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FAMILY STUDY
FOLLOW-UP SURVEY 2014-15
Please note that this survey will only be administered through the web.
There will not be a paper version of this survey.
The web survey is still under development.
Version 2-26-14
1
PRIVACY ACT STATEMENT: You have rights under the Privacy Act. The following statement
describes how that Act applies to this study:
Authority: Authority to request this information is granted under Title 5, U.S. Code 136,
Department of Defense Regulations, Executive Order 9396, DoD RCS#DDHA(AR)2106 (expires XX/XX/20XX), and OMB #0720-0029 (expires XX/XX/20XX).
Personal identifiers will be used to link survey data with medical and other military
records.
Purpose: Medical research information will be collected in a research project titled
"Prospective Studies of U.S. Military Forces: The Millennium Cohort Study." The project
objective is to enhance basic medical knowledge and to improve the treatment and
prevention of illnesses that may be related to military service.
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Routine Uses: The information provided in this questionnaire will be maintained in data files
at the Deployment Health Research Department at the Naval Health Research Center and
used only for medical research purposes. Use of these data may be granted to other federal
and non-federal medical research agencies as approved by the Naval Health Research
Center's Institutional Review Board. However, your personal identifiers will be protected. By
signing the original consent form, you volunteered to disclose your information as identified
above. If you do not agree to this disclosure, your failure will make the research less useful.
The "Blanket Routine Uses" that appears at the beginning of the Department of Defense's
compilation of medical databases also applies to this system.
Anonymity: All responses will be held in confidence by the Deployment Health Research
Department. Information you provide will be considered only when statistically summarized
with the responses of others. Your personal identifiers (name, etc.) will only be used to link
data sets and then the identifiers will be stripped from study data such that medical
researchers cannot identify you individually.
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Voluntary Disclosure: Completion of the questionnaire is voluntary. Failure to respond to any
of the questions will NOT result in any penalties except possible lack of representation of
your views in the final results and outcomes.
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AGENCY DISCLOSURE NOTICE: The public reporting burden for this collection of
information is estimated to average 45 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden, to the Department of Defense, Washington
Headquarters Services, Executive Services Directorate, Information Management Division,
4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100
(0720-0029) Respondents should be aware that notwithstanding any other provision of law,
no person shall be subject to any penalty for failing to comply with a collection of information
if it does not display a currently valid OMB control number.
2
DEMOGRAPHICS & PHYSICAL HEALTH
As you begin, please write in today’s date. Be sure to use a blue or black pen.
MM
DD
YY
Q1. What is your date of birth?
MM
DD
YY
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Q2. Is English your primary language?
O No
O Yes
Q3. How tall are you?
feet
inches
Q4. What is your current weight?
(If you are currently pregnant, please provide your weight prior to your pregnancy.)
pounds
Q5. How much did you weigh a year ago?
(If you were pregnant a year ago, please indicate your weight before pregnancy.)
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pounds
Q6. In general, would you say your health is:
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O Excellent
O Very good
O Good
O Fair
O Poor
FOR OFFICE USE ONLY
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Q7. The following questions are about activities you might do during a typical day. Does your
health now limit you in these activities? If so, how much?
Vigorous activities, such as running, lifting heavy
objects, or participating in strenuous sports?
Moderate activities, such as moving a table,
pushing a vacuum cleaner, bowling, or playing
golf?
Lifting or carrying groceries?
No, not limited
at all
Yes,
limited
a little
Yes,
limited
a lot
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Climbing several flights of stairs?
Climbing one flight of stairs?
Bending, kneeling, or stooping?
Walking more than a mile?
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Walking several blocks?
Walking one block?
Bathing or dressing yourself?
Q8. During the past 4 weeks, have you had any of the following problems with your work or other
regular daily activities as a result of your physical health?
Cut down the amount of time you spent
on work or other activities
No, none of
the time
Yes, a
little of
the time
Yes,
some of
the time
Yes, most
of the time
Yes, all of
the time
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Accomplished less than you would like
R
Were limited in the kind of work or other
activities
Had difficulty performing the work or other
activities (for example, it took extra effort)
Q9. During the past 4 weeks, how much bodily pain have you had?
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O None
O Very mild
O Mild
O Moderate
O Severe
O Very severe
Q10. During the past 4 weeks, how much did pain interfere with your normal work (including both
work outside the home and housework)?
O Not at all
O A little bit
O Moderately
O Quite a bit
O Extremely
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Q11. During the past 4 weeks, how much have you been bothered by any of the following problems?
Stomach pain
Back pain
Pain in your arms, legs, or joints
(knees, hips, etc)
Pain or problems during sexual intercourse
Headaches
Chest pain
Dizziness
Fainting spells
Feeling your heart pound or race
Shortness of breath
Constipation, loose bowels, or diarrhea
Bothered
a little
Bothered
a lot
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
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Nausea, gas, or indigestion
Not Bothered
Feeling tired or having low energy
Trouble sleeping
Women only: menstrual cramps or other problems
with your periods
Q12. In the last 12 months, did you use prescription-strength pain relievers (e.g. codeine, OxyContin,
Percocet)?
O Never
O Once a month or less
O Few days per month
O Few days per week
O Daily
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Q13. Are you currently taking any medicine for anxiety, depression, or stress?
O No
O Yes
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Q14. In the last 3 years, has your doctor or other health professional told you that you have any of
the following conditions?
If yes, in what year
were you first
diagnosed?
Mark here
if ever
hospitalized for
the condition *
Hypertension (high blood pressure)
O No
O Yes
O Hospitalized
b)
High cholesterol requiring medication
O No
O Yes
O Hospitalized
c)
Coronary heart disease
O No
O Yes
O Hospitalized
d)
Heart attack
O No
O Yes
O Hospitalized
e)
Angina (chest pain)
O No
O Yes
O Hospitalized
f)
Any other heart condition
(please specify)
O No
O Yes
O Hospitalized
g)
Asthma
h)
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a)
O No
O Yes
O Hospitalized
Diabetes or sugar diabetes
O No
O Yes
O Hospitalized
i)
Fibromyalgia
O No
O Yes
O Hospitalized
j)
Rheumatoid arthritis
O No
O Yes
O Hospitalized
k)
Lupus
O No
O Yes
O Hospitalized
l)
Stomach, duodenal, or peptic ulcer
O No
O Yes
O Hospitalized
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m) Acid reflux / gastroesophageal reflux
O No O Yes
O Hospitalized
disease requiring medication
* Hospitalized means that you were admitted to the hospital for treatment. Please do not check if you went to the
ER, but were not admitted to the hospital.
6
Q14 (continued). In the last 3 years, has your doctor or other health professional told you that you
have any of the following conditions?
If yes, in what year
were you first
diagnosed?
Mark here
if ever
hospitalized for
the condition *
n)
Migraine headaches
O No
O Yes
O Hospitalized
o)
Stroke
O No
O Yes
O Hospitalized
p)
Sleep apnea
O No
O Yes
O Hospitalized
q)
Thyroid condition other than cancer
O No
O Yes
O Hospitalized
r)
Cancer (please specify)
O No
O Yes
O Hospitalized
O No
O Yes
O Hospitalized
Chronic fatigue syndrome
t)
Depression
O No
O Yes
O Hospitalized
u)
Posttraumatic stress disorder
O No
O Yes
O Hospitalized
v)
Infertility
O No
O Yes
O Hospitalized
O No
O Yes
O Hospitalized
O No
O Yes
O Hospitalized
w) Anxiety
x)
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s)
Memory loss or memory impairment
Eating disorder
O No
O Yes
O Hospitalized
z)
Irritable bowel syndrome
O No
O Yes
O Hospitalized
aa)
Other (please specify below)
O No
O Yes
O Hospitalized
O Hospitalized
O Hospitalized
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y)
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* Hospitalized means that you were admitted to the hospital for treatment. Please do not check if you went to the
ER, but were not admitted to the hospital.
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Q15. Please choose the answer that best describes how true or false each of the following statements
is for you.
I seem to get sick a little easier than
other people
I am as healthy as anybody I know
I expect my health to get worse
My health is excellent
Definitely
true
Mostly
true
Not
sure
Mostly
false
Definitely
false
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Days
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Q16. Over the past 3 years, approximately how much time were you hospitalized because of illness
or injury (exclude hospitalization for pregnancy and childbirth)?
Q17. Over the past 3 years, approximately how many days were you unable to work or perform your
usual activities because of illness or injury (exclude lost time for pregnancy and childbirth)?
Days
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Q18. In the past 3 years, where have you gone for medical care? Mark all that apply.
O Military Treatment Facility (MTF)
O VA facility
O Civilian Provider - TRICARE
O Civilian Provider – private insurance, Medicaid, or Medicare
O Public health centers (free or reduced cost care)
O I do not use healthcare facilities/providers
D
Q19. Compared to 3 years ago, how would you rate your physical health in general now?
O Much better
O Somewhat better
O About the same
O Somewhat worse
O Much worse
Q20. Compared to one year ago, how would you rate your emotional health or well-being (such as
feeling anxious, depressed, or irritable) now?
O Much better
O Somewhat better
O About the same
O Somewhat worse
O Much worse
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We would like to end this section by asking about your (or your spouse's) pregnancy and fertility history.
Q21. In the last 3 years, have you and your spouse tried to get pregnant?
O No Skip to Q22
O Not applicable Skip to Q22
O Yes
(If YES) In the last 3 years, have you and your spouse been unsuccessful getting pregnant for
a year or more (not including time spent apart, such as deployment)?
O No
O Yes
Q22. In the last 3 years, if you and your spouse got pregnant, did you have a miscarriage?
O Does not apply (no pregnancy)
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O No miscarriage
O Yes, 1 miscarriage
Year
O Yes, 2 miscarriages
Years
O Yes, 3 miscarriages
Years
FOR WOMEN ONLY:
O No
O Yes
Q24. Have you given birth within the last 3 years?
O No
O Yes
Q25. In the last 3 years, have you been diagnosed with gestational
diabetes by a glucose tolerance test during pregnancy?
O No
O Yes
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Q23. Are you currently pregnant?
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WELL-BEING
Q26. In the last 4 weeks, have you had an anxiety attack – suddenly feeling fear or panic?
O No Skip to Q27
O Yes
(If YES)
a) Has this ever happened to you before?
O No
O Yes
b) Do some of these attacks come suddenly out of the
blue – that is, in situations where you don’t expect to
be nervous or uncomfortable?
O No
O Yes
c) Do these attacks bother you a lot, or are you worried
about having another attack?
O No
O No
O Yes
O Yes
O Yes
O No O No
O No
O No
O No
O No
O No
O Yes O Yes
O Yes
O Yes
O Yes
O Yes
O Yes
O No
O Yes
O No
O No
O Yes
O Yes
O No
O No
O Yes
O Yes
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O No
d) Think about your last bad anxiety attack.
Were you short of breath?
Did your heart race, pound, or skip?
Did you have chest pain or pressure?
Did you sweat?
Did you feel as if you were choking?
Did you have hot flashes or chills?
Did you have nausea or an upset stomach, or the feeling
that you were going to have diarrhea?
Did you feel dizzy, unsteady, or faint?
Did you have tingling or numbness in parts of your body?
Did you tremble or shake?
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Were you afraid you were dying?
Q27. Over the last 4 weeks, how often have you been bothered by any of the following problems?
More
Not
than half
at all
Several days
the days
D
Feeling nervous, anxious, on edge, or worrying
a lot about different things
O
O
O
Continue
below
Skip to Q28
Feeling restless so that it is hard to sit still
O
O
O
Getting tired very easily
O
O
O
O
O
O
O
O
O
Trouble concentrating on things, such as
reading a book or watching TV
O
O
O
Becoming easily annoyed or irritable
O
O
O
Muscle tension, aches, or soreness
Trouble falling asleep or staying asleep
10
Q28. During the past 4 weeks, how much of the time have you had any of the following problems with
your work or other regular daily activities as a result of any emotional problems (such as feeling
depressed or anxious)?
No,
none of
the time
Yes,
a little of
the time
Yes,
some of the
time
Yes,
most of
the time
Yes,
all of the time
O
O
O
O
O
Accomplished less than you would like
O
O
O
O
O
Didn't do work or other activities as
carefully as usual
O
O
O
O
O
Cut down the amount of time you spent
on work or other activities
Q29. During the past 4 weeks, how much of the time: (Select the single best answer for each question.)
A little of
the time
Some of the
time
A good
bit of the
time
Most of
the time
All of the
time
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Have you felt calm and peaceful?
O
O
O
O
O
O
Did you have a lot of energy?
O
O
O
O
O
O
Have you felt downhearted and
blue?
O
O
O
O
O
O
Did you feel worn out?
O
O
O
O
O
O
Have you been a happy person?
O
O
O
O
O
O
Did you feel tired?
O
O
O
O
O
O
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None of
the time
Did you feel full of pep?
Have you been a very nervous
person?
Have you felt so down in the
dumps that nothing could cheer
you up?
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Q30. How often in the past month did you…
Three or
four
times
Five or
more times
Never
One Time
Two
Times
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Cry persistently or uncontrollably
O
O
O
O
O
Sulk or refuse to talk about an issue
O
O
O
O
O
Never
Almost
Never
Sometimes
Fairly
Often
Very Often
O
O
O
O
O
O
O
O
O
O
Felt that things were going your way
O
O
O
O
O
Felt difficulties were piling up so high
that you could not overcome them
O
O
O
O
O
D
Get angry at someone and yell or
shout at them
Get angry with someone and
kick/smash something, slam the door,
punch the wall, etc.
Get into a fight with someone and hit
the person
Threaten someone with physical
violence
Q31. In the last month, how often have you…
Felt that you were unable to control
the important things in your life
Felt confident about your ability to
handle personal problems
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Q32. During the past 4 weeks, to what extent has your physical health or emotional problems
interfered with your normal social activities with family, friends, neighbors, or groups?
O Not at all
O Slightly
O Moderately
O Quite a bit
O Extremely
Q33. During the past 4 weeks, how much of the time has your physical health or emotional problems
interfered with your social activities (like visiting with friends, relatives)?
O None of the time
O A little of the time
O Some of the time
O Most of the time
O All of the time
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Q34. Below is a list of problems and complaints that people sometimes have in response to
stressful life experiences. Some of these may not apply to you, however, please read each one
carefully and mark the answer that best reflects how much you have been bothered by each
problem in the last month.
In the past month have you experienced…?
A little bit
Moderately
Quite a
bit
Extremely
Repeated, disturbing memories of stressful
experiences from the past
O
O
O
O
O
Repeated, disturbing dreams of stressful
experiences from the past
O
O
O
O
O
Suddenly acting or feeling as if stressful
experiences were happening again
O
O
O
O
O
Feeling very upset when something
happened that reminds you of stressful
experiences from the past
O
O
O
O
O
Trouble remembering important parts of
stressful experiences from the past
O
O
O
O
O
Loss of interest in activities that you used to
enjoy
O
O
O
O
O
Feeling distant or cut off from other people
O
O
O
O
O
Feeling emotionally numb, or being unable
to have loving feelings for those close to you
O
O
O
O
O
Feeling as if your future will somehow be cut
short
O
O
O
O
O
Trouble falling asleep or staying asleep
O
O
O
O
O
Feeling irritable or having angry outbursts
O
O
O
O
O
Difficulty concentrating
O
O
O
O
O
Feeling "super-alert" or watchful or on guard
O
O
O
O
O
Feeling jumpy or easily startled
O
O
O
O
O
Physical reactions when something reminds
you of stressful experiences from the past
O
O
O
O
O
Efforts to avoid thinking about your stressful
experiences from the past or avoid having
feelings about them
O
O
O
O
O
Efforts to avoid activities or situations
because they remind you of stressful
experiences from the past
O
O
O
O
O
D
R
Not at
all
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Q35. Over the last 2 weeks, how often have you been bothered by any of the following problems?
Several
days
More than
half the
days
Nearly
every
day
Little interest or pleasure in doing things
O
O
O
O
Feeling down, depressed, or hopeless
O
O
O
O
Trouble falling or staying asleep, or sleeping too
much
O
O
O
O
Feeling tired or having little energy
O
O
O
O
Poor appetite or overeating
O
O
O
O
Feeling bad about yourself - or that you are a failure
or have let yourself or your family down
O
O
O
O
Trouble concentrating on things, such as reading
the newspaper or watching television
O
O
O
O
Moving or speaking so slowly that other people
could have noticed, or the opposite - being so
fidgety or restless that you have been moving
around a lot more than usual
O
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Not at
all
O
O
O
Q36. Rate each item from 0 (not at all) to 8 (exactly so) to indicate the degree to which each statement describes
your feelings or behavior:
Not
at all
Exactly
So
1
2
3
4
5
6
7
8
O
O
O
O
O
O
O
O
O
When I get angry, I get really mad
O
O
O
O
O
O
O
O
O
R
0
I often find myself getting angry at
people or situations
O
O
O
O
O
O
O
O
O
When I get angry at someone, I want
to clobber the person
O
O
O
O
O
O
O
O
O
My anger prevents me from getting
along with people as well as I'd like to
O
O
O
O
O
O
O
O
O
D
When I get angry I stay angry
Q37. Do you often feel that you can’t control what or how much you eat?
O No
O Yes
Q38. Do you often eat, within any 2 hour period, what most people would regard as an unusually large
amount of food?
O No
O Yes
Q39. If you marked yes to either of the above, has this been as often, on average, as twice a week for
the last 3 months?
O No
O Yes
13
Q40. Please indicate how you feel about each statement.
Very
Strongly
Strongly
Mildly
Disagree Disagree Disagree
Neutral
Mildly
Agree
Strongly
Agree
Very
Strongly
Agree
O
O
O
O
O
O
O
There is a special person with
whom I can share my joys and
sorrows
O
O
O
O
O
O
O
My family really tries to help me
O
O
O
O
O
O
O
I get the emotional help and
support I need from my family
O
O
O
O
O
O
O
I have a special person who is a
real source of comfort to me
O
O
O
O
O
O
O
My friends really try to help me
O
O
O
O
O
O
O
AF
T
There is a special person who is
around when I am in need
I can count on my friends when
things go wrong
O
O
O
O
O
O
O
I can talk about my problems
with my family
O
O
O
O
O
O
O
I have friends with whom I can
share my joys and sorrows
O
O
O
O
O
O
O
There is a special person in my
life who cares about my feelings
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
My family is willing to help me
make decisions
I can talk about my problems
with my friends
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Q41. Indicate the degree to which the follow statements are true in your life.
To a
very
To a
To a
small
small
moderate
Not at all
degree
degree
degree
I prioritize what is important in life
To a
great
degree
To a
very
great
degree
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
I know that I can handle difficulties
O
O
O
O
O
O
I have religious faith
O
O
O
O
O
O
I’m stronger than I thought I was
O
O
O
O
O
O
I have learned a great deal about
how wonderful people are
O
O
O
O
O
O
I have compassion for others
O
O
O
O
O
O
D
I have an appreciation for the
value of my own life
I am able to do good things with
my life
I have an understanding of
spiritual matters
I have a sense of closeness with
others
I have established a path for my
life
14
Q42. Please indicate your level of agreement with these statements:
Neither
Strongly
Agree nor
Disagree
Disagree
Disagree
Agree
Strongly
Agree
O
O
O
O
O
There is really no way I can solve
some of the problems I have
O
O
O
O
O
There is little I can do to change many
of the important things in my life
O
O
O
O
O
I often feel helpless in dealing with the
problems of life
O
O
O
O
O
Sometimes I feel that I am being
pushed around in life
O
O
O
O
O
What happens to me in the future
mostly depends on me
O
O
O
O
O
I can do just about anything I really set
my mind to do
O
O
O
O
O
D
R
AF
T
I have little control over the things that
happen to me
15
LIFE EXPERIENCES
Q43. Have you had any of the following life events happen to you in the last 3 years?
If Yes, did this event occur in
the last 12 months
O No
O Yes
O No
O Yes
You or your partner had an unplanned pregnancy
O No
O Yes
O No
O Yes
You were divorced or separated
O No
O Yes
O No
O Yes
Suffered major financial problems (such as
bankruptcy)
O No
O Yes
O No
O Yes
Suffered forced sexual relations or sexual assault
O No
O Yes
O No
O Yes
Experienced sexual harassment
O No
O Yes
O No
O Yes
Suffered a violent assault
O No
O Yes
O No
O Yes
Had a family member or loved one who became
severely ill
O No
O Yes
O No
O Yes
Had a family member or loved one who died
O No
O Yes
O No
O Yes
Suffered a disabling illness or injury
O No
O Yes
O No
O Yes
AF
T
You changed job, assignment, or career path
involuntarily (for example, you lost a job, or you
had to take a job you did not like)
Q44. In the last year, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
O Never
O Rarely
O Monthly
O Weekly
O Daily
R
Q45. How much time did you spend growing up in a military family?
O None of my childhood
O Very little of my childhood
O Some of my childhood
O Most of my childhood
O All of my childhood
Q46. Please indicate your level of agreement with each item.
Disagree
Slightly
Disagree
Neither
Agree or
Disagree
Slightly
Agree
Agree
Strongly
Agree
O
O
O
O
O
O
O
O
O
O
O
O
O
O
I am satisfied with my life
O
O
O
O
O
O
O
So far I have gotten the
important things I want in life
O
O
O
O
O
O
O
If I could live my life over, I
would change almost
nothing
O
O
O
O
O
O
O
D
Strongly
Disagree
In most ways my life is close
to my ideal
The conditions of my life are
excellent
16
YOUR ALCOHOL USE
Now we would like to ask you some questions about drinking.
Alcoholic beverages include beer, wine, and liquor (such as whiskey, gin, etc.). For the purpose of this questionnaire:
One drink = one 12-ounce beer, one 4-ounce glass of wine, or one 1.5-ounce shot of liquor
Q47. In the past year, how often did you typically drink any type of alcoholic beverage?
O Never Skip to page 17, Q51 on Your Alcohol Use
O Rarely
O Monthly
O Weekly
O Daily
drinks
a) In the past year, on those days that you drank alcoholic beverages, on average, how many
drinks did you have?
AF
T
drinks
b) In a typical week, how many drinks of each type of alcoholic beverage do you have?
beer(s)
wine
liquor
c) Last week, how many drinks of alcoholic beverages did you have? (# of drinks)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
R
d) In the past year, how often did you typically get drunk (intoxicated)?
O Never
O Monthly or less
O 2-4 times per month
O >4 times per month
D
FOR MEN ONLY
Q48. In the past year, how often did you typically have 5 or more drinks of alcoholic beverages
within a 2-hour period?
O Never
O Monthly or less
O 2-4 times per month
O >4 times per month
FOR WOMEN ONLY
Q49. In the past year, how often did you typically have 4 or more drinks of alcoholic beverages
within a 2-hour period?
O Never
O Monthly or less
O 2-4 times per month
O >4 times per month
17
YOUR ALCOHOL USE (continued)
Q50. In the last 12 months, have any of the following happened to you more than once?
You drank alcohol even though a doctor suggested that you stop drinking
because of a problem with your health
O No
O Yes
You drank alcohol, were high from alcohol, or hung over while you were
working, going to school, or taking care of children or other responsibilities
O No
O Yes
You missed or were late for work, school, or other activities because you
were drinking or hung over
O No
O Yes
You had a problem getting along with people while you were drinking
O No
O Yes
You drove a car after having several drinks or after drinking too much
O No
O Yes
Q51. Have you ever felt any of the following?
O No
O Yes
Felt annoyed at anyone who suggested you cut back on your drinking
O No
O Yes
AF
T
Felt you needed to cut back on your drinking
Felt you needed an "eye-opener" or early morning drink
O No
O Yes
Felt guilty about your drinking
O No
O Yes
YOUR TOBACCO USE
Q52. In the past year, have you used any of the following tobacco products?
Cigarettes
Cigars
Pipes
O No
O No
O No
O No
Smokeless tobacco (chew, dip, snuff)
O Yes
O Yes
O Yes
O Yes
R
Q53. In your lifetime, have you smoked at least 100 cigarettes (5 packs)?
O No Skip to pg 18, Q54, Your Sleep Quality
O Yes
(If YES)
D
a) At what age did you start smoking?
years old
b) How many years have or did you smoke an average of at least 3 cigarettes per day
(or one pack per week)?
years
c) When smoking, how many packs per day did you or do you smoke?
O Less than half a day per day
O Half to 1 pack per day
O 1 to 2 packs per day
O More than 2 packs per day
d) Have you ever tried to quit smoking?
O Yes, and succeeded
O Yes, but not successfully
O No
18
YOUR SLEEP QUALITY
Now, we would like to ask you some questions about how you are sleeping. Even if you are pregnant or have a
newborn that is disturbing your sleep, please answer the questions by reflecting on your current sleep pattern.
Q54. Over the past month, how many hours of sleep did you get in an average 24-hour period?
hours
Q55. Please rate your sleep pattern for the past 2 weeks.
Difficulty falling asleep
Difficulty staying asleep
Snoring
Mild
Moderate
Severe
Very
Severe
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
AF
T
Problem waking up too early
None
Q56. How satisfied/dissatisfied are you with your current sleep pattern?
O Very satisfied
O Generally satisfied
O Somewhat dissatisfied
O Very dissatisfied
Q57. To what extent do you consider your sleep pattern to interfere with your daily functioning (e.g.
daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.)?
O Not at all interfering
O A little
O Somewhat
O Much
O Very much interfering
D
R
Q58. How noticeable to others do you think your sleep pattern is in terms of impairing the quality of
your life?
O Not at all noticeable
O A little
O Somewhat
O Much
O Very much noticeable
Q59. How worried/distressed are you about your current sleep problem?
O Not at all
O A little
O Somewhat
O Much
O Very much
Q60. During the past month, how often have you taken medicine (prescribed or "over the counter")
to help you sleep?
O Not during the past month
O Less than once a week
O Once or twice a week
O Three or more times a week
19
EXERCISE
Now we’re going to ask you some questions about your exercise habits.
We realize that some participants may be pregnant, injured, or suffering from an illness when they take the survey,
so please think about your exercise habits in a typical week.
Q61. In a typical week, how much time do you spend participating in …
(Please mark both your typical “days per week” and “minutes per day” doing these activities)
# of
Days per
week
you
exercise
O None
O Cannot physically do
OR
days
minutes
days
minutes
AF
T
VIGOROUS exercise or
work that causes heavy
sweating or large increases
in breathing or heart rate
(such as running, active
sports, biking)?
MODERATE or LIGHT
exercise or work that
causes light sweating or
slight increases in breathing
or heart rate (such as
walking, cleaning, slow
jogging)?
On those days, how
many minutes per
day on average do
you exercise
D
R
O None
O Cannot physically do
20
OR
YOUR MILITARY SERVICE
Q62. In the last 3 years, have you ever served in the US military?
O Yes, Active Duty
O Yes, Reserve or National Guard
O No Skip to page 21, Your Spouse
(If YES)
c) What is your overall feeling about your military service?
O Negative
O Somewhat negative
O Neither negative or positive
O Somewhat positive
O Positive
(If YES)
AF
T
Q63 . Have you deployed for more than 30 days in the last 3 years?
O No Skip to page 21, Your Spouse
O Yes
In the last 3 years, how often have you experienced the following during deployment?
If Yes,
list most recent
year of exposure
Feeling that you were in great
danger of being killed
O
O
O
2 0
Being attacked or ambushed
O
O
O
2
0
Receiving small arms fire
O
O
O
2
0
R
Never
Yes,
1 time
Yes,
more
than 1
time
O
O
O
2
0
O
O
O
2 0
O
O
O
2
0
O
O
O
2
0
O
O
O
2
0
Knowing someone seriously
injured or killed
O
O
O
2
0
Seeing Americans who were
seriously injured or killed
O
O
O
2
0
O
O
O
2
0
O
O
O
2
0
O
O
O
2
0
O
O
O
2
0
Clearing/searching homes or
buildings
Having an improvised
explosive device (IED) or
booby trap explode near you
Being wounded or injured
D
Seen dead bodies or human
remains
Handling or uncovering human
remains
Having a member of your unit
be seriously injured or killed
Being directly responsible for
the death of enemy combatant
Being directly responsible for
the death of a non-combatant
Being exposed to smoke from
burning trash and/or feces
21
YOUR SPOUSE
In order to better understand how military life affects families,
AF
T
this next section asks you questions about your relationship
with your spouse.
“Your spouse” refers to the military service member to whom
you were married in 2011/2012/2013 and the person listed on
the cover letter attached to this survey. Regardless of your
current marital status, the term, “your spouse” will be used
R
throughout the rest of this survey.
D
Please write the name of the spouse who you were
married to in 2011/2012/2013:
_____________________________________
(Spouse’s first and last name when you joined the family study)
22
YOUR SPOUSE’S DEPLOYMENT
Now, we would like to ask you some questions regarding the deployment experience.
Q64. In the last 3 years, has your spouse been deployed for more than 30 days?
O No Skip to page 25, Military Life
O Yes Continue with Q65
O I don’t know Skip to page 25, Military Life
Q65. Is your spouse currently deployed?
O No / I don’t know Skip to Q65c
O Yes
(If YES)
AF
T
a) When did your spouse leave for deployment?
- 2 0
MM
YYYY
b) Has your spouse deployed previously?
O Yes Continue to Q66. Please choose the best answer regarding your spouse’s
last completed deployment
O No Skip to page 25, Military Life
(If NO / I don’t know)
c) When did your spouse return from his/her last completed deployment?
- 2 0
MM
YYYY
D
R
Q66. How much has your spouse shared his/her deployment experiences with you from their last
completed deployment?
O None
O A little
O Somewhat
O A lot
Q67. To what degree were/are you bothered by the deployment experiences your spouse shared with
you? Choose the single best answer.
O Not at all
O A little bit
O Moderately
O Quite a bit
O Extremely
Q68. Were you satisfied with your spouse’s access to communication from the last completed
deployment?
Very Dissatisfied
1
2
3
4
Very
Satisfied
5
O
O
O
O
O
23
Q69. Overall, when you communicated with your spouse during his/her last completed deployment,
how satisfied were you with your ability to support each other (connect emotionally and/or
spiritually)?
Very Dissatisfied
1
2
3
4
Very
Satisfied
5
O
O
O
O
O
AF
T
Q70. Please estimate how much advance notification you had before your spouse left for his/her last
completed deployment.
O More than 6 months
O 3-6 months
O Less than 3 months
O Less than 1 month
O Less than 1 week
O 24 hours or less
Q71. In your opinion, what is/was the level of danger to your spouse during their last completed
deployment?
Very Little Danger
1
2
3
4
Extreme Danger
5
O
O
O
O
O
Q72. Was your spouse’s last completed deployment extended beyond what you originally expected?
O Yes, by less than 2 weeks
O Yes, by 2 weeks to 2 months
O Yes, by more than 2 months
O No, not extended
R
Q73. During the last completed deployment or active duty assignment, how much support did you feel
you received from the following?
Moderate
Only a
None at
Does not
A lot
amount
little
all
apply
Your extended family
O
O
O
O
O
Your friends
O
O
O
O
O
D
Your co-workers
Your neighbors
Your clergyman or chaplain
Support group of those in a situation similar
to yours
Family and community support services
Your mental health provider (e.g. psychiatrist
or psychologist)
Your primary care provider (e.g. family
practice doctor or nurse practitioner)
Other military resources
24
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
The deployment return and reunion process can often be challenging,
so our next questions are about that experience.
Q74. Following your spouse’s last completed deployment, please rate the following statement. The
process of reunion/reintegration with your spouse was stressful.
O Strongly disagree
O Disagree
O Neither agree nor disagree
O Agree
O Strongly agree
AF
T
Q75. Following your spouse's last completed deployment, did you personally participate in any
deployment transition programs such as Return and Reunion? (For instance, programs on how to
prevent or manage the stress related to your spouse returning from a deployment or active duty
assignment.)
O No
O Yes Skip to Q76
(If NO) Indicate which of the following are reasons why you did not participate in a deployment
transition program.
Was this a reason for you?
O No
O Yes
I was not able to take the time to participate in the program
O No
O Yes
I had no child care available
O No
O Yes
I was unable to get off work to attend the program
I had previously received this training and did not need it
again
I did not think such training would help me
O No
O Yes
O No
O Yes
O No
O Yes
I was not aware these programs were available
O No
O Yes
My spouse was not supportive of the program
O No
O Yes
R
No such program was available to me
Q76. Please choose the best answer regarding your spouse’s return from the last completed deployment.
1-2
months
3-5
months
6 months
or more
Not yet
adjusted
How long did it take for you to adjust to your
spouse's return from being away from home?
O
O
O
O
O
How long did it take for your spouse to adjust
to his/her return home?
O
O
O
O
O
How long did it take for your relationship to
return to the way it was before he/she left
home?
O
O
O
O
O
How long did it take for your children to adjust
to his/her return home? (If no children
currently reside in your home, please skip this
question)
O
O
O
O
O
D
Less than
one month
25
MILITARY LIFE
Now, we'd like to ask you some questions about the stress of military life
and the military's efforts to help you and your family deal with those stressors.
Q77. Overall, how would you rate the military's efforts to help your spouse, you, and your family deal
with the stresses of military life?
Help you and your family
O Excellent
O Very Good
O Good
O Fair
O Poor
AF
T
Help your spouse
O Excellent
O Very Good
O Good
O Fair
O Poor
Q78. Please indicate how you feel about each statement:
Generally, on a day-to-day
basis, I am proud to be a
military spouse
Very
strongly
disagree
Strongly
disagree
Mildly
disagree
O
O
O
Neutral
Mildly
agree
Strongly
agree
Very
strongly
agree
O
O
O
O
R
Q79. What is your overall feeling about military life?
O Negative
O Somewhat negative
O Neither negative nor positive
O Somewhat positive
O Positive
Q80. In the last 3 years, how many times have you experienced a permanent change of station (PCS)
move?
times
D
Q81. How long have you lived at your current location?
O Less than a year
O 1 to 2 years
O 3 to 5 years
O 6 or more years
26
Q82a. Which best describes where you currently live?
O Military housing, on base
O Military house, off base
O Civilian housing
Q82b. Do you currently live with extended family (for example, your parents, your in-laws, your
siblings)?
O Yes, in your home Skip to Q83
O Yes, in their home Skip to Q83
O No
AF
T
(If NO) Are you currently living near family (for example, you moved to your
hometown)?
O Yes
O No
D
R
Q83. Is your family enrolled in the Exceptional Family Member Program (EFMP)?
O No
O Yes
27
YOUR FAMILY
Q84. Including yourself, how many people currently reside in your household?
(Please include your spouse even if currently deployed, on temporary duty, or in training, if he/she lives and
sleeps in your household the majority of the time. Please do not include anyone that does not live and sleep
in your household the majority of the time, such as visiting relatives.)
adults (18 and older)
children (17 and younger)
Q85. Do you have children with your spouse or from prior relationship(s)?
(Please include any biological or adopted children.)
O No Skip to page 34, Education and Employment
O Yes
D
R
children
AF
T
Q86. How many children do you have with your spouse or from prior relationship(s)?
(Please include any biological or adopted children.)
28
YOUR CHILDREN
Q87. Please enter the date of birth for each of your children with your spouse or prior relationships.
Please include any biological or adopted children that are 17 years old or younger, if they live and
sleep in your household the majority of the time. If you have more than 6 children, please provide the
date of birth of your oldest 6 children.)
Date of birth
OLDEST
-
Child 1
MM
DD
-
Child 2
Child 6
or
or
Adopted
YY
-
DD
-
-
-
DD
-
DD
or
or
or
YY
YY
D
R
MM
or
YY
-
-
YY
DD
MM
YOUNGEST
-
-
MM
Child 5
or
YY
DD
MM
Child 4
Biological
AF
T
MM
Child 3
Please check:
29
Q88. Before we begin, please record the ages of your children living at home, 3 to 17 years of age
from oldest to youngest. If you have more than 6 children, please provide the ages of your oldest
6 children. Please include any biological or adopted children.
Child
Child
Child
Child
Child
Child
1
2
3
4
5
6
(Oldest)
(Youngest)
age
age
age
age
Child 1
Child 2
Child 3
Child 4
O
O
O
O
age
age
Q89. For each of your children 3 to 17 years
of age living at home, mark whether you
have observed the following behaviors
in the past month. Mark all that apply.
O
AF
T
Considerate of other people’s feelings
Child 5 Child 6
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Rather solitary, prefers to play alone
O
O
O
O
O
O
Generally well behaved, usually does what
adults request
O
O
O
O
O
O
Many worries or often seems worried
O
O
O
O
O
O
Helpful if someone is hurt, upset or feeling ill
O
O
O
O
O
O
Constantly fidgeting or squirming
O
O
O
O
O
O
Has at least one good friend
O
O
O
O
O
O
R
Restless, overactive, cannot stay still for long
O
Often fights with other children or bullies them
O
O
O
O
O
O
Often unhappy, depressed or tearful
O
O
O
O
O
O
Generally liked by other children
O
O
O
O
O
O
Easily distracted, concentration wanders
O
O
O
O
O
O
O
O
O
O
O
O
Kind to younger children
O
O
O
O
O
O
Often lies or cheats
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Thinks things out before acting
O
O
O
O
O
O
Steals from home, school or elsewhere
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Often complains of headaches, stomachaches or sickness
Shares readily with other children, for
example toys, treats, pencils
Often loses temper
D
Nervous or clingy in new situations, easily
loses confidence
Picked on or bullied by other children
Often offers to help others (parents, teachers,
other children)
Gets along better with adults than with other
children
Many fears, easily scared
Good attention span, sees work through to
the end
30
Q90. Please indicate if you are currently interested in your child(ren) receiving mental health
services/counseling? (Note: Children ages 3-17)
Child 1 Child 2 Child 3 Child 4 Child 5
Child 6
(Oldest)
(Youngest)
If yes, please indicate which children.
O
O
O
O
O
O
Q91. On a typical day, how much time does your child spend watching TV/videos, using a computer,
or playing video games? (Note: Children ages 3-17)
Child 1
Child 2
Child 3
Child 4
Child 5 Child 6
AF
T
If yes, please indicate the number of hours
per day.
Q92. Please indicate if your child(ren) is overweight. (Note: Children ages 3-17)
Child 1
Child 2
Child 3
Child 4
O
O
O
O
If yes, please indicate which child(ren).
Child 5 Child 6
O
O
Q93. Please indicate the degree to which your child was disturbed or upset by your spouse's most
recent or current deployment or active duty assignment. (Note: Children ages 3-17)
Child 1 Child 2
A lot
Child 3
Child 4
Child 5
Child 6
O
O
O
O
O
More than just a moderate
amount
O
O
O
O
O
O
A moderate amount
O
O
O
O
O
O
Only a little
O
O
O
O
O
O
Not at all
O
O
O
O
O
O
N/A- no current/recent
deployment or active duty
assignment
O
O
O
O
O
O
D
R
O
31
Q94. In the last 3 years, have any of your children 17 or younger, received any of these services or
been placed in any of the following: (If you have more than one child, please mark all that apply for
any of your children.)
Yes
Inpatient psychiatric unit or a hospital for mental health problems
O
O
Residential treatment center (A self-contained treatment facility where
the child lives and goes to school)
O
O
Detention center, training school, jail, or prison
O
O
Group home (A group residence in a community setting)
O
O
Treatment foster care (Placement with foster parents who receive special
training and supervision to help children with problems
O
O
AF
T
No
O
O
Day treatment program (A day program that includes a focus on therapy
and may also provide education while the child is there)
O
O
Case management or care coordination (Someone who helps the child
get the kinds of services he/she needs)
O
O
In-home counseling (Services, therapy, or treatment provided in the
child's home)
O
O
Outpatient counseling/therapy (From psychologist, social worker,
therapist, or other counselor)
O
O
Outpatient treatment from a psychiatrist
O
O
Primary care physician/pediatrician for symptoms related to trauma or
emotional/behavioral problems. (Excluding emergency room)
O
O
School counselor, school psychologist, or school social worker (For
behavioral or emotional problems.)
O
O
Special class or special school (For all or part of the day)
O
O
Child Welfare or Department of Social Services (Include any type of
contact)
O
O
Foster care (Placement in kinship or non-relative foster care)
O
O
Therapeutic recreation services or mentor
O
O
Hospital emergency room (For problems related to trauma or emotional
or behavioral problems)
O
O
Self-help groups (such as Alcoholics Anonymous, Narcotics Anonymous)
O
O
D
R
Probation officer or court counselor
32
Q95. In the last 3 years, has a doctor or health professional told you that any of your children 17 or
younger, has any of the following conditions? (If you have more than one child, and more than one
child has the condition, please mark the severity level for the child that is most affected by the
condition.)
No
Yes
If Yes
Food allergies
O
O
O Mild
O Moderate
O Severe
Non-food allergies
O
O
O Mild
O Moderate
O Severe
Obesity
O
O
O Mild
O Moderate
O Severe
Asthma
O
O
O Mild
O Moderate
O Severe
O
O
O Mild
O Moderate
O Severe
O
O
O Mild
O Moderate
O Severe
O
O
O Mild
O Moderate
O Severe
Depression
O
O
O Mild
O Moderate
O Severe
Anxiety problems or other
emotional problems
O
O
O Mild
O Moderate
O Severe
Eating disorder
O
O
O Mild
O Moderate
O Severe
O
O
O Mild
O Moderate
O Severe
O
O
O Mild
O Moderate
O Severe
Tourette Syndrome
O
O
O Mild
O Moderate
O Severe
Diabetes
O
O
O Mild
O Moderate
O Severe
Cystic Fibrosis
O
O
O Mild
O Moderate
O Severe
Cerebral Palsy
O
O
O Mild
O Moderate
O Severe
Muscular Dystrophy
O
O
O Mild
O Moderate
O Severe
Epilepsy or other seizure disorder
O
O
O Mild
O Moderate
O Severe
Migraine or frequent headaches
O
O
O Mild
O Moderate
O Severe
Arthritis or other joint problems
O
O
O Mild
O Moderate
O Severe
Hearing problem
O
O
O Mild
O Moderate
O Severe
Vision problems that cannot be
corrected with glasses or contact
lenses
O
O
O Mild
O Moderate
O Severe
A brain injury or concussion
O
O
O Mild
O Moderate
O Severe
Blood problems such as anemia
or sickle cell disease
O
O
O Mild
O Moderate
O Severe
AF
T
Any developmental delay that
affects (his/her) ability to learn
Stuttering, stammering, or other
speech problems
Attention Deficit Disorder (ADD)
or Attention Deficit Hyperactive
Disorder (ADHD)
D
R
Behavioral or conduct problems,
such as oppositional defiant
disorder or conduct disorder
Autism or Autism Spectrum
Disorder (ASD)
33
Q96. In the past 3 years, where has your child(ren) 17 or younger, gone for care? Mark all that apply.
O Military Treatment Facility (MTF)
O Civilian Provider - TRICARE
O Civilian Provider – private insurance, Medicaid, or SCHIP (State Children’s Health Insurance
Program)
O Public health centers (free or reduced cost care)
O My child(ren) do not use healthcare facilities/providers
D
R
AF
T
Q97. To best understand the dynamics of health care utilization and the needs of service members and
their families, are you willing to allow us to link your survey data to DoD medical records of any
children you may have that are 17 or younger?
O No
O Yes
34
EDUCATION AND EMPLOYMENT
Q98. What is the highest level of education that you have completed? (Choose the single best answer.)
O Less than high school completion/diploma
O High school degree/GED/or equivalent
O Some college, no degree
O Associate's degree
O Bachelor's degree
O Master's, doctorate, or professional degree
Q99. Are you currently a student?
O No
O Yes, full-time
O Yes, part-time
Q100. Which of the following best describes your employment status? (Choose the single best answer.)
AF
T
O Full-time work (greater than or equal to 30 hours per week)
O Part-time work (less than 30 hours per week)
O Homemaker
O Not employed, looking for work
O Not employed, not looking for work
O Not employed, retired
O Not employed, disabled
O Other (please specify):
(IF FULL-TIME WORK, PART-TIME WORK, OR HOMEMAKER)
a) How satisfying is your current employment?
Not
satisfying
1
2
3
4
5
6
Extremely
satisfying
7
O
O
O
O
O
O
O
R
(IF FULL-TIME OR PART-TIME WORK)
b) How long did it take you to find employment after your last permanent change of
station (PCS)?
D
O Less than 1 month
O 1 to 4 months
O 5 to 8 months
O 9 months to 1 year
O More than 1 year
Q101. Do you feel that being a military spouse has hindered your career development (In other words,
that you have not achieved in your career as much as you would have if you were not a military
spouse)?
Not at all
hindered
1
2
3
4
5
6
Extremely
hindered
7
O
O
O
O
O
O
O
Q102. What is your annual household income? (Please include Basic Allowance for Housing (BAH), even if
you live in base housing, and any other regular income that your family receives.)
O less than $25,000
O $25,000-$49,999
O $50,000-$74,999
O $75,000-$99,999
O $100,000-$124,999
O $125,000-$149,999
O $150,000 or more
35
CONTACT INFORMATION
Because we are interested in how military life and deployment affect families over time, it
is important for us to have contact information that you will have for at least the next
three years. We realize that you may move before then, but you may have cell phones and
email addresses that you will maintain for long periods of time.
A) Please write your full name
Last Name
First Name
AF
T
B) Please include your mailing address below, so we can mail you your gift.
Address Line 1:
Apt/Suite:
City (or FPO/APO):
State/Province/Region
(or AA/AE/AP):
-
ZIP/Postal Code:
Country:
Daytime Phone Number:
Home:
Mobile:
R
Work:
Your Email Address(es):
Primary:
D
Secondary:
C) What is your full Social Security number?
(The reason for asking you your SSN is to assist us in maintaining contact with you and to be
included in all analyses. Your SSN will not be stored with your survey responses and will be
confidentially maintained.)
-
-
This page will be removed and stored separately from your survey.
YOUR SURVEY IS NOT YET COMPLETE.
PLEASE CONTINUE THE SURVEY ON PAGE 36.
36
FOR OFFICE USE ONLY
-
To help us contact you in the future, please provide the name and contact information for two
people who are likely to know where you can be reached. Please do not include individuals that
live in your household. We will NOT share your questionnaire responses with these individuals
and they will ONLY be contacted if we have difficulty contacting you.
D) First Alternate Contact
Name:
Phone:
Email:
E) Second Alternate Contact
AF
T
Name:
Phone:
Email:
F) A great deal has been learned from this study and as a consequence we’ve been asked to consider
other research possibilities. If other related research studies become available, is it ok to contact
you to let you know about these opportunities?
O No
O Yes
D
R
G) Finally, do you have any concerns about your health that are not covered in this questionnaire that
you would like to share?
YOUR SURVEY IS NOT YET COMPLETE.
PLEASE CONTINUE THE SURVEY ON PAGE 37.
This page will be removed and stored separately from your survey.
37
MARITAL STATUS
In order to better understand how military life affects families, this
next section asks you questions about your relationship with your spouse.
Once again, we'd like to remind you that all your answers are strictly confidential.
Q103. What is your current marital status with your spouse that you listed on page 21 of this
survey?
AF
T
NOTE: Spouse refers to the military service member who is a member of the Millennium Cohort
Study and to whom you were married in 2011/2012/2013. Regardless of your current marital
status, the term "your spouse" will be used throughout the rest of this survey.
Now married Please complete page 39 – 42
O
Separated/Divorced Please complete pages 44 – 47
O
Widowed Please complete page 49
D
R
O
38
AF
T
Section A:
MARRIED SECTION
D
R
If you selected married on page 38, please complete page 40-43.
39
A1. How many years have you been married to your spouse?
years
A2. On average, during the past month, or the most recent month your spouse was home, how many
hours did your spouse work per week (including weekends)?
hours per week
A3. On average, during the past year, how many days of leave from work did your spouse take?
Please round to nearest whole number and do not use dashes or decimals.
days in the past year
A4. How many total months was your spouse away from home in the past year (including
deployments, training, temporary duty-TDY/TAD, civilian job)?
AF
T
months in the past year
A5. Many situations experienced by military families can be stressful for them. For each of the
following possible stressful situations you and your family personally experienced in the past
12 months, please indicate how stressful you felt it was for you and your family.
______
__
In the past 12 months_____
________
Very
stressful
Moderately
stressful
Slightly
stressful
Not at all
stressful
Have not
experienced
in past 12
months
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
A non-combat injury to your spouse from
carrying out his/her military duties
O
O
O
O
O
Caring for your ill, injured, or disabled spouse
O
O
O
O
O
Intensified training schedule for your spouse
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
A combat-related deployment or duty
assignment for your spouse
A non-combat-related deployment or duty
assignment requiring your spouse to be away
from home
Uncertainty about future deployments or duty
assignments
R
Combat-related injury to your spouse
D
Increased time spouse spent away from family,
or missed family celebrations, while performing
military duties
Family conflict over whether spouse should
remain in the military or reserves
Difficulty balancing demands of family life and
your spouse's military duties
A permanent change of station (PCS)
For Reserve families only:
Unpredictability of when reservists will be
activated for duty
Changes in your family's financial situation due
to your spouse's active duty
Concern over your spouse's employment when
de-activated
Concern over continuity of access to healthcare
for your family
40
A6. Taking all things together, how would you describe your marriage?
Very
Unhappy
1
2
3
4
5
6
Very
Happy
7
O
O
O
O
O
O
O
A7. How happy are you with each of the following aspects of your marriage?
2
3
4
5
6
Very
Happy
7
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
AF
T
The understanding you receive
from your spouse
The love and affection you get from
your spouse
The amount of time you spend with
your spouse
The demands your spouse places
on you
Very
Unhappy
1
Your sexual relationship
The way your spouse spends
money
The work your spouse does around
the house
Your spouse as a parent (N/A if not
a parent)
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
A8. In the last year, have you or your spouse seriously suggested the idea of divorce or permanent
separation?
O No
O Yes
R
A9. Have you and your spouse ever received marital counseling?
O Never
O Once
O Twice
O Three or more times
A10. Please rate the following statements regarding your spouse’s current job.
(This question refers to your spouse’s current military job. If your spouse I no longer in the military,
please refer to your spouse’s current civilian job.)
Disagree
Neither
agree nor
disagree
Agree
Strongly
agree
O
O
O
O
O
The amount of time my spouse's job takes up makes it
difficult for him/her to fulfill family responsibilities
O
O
O
O
O
My spouse's job produces stress/strain that makes it
difficult for him/her to fulfill family responsibilities
O
O
O
O
O
My spouse's job produces stress/strain that makes it
difficult for me to fulfill family responsibilities
O
O
O
O
O
Frequent TDY/TAD (training duty) interfere with our
home and family life
O
O
O
O
O
The demands of my spouse's work interfere with our
home and family life
D
Strongly
disagree
41
Please complete the following questions if you have children with – biological or adopted.
A11. The questions listed below concern what happens between you and . While you
may not find an answer which exactly describes what you think, please mark the answer that comes
closest to what you think. Your first reaction should be your first answer.
Strongly
agree
Agree
Not sure
Disagree
Strongly
disagree
enjoys being alone
with our child
O
O
O
O
O
During pregnancy,
expressed confidence in my ability to be
a good parent
O
O
O
O
O
When there is a problem with our child,
we work out a good solution together
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
AF
T
and I communicate
well about our child
is willing to make
personal sacrifices to help take care of
our child
Talking to about our
child is something I look forward to
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
I feel close to when I
see him/her play with our child
O
O
O
O
O
knows how to handle
children well
O
O
O
O
O
and I are a good team
O
O
O
O
O
believes I am a good
parent
O
O
O
O
O
I believe is a good
parent
O
O
O
O
O
makes my job of
being a parent easier
O
O
O
O
O
sees our child in the
same way I do
O
O
O
O
O
and I would basically
describe our child in the same way
O
O
O
O
O
If our child needs to be punished,
and I usually agree on
the type of punishment
O
O
O
O
O
I feel good about ’s
judgment about what is right for our child
O
O
O
O
O
tells me I am a good
parent
O
O
O
O
O
and I have the same
goals for our child
O
O
O
O
O
D
R
pays a great deal of
attention to our child
and I agree on what
our child should and should not be
permitted to do
42
We would now like to ask you some questions about your family.
By family we mean you, your current spouse, and your children (if applicable).
A12.
Please rate the following statements in regard to your family, including you, your spouse, and
your children (if applicable).
Strongly
disagree
Generally
disagree
Undecided
Generally
agree
Strongly
agree
O
O
O
O
O
O
O
O
O
O
Family members express affection to
each other
O
O
O
O
O
Family members are able to ask
each other for what they want
O
O
O
O
O
Family members can calmly discuss
problems with each other
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
When angry, family members seldom
say negative things about each other
O
O
O
O
O
Family members express their true
feelings to each other
O
O
O
O
O
AF
T
Family members are satisfied with
how they communicate with each
other
Family members are very good
listeners
Family members discuss their ideas
and beliefs with each other
When family members ask questions
of each other, they get honest
answers
Family members try to understand
each other's feelings
A13. How satisfied are you with:
Very
dissatisfied
Somewhat
dissatisfied
Generally
satisfied
Very
satisfied
Extremely
satisfied
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
The way problems are discussed
O
O
O
O
O
The fairness of criticism in your family
O
O
O
O
O
Family members' concern for each
other
O
O
O
O
O
R
The degree of closeness between
family members
Your family's ability to cope with
stress
Your family's ability to be flexible
D
Your family's ability to share positive
experiences
The quality of communication
between family members
Your family's ability to resolve
conflicts
The amount of time you spend
together as a family
THANK YOU FOR COMPLETING THE FAMILY STUDY SURVEY!
If you have any questions or concerns, you can contact the Millennium Family Study team
toll free at (800) 571-9248. You can also email us at familycohortinfo@med.navy.mil.
43
AF
T
Section B:
SEPARATED/DIVORCED
D
R
If you selected separated/divorced on page 38, please complete pages 45-48.
44
The following questions are designed for spouses that are separated or divorced from the service member
that enrolled in the Millennium Cohort Study in 2011/2012. We realize that you may be in a new relationship
or have remarried, but for simplicity we use the term "your spouse" to refer to the service member you were
married to in 2011/2012 when you completed the first Family Study survey.
IF SEPARATED
B1. In what month and year did you and your spouse separate?
MM
YY
B2. How many years have you been married to your spouse?
years
IF DIVORCED
AF
T
B3. In what month and year did you and your spouse separate?
-
MM
OR
Not applicable
YY
B4. In what month and year did you and your spouse divorce?
-
MM
YY
B5. How many years were you married to your spouse?
years
B6. Are you remarried? If so, date remarried:
-
YY
R
MM
B7. On average, during the past month, or the most recent month your spouse was home, how many
hours did your spouse work per week (including weekends)?
hours per week
I don’t know
D
B8. On average, during the past year, how many days of leave from work did your spouse take?
Please round to nearest whole number and do not use dashes or decimals.
days in the past year
I don’t know
B9. How many total months was your spouse away from home in the past year (including
deployments, training, temporary duty-TDY/TAD, civilian job)?
months in the past year
I don’t know
45
B10. Many situations experienced by military families can be stressful for them. For each of the
following possible stressful situations you and your family personally experienced in the past
12 months, please indicate how stressful you felt it was for you and your family.
______
__
In the past 12 months_____
________
Very
stressful
Moderately
stressful
Slightly
stressful
Not at all
stressful
Have not
experienced
in past 12
months
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Combat-related injury to your spouse
O
O
O
O
O
A non-combat injury to your spouse from
carrying out his/her military duties
O
O
O
O
O
Caring for your ill, injured, or disabled spouse
O
O
O
O
O
Intensified training schedule for your spouse
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
AF
T
A combat-related deployment or duty
assignment for your spouse
A non-combat-related deployment or duty
assignment requiring your spouse to be away
from home
Uncertainty about future deployments or duty
assignments
Increased time spouse spent away from family,
or missed family celebrations, while performing
military duties
Family conflict over whether spouse should
remain in the military or reserves
Difficulty balancing demands of family life and
your spouse's military duties
A permanent change of station (PCS)
For Reserve families only:
D
R
Unpredictability of when reservists will be
activated for duty
Changes in your family's financial situation due
to your spouse's active duty
Concern over your spouse's employment when
de-activated
Concern over continuity of access to healthcare
for your family
46
B11. Taking all things together, how would you describe your marriage with the service member you
were married to in 2011/2012?
Very
Unhappy
1
2
3
4
5
6
Very
Happy
7
O
O
O
O
O
O
O
B12. At the time of separation or divorce , how happy were you with each of the
following aspects of your marriage?
Very
Unhappy
1
2
3
4
5
6
Very
Happy
7
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
N/A
AF
T
The understanding you receive
from your spouse
The love and affection you get
from your spouse
The amount of time you spend with
your spouse
The demands your spouse places
on you
Your sexual relationship
The way your spouse spends
money
The work your spouse does
around the house
Your spouse as a parent (N/A if not
a parent)
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
R
B13. At the time of your separation or divorce, please rate the following statements regarding ’s job.
(This question refers to your spouse’s military job. If your spouse was no longer in the military, lease
refer to your spouse’s civilian job.)
Disagree
Neither
agree nor
disagree
Agree
Strongly
agree
O
O
O
O
O
O
O
O
O
O
O
My spouse's job produces stress/strain that
makes it difficult for him/her to fulfill family
responsibilities
O
O
O
O
O
O
My spouse's job produces stress/strain that
makes it difficult for me to fulfill family
responsibilities
O
O
O
O
O
O
Frequent TDY/TAD (training duty) interfere with
our home and family life
O
O
O
O
O
O
The demands of my spouse's work interfere
with our home and family life
O
The amount of time my spouse's job takes up
makes it difficult for him/her to fulfill family
responsibilities
D
N/A
Strongly
disagree
B14. At the time of your separation or divorce, had you and ever received marital
counseling?
O Never
O Once
O Twice
O Three or more times
47
Please complete the following questions if you have children with – biological or adopted.
B15. The questions listed below concern what happens between you and . While you
may not find an answer which exactly describes what you think, please mark the answer that comes
closest to what you think. Your first reaction should be your first answer.
Strongly
agree
Agree
Not sure
Disagree
Strongly
disagree
enjoys being alone
with our child
O
O
O
O
O
During pregnancy,
expressed confidence in my ability to be
a good parent
O
O
O
O
O
When there is a problem with our child,
we work out a good solution together
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
I feel close to when I
see him/her play with our child
O
O
O
O
O
knows how to handle
children well
O
O
O
O
O
and I are a good team
O
O
O
O
O
believes I am a good
parent
O
O
O
O
O
I believe is a good
parent
O
O
O
O
O
makes my job of
being a parent easier
O
O
O
O
O
sees our child in the
same way I do
O
O
O
O
O
and I would basically
describe our child in the same way
O
O
O
O
O
If our child needs to be punished,
and I usually agree on
the type of punishment
O
O
O
O
O
I feel good about ’s
judgment about what is right for our child
O
O
O
O
O
tells me I am a good
parent
O
O
O
O
O
and I have the same
goals for our child
O
O
O
O
O
AF
T
and I communicate
well about our child
is willing to make
personal sacrifices to help take care of
our child
Talking to about our
child is something I look forward to
D
R
pays a great deal of
attention to our child
and I agree on what
our child should and should not be
permitted to do
THANK YOU FOR COMPLETING THE FAMILY STUDY SURVEY!
If you have any questions or concerns, you can contact the Millennium Family Study team
toll free at (800) 571-9248. You can also email us at familycohortinfo@med.navy.mil.
48
AF
T
Section C:
WIDOWED
D
R
If you selected widowed on page 38, please complete page 50.
49
C1. In what month and year did your spouse die?
MM
YY
C2. What was the main cause of your spouse’s death?
O Combat
O Accident (on-duty)
O Accident (off-duty)
O Illness/Disease
O Homicide
O Suicide
O Unknown
O Other
years
AF
T
C3. How many years were you married to your spouse?
C4. Are you remarried? If so, date remarried:
MM
YY
THANK YOU FOR COMPLETING THE FAMILY STUDY SURVEY!
D
R
If you have any questions or concerns, you can contact the Millennium Family Study team
toll free at (800) 571-9248. You can also email us at familycohortinfo@med.navy.mil.
at
50
| File Type | application/pdf |
| File Modified | 2014-03-27 |
| File Created | 2014-02-26 |