Adverse Childhood Experiences International Questionnaire

Pilot study review and finalization meeting,

4-5 May 2011, WHO Headquarters, Geneva
Meeting Report

Summary

Version 1 of an Adverse Childhood Experiences International Questionnaire (ACE-IQ) has

been produced. It is based largely on tried and tested questions, and the ACE-IQ content has
been qualitatively tested in six culturally diverse settings. ACE-IQ is intended to be included
as a module in broader health surveys.
The next step is to identify opportunities to validate ACE-IQ by implementing it as part of
broader health surveys in 6-8 countries.
A standardized ACE-IQ will enable the measurement of childhood adversities in all countries
and comparisons of such adversities between them; the drawing of associations between
childhood adversities and health risk behaviours and health outcomes in later life; advocacy
for increased investments to reduce childhood adversities, and scientific information to inform
the design of prevention programmes.
Background

The consequences of adverse childhood experiences (ACEs) such as child maltreatment and other
traumatic stressors for health risk behaviours and long-term chronic diseases has been the focus of a
growing number of studies. These have occurred in a context of raised global awareness of ACEs
following the launch of reports such as WHO's 2002 World report on violence and health and the
2006 UN Study on Violence against Children, and increased global interest in noncommunicable and
chronic disease prevention (with the first UN summit on noncommunicable diseases scheduled for
September 2011).
ACE surveillance is spreading through the USA (with several states having integrated ACE questions
into their Behavioural Risk Factor Surveillance Systems) and internationally through country-specific
projects. However many countries have yet to appreciate the major public health implications of
ACEs and their lifelong consequences. For this recognition to spread requires that data on ACEs are
collected as part of broader health and health risk behaviour surveys, and that the findings are used to
advocate for and inform policies and programmes designed to reduce ACEs and promote safe, stable
and nurturing relationships between children and their parent or caregivers.
In May 2009, an international ACE research network was established to advance global understanding
and measurement of ACEs. Led by the WHO Departments of Violence and Injury Prevention and
Disability, and Chronic Diseases and Health Promotion, and the US Centers for Disease Control and
Prevention (CDC), network members agreed to adapt the original ACE questionnaire with the aim of
producing a standardized international questionnaire that reflects the range of adversities prevalent
across low-, middle- and high-income countries.
Field Testing
Between May 2009 and March 2011, the draft ACE-IQ was field tested in China, the Former
Yugoslav Republic of Macedonia, Philippines, Thailand, Saudi Arabia, South Africa and Vietnam.
These field tests aimed to evaluate whether the draft could be easily understood and responded to by
the interviewees, easily understood and implemented by interviewers, and whether the data generated
looked credible. In Vietnam, the draft ACE-IQ was also implemented as part of a broader mental
health survey.
In each country, the draft ACE-IQ was translated (including back translation) into one official national
language (if applicable). It was then administered (usually by interviewers but in some instances
through self-administration) to 200-300 respondents in each of the seven countries. Respondents were
all aged 18 and over, and were purposively selected to include equal proportions of men and women,
and to reflect a wide range in respect of age, socio-economic and employment status. Informed
2

consent was obtained in all cases, and where relevant, interviewees were referred to psychosocial
services.
Each country then produced a report of the findings from the field testing, identifying possible gaps in
the questionnaire, outlining practical issues around implementing the questionnaire, and suggesting
improvements. These reports included a summary of the data obtained and simple descriptive analyses
of the data.
Meeting aims and participants
The meeting aimed to review findings from the field tests; to develop ACE-IQ Version 1, and to
identify opportunities for validating ACE IQ Version 1 by implementing it as part of broader health
surveys.
Meeting participants were the lead investigators from countries where the draft ACE-IQ was field
tested, from Lithuania where the original ACE questionnaire had recently been applied, and staff from
the WHO Departments of Violence and Injury Prevention and Disability, Chronic Diseases and
Health Promotion, and Reproductive Health and Research. Apologies were received from the US
CDC. Annex 1 provides the full list of participants.
Review of findings from field tests of draft ACE-IQ
Field-tests of the draft ACE-IQ (see Annex 2) in China, the Former Yugoslav Republic of Macedonia,
Philippines, Thailand, Saudi Arabia, South Africa and Vietnam showed that most items were easily
understood by respondents and easily delivered by interviewers. However, the phrasing and/or content
of several questions was identified as problematic, and there was consensus that the draft
questionnaire was too long.
Accessibility
On the whole the questionnaire was found to be worded simply by both respondents and
interviewers;
Across the pilots around 85% of respondents said they understood all of the questions;
Improved clarity of wording was required for questions on protection and neglect;
Improved clarity of layout was required for questions relating to violence experienced in the
household.
Acceptability
Level of refusal was relatively low given the sensitive nature of many questions, ranging from
1-20% of respondents refusing to answer at least one question;
Questions on adverse experiences within the household and on sexual violence were found to
be particularly sensitive.
Duration of interview
The duration of interview varied from 5-90 minutes, but on average took around 20-30minutes
Although this was not found to be too long by respondents, it was agreed that it was too long
for a questionnaire that is intended to be included as a module in broader health surveys.

Vietnam: ACE-IQ and mental health in students aged 13-19 years

If the draft ACE-IQ actually measures exposure to adversity, predictable and possibly strong
associations between the adversities it measures and poor mental health and common health risk
behaviours should be observed. Accordingly, this field test in Vietnam examined how the draft ACEIQ performed in a survey of 1,226 students aged 13-19 years. The draft ACE-IQ was integrated into a
broad mental health survey that covered demographic characteristics; the family environment; the
school environment; educational pressure, and negative and positive aspects of mental health,
including Depression (measured using CES-D 20), youth risk behaviour (measure adapted from US
CDC), and mental well-being (measured using the WHO-5).
The sample was a partially randomized cluster sample: 30 classes were randomly selected within six
schools. Classes were visited by two researchers; teachers and other school personnel were not present
during data collection. 1226/1283 students (95.6% response rate) aged 13-19 completed
questionnaires. Ethical clearance and approvals were obtained prior to the study from: the Human
Research Ethics Committees of Queensland University of Technology and Ho Chi Minh City
University of Medicine and Pharmacy, and principals of the schools where it was administered.
Informed, signed consent was obtained from the students, and parents were advised of the survey by
the school administration and given the opportunity to withdraw their children.
The data were examined for correlations with total ACE score, and dose-response relationships for
multiple adversity (0,1,2,3,4+ ACEs), with depression; well-being; suicidal thoughts; smoking;
drinking and underage driving. All correlations were statistically significant at p<0.05 except that with
smoking. This suggests that the draft ACE-IQ has good concurrent validity with measures of mental
health and well-being in Vietnamese young people. When included in an omnibus survey the draft
ACE-IQ did not take much time and there were few missing data
This box is adapted from a PowerPoint presentation prepared by Thai Thanh Truc1,2; Kim Xuan
Loan1,2; Nguyen Do Nguyen1; Jiandong Sun2; Jason Dixon2, and Michael Dunne2.
1. Ho Chi Minh City University of Medicine and Pharmacy
2. Queensland University of Technology

Revision of draft ACE-IQ

Based upon findings from the field tests and the discussions, the draft ACE-IQ was revised to produce
the ACE-IQ Version 1 (see Annex 3).
Implementing ACE-IQ
As part of broader health surveys
It was agreed that ACE-IQ should always be integrated into broader health surveys. Although data
about adversities on their own may be useful for some purposes, the real value of ACE-IQ lies in
demonstrating the associations between early exposures to ACEs and subsequent risk behaviours and
health outcomes. It is only by integrating ACE-IQ into broader health surveys that such associations
can be measured.
It was suggested that when it is administered as part of broader health surveys, ACE-IQ be included in
the middle of the instrument to ensure that an adequate level of rapport between the interviewer and
respondent can be established before asking the sensitive questions it contains.
4

Face-to-face interview and self-administration

It was agreed that ACE-IQ should be designed to be delivered either through face-to-face interview or
by means of paper and pencil or computer-based self-administration. The support materials to be
developed (see below) will therefore need to address both methods.
Support materials
The ACE-IQ is designed to be a flexible tool, therefore the support materials should provide guidance
on the different delivery options and its use in different settings. Support materials will be developed
to support second stage testing and implementation proper. They will include:
Consent form
Information sheet
Ethics committee pack
List of services
Question by question annotation for interviewers and respondents
Interviewer manual
Interviewer-administered guidance
Self-administration guidance
Interviewer selection criteria
Interviewer training module
Data management manual
Data analysis guide
Reliability and validity testing of ACE-IQ Version 1
It was agreed that the main next step is to test the reliability and validity of ACE-IQ Version 1 by
implementing it as part of broader health surveys in 6-8 countries. These surveys should aim to
produce data that can be used to test the psychometric properties of the tool, compare findings across
sites and with other studies, and check internal consistencies. The approach taken in establishing the
reliability and validity of WHO's "Global physical activity questionnaire" (GPAQ) was suggested as
one model for how to do this. The reference to the GPAQ study is:
Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine
country reliability and validity study. J Phys Act Health. 2009 Nov; 6(6): 790-804.
Next steps
1. WHO HQ to prepare draft ACE-IQ Version 1 questionnaire, review with meeting
participants, and finalize.
2. All participants (including WHO HQ) to mobilize resources for reliability and validity
testing. It is estimated that in countries where other health and health risk behaviour
surveys are in place, US$25,000-30,000 should be sufficient to cover the costs of adding
ACE-IQ Version 1 into these surveys.
3. All participants to identify opportunities for integrating ACE-IQ Version 1 into broader
health surveys. If required, WHO staff can assist in helping to make the case for this.
4. WHO HQ to develop ACE-IQ Version 1 support materials.
5. WHO HQ to explore ACE-IQ Version 1 copyright issues with CDC.
6. Prepare journal article on ACE-IQ Version 1 development and plans.

ANNEX 1: LIST OF PARTICIPANTS

Dr Chen Jingqi
Institute of Child and Adolescent Health
Peking University Health Science Center
Beijing, 100191
China
Dr Laurie S. Ramiro
Department of Behavioral Sciences
College of Arts and Sciences
University of the Philippines Manila
Padre Faura st, Ermita, Manila
Philippines
Dr Somporn Kantharadussadee Triamchaisri
Department of Public Health
Nursing Faculty of Public Health
Mahidol University
Bangkok
Thailand, 10400
Dr Mokhantso Makoae
Child, Youth, Family and Social Development
Human Sciences Research Council (HSRC)
69-83 Plein Street, 12th Floor Pleinpark Building
Private Bag X9182
Cape Town 8000
South Africa
Dr Maha Al Muneef
King Abdulaziz Medical City
National Family Safety Program (3202)
P.O Box 22490
Riyadh 11426
Kingdom of Saudi Arabia
Assoc. Prof. Dr. Marija Raleva
Focal Point for Violence Prevention
Clinic for Psychiatry
Clinical Center Skopje
Vodnjanska 17
1000 Skopje
The Former Yugoslav Republic of Macedonia
Dr Michael Dunne
International Health Program,
School of Public Health
Queensland University of Technology
Victoria Park Road, Kelvin Grove
4059 Queensland
Australia

Email : g3jing_qi@bjmu.edu.cn

Email : lsramiro8888@yahoo.com

Email : phstr@mahidol.ac.th

Email : mmakoae@hsrc.ac.za

Email : mahamuneef@gmail.com

Email : marijaraleva@gmail.com

Email : m.dunne@qut.edu.au

Thai Thanh Truc

International Health Program,
School of Public Health
Queensland University of Technology
Victoria Park Road, Kelvin Grove
4059 Queensland
Australia

Email : thaithanhtruc@gmail.com

Robertas Povilaitis
Childline Lithuania
Vilnius, Lithuania

Email : robertas.povilaitis@mf.vu.lt

WHO
Dr Alexander BUTCHART
Coordinator

Email : butcharta@who.int

Ms Beverly J. FERGUSON
Scientist

Email : fergusonj@who.int

Dr Claudia M. GARCIA MORENO ESTEVA

Medical Officer

Email : garciamorenoc@who.int

Dr Etienne G.G. KRUG

Director

Email : kruge@who.int

Dr Christopher Mikton
Technical Officer

Email : miktonc@who.int

Ms Alison Gehring
Consultant

Email : gehringa@who.int

0
0.1
0.2
0.3
0.4

0.5

0.6

0.7

1
1.1
1.2

1.3

1.4

ANNEX 2: ACE-IQ PILOT QUESTIONNAIRE

Demographic Information
Sex (Record Male / Female as observed)
Male
Female
What is your date of birth? (if unknown ask
Day [ ][ ] Month [ ][ ] Year [ ][ ][ ][ ]
0.3)
How old are you?
[ ][ ]
What is your [insert relevant ethnic group /
[Locally defined]
racial group / cultural group / others]
[Locally defined]
background?
[Locally defined]
Refused
Which is the highest level of education you
No formal schooling
have completed?
Less than primary school
Primary school completed
Secondary school completed
High school completed
College/University completed
Post graduate degree
Refused
Which of the following best describes your
Government employee
main work status over the last 12 months?
Non-government employee
Self-employed
Non-paid
Student
Homemaker
Retired
Unemployed (able to work)
Unemployed (unable to work)
Refused
What is your civic status?
Married
Living as couple
Divorced or separated
Single
Widowed
Other
Refused
Marriage and Family
If you have ever been married at what age
Age [ ][ ]
were you first married? (If No go to Q.2)
Did you yourself choose your husband/wife at
Yes
the time?
No
Don't know / Not sure
Refused
If you did not choose your husband/wife
Yes
yourself, did you give your consent to the
No
choice?
Refused
If you are a mother or father at what age was
Age [ ][ ]
your first child born?
Refused

Question prelude: While you were growing up, during your first 18 years of life . . .
2
2.1

Protection
How true was each of the following statements:
Your parents or guardian communicated
openly with you.

2.2

Your parents or guardian TRIED to know what

you did with your free time.

2.3

Your parents or guardian would change the

subject whenever you had something to say.

Very often
Often
Sometimes
Rarely
Never
Refused
Very often
Often
Sometimes
Rarely
Never
Refused
Very often
Often
Sometimes
Rarely
Never
Refused

Question prelude: While you were growing up, during your first 18 years of life . . .
3
3.1

Neglect
How true was each of the following statements:
Your parents or other adults in your family did
not give you enough food.

3.2

Your parents were too drunk or intoxicated by

drugs to take care of the family.

3.3

Your parents or other adults in the family did

not take you to get medical treatment when
you needed it.

Very often true

Often true
Sometimes true
Rarely true
Never true
Refused
Very often true
Often true
Sometimes true
Rarely true
Never true
Refused
Very often true
Often true
Sometimes true
Rarely true
Never true
Refused

Question Prelude: When you were growing up, during the first 18 years
4
4.1

Household Dysfunction
Did you . . .
Live with anyone who was a problem drinker
or alcoholic?

Yes
No
9

4.2

4.3

4.4

4.5
a.b.c

4.6
a.b.c

4.7
a.b.c

4.8
a.b.c

4.9

4.10

4.11

4.12

Refused
Yes
No
Refused
Live with a depressed or mentally ill person?
Yes
No
Refused
Have a household member attempt suicide?
Yes
No
Refused
When at home was your [mother (or female guardian) / father (or male guardian) / brother(s) or
sister(s) (or step brother(s) or step sister(s)) ] .
Mother
Father
Brother(s) or
(or female
(or male guardian)
sister(s)
guardian)
(or stepbrother(s)/sister(s))
Often or very often pushed,
Yes
Yes
Yes
grabbed, slapped, or had
No
No
No
something thrown at her/him?
Refused
Refused
Refused
Often or very often hit so hard
Yes
Yes
Yes
that she/he had marks or was
No
No
No
injured?
Refused
Refused
Refused
Ever threatened with or hurt
Yes
Yes
Yes
by a knife or gun?
No
No
No
Refused
Refused
Refused
Often or very often yelled,
Yes
Yes
Yes
screamed or sworn at?
No
No
No
Refused
Refused
Refused
Often or very often insulted or
Yes
Yes
Yes
humiliated?
No
No
No
Refused
Refused
Refused
Was a household member ever sent to jail or
Yes
prison?
No
Refused
Were your parents ever separated or
Yes
divorced?
No
Refused
Did your mother, father or guardian die?
Yes
No
Refused
Live with anyone who misused street or
prescription drugs?

Question prelude: When you were growing up, during the first 18 years . . .
5
5.1

5.2

Abuse
Did a parent, guardian or other adult in the household . . .
Often or very often call you bad words, insult
you, or put you down?
Often or very often threaten you with physical
harm?

Yes
No
Refused
Yes
No
Refused

Did a parent, guardian or other adult in the household . . .

10

5.3

Often or very often push, grab, slap, or throw

something at you?

5.4

Often or very often hit you so hard that you

had marks or were injured?

5.5

Did an adult or person at least 5 years older ever . . .

Touch or fondle you in a sexual way?

5.6

Have you touch their body in a sexual way?

5.7

Attempt oral, anal, or vaginal intercourse with

you?

5.8

Actually have oral, anal or vaginal intercourse

with you?

Yes
No
Refused
Yes
No
Refused
Yes
No
Refused
Yes
No
Refused
Yes
No
Refused
Yes
No
Refused

Question prelude: This question is about being bullied when you were growing up. Bullying is
when a young person or group of young people say or do bad and unpleasant things to another
young person. It is also bullying when a young person is teased a lot in an unpleasant way or
when a young person is left out of things on purpose. It is not bullying when two young people of
about the same strength or power argue or fight when teasing is done in a friendly and fun way.
Before you reached the age 18 years . . .
6
6.1

Peer Violence
How often were you bullied?

Very Frequently
Frequently
Occasionally
Rarely
Very Rarely
Never
Dont know / Not sure
Refused

Question prelude: This question is about how often, when you were a child, you may have seen
or heard certain things around your home and neighbourhood (not on TV, in movies, or on the
radio).
When you were growing up, during the first 18 years
7

Witnessing Community Violence

7.1

Did you see . . .

Someone being beaten up.

7.2

Somebody get stabbed.

Many times
A few times
Once or twice
Never
Refused
Many times
11

7.3

Somebody get shot.

7.4

Somebody being threatened by a gun.

7.5

Someone in your home getting shot or stabbed.

7.6

Did . . .
A thief or burglar force their way into your
home

A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused

Question prelude: This question is about whether you did or did not experience any of the
following events when you were a child. The events are all to do with collective violence,
including wars, terrorism and political conflicts, genocide, repression, disappearances, torture
and organized violent crime such as banditry and gang warfare.
When you were growing up, during the first 18 years,
8
8.1

8.2

8.3

8.4

Children's Exposure to War/Collective Violence

Did you experience . . .
Being forced to go and live in another
Yes
place.
No
Refused
The deliberate destruction of your home.
Yes
No
Refused
Being beaten by soldiers, police, militia
Yes
or gangs.
No
Refused
The killing of family member or friend
Yes
by soldiers, police, militia or gangs.
No
Refused

12

9
9.1
9.2
9.3

9.4

Questionnaire Experience
Were there any questions that made you
Yes
too uncomfortable?
No
Were there any questions that you did
Yes
not understand?
No
Were there any questions the participant
Yes
refused to answer? (Record as observed)
No
If yes to 9.3 please note the question
[ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ]
number(s) refused.
[ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ]
[ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ]
How long did the interview take to
complete?

[ ].[ ]
[ ].[ ]
[ ].[ ]

[ ].[ ]
[ ].[ ]
[ ].[ ]

[ ] : [ ][ ]
hrs mins

13

ANNEX 3: ACE-IQ VERSION 1

0

DEMOGRAPHIC INFORMATION

0.1

Sex (Record Male / Female as observed)

0.2

What is your date of birth? (if unknown ask

0.3)
How old are you?
What is your [insert relevant ethnic group /
racial group / cultural group / others]
background?

0.3
0.4

0.5

Which is the highest level of education you

have completed?

0.6

Which of the following best describes your

main work status over the last 12 months?

0.7

What is your civic status?

[ ][ ]
[Locally defined]
[Locally defined]
[Locally defined]
Refused
No formal schooling
Less than primary school
Primary school completed
Secondary school completed
High school completed
College/University completed
Post graduate degree
Refused
Government employee
Non-government employee
Self-employed
Non-paid
Student
Homemaker
Retired
Unemployed (able to work)
Unemployed (unable to work)
Refused
Married (Go to Q.1.2)
Living as couple
Divorced or separated
Single
Widowed (Go to Q.1.2)
Other
Refused

MARRIAGE AND FAMILY

1.1

Have you ever been married? (If No go to

Q.1.5)

1.2

At what age were you first married?

1.3

At the time of your first marriage did you

yourself choose your husband/wife at the
time? (If Yes go to Q.1.5)

1.4

At the time of your first marriage if you did

not choose your husband/wife yourself, did
you give your consent to the choice?
If you are a mother or father at what age was
your first child born?

1.5

Male
Female
Day [ ][ ] Month [ ][ ] Year [ ][ ][ ][ ]

Yes
No
Refused
Age [ ][ ]
Refused
Yes
No
Don't know / Not sure
Refused
Yes
No
Refused
Age [ ][ ]
Not applicable
Refused
14

Question prelude: While you were growing up, during your first 18 years of life . . .
2

PROTECTION

2.1

Did a parent/guardian give you attention and

listen to you?

2.2

Did a parent/guardian really know what you

were doing with your free time when you were
not at school or work?

Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused

Question prelude: While you were growing up, during your first 18 years of life . . .
3

NEGLECT

3.1

Did a parent/guardian not give you enough

food even when it was available?

3.2

Was a parent/guardian too drunk or intoxicated

by drugs to take care of you?

3.3

Did a parent/guardian not send you to school

even when it was available?

Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused

Question Prelude: When you were growing up, during the first 18 years
4
4.1

4.2

4.3

HOUSEHOLD DYSFUNCTION
Did you live with a household member who
was a problem drinker or alcoholic, or
misused street or prescription drugs?
Did you live with a household member who
was depressed, mentally ill or suicidal?
Did you live with a household member who
was ever sent to jail or prison?

Yes
No
Refused
Yes
No
Refused
Yes
No
Refused

Sub-Question Prelude: When you were growing up, during the first 18 years . . .
4.4

Were your parents ever separated or divorced?

4.5

Did your mother, father or guardian die?

Yes
No
Not applicable
Refused
Yes
No
15

Refused
Sub-Question prelude: This question is about certain things you may have heard or seen in your
home. These are things that may have been done to another household member but not
necessarily to you. When you were growing up, during the first 18 years . . .
4.6

Did you see or hear a parent or household

member in your home yelled, screamed, or
sworn at insulted or humiliated?

4.7

Did you see or hear a parent or household

member in your home slapped, kicked,
punched or beaten up?

4.8

Did you see or hear a parent or household

member in your home hit with an object, such
as a bottle, club, knife, whip etc?

Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused

Question prelude: This question is about certain things you may have experienced.
When you were growing up, during the first 18 years . . .
5

ABUSE

5.1

Did a parent, guardian or other household

member yell, scream or swear at you, insult or
humiliate you?

5.2

Did a parent, guardian or other household

member threaten to abandon you or throw you
out of the house?

5.3

Did a parent, guardian or other household

member spank, slap, kick, punch or beat you
up?

5.4

Did a parent, guardian or other household

member hit you with an object, such as a
bottle, club, knife, whip etc?

5.5

Did someone touch or fondle you in a sexual

way when you did not want them to?

5.6

Did someone make you touch their body in a

sexual way when you did not want them to?

Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
16

5.7

Did someone attempt oral, anal, or vaginal

intercourse with you when you did not want
them to?

5.8

Did someone actually have oral, anal, or

vaginal intercourse with you when you did not
want them to?

Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused

Question prelude: This question is about being bullied when you were growing up. Bullying is
when a young person or group of young people say or do bad and unpleasant things to another
young person. It is also bullying when a young person is teased a lot in an unpleasant way or
when a young person is left out of things on purpose. It is not bullying when two young people of
about the same strength or power argue or fight when teasing is done in a friendly and fun way.
Before you reached the age 18 years . . .
6

PEER VIOLENCE

6.1

How often were you bullied?

6.2

How were you bullied most often?

Many times
A few times
Once or twice
Never (Go to Q.6.3)
Refused
I was hit, kicked, pushed, shoved around, or
locked indoors
I was made fun of because of my race,
nationality or colour
I was made fun of because of my religion
I was made fun of with sexual jokes,
comments, or gestures
I was left out of activities on purpose or
completely ignored
I was made fun of because of how my body or
face looks
I was bullied in some other way
Refused

Sub-Question prelude: This question is about physical fights. A physical fight occurs when two
students of about the same strength or power choose to fight each other.
Before you reached the age 18 years . . .
6.3

How often were you in a physical fight?

Many times
A few times
Once or twice
Never
Refused

Question prelude: This question is about how often, when you were a child, you may have seen
or heard certain things in your neighbourhood and community for example in a public area,
park or school, but NOT in your home (NOT on TV, in movies, or on the radio).
When you were growing up, during the first 18 years . . .
17

WITNESSING COMMUNITY VIOLENCE

7.1

Did you see someone beaten up in front of you

in real life?

7.2

Did you see someone stabbed or shot in front

of you in real life?

7.3

Did you see someone threatened by a knife or

gun in front of you in real life?

Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused

Question prelude: This question is about whether you did or did not experience any of the
following events when you were a child. The events are all to do with collective violence,
including wars, terrorism and political conflicts, genocide, repression, disappearances, torture
and organized violent crime such as banditry and gang warfare.
When you were growing up, during the first 18 years . . .
8

Children's Exposure to War/Collective Violence

8.1

Were you forced to go and live in

another place?

8.2

Did you experience the deliberate

destruction of your home?

8.3

Were you beaten by soldiers, police,

militia, or gangs?

8.4

Did you experience the killing of family

member or friend by soldiers, police,
militia, or gangs.

Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice
Never
Refused

18