Instrument 1- Baseline Youth Survey

OPRE Study: Evaluation of LifeSet [Impact and Implementation Evaluation]

Instrument 1- Baseline Youth Survey_2022_01_10_Clean

Instrument 1- Baseline Youth Survey

OMB: 0970-0577

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0970-0577 can be found here:

2022-11-22 - Revision of a currently approved collection

Document [docx]

Download: docx | pdf

LifeSet Baseline Survey

This survey is intended to be administered at baseline to all youth in the study by interviewers of the subcontracted survey firm. As this will be the first data collection for the evaluation, the interview will begin with the informed consent process. However, items gathering information to aid in follow-up contact are placed at the end of the survey so that rapport may be built prior to asking for contact information.

Instructions 2

Set Up And Introduction 2

Demographics 3

Living Arrangements 5

Social Support 6

Fertility 8

Education 9

Employment and Earnings 11

Economic Hardships 13

ACASI Set Up 14

Mental Health Services 16

Substance Abuse 17

Criminal Justice Involvement 18

Spouse/Partner Violence 19

Youth Resiliency 21

Social-Emotional Competence 23

LifeSet Services 27

Information for Follow Up Contact 28

Instructions

Thank you for joining us today. We would like to invite you to participate in a survey that will last about 35 minutes. We are conducting this survey as part of the Young Adult Services Study (YASS). The survey contains questions about the services you received during foster care. There are also questions about your experiences leaving foster care such as education and work, places you lived, and the relationships you have with family and friends.

Some questions ask about your emotions, alcohol and drug use, and behavior that might be against the law but are very common for young people your age.

[IF MODE =1] I will read the questions to you and enter your responses into the computer. You may skip over any questions you do not want to answer.

[IF MODE = 2] If you want, you can listen to these questions on headphones and enter your answers on a computer. The interviewer will not see your answers to these questions.

We will use this information to better understand the services that young adults in New Jersey get and what it is like for them leaving foster care.

Your participation in this survey is voluntary. You can choose not to answer any question or not participate in the survey at all. There will be no consequences to you if you choose not to participate. We will keep the information you provide private and will not share it with anyone except for research staff working on the study. Additionally, federal law states that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this data collection is 0970-0577 and the expiration date is 09/30/2024.

Set Up And Introduction

prld_age What is your date of birth?

ENTER MONTH |_|_| (2-DIGIT)

ENTER DAY |_|_| (2-DIGIT)

ENTER YEAR |_|_|_|_| (4-DIGIT)

prld_group Treatment Case or Control Group Case (relevant routing in LifeSet Services Section)

TREATMENT
CONTROL

intloc (INTERVIEWER: WHERE IS THIS INTERVIEW TAKING PLACE?)

1 RESPONDENT’S HOME [Do not allow if incar1=1]

2 ALTERNATE LOCATION (SPECIFY)

intloc_specify [IF INTLOC=2] WHERE IS THE INTERVIEW TAKING PLACE?

[TEXT BOX]

VERIFY Case ID: XXXXXXX

Subject Name: Respondent First and Last Name

Respondent DOB: XX/XX/XXXX

INTERVIEWER: PLEASE MAKE SURE YOU HAVE SELECTED THE CORRECT CASE BEFORE ENTERING 1 TO CONTINUE.

ENTER 1 TO CONTINUE.

MODE INTERVIEWER: INDICATE MODE OF ADMINISTRATION.

TELEPHONE
IN-PERSON

INTRO6

INTERVIEWER: BE SURE TO READ VERBATIM.

Before we begin, I would like to remind you of the study details. These study details are also included on the Study Fact Sheet and [PROGRAMMER: IF R AGE IS >=18, THEN FILL: “Consent”; IF R AGE IS <18, THEN FILL: “Assent”] Form that were provided to you by mail or email. I can send these materials to you again if you did not receive them or have not had a chance to review them yet.

Did you have time to review the materials?

1 YES [GO TO Y_REVIEW]

0 NO [GO TO Y_NOREVIEW]

Y_REVIEW

INTERVIEWER: BE SURE TO READ VERBATIM.

Great, this study is funded by the Administration for Children and Families, an agency within the U.S. Department of Health and Human Services. This interview involves questions about the services you have received while in foster care, as well as questions about education and work, places you have lived, and relationships with family and friends. We are asking over 600 youth in foster care to take part. Your input is needed to understand and improve the services youth and young adults receive before and after they leave care.

Federal law requires us to keep your answers private. Any data you provide will only be used by authorized personnel for statistical purposes. The only exceptions to this promise of privacy are if you tell me you intend to seriously harm yourself or someone else, or if a child has been or will be seriously harmed. In this situation, I may need to notify a mental health professional or other authorities.

Your participation is voluntary. The [FILL IF MODE=1: "telephone interview"; FILL IF MODE=2: "interview"] will take about 35 minutes to complete. You may consider some of the questions to be sensitive and some of the questions may also make you feel certain emotions, such as sadness. Remember you can choose not to answer any questions you do not want to answer, and you can stop the interview at any time. If you become upset at any time during the interview and wish to speak to a mental health professional about how you are feeling, I will provide you with some toll-free hotline numbers to call. A $25 electronic gift card will be sent to you after the [FILL IF MODE=1: "telephone interview"; FILL IF MODE=2: "interview"]. We may also telephone you in the future to check on the quality of my work during this interview. This consists of a brief set of questions for participants to answer to check for professionalism, time to complete the interview, and if data collection procedures were followed.

[PROGRAMMER: IF R AGE>=18: Do you have any questions before we begin?]

[PROGRAMMER: IF R AGE<18: Do you have any questions?]

INTERVIEWER: ANSWER RESPONDENT QUESTIONS.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF R AGE<18, THEN GO TO M_TB. IF R AGE>=18, THEN GO TO AGREE1.]

Y_NOREVIEW

Before we begin, I must review the [IF R AGE>=18, THEN FILL: “consent”; IF R AGE<18, THEN FILL: “assent”] form with you to ensure you are fully informed about study participation and your rights as a respondent. This will take just a few minutes.

FI: OFFER TO SEND THE FACT SHEET/CONSENT FORM AGAIN.

INTERVIEWER IF NEEDED: Please visit our website YASS.rti.org to view and download a copy of the study fact sheet.

INTERVIEWER: ENTER 1 TO CONTINUE.

CONSENT1

INTERVIEWER: BE SURE TO READ VERBATIM.

We are from RTI International. We have been hired to interview young people as part of a study being conducted by the Urban Institute. The Urban Institute is a non-political nonprofit social policy research organization in Washington DC. The Urban Institute study looks at what it’s like for young adults who are leaving foster care and the services they may receive. This study is funded by the U.S. Department of Health and Human Services, Administration for Children and Families. We are asking over 600 youth in foster care to help us with this study. You have been asked to be in the study because you are a youth in foster care in New Jersey. We call this study the Young Adult Services Study, or YASS.

INTERVIEWER: ENTER 1 TO CONTINUE.

CONSENT2

INTERVIEWER: BE SURE TO READ VERBATIM.

If you decide to participate in this study, we would like to interview you today and two more times, once in 12 months and again in 24 months, for a total of three interviews. For the interview today, I will ask you questions about the services you received during foster care. There are also questions about your experiences leaving foster care such as education and work, places you lived, and the relationships you have with family and friends. The interview today will last about 35 minutes and future interviews will last about 60-75 minutes. The interviews can be done at a time that works best for you. Some portions of the interview may be recorded to make sure that I am doing a good job.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF MODE=TELEPHONE] CONSENT3A

INTERVIEWER: BE SURE TO READ VERBATIM.

Some questions ask about your emotions, alcohol and drug use, and behavior that might be against the law. I will read the questions to you and enter your responses into the computer. I will know your answers to these questions. You may skip over any questions you do not want to answer.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF MODE=IN PERSON] CONSENT3B

INTERVIEWER: BE SURE TO READ VERBATIM.

Some questions ask about your emotions, alcohol and drug use, and behavior that might be against the law. If you want, you can listen to these questions on headphones and enter your answers on a computer. I will not see your answers to these questions. If you do not want to use the computer, I can read you the questions. I will enter your answers into the computer. If you do it this way, I will know your answers to these questions.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF R AGE>=18] CONSENT4A

INTERVIEWER: BE SURE TO READ VERBATIM.

We would like to ask your permission to allow the YASS research team to review administrative records that might contain information that can be used to see how you are doing. These include the following types of records; public assistance; education; foster care agency; unemployment insurance wages; vital statistics; and criminal justice. These and other records such as department of motor vehicles information may also be used to locate you if we should lose contact.

INTERVIEWER: ENTER 1 TO CONTINUE

[IF R AGE<18] CONSENT4B

INTERVIEWER: BE SURE TO READ VERBATIM.

We may contact you in between interviews to confirm or update your contact information. With your permission, we would like to use consumer/credit databases that may have your phone number or address to locate you once you turn 18. We will only use these sources to help us find you when we want to interview you again.

INTERVIEWER: ENTER 1 TO CONTINUE.

CONSENT5

INTERVIEWER: BE SURE TO READ VERBATIM.

In the future, you may also be asked to participate in a small group discussion or one-on-one interview as part of the study. These discussions will help us better understand how you are experiencing the services offered to you. All opportunities to participate in any future discussion are voluntary and you can choose not to participate at any time.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF R AGE>=18] CONSENT6A
INTERVIEWER: BE SURE TO READ VERBATIM.

You don’t have to be in this study. Being in the study is voluntary. If you don’t want to be in the study just tell me. You can say yes now but you can stop if you change your mind later. You can still be in the study even if you do not give us permission to get information about you from administrative data. Whether or not you choose to be in this study will not change anything for you in terms of the care you receive from the state or any other services you may be eligible for. In other words, it will not change your placement or the services you get.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF R AGE<18] CONSENT6B

INTERVIEWER: BE SURE TO READ VERBATIM.

You don’t have to be in this study. Being in the study is voluntary. If you don’t want to be in the study just tell me. You can say yes now but you can stop if you change your mind later. Whether or not you choose to be in this study will not change anything for you in terms of the care you receive from the state or any other services you may be eligible for. In other words, it will not change your placement or the services you get.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF R AGE>=18] CONSENT7A

INTERVIEWER: BE SURE TO READ VERBATIM.

Members of the research team will be able to see your information. Information that could identify you will be removed from the information you share today and any of the data we collect about you in the future. The information may be combined and made available for other researchers to use; these files will not include any information that could identify you and will only be available under password protected secure access. If ACF decides to extend this project, we may share your information with the researchers working on that extension, but they would keep the information that is identifiable private to the same extent we do. One exception to not sharing your identity, is that I may need to tell the appropriate authorities if you report evidence of current abuse or neglect. I may also need to report if you threaten yourself or someone else.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF R AGE<18] CONSENT7B

INTERVIEWER: BE SURE TO READ VERBATIM.

Members of the research team will be able to see your information. Information that could identify you will be removed from the information you share today and any of the data we collect about you in the future. The information will be combined and made available for other researchers to use; these files will not include your name and will only be available under password protected secure access. If ACF decides to extend this project, we may share your information with the researchers working on that extension, but they would keep the information that is identifiable private to the same extent that we do. One exception to not sharing your identity, is that I may need to tell the appropriate authorities if you report evidence of current abuse or neglect. I may also need to report if you threaten to hurt yourself or someone else.

INTERVIEWER: ENTER 1 TO CONTINUE.

CONSENT8

INTERVIEWER: BE SURE TO READ VERBATIM.

We will do many things to keep your information private. We will only let the research team see your information. We will store information about you either in a locked drawer or on a secure computer. The computer will be password protected. We will also not use your name in any reports or papers.

We also have a Certificate of Confidentiality from the government to protect your privacy. This Certificate of Confidentiality strictly limits when we can share identifiable information collected through our research. For example, we cannot be forced to give a court information about you. However, you should know that the Certificate does not stop reporting that federal, state or local laws require, for example reporting child or elder abuse, some communicable diseases, and threats to harm yourself or others.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF R AGE>=18] CONSENT9A

INTERVIEWER: BE SURE TO READ VERBATIM.

Some of the questions you are asked may make you feel uneasy. You do not have to answer any questions that you do not want to answer. Additionally, any administrative data you may agree to provide us access to could be compromised in a breach of data and the answers you may provide in the interview could be revealed. As mentioned, we have taken precautions to minimize the risk of any data being compromised.

INTERVIEWER: ENTER 1 TO CONTINUE.

[IF R AGE<18] CONSENT9B

INTERVIEWER: BE SURE TO READ VERBATIM.

Some of the questions you are asked may make you feel uneasy. You do not have to answer any questions that you do not want to answer. Additionally, any data you may agree to provide us access to could be compromised in a breach of data and the answers you may provide in the interview could be revealed. As mentioned, we have taken precautions to minimize the risk of any data being compromised.

INTERVIEWER: ENTER 1 TO CONTINUE.

CONSENT10

INTERVIEWER: BE SURE TO READ VERBATIM.

You will not benefit directly from this study. But data we get from the study is important. Being in this study will let you tell officials about your experiences during and after foster care. This information may be used to improve the services that youth receive before and after they leave care. Many youth in foster care appreciate the chance to tell their story and be listened to.

INTERVIEWER: ENTER 1 TO CONTINUE.

CONSENT11

INTERVIEWER: BE SURE TO READ VERBATIM.

For helping me with this study, you will receive a $25 gift card for this survey, $50 for the second survey in 12 months, and $50 for the third survey in 24 months. If you decide to stop being in the study or skip some of the questions today you still get $25. It’s all up to you.

INTERVIEWER: ENTER 1 TO CONTINUE.

CONSENT12

INTERVIEWER: BE SURE TO READ VERBATIM.

This study is being done by the Urban Institute, the University of Chicago, and the Survey Firm, RTI International. The US Department of Health and Human Services is paying for this study. The people in charge of the study are Dr. Michael Pergamit and Dr. Mark Courtney. If you have any questions or concerns about this study, I can give you the necessary contact information.

INTERVIEWER, IF NECESSARY:

Dr. Michael Pergamit

mpergamit@urban.org

Dr. Mark Courtney

markc@uchicago.edu

Jennifer Keeney

RTI International

919-316-3525

1-800-334-8571 extension 23525

jkeeney@rti.org

INTERVIEWER: ENTER 1 TO CONTINUE.

[ASK ONLY IF R AGE<18; IF R AGE >=18, THEN GO TO AGREE1]

M_TB. I want to make sure I was clear when I talked to you about the survey and went through the assent process. I would like to ask you a few questions to make sure you understand what agreeing to take part means. This is a way for me to review with you anything where you might still have questions.

INTERVIEWER: ENTER 1 TO CONTINUE

M_TB1. First, please tell me what you think is involved in joining this study?

INTERVIEWER: CODE RESPONSE

1. CORRECT RESPONSE: SURVEYS/ANSWERING QUESTIONS/35-MINUTE SURVEY

2. INCORRECT RESPONSE OR MINOR SAYS DON’T KNOW

M.TB2. Are you required to join and complete this survey?

INTERVIEWER: CODE RESPONSE

1 = CORRECT RESPONSE: NO

2 = INCORRECT RESPONSE: YES OR DON’T KNOW RESPONSE.

M__TB3. What will happen if you do not answer all of the survey questions or want to stop the survey early?

INTERVIEWER: CODE RESPONSE

1 = CORRECT RESPONSE: NOTHING. I CAN DECLINE/REFUSE TO ANSWER ANY QUESTION OR LEAVE AT ANY TIME.

2 = INCORRECT RESPONSE OR MINOR SAYS DON’T KNOW

M_TB4. We will not tell anyone that you are taking part in this survey or share your information. There is an exception to this. Can you tell me what that is?

INTERVIEWER: CODE RESPONSE

1 = CORRECT RESPONSE: SELF-HARM OR HARM TO OTHERS

2 = INCORRECT RESPONSE OR MINOR SAYS DON’T KNOW

LOGIC before: IF R answered items M_TB1 – M_TB4 correctly (=1) GOTO M_TB5.

M_TB5. INTERVIEWER: THIS RESPONDENT SUCCESSFULLY COMPLETED THE ASSENT COMPREHENSION ASSESSMENT. PRESS 1 TO CONTINUE.

IF R answered any items incorrectly for M_TB1-M_TB4 (=2), GOTO M_TB6.

M_TB6.

Based on your responses, I will need to review the assent form with you again to make sure you understand what agreeing to take part means.

INTERVIEWER: BACK UP AND REVIEW M_TB1 THROUGH M_TB4. FOR ALL THE DETAILS, MAKE SURE INTRO6 IS A ‘NO’

1 = TRY AGAIN

2 = DO NOT CONTINUE: MINOR NOT ABLE TO PASS COMPREHENSON ASSESSMENT

AFTER THREE ATTEMPTS

PROGRAMMER: USE POP-UP WINDOW TO ALLOW INTERVIEWER TO GO BACK TO INTRO6. POP-UP WINDOW SHOULD SAY: “INTERVIEWER: CLICK ON Goto BELOW AND PLEASE SELECT ‘NO’ WHEN YOU REACH INTRO6 TO REVIEW THE FULL ASSENT STATEMENT WITH THIS PARTICIPANT.”

IF M_TB6 = 2

M_TBEND. Thank you for taking the time to discuss the survey with me. There are many reasons people are eligible or not eligible to complete the survey. Unfortunately, we will not be able to continue with the survey.

AGREE1

Do you agree to participate in today’s survey?

1 = YES, AGREES TO STUDY PARTICIPATION [GO TO AGREE 3]

0 = NO, DOES NOT AGREE TO STUDY PARTICIPATION [GO TO DISAGREE]

AGREE3

We would like to contact you again for another interview in about 12 months and then again 12 months after that. The interviews may be done at a time that works best for you. You can choose not to be in the study at those times.
Do you agree to be contacted for future interviews?

1 YES, AGREES TO CONTACT FOR FUTURE INTERVIEWS [GO TO AGREE4]

0 NO, DOES NOT AGREE TO CONTACT FOR FUTURE INTERVIEWS [GO TO AGREE4]

DISAGREE

Thank you for your time.

INTERVIEWER: END CALL/INTERVIEW. DOCUMENT THE SITUATION.

AGREE4

We also use a laptop quality control system on this study. The system runs on the computer and will record what you and I say to each other during parts of the survey. Neither you nor I will know when the computer records what we say. My bosses will listen to the recordings to monitor my work. We keep the recordings for those purposes only and we keep them private. We will destroy the files after this review.

Do we have your okay to run this system during the interview?

1 YES, AGREES TO HAVING PARTS OF THE SURVEY RECORDED FOR QUALITY REVIEWS [GO TO PRIVACY1 IF MODE=TELEPHONE; GO TO RESOURCES IF MODE=IN-PERSON]

0 NO, DOES NOT AGREE TO HAVING PARTS OF THE SURVEY RECORDED [GO TO PRIVACY1 IF MODE=TELEPHONE; GO TO RESOURCES IF MODE=IN-PERSON]

[IF MODE=TELEPHONE] PRIVACY1

Because you may not want others to hear the responses to some of our questions, I would like to be sure you are in a private area. Are you in an area where you can answer these questions privately?

1 YES [GO TO RESOURCES]

0 NO [GO TO PRIVACY2]

PRIVACY2

Please move to a more private area. Do you need more time?

1 YES [GO TO PRIVACY3]

0 NO [GO TO RESOURCES]

PRIVACY3

INTERVIEWER: GIVE THE RESPONDENT TIME TO MOVE TO A MORE PRIVATE AREA. WHEN THE RESPONDENT IS READY, ENTER 1 TO CONTINUE.

RESOURCES

If you are feeling upset by the issues discussed in this survey, the [FILL IF R AGE>=18: “consent”; FILL IF R AGE<18: “assent”] form provides some resources that you can access. I can provide these again at the end of the survey.

INTERVIEWER, IF NECESSARY:

IF THE RESPONDENT HAS ANY QUESTIONS OR CONCERNS ABOUT THIS STUDY, THEY CAN CONTACT:

Jennifer Keeney

RTI International

3040 Cornwallis Road

Research Triangle Park, NC 27709

919-316-3525

1-800-334-8571 extension 23525

jkeeney@rti.org

IF THE RESPONDENT AGREES TO BE IN THIS STUDY AND FEELS THAT THEY WERE NOT TREATED FAIRLY, THEY CAN CONTACT:

The Institutional Review Board Administrator

Everett Madden

Urban Institute

500 L’Enfant Plaza SW

Washington, DC 20004

202.261.5632

emadden@urban.org

IF THE RESPONDENT IS FEELING UPSET BY THE ISSUES DISCUSSED IN THIS SURVEY AND WOULD LIKE TO TALK WITH SOMEONE ABOUT THEIR FEELINGS, WE SUGGEST THEY CALL THEIR CURRENT CLINICIAN OR REACH OUT TO ANOTHER PROVIDER ORGANIZATION.

IF NOT, BELOW ARE SOME NUMBERS THEY CAN CALL.

2^nd Floor Youth Helpline: Call or text 1-888-222-2228.

Children’s System of Care: Call or text 1-877-652-7624.

INTERVIEWER: ENTER 1 TO CONTINUE.

Demographics

name_w1_fn What is your legal name?

(INTERVIEWER: VERIFY SPELLING)

(INTERVIEWER: IF NEEDED, A LEGAL NAME IS THE NAME THAT IDENTIFIES A PERSON FOR LEGAL, ADMINISTRATIVE, AND OTHER OFFICIAL PURPOSES. A PERSON’S LEGAL NAME GENERALLY IS THE NAME OF THE PERSON THAT WAS GIVEN AT BIRTH AND WHICH THEN APPEARS ON A BIRTH CERTIFICATE. A LEGAL NAME MAY CHANGE, FOR EXAMPLE, FOLLOWING MARRIAGE.)

FIRST NAME:

name_w1_lna LAST NAME:

rage_w1 What is your date of birth?

ENTER MONTH |_|_| (2-DIGIT)

ENTER DAY |_|_| (2-DIGIT)

ENTER YEAR |_|_|_|_| (4-DIGIT)

F3 DON’T KNOW

F4 REFUSED

race1_w1 Are you of Hispanic, Latino, or Spanish origin?

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

race2_w1 What race or races do you consider yourself to be? Would you say you are White, Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, or mixed race? You may select one or more.

1 WHITE

2 BLACK OR AFRICAN AMERICAN

3 AMERICAN INDIAN OR ALASKA NATIVE

4 ASIAN

5 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

6 MIXED RACE

F3 DON’T KNOW

F4 REFUSED

lang_w1 What language is usually spoken in your home?

1 ENGLISH

2 SPANISH

3 CHINESE

4 ARABIC

5 GUJARATI

6 OTHER

F3 DON’T KNOW

F4 REFUSED

adopt_w1 Have you ever been adopted?

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

Living Arrangements

LA1_W1 [IF MODE = 2] USE CARD 1. Please look at Card 1. Where do you live now or where you stay most often?

[IF MODE =1] Where do you live now or where do you stay most often?

1 OWN PLACE WITHOUT A HOUSING VOUCHER (APARTMENT, HOUSE, TRAILER, ETC.)

2 OWN PLACE WITH A HOUSING VOUCHER

3 OWN ROOM IN MOTEL, HOTEL, OR SRO

4 IN THE HOME OF BIRTH PARENT(S)

5 IN THE HOME OF ADOPTIVE PARENT(S)

6 IN THE HOME OF OTHER RELATIVE(S)

7 IN THE HOME OF CURRENT RESOURCE/FOSTER PARENT(S)

8 IN THE HOME OF FORMER RESOURCE/FOSTER PARENT(S)

9 IN THE HOME OF SPOUSE/PARTNER

10 IN THE HOME OF FRIEND(S)

11 IN A TRANSITIONAL LIVING PROGRAM (MAY BE REFERRED TO AS ADOLESCENT HOUSING HUB OR INDEPENDENT LIVING PROGRAM)

12 GROUP QUARTERS (DORMITORY, MILITARY BARRACKS, ETC.)

13 HOSPITAL, TREATMENT OR REHAB FACILITY

14 HOMELESS: (YOU HAVE NO REGULAR PLACE TO STAY)

15 OTHER

F3 DON'T KNOW

F4 REFUSED

LA1_W1_OT [IF LA1_W1=15] PLEASE SPECIFY

[TEXT BOX]

F3 DON’T KNOW

F4 REFUSED

LA2_W1 Do you live alone or with others?

1 ALONE

2 WITH OTHERS

F3 DON’T KNOW

F4 REFUSED

LA3_W1 How many times have you moved from one living arrangement to another during the past 12 months?

____ 0-15

F3 DON'T KNOW

F4 REFUSED

LA4_W1 Have you ever couch surfed—that is, moved from one temporary housing arrangement provided by friends, family, or strangers to another during the past 12 months?

1 YES

0 NO

F3 DON'T KNOW

F4 REFUSED

LA5_W1 [IF LA1_W1=14, GO TO SSN0_W1] Have you ever been homeless for at least one night during the past 12 months? That is have you slept in a homeless shelter or in a place where people weren’t meant to sleep because you didn’t have a place to stay?

1 YES

0 NO

F3 DON'T KNOW

F4 REFUSED

Social Support

SSN0_W1 Now I am going to ask a few general questions about the amount of support you receive and the amount of stress that comes from your relationships with people that are important to you. These questions are not just about your parents, caregivers, or friends, but about all the people who are important to you.

1 CONTINUE

SSN1_W1 When you need to talk to someone about something personal or private – for instance, if you had something on your mind that was worrying you or making you feel down – are there enough people you can count on, too few people you can count on, or no one you can count on?

1 ENOUGH PEOPLE YOU CAN COUNT ON

2 TOO FEW PEOPLE YOU CAN COUNT ON

3 NO ONE YOU CAN COUNT ON

F3 DON’T KNOW

F4 REFUSED

SSN2_W1 When you need someone to lend a hand or give you something you needed or pitch in to help you with something – for instance, run an errand for you, lend you money, food, clothing or drive you somewhere you needed to go – are there enough people you can count on, too few people you can count on, or no one you can count on?

1 ENOUGH PEOPLE YOU CAN COUNT ON

2 TOO FEW PEOPLE YOU CAN COUNT ON

3 NO ONE YOU CAN COUNT ON

F3 DON’T KNOW

F4 REFUSED

SSN3_W1 When you need advice or information – for example, if you didn’t know where to get something or how to do something you needed to do – are there enough people you can count on, too few people you can count on, or no one you can count on?

1 ENOUGH PEOPLE YOU CAN COUNT ON

2 TOO FEW PEOPLE YOU CAN COUNT ON

3 NO ONE YOU CAN COUNT ON

F3 DON’T KNOW

F4 REFUSED

SSN4_W1 When it comes to people who have disappointed you – for example, broken promises they’ve made, not come through for you when you most need them, or disappoint you in some other way. Are there many people, some people, a few people, or no one who disappoints you?

1 MANY PEOPLE

2 SOME PEOPLE

3 A FEW PEOPLE

4 NO ONE

F3 DON’T KNOW

F4 REFUSED

SSN5_W1 When it comes to people who butt into your business – for example, watch over the things you do, boss you around, or act like they know what’s best for you – are there many people, some people, a few people, or no one who butts into your business?

1 MANY PEOPLE

2 SOME PEOPLE

3 A FEW PEOPLE

4 NO ONE

F3 DON’T KNOW

F4 REFUSED

SSN6_W1 When it comes to people who criticize you – for instance, put you down or make you feel stupid – are there many people, some people, a few people, or no one who criticizes you?

1 MANY PEOPLE

2 SOME PEOPLE

3 A FEW PEOPLE

4 NO ONE

F3 DON’T KNOW

F4 REFUSED

SSN7_W1 When it comes to people who you have fights or strong disagreements with, are there many people, some people, a few people, or no one who you have fights or strong disagreements with?

1 MANY PEOPLE

2 SOME PEOPLE

3 A FEW PEOPLE

4 NO ONE

F3 DON’T KNOW

F4 REFUSED

Fertility

F1_W1 How many living biological children do you have, regardless of whether they live with you? By biological children, I mean children that you gave birth to or fathered.

INTERVIEWER INSTRUCTION: IF RESPONDENT SAYS S/HE IS EXPECTING A CHILD, PROBE: “Do you have any biological children other than the child that you are expecting?”

ENTER NUMBER |_| (1-DIGIT; CHECK: MIN=0, MAX=9)

F3 DON’T KNOW [Go to F3_W1]

F4 REFUSED [Go to F3_W1]

PROGRAMMER: IF F1_W1=0, THEN GO TO F3_W1

F2_W1 [ASK IF F1 >0] How many of your children currently live with you?

ENTER NUMBER |_| (1-DIGIT; CHECK: MIN=0, MAX=9)

F3 DON’T KNOW

F4 REFUSED

PROGRAMMER: ADD ERROR MESSAGE IF F2_W1>F1_W1:

INTERVIEWER: THE RESPONSE CANNOT BE GREATER THAN [FILL WITH F1_W1], WHICH IS THE NUMBER OF CHILDREN THE RESPONDENT HAS.

F3_W1 Are you currently pregnant or expecting a child?

1 YES [Go to F4_W1]

0 NO [Go to EDU1_W1]

F3 DON’T KNOW [Go to EDU1_W1]

F4 REFUSED [Go to EDU1_W1]

F4_W1 How many weeks along in the pregnancy are you/is your partner?

INTERVIEWER: ENTER WEEKS OR MONTHS.

ENTER MONTHS OR ___ (3-DIGIT; CHECK: MIN=0, MAX=9.5)

ENTER WEEKS |_|_| (2-DIGIT; CHECK: MIN=0, MAX=40)

F3 DON’T KNOW

F4 REFUSED

PROGRAMMER: IF INTERVIEWER ENTERS WEEKS AND MONTHS, ADD A POP-UP ERROR: “INTERVIEWER: ENTER WEEKS OR MONTHS”

Education

EDU1_W1 The next few questions are about your education.

Are you currently enrolled in school full-time, part-time, or are you not in school?

1 YES, ENROLLED FULL-TIME [Go to EDU2_W1]

2 YES, ENROLLED PART-TIME [Go to EDU2_W1]

3 NOT IN SCHOOL [Go to EDU3_W1]

F3 DON’T KNOW [Go to EDU3_W1]

F4 REFUSED [Go to EDU3_W1]

EDU2_W1 What type of school are you enrolled in? Would you say high school, G.E.D. classes, vocational school, 2-year or community college, 4-year college, or something else?

1 HIGH SCHOOL

2 G.E.D. CLASSES

3 VOCATIONAL SCHOOL

4 2-YEAR OR COMMUNITY COLLEGE

5 4-YEAR COLLEGE

6 OTHER

F3 DON’T KNOW

F4 REFUSED

EDU2_W1_O [IF EDU2_W1=6] PLEASE SPECIFY

[TEXT BOX]

F3 DON’T KNOW

F4 REFUSED

EDU3_W1_M [IF EDU_W1=1 OR 2, GO TO EDU4_W1] When were you last enrolled in school--what month and year?

ENTER MONTH |_|_| (2-DIGIT)

F3 DON’T KNOW

F4 REFUSED

EDU3_W1_Y When were you last enrolled in school--what month and year?

AND YEAR |_|_|_|_| (4-DIGIT)

F3 DON’T KNOW

F4 REFUSED

PROGRAMMER: ADD CONSISTENCY CHECK. YEAR CANNOT BE GREATER THAN CURRENT YEAR.

EDU4_W1 What is the highest grade or year of schooling you have completed? Please include any years of college you have completed even if you do not have a college degree. If you are currently attending school, do not count the grade or year that you are in right now.

INTERVIEWER: CODE RESPONSE PROVIDED

1-12 FIRST THROUGH TWELFTH GRADE

13 FIRST YEAR OF VOCATIONAL/TECHNICAL SCHOOL

14 SECOND YEAR OF VOCATIONAL/TECHNICAL SCHOOL

15 FIRST/FRESHMAN YEAR OF COLLEGE

16 SECOND/SOPHOMORE YEAR OF COLLEGE

17 THIRD/JUNIOR YEAR OF COLLEGE

18 FOURTH/SENIOR YEAR OF COLLEGE

F3 DON’T KNOW

F4 REFUSED

EDU5_W1 Do you have a high school diploma, a home school certificate, or a High School Equivalency Certificate after passing the G.E.D., HiSET, or TASC?

1 HIGH SCHOOL DIPLOMA

2 HOME SCHOOL CERTIFICATE

3 HIGH SCHOOL EQUIVALENCY CERTIFICATE AFTER PASSING GED, HiSET, OR TASC

4 I DO NOT HAVE A HIGH SCHOOL DIPLOMA, G.E.D. OR CERTIFICATE

F3 DON’T KNOW

F4 REFUSED

EDU6_W1 Do you have a license or certificate from any vocational training that you received?

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

EDU7_W1 [If EDU5_W1 = 4, go to EDU8_W1]. Do you have a college degree from a two-year college?

1 YES - ASSOCIATES DEGREE OR TWO-YEAR COLLEGE DEGREE

0 NO - NO COLLEGE DEGREE FROM A TWO-YEAR COLLEGE

F3 DON’T KNOW

F4 REFUSED

EDU8_W1 Have you ever repeated a grade or been held back?

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

EDU9_W1 Have you ever been suspended from school?

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

EDU10_W1 Were you ever placed in a special education program?

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

Employment and Earnings

EMP0_W1 Now I’d like to ask you about any work you may have done. I am going to distinguish between two types of work. First, we will talk about formal employment. Formal employment is a job where you had an on-going relationship with a single employer, for example, working in a supermarket or restaurant. Second, we will talk about informal jobs, that is, doing one or a few tasks for several people and not having a "boss", for example, babysitting, mowing lawns, anything under the table, day labor, or work done through an app such as Uber, Doordash, Amazon Flex, or Taskrabbit. Informal jobs are sometimes called freelance, contract, or gig work.

First, let’s talk about any formal work you have done for an employer.

EMP1_W1 Are you currently working at a full or part-time job or jobs?

1 YES [Go to EMP4_W1]

0 NO

F3 DON’T KNOW

F4 REFUSED

EMP2_W1 Have you been formally employed in the past 12 months, that is since (Text fill: (CURRENT MONTH)) (Text fill: (CURRENT YEAR MINUS ONE YEAR))?

1 YES [Go to EMP4_W1]

0 NO

F3 DON’T KNOW

F4 REFUSED

EMP3_W1 Have you ever been formally employed?

1 YES

0 NO [GO TO EMP7_W1]

F3 DON’T KNOW

F4 REFUSED

EMP4_W1 How many hours per week [FILL IF EMP1_W1=1: “do”; FILL IF EMP1_W1=0: “did”] you usually work at formal employment? (PROBE: DURING WEEKS WHEN YOU WORKED).

ENTER HOURS |_|_|_| (5-DIGITS; CHECK: MIN=1, MAX=168)

F3 DON’T KNOW

F4 REFUSED

EMP5_W1 In the past 12 months, how much, in total, did you earn from formal employment?

ENTER AMOUNT $_ _ _,_ _ _. _ _

F3 DON’T KNOW

F4 REFUSED

EMP6_W1 [ASK IF EMP5_W1 = D OR R] Would you say it is …

1 Less than $1,000

2 $1,000 but less than $5,000

3 $5,000 but less than $15,000

4 $15,000 but less than $20,000

5 $20,000 but less than $25,000

6 More than $25,000

F3 DON’T KNOW

F4 REFUSED

EMP7_W1 Now let’s talk about informal jobs such as baby-sitting, lawn mowing, day labor, work done through an app such as Uber or Amazon Flex, or work that is done “under the table”. Have you had any informal jobs in the past 12 months?

1 YES

0 NO [GO TO EMPEND]

F3 DON’T KNOW

F4 REFUSED

EMP8_W1 In the past 12 months, how much did you earn from informal employment, in total?

ENTER AMOUNT $_ _ _,_ _ _. _ _

F3 DON’T KNOW

F4 REFUSED

EMP9_W1 (ASK IF EMP8_W1 = D OR R) Would you say it is …

1 Less than $1,000

2 $1,000 but less than $5,000

3 $5,000 but less than $15,000

4 $15,000 but less than $20,000

5 $20,000 but less than $25,000

6 More than $25,000

F3 DON’T KNOW

F4 REFUSED

EMPEND

Economic Hardships

ECON1_W1 The next few questions are about financial challenges you may have experienced.

Was there ever a time during the past 12 months when you did not buy clothing or shoes that you needed because you did not have enough money?

1 YES

0 NO

F3 DON'T KNOW

F4 REFUSED

ECON2_W1 Was there ever a time during the past 12 months when you could not pay your rent or mortgage because you did not have enough money?

1 YES

0 NO

2 DOES NOT APPLY TO ME, I DO NOT PAY FOR HOUSING

F3 DON'T KNOW

F4 REFUSED

ECON3_W1 Was there ever a time during the past 12 months when you could not pay a utility bill because you did not have enough money? By utility bill, I mean a bill for gas, electricity or telephone service.

1 YES

0 NO

2 DOES NOT APPLY TO ME, I DO NOT PAY FOR UTILITIES

F3 DON'T KNOW

F4 REFUSED

ACASI Set Up

IF MODE = 1. GOTO ACASI_PHONE

IF MODE = 2 GOTO ACASI_Intro

PROGRAMMER: THROUGHOUT THE ACASI SECTION, THERE SHOULD BE HOT KEYS FOR THE FOLLOWING OPTIONS:

F11 REPLAY QUESTION/RESPONSES

Ctrl+F11 TURN QUESTION/RESPONSE AUDIO ON/OFF

ACASI_Phone.

The next set of questions may seem more personal to you. Some questions ask about your emotions, alcohol or drug use, or behavior that might be against the law. Please remember that everything you tell me will be kept private in the ways that we talked about at the beginning of the survey. You may refuse to answer any question you do not want to answer.

GOTO sex_W1

IF MODE = 2

ACASI_Intro (INTERVIEWER: THIS IS THE BEGINNING OF THE FIRST PART OF THE AUDIO SELF INTERVIEW)

For this next section of questions, I’m going to hand the laptop over to you so that you can enter your answers yourself. I have headphones for you to use so that you can listen to questions being read to you. You can keep the headphones as a gift. I will not be able to hear the questions or see the answers you type into the laptop. Some of the questions might be sensitive, so this way, you can listen and answer privately.

This section is very important – that is why it is set up this way using the laptop with the headphones. Please settle in and take your time to listen to the questions and give your answers. This section will take 5 to 10 minutes or so. If you have any questions for me during this section, just let me know.

1 CONTINUE

ACASI_Start INTERVIEWER: HELP THE RESPONDENT GET SET UP AT THE LAPTOP AND USE THE HEADPHONES

ADJUST VOLUME

IF THERE IS A REASON WHY THE AUDIO PORTION CAN NOT BE ADMINISTERED (I.E. CONDITIONS WILL NOT ALLOW, ETC), ENTER '2' AND SPECIFY THE REASON.

1 PROCEED TO AUDIO SECTION AFTER RESPONDENT IS SEATED AND READY TO CONTINUE

2 SKIP AUDIO SECTION (SPECIFY REASON)

ACASI_SPECI [IF ACASI_START=2] WHY IS ACASI BEING SKIPPED?

[TEXT BOX]

ACint2 ENTER 1 TO BEGIN AUDIO PORTION

1 BEGIN AUDIO PORTION

ac1a For these next questions, please listen to the questions and answers. Type the number associated with your answer and then press Enter.

If at any time you do not want to answer the question, please press the “F4” key for "refused" and press Enter. If you do not know the answer, please give your best estimate. If you're still not sure, press the “F3” key for "don't know" and press Enter.

When you are ready to continue type “1” and press Enter.

1 CONTINUE

ac1a2 For example, here is a practice question:

Today, the weather is nice.

Would you agree or disagree?

Enter 1 for AGREE or 2 for DISAGREE.

1 AGREE

2 DISAGREE

F3 DON’T KNOW

F4 REFUSED

ac1c That ends our example question. If you would like to listen to the question and answers again, please press “F11”. If you would like to turn off the audio for the questions and answers, please press “Ctrl” and “F11” at the same time. To turn the audio for the questions and answers back on, please press “Ctrl” and “F11” at the same time again. If you have any questions before we begin, please ask the interviewer now. When you are ready, enter 1 to continue.

1 CONTINUE

ACpause Please sit comfortably and adjust your headphones. This section will take about 5 to 10 minutes. If at any time you would like the interviewer to read these questions instead of listening to the audio, just let the interviewer know.

Enter 1 to continue.

Demographics

sex_w1 What sex were you assigned at birth, on your original birth certificate?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 MALE

2 FEMALE

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN REPSONSE OPTION FORMATTING:

Male
Female

F3 DON’T KNOW

F4 REFUSED

gender_w1 What gender do you identify as?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

[INTERVIEWER: If needed, definitions noted in brackets]

1 GENDERQUEER/NONBINARY [DO NOT IDENTIFY AS EITHER A WOMAN NOR A MAN]

2 TRANSGENDER MAN [ASSIGNED FEMALE AT BIRTH BUT IDENTIFY AS A MAN]

3 TRANSGENDER WOMAN [ASSIGNED MALE AT BIRTH BUT IDENTIFY AS A WOMAN]

4 CISGENDER WOMAN [ASSIGNED FEMALE AT BIRTH AND IDENTIFY AS A WOMAN]

5 CISGENDER MAN [ASSIGNED MALE AT BIRTH AND IDENTIFY AS A MAN]

6 SOMETHING ELSE

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Genderqueer/Nonbinary (do not identify as either a woman nor a man)

2 Transgender man (assigned female at birth but identify as a man)

3 Transgender woman (assigned male at birth but identify as a woman)

4 Cisgender woman (assigned female at birth and identify as a woman)

5 Cisgender man (assigned male at birth and identify as a man)

6 SOMETHING ELSE

F3 DON’T KNOW

F4 REFUSED

gender_w1_ [IF gender_W1=6 AND MODE=1]

Please specify your gender identity if you would like to.

INTERVIEWER: ENTER RESPONDENT’S GENDER IDENTITY.

F3 DON’T KNOW

F4 REFUSED

[IF gender_W1=6 AND MODE=2] Please specify your gender identity if

you would like to:

[TEXT BOX]

F3 DON’T KNOW

F4 REFUSED

sorient_w1 Which of the following best represents how you think of yourself?

IF MODE=1, THEN REPSONSE OPTION FORMATTING:

[INTERVIEWER: If needed, definitions noted in brackets]

1 Gay or lesbian

2 Bisexual

3 Pansexual

4 Asexual

5 Straight or heterosexual

6 Something else

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Gay or lesbian

2 Bisexual

3 Pansexual

4 Asexual

5 Straight or heterosexual

6 Something else

F3 DON’T KNOW

F4 REFUSED

sorient_w1_m [IF sorient_W1=6 AND MODE=1] Please specify your sexual orientation if you would like to.

INTERVIEWER: ENTER RESPONDENT’S SEXUAL ORIENTATION

F3 DON’T KNOW

F4 REFUSED

[IF sorient_W1=6 AND MODE=2] Please specify your sexual orientation if you would like to.

[TEXT BOX]

F3 DON’T KNOW

F4 REFUSED

Mental Health Services

MH1_W1 Do you have an emotional problem that occasionally causes you to miss a day of school, work, or social or recreational activities?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

MH2_W1 In the past 12 months, have you received psychological or emotional counseling?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

MH3_W1 In the past 12 months did you receive medication for a psychological or emotional problem?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

MH4_W1 In the past 12 months were you in a psychiatric hospital?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

Substance Abuse

SA1_W1 In the past 30 days, have you had a drink of an alcoholic beverage? By a drink we mean a can or bottle of beer, a glass of wine, a mixed drink, or a shot of liquor.

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No [Go to SA3_W1]

F3 DON’T KNOW [Go to SA3_W1]

F4 REFUSED [Go to SA3_W1]

SA2_W1 On how many days did you have five or more drinks on the same occasion during the past 30 days? By occasion we mean at the same time or within hours of each other.

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

ENTER DAYS: |_|_| (2=DIGIT; CHECK: MIN=0, MAX=30)

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

Enter Days: |_|_| (2-DIGIT; CHECK: MIN=0, MAX=30)

F3 DON’T KNOW

F4 REFUSED

SA3_W1 In the past 30 days, have you used any illegal drugs? This includes marijuana, heroin, cocaine, amphetamines (uppers, speed, etc.), barbiturates (downers), sniffing/huffing, hallucinogens (mushrooms, LSD, acid), or club drugs (Ecstasy, Special K, GHB)?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

SA4_W1 In the past 30 days, have you used any prescription drugs without a doctor’s permission, or beyond what your prescription requires?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

SA5_W1 In the past 12 months, did you get any kind of treatment for an alcohol or drug problem?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

Criminal Justice Involvement

CRM1_W1 Have you ever been arrested?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

CRM2_W1 Have you ever spent at least one night in a jail, prison, juvenile hall, or

another correctional facility?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

F3 DON’T KNOW

F4 REFUSED

Spouse/Partner Violence

REL0_W1 The next set of questions is about romantic relationships you might currently have.

REL1_W1 Are you currently married or involved in a dating or romantic relationship?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

YES [Go to CTS0_W1]

NO [Go to CTSEND]

F3 DON’T KNOW [Go to CTSEND]

F4 REFUSED [Go to CTSEND]

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes [Go to CTS0_W1]

0 No [Go to CTSEND]

F3 DON’T KNOW [Go to CTSEND]

F4 REFUSED [Go to CTSEND]

CTS0_W1 No matter how well a couple gets along, there are times when they disagree or fight. Couples may also have different ways of dealing with conflicts when they occur. I am going to read you a list of things that might have happened in your relationship with your partner. Please tell me how many times each of these things happened during the past year: never, once, twice, three to five times, six to ten times, eleven to twenty times or more than twenty times.

CTS1_W1 How often has your spouse/partner slapped, hit, choked, or kicked, pushed or shoved you, or thrown something at you that could hurt during the past year?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

INTERVIEWER: READ RESPONSES, IF NECESSARY

0 NEVER IN THE PAST YEAR

1 ONCE IN THE PAST YEAR

2 TWICE IN THE PAST YEAR

3 3-5 TIMES IN THE PAST YEAR

4 6-10 TIMES IN THE PAST YEAR

5 11-20 TIMES IN THE PAST YEAR

6 MORE THAN 20 TIMES IN THE PAST YEAR

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

0 Never in the past year

1 Once in the past year

2 Twice in the past year

3 3-5 times in the past year

4 6-10 times in the past year

5 11-20 times in the past year

6 More than 20 times in the past year

F3 DON’T KNOW

F4 REFUSED

CTS2_W1 How often has your spouse/partner insisted on or made you have sexual relations with them when you didn’t want to during the past year?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

INTERVIEWER: READ RESPONSES, IF NECESSARY

0 NEVER IN THE PAST YEAR

1 ONCE IN THE PAST YEAR

2 TWICE IN THE PAST YEAR

3 3-5 TIMES IN THE PAST YEAR

4 6-10 TIMES IN THE PAST YEAR

5 11-20 TIMES IN THE PAST YEAR

6 MORE THAN 20 TIMES IN THE PAST YEAR

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

0 Never in the past year

1 Once in the past year

2 Twice in the past year

3 3-5 times in the past year

4 6-10 times in the past year

5 11-20 times in the past year

6 More than 20 times in the past year

F3 DON’T KNOW

F4 REFUSED

CTS3_W1 How often have you slapped, hit, choked, or kicked, pushed or shoved, or thrown something at your spouse/partner that could hurt during the past year?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

INTERVIEWER: READ RESPONSES, IF NECESSARY

0 NEVER IN THE PAST YEAR

1 ONCE IN THE PAST YEAR

2 TWICE IN THE PAST YEAR

3 3-5 TIMES IN THE PAST YEAR

4 6-10 TIMES IN THE PAST YEAR

5 11-20 TIMES IN THE PAST YEAR

6 MORE THAN 20 TIMES IN THE PAST YEAR

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

0 Never in the past year

1 Once in the past year

2 Twice in the past year

3 3-5 times in the past year

4 6-10 times in the past year

5 11-20 times in the past year

6 More than 20 times in the past year

F3 DON’T KNOW

F4 REFUSED

CTS4_W1 How often have you insisted on or made your spouse/partner have sexual relations with you when they didn’t want to during the past year?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

INTERVIEWER: READ RESPONSES, IF NECESSARY

0 NEVER IN THE PAST YEAR

1 ONCE IN THE PAST YEAR

2 TWICE IN THE PAST YEAR

3 3-5 TIMES IN THE PAST YEAR

4 6-10 TIMES IN THE PAST YEAR

5 11-20 TIMES IN THE PAST YEAR

6 MORE THAN 20 TIMES IN THE PAST YEAR

F3 DON’T KNOW

F4 REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

0 Never in the past year

1 Once in the past year

2 Twice in the past year

3 3-5 times in the past year

4 6-10 times in the past year

5 11-20 times in the past year

6 More than 20 times in the past year

F3 DON’T KNOW

F4 REFUSED

[CTSEND]

[END ACASI]. [IF MODE= 2]. Please tell the interviewer you are done.

PASSWORD [IF MODE=2] INTERVIEWER: ENTER PASSWORD TO CONTINUE.

[TEXT BOX FOR PASSWORD]

PROGRAMMER: FOR TESTING PURPOSES, THE PASSWORD CAN BE LIFESET

Youth Resiliency

YR0_W1 Please use the answer choices to tell us how much each statement is—or is not—like you. The answer choices are not at all like me, a little like me, sort of like me, a lot like me, or very much like me.

YR1_W1 I learn from my mistakes.

Not at all like me
A little like me
Sort of like me
A lot like me
Very much like me

F3 DON’T KNOW

F4 REFUSED

YR2_W1 I believe I will be okay even when bad things happen.

Not at all like me
A little like me
Sort of like me
A lot like me
Very much like me

F3 DON’T KNOW

F4 REFSUED

YR3_W1 I do a good job in handling problems in my life.