33<3) OR (IF FS40<3 OR FS38.1=1)) |
his IF FEMALE; her IF MALE |
Are any of these accounts in…
a |
Both your names? |
YES |
NO |
WW36 |
b |
[His/Her] name only? |
YES |
NO |
|
c |
Your name only? |
YES |
NO |
|
|
DK |
d |
||
|
REF |
r |
WW36 |
(IF FS25=1) OR (IF FS33<3) OR (IF FS40<3 OR FS38.1=1) |
FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; and CURRENT PARTNER IF FS40<3 |
People handle money differently. Which of the following best describes how you and [FATHER/MOTHER/CURRENT PARTNER] handle your money?
We put all our money together. |
1 |
WW37 |
We put some of our money together but keep the rest separate, or |
2 |
|
We keep all our money separate. |
3 |
|
DK |
d |
|
REF |
r |
WW37 |
(IF FS25=1) OR (IF FS33<3) OR (IF FS40<3 OR FS38.1=1) |
FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; CURRENT PARTNER IF FS40<3 |
People also make different arrangements for handling household expenses, such as paying for rent, food, or utilities. Which of the following best describes how you and [FATHER/MOTHER/CURRENT PARTNER] pay for household expenses?
We usually both contribute to household expenses. |
1 |
WW38 |
I usually cover household expenses. |
2 |
|
[FATHER/MOTHER/CURRENT PARTNER] usually covers household expenses. |
3 |
|
Someone else covers most of our household expenses, or |
4 |
WW37.1 |
We have some other kind of arrangement. |
5 |
WW37.2 |
DK |
d |
WW38 |
REF |
r |
WW37.1 |
IFWW37=4 |
Who covers these household expenses?
INSTRUCTION: PROBE FOR RELATIONSHIP TO RESPONDENT.
DESCRIBE PERSON |
STRING OF 50 |
WW38 |
WW37.2 |
IF WW37=5 |
What kind of arrangement do you have?
INSTRUCTION: DESCRIBE THE ARRANGEMENT.
DESCRIBE ARRANGEMENT |
STRING OF 50 |
WW38 |
WW38 |
ALL |
or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; and/or CURRENT PARTNER IF FS40<3 OR FS38.1=1 |
YES |
1 |
WW40 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW40 |
ALL |
FATHER/MOTHER/CURRENT PARTNER |
or FATHER (IF FS25=1 OR IF FS33<3) AND FEMALE; or MOTHER (IF FS25=1 OR IF FS33<3) AND MALE; or CURRENT PARTNER IF FS40<3 OR FS38.1=1 |
YES |
1 |
WW53 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW53 |
ALL |
Now, I have some questions about financial difficulties you may have experienced in the past 12 months.
Please tell me if there has been a time during the past 12 months when…
|
|
YES |
NO |
DK |
REF |
a |
You could not pay the full amount of the rent or mortgage that you were supposed to pay? |
1 |
0 |
d |
r |
b |
You had service turned off by the water, gas or electric company, or the oil company would not deliver oil because you could not afford to pay the bill? |
1 |
0 |
d |
r |
c |
You were evicted from your home or apartment because you could not pay the rent or mortgage? |
1 |
0 |
d |
r |
|
|
WW54 |
WW54 |
IF FS5<>2 OR 4 OR FS7<>2,3,4,5 (child alive) |
NOTE: NEED STATE/LOCAL FILL FOR MEDICAID |
The next questions are about health insurance coverage.
Is [CHILD] currently covered by Medicaid, [STATE/LOCAL FILL], or any other government program that pays for medical care?
YES |
1 |
WW55.1.1 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW55.1.1 |
IF FS5<>2,4 OR FS7<>2,3,4,5 (child alive) |
Is [CHILD] currently covered by health insurance through your or someone else’s employer, or insurance purchased directly from a private insurance company?
YES |
1 |
WW55.2 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW55.2 |
ALL |
NOTE: NEED STATE/LOCAL FILL FOR MEDICAID. |
Are you currently covered by Medicaid, [STATE/LOCAL FILL], or any other government program that pays for medical care?
YES |
1 |
WW55.2.1 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW55.2.1 |
ALL |
Are you currently covered by health insurance through your or someone else’s employer, or insurance purchased directly from a private insurance company?
YES |
1 |
WW55.3 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW55.3 |
ALL |
In general would you say your health is…
Excellent, |
1 |
WW57.1 |
Very good, |
2 |
|
Good, |
3 |
|
Fair, or |
4 |
|
Poor? |
5 |
|
DK |
d |
|
REF |
r |
WW57.1 |
IF FS19<>3 AND FS25<>6,7 |
FATHER IF FEMALE; MOTHER IF MALE |
Next I have some questions about people who are available to help you in an emergency
Would you be able to count on [FATHER/MOTHER] to take care of [CHILD] in an emergency?
YES |
1 |
WW57 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW57 |
ALL |
Besides [FATHER/MOTHER], how many other people would you be able to count on to take care of [CHILD] in an emergency?
PROBE: Your best estimate is fine.
INSTRUCTION: IF MORE THAN 25 ENTER 25.
NUMBER OF PEOPLE |
FF |
WW57.1 |
DK |
d |
|
REF |
r |
WW58.1 |
IF FS19<>3 AND FS25<>6,7 |
FATHER IF FEMALE; MOTHER IF MALE |
Could you turn to [FATHER/MOTHER] if you suddenly needed to borrow $100?
YES |
1 |
WW58 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW58 |
ALL |
Besides [FATHER/MOTHER] how many other people could you turn to if you suddenly needed to borrow $100 in an emergency?
PROBE: Your best estimate is fine.
INSTRUCTION: IF MORE THAN 25 ENTER 25.
NUMBER OF PEOPLE |
FF |
WW58.1 |
DK |
d |
|
REF |
r |
WW60 |
IF FS19<>3 AND FS25<>6,7) |
FATHER IF FEMALE; MOTHER IF MALE |
Suppose you had a problem, and you were feeling depressed or confused about what to do.
Could you turn to [FATHER/MOTHER] for help or advice if you had a problem and felt like that?
YES |
1 |
WW59 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WW59 |
Besides [FATHER/MOTHER], how many other people would you be able to turn to for help or advice if you had a problem and felt like that?
PROBE: Your best estimate is fine.
INSTRUCTION: IF MORE THAN 25 ENTER 25.
NUMBER OF PEOPLE |
FF |
END OF SECTION |
DK |
d |
|
REF |
r |
WB9 |
ALL |
INSTRUCTION: IS RESPONDENT CURRENTLY IN PRISON OR JAIL?
YES |
1 |
WB11.1 |
NO |
0 |
WB11 |
WB11 |
IF WB9=NO |
The next questions are about involvement you may have had with the police or the criminal justice system.
Have you ever been arrested? Please include all arrests whether you were guilty or not.
YES |
1 |
WB11.1 |
NO |
0 |
WB25.1 OR END OF SECTION
|
DK |
d |
|
REF |
r |
WB11.1 |
IF WB11=YES OR IF WB9=YES |
IF 15MO=0 THEN [RA DATE], IF 15MO=1 THEN [15MO_SURV DATE] |
(IF WB9=YES) The next questions are about involvement you may have had with the police and/or the criminal justice system.
(IF WB9=NO) Have you been arrested since [RA DATE]? That is about (three/two) years ago.
YES |
1 |
WB11.2 |
NO |
0 |
WB15 |
DK |
d |
|
REF |
r |
WB11.2 |
IF WB11.1=YES |
How many times have you been arrested in the past three years?
NUMBER OF ARRESTS |
FF |
WB15 IF DID A 15M INTERVIEW THEN SKIP TO WB26 |
DK |
d |
|
REF |
r |
WB15 |
IF WB11.1<> NO or r, AND 15MO=0; IF 15MO=1 – GOTO WB30WB26 |
Now, I would like to ask you about the time before [RA DATE].
Before [RA DATE], were you ever in jail or prison?
YES |
1 |
WB23 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WB23 |
15MO=0 |
I would also like to ask you about any convictions or sentences you may have received.
Before [RA DATE], were you ever convicted and sentenced to go to jail or prison? Please include any sentence you received, even if you did not serve any time.
YES |
1 |
WB24 |
NO |
0 |
WB25.1 OR END OF SECTION |
DK |
d |
|
REF |
r |
WB24 |
If WB23=YES AND 15MO=0 |
Please think about the longest sentence you received before [RA DATE]. How long was that sentence? Please tell me the total length of the prison sentence, even if you did not serve all of it.
INSTRUCTION: IF LESS THAN 1 WEEK, ENTER 1 WEEK.
INSTRUCTION: FIRST ENTER IF RESPONSE IS WEEKS, MONTHS AND/OR YEARS. YOU WILL ENTER THE NUMBER OF YEARS AND/OR MONTH ON NEXT TWO SCREENS.
b |
WEEKS |
YES |
|
NO |
|||
c |
MONTHS |
YES |
|
NO |
|||
d |
YEARS |
YES |
|
|
NO |
||
|
DK |
d |
WB25.1 |
|
REF |
r |
WB24.1 |
IF WW24b=YES AND 15MO=0 |
WEEKS |
FF |
WB24.2 OR WB24.3 |
WB24.2 |
IF WB24c=YES AND 15MO=0 |
MONTHS |
FF |
WB24.3 |
WB24.3 |
IF WB24d=YES AND 15MO=0 |
YEARS |
FF |
WB25.1 OR WB31 |
WB25.1 |
IF FEMALE IS RESPONDENT AND 15MO=0 |
The next questions are about involvement [FATHER] may have had with the police or the criminal justice system.
Has [FATHER] ever been arrested? Please include all arrests whether he was guilty or not.
YES |
1 |
WB26 |
NO |
0 |
END OF SECTION |
DK |
d |
|
REF |
r |
WB26 |
IF WB25.1=YES |
IF 15MO=0 THEN [RA DATE] AND (that is about three years ago), IF 15MO=1 THEN [15MO-SURVDATE] AND (that is about two years ago) |
(ONLY SAY THIS INTRO IF HAD A 15M INTERVIEW (AND FATHER WAS ALIVE THEN): The next questions are about involvement [FATHER] may have had with the police or the criminal justice system.)
Has [FATHER] been arrested since [RA DATE]? (That is about three years ago./That is about two years ago.)
NEW WORDING IF FATHER KNOWN TO HAVE DIED FROM 36M INTERVIEW: Was [FATHER] arrested after [RA DATE]? That is about three years ago.
YES |
1 |
WB27 |
NO |
0 |
WB30 |
DK |
d |
|
REF |
r |
WB27 |
IF WB26=YES |
IF 15MO=0 THEN (three years), IF 15MO=1 THEN (two years) |
How many times in the past (three years/two years) has [FATHER] been arrested?
NEW WORDING IF FATHER KNOWN TO HAVE DIED FROM 36M INTERVIEW: How many times in the past three years was [FATHER] arrested?
NUMBER OF ARRESTS |
FF |
WB30 |
DK |
d |
|
REF |
r |
WB30 |
IF WB27<>0 |
Is [FATHER] currently in prison or jail?
YES |
1 |
CC1 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WB31 |
IF MALE IS RESPONDENT |
IF 15MO=0 THEN [RATE DATE], IF 15MO=1 THEN [15MO_SURV DATE] |
YES |
1 |
WB32 |
NO |
0 |
|
DK |
d |
|
REF |
r |
WB32 |
ALL |
IF 15MO=0 THEN [RATE DATE], IF 15MO=1 THEN [15MO_SURV DATE] |
Since [RA DATE], have you been convicted and sentenced to go to jail or prison? Please include any sentence you received, even if you did not serve any time.
YES |
1 |
WB33 |
NO |
0 |
END OF SECTION |
DK |
d |
|
REF |
r |
WB33 |
IF WB32=1 |
IF 15MO=0 THEN [RATE DATE], IF 15MO=1 THEN [15MO_SURV DATE] |
Please think about the longest sentence you received since [RA DATE]. How long was that sentence? Please tell me the total length of the prison sentence, even if you did not serve all of it.
INSTRUCTION: IF LESS THAN 1 WEEK, ENTER 1 WEEK.
INSTRUCTION: FIRST ENTER IF RESPONSE IS WEEKS, MONTHS AND/OR YEARS. YOU WILL ENTER THE NUMBER OF YEARS AND/OR MONTH ON NEXT TWO SCREENS.
a |
WEEKS |
YES |
|
NO |
|||
b |
MONTHS |
YES |
|
NO |
|||
c |
YEARS |
YES |
|
|
NO |
||
|
DK |
d |
END OF SECTION |
|
REF |
r |
WB33.1 |
IF WB33a=YES |
WEEKS |
FF |
WB33.2 OR WB33.3 |
WB33.2 |
IF WB33b=YES |
MONTHS |
FF |
WB33.3 |
WB33.3 |
IF WB23c=YES |
YEARS |
FF |
WB34 |
WB34 |
ALL |
Are you currently on probation or parole?
YES |
1 |
END OF SECTION |
NO |
0 |
|
DK |
d |
|
REF |
r |
CC1 |
IF 15MO=1, GO TO BP10 |
Next, I would like to ask you some questions about where you were born and about your childhood.
UNITED STATES |
1 |
BP1 |
PUERTO RICO |
2 |
|
CANADA |
3 |
CC2 |
MEXICO |
4 |
|
CUBA |
5 |
|
DOMINICAN REPUBLIC |
6 |
|
EL SALVADOR |
7 |
|
HAITI |
8 |
|
JAMAICA |
9 |
|
GUATEMALA |
10 |
|
NICARAGUA |
11 |
|
OTHER COUNTRY |
12 |
CC1.1 |
DK |
d |
CC2 |
REFUSED |
r |
CC1.1 |
CC1=12 |
INSTRUCTION: |
SPECIFY OTHER COUNTRY |
CC2 |
CC2 |
IF CC1>2 |
INSTRUCTION: FIRST CODE IF ANSWER IS, ‘SPECIFIC YEAR’ OR ‘NUMBER OF YEARS AGO’…
INSTRUCTION: YOU WILL BE ABLE TO ENTER SPECIFIC YEAR OR NUMBER OF YEARS ON THE NEXT SCREEN.
SPECIFIC YEAR |
1 |
CC2.1 |
NUMBER OF YEARS AGO |
2 |
CC2.2 |
DK |
d |
BP1 |
REF |
r |
CC2.1 |
IF CC2=1 |
INSTRUCTION: |
ENTER SPECIFIC YEAR |
BP1 |
CI2.2 |
IF CC2=2 |
INSTRUCTION: |
ENTER NUMBER OF YEARS AGO |
BP1 |
BP1 |
ALL |
When you were growing up—that is before you turned 18—did you live most of the time with…
PROBE: In which of these living situations did you spend most of your time before you turned 18?
Both your biological mother and your biological father, |
1 |
BP2 |
Your biological mother only, |
2 |
BP3 |
Your biological father only, or |
3 |
|
Neither of your biological parents? |
4 |
|
DK |
d |
|
REF |
r |
BP2 |
If BP1=1 |
Did you usually live with both your parents at the same time?
YES |
1 |
BP3 |
NO |
0 |
|
DK |
d |
|
REF |
r |
BP3 |
Were your biological parents ever married to each other?
INTERVIEWER: IF RESPONDENT ANSWERS DON’T KNOW DO NOT REPEAT THE QUESTION.
YES |
1 |
BP7 |
NO |
0 |
|
DK |
d |
|
REF |
r |
BP7 |
Before you turned 18, did anyone—a stranger, friend, date, relative, or someone else you knew—ever do or try to do something sexual to you or make you do something sexual to them against your wishes?
YES |
1 |
BP8 |
NO |
0 |
|
DK |
d |
|
REF |
r |
BP8 |
Before you turned 18, were you ever beaten up, burned, assaulted with a weapon, or had your life threatened by an adult in your family or household?
YES |
1 |
BP9 |
NO |
0 |
|
DK |
d |
|
REF |
r |
BP9 |
man IF FEMALE; woman IF MALE |
I have a few more questions about your sexual relationships.
How old were you the first time you had sexual intercourse with a [man/woman]?
PROBE: By sexual intercourse I mean that you made love, had sex, or went all the way with a [man/woman].
AGE OF FIRST INTERCOURSE |
FF |
BP10
|
DK |
d |
|
REF |
r |
BP10 |
ALL |
man IF FEMALE; woman IF MALE |
male IF FEMALE; female IF MALE |
In the past three years, how many [men/women] have you had sexual intercourse with? Please count every [male/female] sexual partner in the past three years even if you had sex only once.
PROBE: And that is since in the last three years?
NUMBER OF TIMES |
FFF |
END OF SECTION |
DK |
d |
|
REF |
r |
LO1 |
ALL |
HIDE REFERENCE TO MONEY IF CELL PHONE COMP |
What is your full address?
PROBE: Can you spell the street name for me please?
PROBE: Is there an apartment number?
PROBE: Besides the P.O. Box, do you have a street address?
ADDR LINE 1 |
STRING OF 20 |
LO1.1 |
LO1.1 |
|
INSTRUCTION: |
ENTER ADDR LINE 2 |
LO1.2 |
LO1.2 |
|
INSTRUCTION: |
ENTER CITY |
LO1.3 |
LO1.3 |
|
INSTRUCTION: |
ENTER STATE |
LO1.3.1 |
LO1.3.1 |
|
INSTRUCTION: |
ENTER ZIP CODE |
LO2 |
LO2 |
ALL |
What is your home phone number?
HOME PHONE NUMBER |
FFF-FFF-FFFF |
LO2.1 |
DOES NOT HAVE PHONE |
1 |
LO3 |
DK |
d |
LO3 |
REF |
r |
LO2.1 |
LO2=phone number |
Whose name is that phone number listed in?
ENTER NAME |
STRING OF 20 |
LO3 |
LISTED IN SAMPLE MEMBER’S NAME |
0 |
|
DK |
d |
|
REF |
r |
LO3 |
ALL |
Is there (a/another) phone number where you can be reached?
HOME PHONE NUMBER |
FFF-FFF-FFFF |
LO3.1 |
NO OTHER PHONE |
0 |
LO4 |
DK |
d |
|
REF |
r |
LO3.1 |
LO3=phone number |
Whose name is that phone number listed in?
ENTER NAME |
STRING OF 20 |
LO3.2 |
LISTED IN SAMPLE MEMBER’S NAME |
0 |
LO4 |
DK |
d |
|
REF |
r |
LO3.2 |
LO3=NAME |
What is their relationship to you?
RELATIONSHIP |
STRING OF 20 |
LO4 |
DK |
d |
|
REF |
r |
LO4 |
ALL |
Do you (also) have a cell-phone or pager number?
CELL-PHONE/ PAGER NUMBER |
FFF-FFF-FFFF |
LO17 |
DOES NOT HAVE PHONE |
1 |
|
DK |
d |
|
REF |
r |
LO17 |
COMPLETES FROM SOC |
Thank you very much for your time. Those are all the questions I have right now.
Is [FATHER/MOTHER] available? I’d like to interview [him/her] too, if (he/she) is around.
INSTRUCTION: IF [FATHER/MOTHER] IS AVAILABLE, ASK TO SPEAK TO [HIM/HER]. CLOSE THE CURRENT CASE AFTER LEAVING A NOTE ABOUT THIS CASE AND OPEN [FATHER/MOTHER]’S CASE.
INSTRUCTION: IF [FATHER/MOTHER] ISN’T AVAILABLE, ASK FOR THE BEST TIME TO REACH [HIM/HER] AND RECORD ON [FATHER/MOTHER]’S CONTACT SHEET.
LO18 |
COMPLETES WITH FIELD LOCATOR |
Thank you very much for your time. Those are all the questions I have right now.
Is [FATHER/MOTHER] available? I’d like to interview [him/her] too, if [he/she] is around.
INSTRUCTION: IF [FATHER/MOTHER] IS AVAILABLE, ASK TO SPEAK TO HIM/HER. CLOSE THE CURRENT CASE AFTER LEAVING A NOTE ABOUT THIS CASE AND OPEN [FATHER/MOTHER]’S CASE.
INSTRUCTION: IF [FATHER/MOTHER] ISN’T AVAILABLE, ASK FOR THE BEST TIME TO REACH HIM/HER AND RECORD ON [FATHER/MOTHER]’S CONTACT SHEET.
Please hand the phone back to our field locator.
INTERVIEWER: CONFIRM WITH FIELD LOCATOR THAT SM HAS BEEN PAID.
YES |
1 |
END |
NO |
0 |
|
DK |
d |
|
REF |
r |
MPR DOCUMENTATION:
(REV – 6/4/08)
BSF - 8935-144
Lynne revised for Shannon Monahan
File Type | application/msword |
File Title | Building Strong Families: 36 Month Follow-Up Survey |
Subject | Questionnaire |
Author | Shawn Marsh |
Last Modified By | Seth F. Chamberlain |
File Modified | 2008-06-06 |
File Created | 2008-06-06 |