Natscev Yrs

NATSCEV YOUTH SURVEY
Table of Contents
Parent Screen and Consent ....................................................................................................... 1

Section 1: Parent Screener Interview ......................................................................................... 5
Parent Consent to Interview Child 10 and Older ....................................................................... 14
Child Assent ............................................................................................................................. 15
Section 2: Youth Report Background Questions ....................................................................... 16
Section 3: JVQ Screener Questions ......................................................................................... 17
Section 4: Social Support ......................................................................................................... 22
Section 5: Mental Health .......................................................................................................... 22
Section 6: NATSCEV Supplemental Screener Questions ......................................................... 24
Section 7: JVQ & NATSCEV Follow-up Questions ................................................................... 26
Section 8: Lifetime and Past Year Adversity ........................................................................... 183
Section 9: Internet Victimization ............................................................................................. 186
Section 10: Community Disorder ............................................................................................ 186
Section 11: Delinquency ......................................................................................................... 189
Section 12: Self-Concept ........................................................................................................ 191
Section 13: Parental Conflict .................................................................................................. 192
Section 14: Alcohol Use ......................................................................................................... 192
1 10/19/2015
NATSCEV SURVEY: YOUTH INTERVIEW

INTERVIEWER: ___________________________________
DATE: __________________
TELEPHONE #: ____ ____ ____-____ ____ ____-____ ____ ____ ____
PARENT SCREEN AND CONSENT
Hello, I’m __________________________ from SRBI calling on behalf of the University of New
Hampshire. We are not selling anything. We are conducting a national survey on issues of
children’s safety in the United States. This is an important study that will give us a better
understanding of the kinds of problems that children face and help us to better plan for the future
needs of children and their families.
[IF NEEDED: “May I speak to an adult in the household?” Re-read introduction if a new person
comes to the phone]
CON1. Including yourself, how many people, live in this household? Please count adults and
children.
________ persons in household

9 Refused
CON2. Are there any children between the ages of 0 and 17 living in this household, whether they
are home now or not?
1 Yes
2 No [Thank and end interview. Screen out because no 0-17 year old child in house.]
3 Refused [Not Qualified]
CON3. We need to speak to the parent or guardian living in the household who is likely to be most
familiar with the everyday activities of the child/children. May I speak to that person?
1 Speaking [GO TO CONSENT6]

2. New person comes to phone [GO TO INTRO BEFORE CONSENT6]
2 Not here [SCHEDULE CALLBACK AND ASK FOR FIRST NAME]
4 Refused [GO TO CONSENT4]
CON4. Could I send you a letter explaining the study?
1 Yes [CODE DISPOSITION AS WANTING LETTER AND SET CALLBACK FOR 7

DAYS]
2 NO [GO TO CONSENT5]
CON5. Would you please tell me why you do not want to participate?
_______________________________________________
9 Refusal [CODE CONSENT5 CODE AS QUALIFIED]

2 10/19/2015
[IF NEW ADULT IN HOUSEHOLD COMES TO PHONE, READ:]
Hello, I’m __________________________ from SRBI, calling on behalf of University of New

Hampshire. We are not selling anything. We are conducting a national survey on issues of
children’s safety in the United States. This is an important study that will give us a better
understanding of the kinds of problems that children face and help us to better plan for the future
needs of children and their families.
CON6. How many children, aged 0 to 17 years, are living in this household?
___________ number currently living in household
9 Refused [QUALIFIED]
[IF 0 SCREEN OUT]
CON7. What is the age of the first child, aged 0 to 17, who is living in the household?
Second child? 3rd? etc.
Child 1 age (years)______________

Child 2 age (years)______________
Child 3 age (years)______________
Child 4 age (years)______________
Child 5 age (years)______________
Child 6 age (years)______________
IF ONLY ONE CHILD AGED 0 TO 17, THIS IS THE DESIGNATED CHILD. GO TO CONSENT9.
IF MORE THAN ONE CHILD IS IN ELIGIBLE AGE RANGE, SAY:
CON8. For the next questions we need to focus on just one child. Could you tell me which of these
children (aged 0 to 17) has had the most recent birthday/will have the next birthday?
. __________age of designated child [IN YEARS]
CON9. Is the child a boy or a girl?
1 Male
2 Female
IF CHILD IS 0-9 GO TO ‘PARENT CONSENT TO CONTINUE WITH PARENT-REPORT

INTERVIEW FOR CHILD 0-9 YEARS OLD’. IF CHILD IS 10-17 GO TO ‘PARENT CONSENT TO
CONTINUE WITH PARENT INTERVIEW FOR ADOLESCENTS AGE 10-17’.
PARENT CONSENT TO CONTINUE WITH PARENT-REPORT INTERVIEW FOR CHILD 0-9

YEARS OLD
3 10/19/2015
We’d like to ask you some questions about your __-year-old’s experiences over his/her lifetime and
the past 12 months.
As I mentioned earlier, we are conducting a survey for the University of New Hampshire on the
experiences of children in the United States. This study is being supported by the U.S. Office of
Juvenile Justice. For this study, we will be interviewing 4,000 children and parents across the
country to find out about potentially stressful circumstances that children sometimes confront, and
how we may better protect kids from dangerous situations. This is an important study that will give
us a better understanding of the kinds of problems that children face and help us to better plan for
the future needs of children and their families. We would like to interview you concerning your
child [child’s name]. You have been randomly selected to represent parents of children in [child’s
name] age group.
This interview will take approximately 30-40 minutes and can be done at any time that is
convenient to you. We will be asking you about things that may have happened to [child’s name]
at school, in your neighborhood, or at home. We will also ask you some questions about his/her
health and behavior. This interview is completely confidential; you or your child’s name will not be
recorded or linked to the answers that you provide. The interview is completely voluntary – you
can, of course, decline to participate in the interview or can refuse to answer any particular
question. At the end of the interview we will send you a check for $20 as a token of our
appreciation. If you would like to check on the authenticity of this study, I can give you a toll-free
number to confirm it – 1-800-XXX-XXXX.
PI1. Could we begin?
1 Yes [SKIP TO PI3]

2 Want to confirm [ARRANGE CALLBACK]
3 Want to think about it [ARRANGE CALLBACK]
4 Refused [RECORD REASON AND TERMINATE]
PARENT CONSENT TO CONTINUE WITH PARENT INTERVIEW FOR ADOLESCENTS AGE

10-17
Now I have some questions about your child’s experiences and health. Your interview will take
about 10 minutes. We will be asking you about things that may have happened in your child’s
school, neighborhood, or home, and about how your child’s health has been lately. We assure you
that the interview is completely confidential; you or your child’s name will not be linked to the
answers you provide. Your participation is voluntary, and if there is a question you would prefer not
to answer, that’s ok. The information you provide will be combined with that of 4000 other families
to help us better understand the kinds of risks that children face and how schools and various
agencies may better protect children and their families.
If you would like to check on the authenticity of this study, I can give you our toll-free number to
confirm it. That number is XXX.
PI2. Could we begin?
1 Yes [GO TO PI3]

2 Want to confirm [ARRANGE CALLBACK]
4 Refused (Qualified) [RECORD REASON AND TERMINATE]
4 10/19/2015
SECTION 1: PARENT SCREENER INTERVIEW
PI3. Parent Gender [Do not ask unless unclear]
1 Male
2 Female
PI4. What is your child’s date of birth?
DD/MM/YYYY
98 Don’t know
99 Refused
PI5. In what grade or year of school is your [CHILD’S AGE]-year-old?
[INTERVIEWER: Ask only of children 5 and older]
________________grade/year of school (list kindergarten to college, dropout, GED)
PI6. How much of a problem is violence in your [CHILD’S AGE]-year-old’s school? Is it a big
problem, somewhat of a problem, not too much of a problem, or not a problem at all?
[INTERVIEWER: Ask only of children 5 and older. Skip if PI5 = High school or college
graduate, dropped out, GED, or home-schooled]
1 Big problem
2 Somewhat of a problem
3 Not too much of a problem
4 Not a problem at all
PI7. How much of a problem is violence in your neighborhood? Is it a big problem, somewhat of
a problem, not too much of a problem, or not a problem at all?
1 Big problem
PI8. How much of a problem is violence in your town or city? Is it a big problem, somewhat of a
problem, not too much of a problem, or not a problem at all?
1 Big problem
PI9. Would you like to see youth organizations pay more attention to preventing victimization,
pay less attention or do about what they are doing now?
1 Pay more attention

5 10/19/2015
2 Pay less attention

3 Stay about the same.
Now I have a few questions about you and your family for classification purposes.
PI10. Including yourself, how many adults age 18 or older currently live in this household?
____ persons in household (including respondent)
PI11. Who are the adults currently living in the household? Let’s start with you.
What is your relationship to the [CHILD’S AGE] year-old? What is the relationship of the
next adult in the household to the [CHILD’S AGE] year-old? [DO NOT READ LIST. CODE
RELATIONSHIP TO CHILD FOR EACH ADULT. RECORD ALL THAT APPLY]
1 Biological father
2 Adoptive father
3 Step-father
4 Foster Father
5 Biological mother
6 Adoptive mother
7 Step-mother
8 Foster mother
9 Mother’s unmarried partner (not a parent to [CHILD’S AGE]-year-old)
10 Father’s unmarried partner (not a parent to [CHILD’S AGE]-year-old)
11 Grandfather
12 Grandmother
13 Brother
14 Sister
15 Some other relative ______________________
16 Or something else ______________________
PI12. Do any additional adults spend the night at this household on a regular basis?
1 Yes
2 No
[CATI CHECK: If child does not live with BOTH biological/adoptive parents: Ask PI13]
PI13. How old was your [CHILD’S AGE]-year-old when (he/she) stopped living with both (his/her)
biological parents? [Interviewer: code 0 if child never lived with both biological/adoptive
parents]
________________ age (range 0 to 17)
PI14. What is your current marital status? Are you… (READ LIST)?
6 10/19/2015
1 Married
2 Unmarried but living with a partner
3 Separated
4 Divorced
5 Widowed
6 Single (Never married)
7 Refused
PI15. How many DIFFERENT marriages or live-in partners have you had since your [CHILD’S
AGE]-year-old was born?
[Interviewer: Count marriage or live-in to same partner only once]
__________________ (code number)
PI16. In the last year, has the [CHILD’S AGE]-year old lived somewhere else besides your
household (other than when on vacation with you). Like, with another parent, relative,
foster care, or boarding school?
1 Yes CONTINUE WITH PI16a

2 No SKIP TO PI18
PI16a. Taking all the times together, for about how long over the last week was he/she living
somewhere else?
[Code in weeks. Less than 1 week = 1.]
___________ weeks (Range 1-52)
PI17. How long has your [CHILD’S AGE]-year old been living at this particular residence?
[Code in months. Less than 1 month = 1.]
___________ months
IF LESS THAN 12 MONTHS, GO TO PI18.

IF MORE THAN 12 MONTHS GO TO PI19.
PI18. How many times has your [CHILD’S AGE]-year old moved in the last year?
___________ times
PI19. How many times has your [CHILD’S AGE]-year old moved since he/she was born?
___________ times
PI20. Are you currently employed full-time, employed part-time, in the military, unemployed and
looking for work, retired, student, homemaker or something else?
1 Employed full-time
2 Employed part-time
3 In the military
7 10/19/2015
4 Unemployed and looking for work

5 Retired
6 Student
7 Homemaker
8 Disabled or too ill to work
9 Other
19 Refused
PI21. What is the highest level of school that you completed?
1 Grade school or lower

2 Junior high/middle school only
3 Some high school, did not graduate
4 High school graduate or GED
5 Technical or vocational school
6 Some college, no degree
7 Earned associate (2 year) degree
8 Earned bachelors (4 year) degree
9 Some graduate school, no additional degrees
10 Master’s degree
11 Graduate degree (PhD, MD, JD)
PI22. [ASK PI22 AND PI23 ONLY IF PI11=1 through 10]

How about the other adult in your household who is a parent or is your partner? Is this
person currently employed full-time, employed part-time, in the military, unemployed and
looking for work, retired, student, homemaker or something else?
1 Employed full-time
2 Employed part-time
3 In the military
4 Unemployed and looking for work
5 Retired
6 Student
7 Homemaker
8 Disabled or too ill to work
9 Other
19 Refused
PI23. What is the highest level of school that he/she completed?
1 Grade school or lower

2 Junior high/middle school only
3 Some high school, did not graduate
4 High school graduate or GED
5 Technical or vocational school
6 Some college, no degree
7 Earned associate (2 year) degree
8 Earned bachelors (4 year) degree
9 Some graduate school, no additional degrees
10 Master’s degree
11 Graduate degree (PhD, MD, JD)
8 10/19/2015
PI24. Do you consider yourself to be American Indian or Alaskan Native, Asian, Black or African
American, Native Hawaiian or other Pacific Islander, or White? [Interviewer: Allow more
than one response category]
1 American Indian or Alaska Native

2 Asian
3 Black or African American
4 Native Hawaiian or other Pacific Islander
5 White
PI25. Do you consider yourself to be Hispanic or Latino?
1 Yes
2 No
3 Not sure [Interviewer: Do not read as choice.]
4 Refused [Interviewer: Do not read as choice.]
PI26. Do you think that your [CHILD’S AGE]-year old child would consider himself/herself to be
American Indian or Alaskan Native, Asian, Black or African American, Native Hawaiian or
other Pacific Islander, or White? [Interviewer: Allow more than one response category]
1 American Indian or Alaska Native

2 Asian
3 Black or African American
4 Native Hawaiian or other Pacific Islander
5 White
PI27. Would your [CHILD’S AGE]-year old child consider himself/herself to be Hispanic or Latino?
1 Yes
2 No
3 Not sure [DO NOT READ AS CHOICE]
4 Refused [DO NOT READ AS CHOICE]
PI28. What was your total household income (including all wages, public assistance and child
support) for 2006, before taxes? Counting all members in your household, was it less than
$20,000, $20,000 to $50,000 or more than $50,000?
1 Less than $20,000 ASK PI28a

2 $20,000-$50,000 ASK PI28b
3 More than $50,000 ASK PI28c
5 Refused SKIP TO PI29
PI28a. O.K. Would you say that your total 2006 household income was…?
1 $5000 or less
2 $5000 to $10,000
3 $10,000 to $15,000
4 $15,000 to $20,000
5 Refused
[SKIP TO PI29]
9 10/19/2015
PI28b. O.K. Would you say that your total 2006 household income was…?
1 $20,000 to $30,000
2 $30,000 to $40,000
3 $40,000 to $50,000
5 Refused
[SKIP TO PI29]
PI28c. O.K. Would you say that your total 2006 household income was…?
1 $50,000 to $75,000
2 $75,000 to $100,000
3 More than $100,000
5 Refused
PI29. Do you currently receive Temporary Aid to Needy Families (TANF), WIC, welfare, Medicaid,
or any other public assistance?
1 Yes
2 No
PI30. Would you describe the place in which you live as being a large city, the suburb of a large
city, a smaller city, a town or rural area? [Interviewer: Read population if needed.]
1 Large city (population over 300,000)

2 Suburb of a large city
3 Smaller city (population about 100,000-300,000)
4 Town (population about 20,000-100,000)
5 Small town (population about 2,500-20,000)
6 Rural area (population under 2,500)
PI31. [SKIP IF PI5 = H.S. or COLLEGE GRADUATE, DROPPED OUT, GED, or home-schooled]
Does your child currently receive special services at school? These might include an
individualized education plan (IEP), 504 plan, or special education services.
1 Yes
2 No
PI32. Does you child currently take any medication associated with an emotional, behavioral, or
learning problem?
1 Yes
2 No
PI33. Has your [CHILD’S AGE]-year old ever been diagnosed with a physical disability? This
would be a physical health or medical problem that affects the kinds of activities that he or
she can do?
1 Yes
2 No
10 10/19/2015
PI34. Has your [CHILD’S AGE] year-old had an evaluation or received any counseling for
emotional, behavioral, or developmental problems in the last year?
1 Yes [GO TO PI35]

2 No [SKIP TO PI36]
PI35. Who did your child see for counseling? [Interviewer: Read list and code all that apply ]
1 A psychologist or other counselor in the community, like at a community mental

health center or private office
2 A psychologist or other counselor at school
3 A psychologist or other counselor in a hospital setting
4 Someone from church, synagogue, or another religious setting
5 Someone else (Specify): ___________________________
PI36. Has your [CHILD’S AGE]-year-old ever been diagnosed by a doctor, therapist or another
professional with any of the following: [Interviewer: Read list and code all that apply]
P136A. For each “yes” response below, ask: “At what age did he/she first receive this
diagnosis?”
FOR ALL RESPONSES BELOW, USE CODING OF:
1 Yes
2 No
3 Not sure
4 Refused
a. Post-traumatic stress disorder (PTSD)

b. An anxiety disorder (other than PTSD)
c. Attention deficit disorder or Attention deficit hyperactivity disorder (ADD, ADHD)
d. Oppositional/defiant disorder or conduct disorder (ODD or CD)
e. Autism, Pervasive Developmental Disorder (PDD) or Asperger’s
f. Developmental delay or retardation
g. Depression
h. Learning disorders (Dyslexia, reading, math or other learning problem. Code
ADD/ADHD under ADD/ADHD above.)
i. Another disorder (specify) _______________________
PI37. Has anyone in your [CHILD’S AGE]-year-old’s family ever been diagnosed by a doctor,
therapist or another professional with any of the following?
FOR ALL RESPONSES BELOW, USE CODING OF:
1 Yes
2 No [SKIP TO PI38]
3 Not sure
4 Refused
a. Major Depressive Disorder

b. Bipolar Disorder
11 10/19/2015
c. Anxiety Disorder
d. Substance or Alcohol Related Disorder
e. Some other Psychiatric Disorder
PI37a. Was that person (or those people) his/her mother, father, stepmother, stepfather, sister,
brother, or someone else? [CODE ALL THAT APPLY]
1 Mother
2 Father
3 Stepmother
4 Stepfather
5 Sister
6 Brother
7 Someone else
PI38. How does your child do in school? Would you say that he/she gets mostly below average
grades, pretty much average grades or mostly above average grades?
[Ask PI37 only if child is 5 or older. Skip if PI5 = high school or college graduate, dropped
out, GED, or home-schooled.]
1 Below average
2 Average
3 Above average
4 Don’t know
PI39. How would you rate your [CHILD’S AGE]-year olds physical and social development
compared to other children his/her age? Would you say that his/her development is:
[Ask PI36 only if child is 6 or younger]
1 Quite a bit behind

2 Slightly behind
3 Average
4 Slightly ahead
5 Quite a bit ahead
PI40. Compared to other boys/girls his/her age, would you say your [CHILD’S AGE] year old is:
1 Taller than average

2 About average in height
3 Shorter than average
PI41. Compared to other boys/girls his/her age, would you say your [CHILD’S AGE] year old is:
1 Thinner than average

2 About average in weight
3 A little overweight
4 Quite a bit overweight
12 10/19/2015
The next set of questions describe ways that parents act with their children and how they deal with
misbehavior. Thinking of the last year, tell me how often you have done the following with your
[CHILD’S AGE] year old:
FOR ALL RESPONSES BELOW USE CODING OF:
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Not applicable [ONLY IF VOLUNTEERED]
PI42. You encouraged your child to talk about his/her troubles.

[DO NOT INCLUDE ITEM FOR 0-2 YEAR OLDS.]
PI43. You gave praise when your child was good.
PI44. You joked and played with your child.
PI45. You gave comfort and understanding when your child was upset.
PI46. You responded to your child’s feelings or needs.
PI47. You told your child that you appreciate what he/she tried or accomplished.
PI48. You were aware of problems or concerns about your child in school or daycare.
PI49. You expressed affection by hugging or holding your child.
PI50. You apologized to your child when making a mistake in parenting.

PI51. You had warm and intimate times together with your child.
PI52. You took away privileges from your child as a punishment.
PI53. You spanked your child with your hand when he/she did something wrong.
PI54. You lost control of your temper when your child misbehaved.
PI55. You felt that getting your child to obey you was a lot of trouble.
PI56. You used time out as a punishment (such as making him/her sit in a corner or sending
him/her to his/her room when he/she misbehaved).
PI57. You slapped your child when he/she did something wrong.
PI58. The punishment you gave your child depended on your mood.
PI59. You yelled or shouted when your child misbehaved.

13 10/19/2015
PI60. You hit your child with a belt, switch, or other object when he/she did something wrong.
PI61. You calmly explained to your child why his/her behavior was wrong when he/she
misbehaved.
PI62. Your child talked you out of being punished after he/she did something wrong.
PI63. You argued with your child.
PI64. Your child went to school without eating breakfast.
PI65. Parents checked that your child’s homework was done on school nights.
PI66. When you and any other parent in the household have free time you spend it with your
child.
[ASK PI67 – PI69 ONLY FOR CHILDREN 10 AND OLDER]:
PI67. Your child is out with friends you do not know.
PI68. Your child goes out without a set time to be home.
PI69. You get so busy you forget where your child is and what he/she is doing.
PI70. Your child is home without adult supervision overnight.
PI71. You don’t tell your child where you are going.
[ASK PI72 – PI75 ONLY FOR CHILDREN 0-9]:
PI72. Your child plays outside without being watched or checked on by an adult.
PI73. Your child takes a bath or shower without being watched or checked on by an adult.
PI74. Your child is left alone in a car while you go into a store, bank, or post office.
PI75. Your child uses public restrooms without a parent or other caregiver waiting nearby.
[IF CHILD IS 0-9 GO TO ‘INTRODUCTION TO MAIN PART OF INTERVIEW FOR PARENTS OF

0-9 YEAR OLDS.’ If CHILD IS 10-17 GO TO ‘PARENTAL CONSENT TO INTERVIEW CHILD
FOR PARENTS OF CHILDREN 10 AND OLDER.’]
INTRODUCTION TO MAIN PART OF INTERVIEW FOR PARENTS OF 0-9 YEAR OLDS
Now we are ready to begin the main part of child safety study. It will take about 30-40 minutes. [GO
TO PK1]
[IF NECESSARY, ARRANGE TO CALL BACK AT ANOTHER TIME].
PARENTAL CONSENT TO INTERVIEW CHILD FOR PARENTS OF CHILDREN 10 AND

OLDER:
14 10/19/2015
We are conducting a survey for the University of New Hampshire on the experiences of children in
the United States. The study is being supported by the U.S. Office of Juvenile Justice. For this
study, we will be interviewing over 4,000 children across the country to find out about potentially
stressful circumstances that children sometimes confront, and how we may better protect kids from
dangerous situations. This is an important study that will give us a better understanding of the
kinds of problems that children face and help us to better plan for the future needs of children and
their families. We would like to get your permission to ask your child [child’s name] to participate in
this study. [Child’s name] has been randomly selected to represent U.S. children in his/her age
group.
The interview will take approximately 30-40 minutes and can be done at any time that is
convenient for him/her. We will be asking him/her about things that may have happened in his/her
school, neighborhood, or home, and about how his/her health has been lately. Some of the
questions will involve sensitive issues, such as whether he/she has ever experienced unwanted
sexual advances and whether he/she has been a victim of violence. We assure you that the
interview is completely confidential; you or your child’s name will not recorded or linked to the
answers that he/she provides. He/she can, of course, decline to participate in the interview or can
refuse to answer any particular question. The information that your child provides will be combined
with that of over 4,000 other children to help us better understand the kinds of risks that children
face and how we may be better able to protect children and their families. If [child’s name)
chooses to participate, we will send him/her a check for $20 as a token of our appreciation.
If you would like to check on the authenticity of this study, I can give you our toll-free number to
confirm it--- 1(800) XXX-XXXX.
[IF NECESSARY: We would also be happy to send you a letter before the interview, if you would
like that.]
PI76. May we speak to (child’s name) to see if he/she would like to participate in the study?
1 Yes [GO TO CHILD ASSENT & PI77]

2 Not available now, but living in household [ARRANGE CALLBACK]
3 Want letter sent [ENTER ADDRESS]
4 Refused [QUALIFIED - RECORD REASON]
CHILD ASSENT
We would like to ask you to participate in an important study. This is part of a national survey of
over 4,000 children and teenagers. We are interested in your experiences, so that we can better
understand the kinds of things that young people go through. In this interview we will be asking you
some questions about stuff that may have happened in your school, in your neighborhood, or at
home. We’ll also be asking you about your health and how you’ve been feeling lately.
You were chosen completely at random to represent the experiences of thousands and thousands
of young people your age. We do this by dialing random phone numbers until we find someone
the right age. You don't have to participate in this interview if you don't want to, but your help will
make a big difference.
The interview will take about 30-40 minutes to complete. We will be asking you some questions
about dangerous situations you may have faced and about some personal situations, where you
might have been threatened. You can stop the interview at any time. If this is a bad time to talk, I
15 10/19/2015
could call back at a better time for you. To thank you for your help, we will be sending you check
for $20.
Everything you say will be completely confidential. We are not going to tell your parents, your
school, or anyone else anything you told us. We are going to be combining your answers with
those from thousands of other kids to present a picture of the experiences of young people in the
United States.
We would like you to try to answer every question that you can. However, if there is any question
that you don't want to answer, that will be OK. Also, if there is any question that you don't
understand, please say so. If there are too many people around for you to talk freely, just let me
know and I can call back later.
PI77. If you have any questions about the study, I can give you our toll-free number to confirm it.
Can we begin now?
1 Yes [GO TO K1]

2 No, want to confirm [ARRANGE CALLBACK]
4 Child Refused [QUALIFIED – RECORD REASON]
SECTION 2: YOUTH REPORT BACKGROUND QUESTIONS
K1. How much do you like school? Would you say you like it…. a lot, a little, not very much, or
not at all?
1 A lot
2 Pretty much
3 A little
4 Not very much
5 Not at all
K2. What grades are there at your school? What is the lowest grade at your school? What is
the highest grade at your school?
a. Lowest grade_______
b. Highest grade_______
KINDERGARTEN, 1ST, 2ND, 3RD, 4TH, 5TH, 6TH, 7TH, 8TH, 9TH,10TH,11TH,12TH
K3. Are you involved in any after-school sports teams or clubs?
1 Yes
2 No
K4. How much homework do you usually do each day? Would you say….
1 Most days you don’t do any homework

2 You spend less than one hour each day on homework
3 You do 1-2 hours each day
4 You do more than two hours of homework each day
16 10/19/2015
K5. On the weekends when you are not in school, where do you play or hang out the most?
Would you say that most of the time, you are……
[Interviewer: Accept more than one answer if respondent offers more than one. If child has
shared custody, take answers for each home, only if child mentions staying at more than
one home.]
1 At your house
2 At a friend’s house
3 Outside, somewhere in your neighborhood (that is, pretty close to your house)
4 Outside, somewhere away from your neighborhood (pretty far from your house)
5 Somewhere else (specify)___________________
K6. SKIP
K7. SKIP
K8. SKIP
K9. How many really good friends do you have at school? These would be kids that you play
with or hang out with a lot.
____________ [enter number]
K10. Do you think your friends at school would stick up for you if other kids were being mean or
picking on you? Would you say…. Yes, they definitely would stick up for you, maybe they
would stick up for you, or no, they probably would not stick up for you.
1 Yes - they definitely would stick up for him/her

2 Maybe they would stick up for him/her
3 No - they probably would not stick up for him/her
Now we are going to ask you about some things that might have happened in your life.
SECTION 3: JVQ SCREENER QUESTIONS [SELF REPORT 10-17]
MODULE A: CONVENTIONAL CRIME SCREENERS
KC1. At any time in your life, did anyone use force to take something away from you that you
were carrying or wearing?
1 Yes
2 No
KC2. At any time in your life, did anyone steal something from you and never give it back?
Things like a backpack, money, watch, clothing, bike, stereo, or anything else?
1 Yes
2 No
KC3. At any time in your life, did anyone break or ruin any of your things on purpose?
17 10/19/2015
1 Yes
2 No
KC4. Sometimes people are attacked with sticks, rocks, guns, knives, or other things that would
hurt. At any time in your life, did anyone hit or attack you on purpose with an object or
weapon? Somewhere like: at home, at school, at a store, in a car, on the street, or
anywhere else?
1 Yes
2 No
KC5. At any time in your life, did anyone hit or attack you WITHOUT using an object or weapon?
1 Yes
2 No
KC6. At any time in your life, did someone start to attack you, but for some reason, it didn’t
happen? For example, someone helped you or you got away?
1 Yes
2 No
KC7. At any time in your life, did someone threaten to hurt you when you thought they might
really do it?
1 Yes
2 No
KC8. When a person is kidnapped, it means they were made to go somewhere, like into a car, by
someone who they thought might hurt them. At any time in your life, has anyone ever tried
to kidnap you?
1 Yes
2 No
KC9. At any time in your life, have you been hit or attacked because of your skin color, religion,
or where your family comes from? Because of a physical problem you have? Or because
someone said you were gay?
1 Yes
2 No
MODULE B: CHILD MALTREATMENT SCREENERS
Next, we are going to ask about grown-ups who take care of you. This means parents, babysitters,
adults who live with you, or others who watch you. Before we begin, I want to remind you that your
answers will be kept totally private. If there is a particular question that you don't want to answer,
that's O.K. But it is important that you be as honest as you can, so that the researchers can get a
better idea of the kinds of things that kids your age sometimes face.
KM1. Not including spanking on your bottom, at any time in your life did a grown-up in your life
hit, beat, kick, or physically hurt you in any way?
18 10/19/2015
1 Yes
2 No
KM2. At any time in your life, did you get scared or feel really bad because grown-ups in your life
called you names, said mean things to you, or said they didn’t want you?
1 Yes
2 No
KM3. When someone is neglected, it means that the grown-ups in their life didn’t take care of
them the way they should. They might not get them enough food, take them to the doctor
when they are sick, or make sure they have a safe place to stay. At any time in your life,
were you neglected?
1 Yes
2 No
KM4. Sometimes a family fights over where a child should live. At any time in your life did a
parent take, keep, or hide you to stop you from being with another parent?
1 Yes
2 No
MODULE C: PEER AND SIBLING VICTIMIZATION SCREENERS
KP1. Sometimes groups of kids or gangs attack people. At any time in your life, did a group of
kids or a gang hit, jump, or attack you?
1 Yes
2 No
KP2. (If yes to P1, say: “Other than what you just told me about…..”) At any time in your life, did
any kid, even a brother or sister, hit you? Somewhere like: at home, at school, out playing,
in a store, or anywhere else?
1 Yes
2 No
KP3. At any time in your life, did any kids try to hurt your private parts on purpose by hitting or
kicking you there?
1 Yes
2 No
KP4. At any time in your life, did any kids, even a brother or sister, pick on you by chasing you or
grabbing you or by making you do something you didn’t want to do?
1 Yes
2 No
19 10/19/2015
KP5. At any time in your life, did you get really scared or feel really bad because kids were calling
you names, saying mean things to you, or saying they didn’t want you around?
1 Yes
2 No
KP6. [ASK FOR CHILDREN 12 AND OLDER]

At any time in your life, did a boyfriend or girlfriend or anyone you went on a date with slap
or hit you?
1 Yes
2 No
MODULE D: SEXUAL ASSAULT SCREENERS
KS1. At any time in your life, did a grown-up you know touch your private parts when they
shouldn’t have or make you touch their private parts? Or did a grown-up you know force
you to have sex?
1 Yes
2 No
KS2. At any time in your life, did a grown-up you did not know touch your private parts when they
shouldn’t have, make you touch their private parts or force you to have sex?
1 Yes
2 No
KS3. Now think about other kids, like from school, a boy friend or girl friend, or even a brother or
sister. At any time in your life, did another child or teen make you do sexual things?
1 Yes
2 No
KS4. At any time in your life, did anyone TRY to force you to have sex, that is sexual intercourse
of any kind, even if it didn’t happen?
1 Yes
2 No
KS5. At any time in your life, did anyone make you look at their private parts by using force or
surprise, or by “flashing” you?
1 Yes
2 No
KS6. At any time in your life, did anyone hurt your feelings by saying or writing something sexual
about you or your body?
1 Yes
2 No
20 10/19/2015
KS7. [ASK S7 ONLY FOR CHILDREN 12 AND OLDER]

At any time in your life, did you do sexual things with anyone 18 or older, even things you
wanted?
1 Yes
2 No
MODULE E: WITNESSING AND INDIRECT VICTIMIZATIONS SCREENERS
KW1. At any time in your life did you SEE a parent get pushed, slapped, hit, punched, or beat up
by another parent, or their boyfriend or girlfriend?
1 Yes
2 No
KW2. At any time in your life, did you SEE a parent hit, beat, kick, or physically hurt your brothers
or sisters, not including a spanking on the bottom?
1 Yes
2 No
KW3. At any time in your life, in real life, did you SEE anyone get attacked or hit on purpose
WITH a stick, rock, gun, knife, or other thing that would hurt? Somewhere like: at home, at
school, at a store, in a car, on the street, or anywhere else?
1 Yes
2 No
KW4. At any time in your life, in real life, did you SEE anyone get attacked or hit on purpose
WITHOUT using a stick, rock, gun, knife, or something that would hurt?
1 Yes
2 No
KW5. At any time in your life, did anyone steal some thing from your house that belongs to your
family or someone you live with? Things like a TV, stereo, car, or anything else?
1 Yes
2 No
KW6. At any time in your life, was anyone close to you murdered, like a friend, neighbor or
someone in your family?
1 Yes
2 No
KW7. At any time in your life, did you see someone murdered in real life? This means not on TV,
video games, or in the movies?
1 Yes
2 No
21 10/19/2015
KW9. At any time in your life, were you in any place in real life where you could see or hear
people being shot, bombs going off, or street riots?
1 Yes
2 No
KW9. At any time in your life, were you in the middle of a war where you could hear real fighting
with guns or bombs?
1 Yes
2 No
SECTION 4: SOCIAL SUPPORT
Next we’d like to ask you about your relationships with family and friends. For each statement
please say how often it is true: Never, sometimes, usually or always.
For KSS1 – KSS8, response categories are:
1 Never
2 Sometimes
3 Usually
4 Always
KSS1. My family really tries to help me
KSS2. My family lets me know that they care about me
KSS3. I can talk about my problems with my family
KSS4. My family is willing to help me make decisions
KSS5. My friends really try to help me
KSS6. I can count on my friends when things go wrong
KSS7. I have friends with whom I can share my good times and bad times
KSS8. I can talk about my problems with my friends
SECTION 5: MENTAL HEALTH
Now I’d like to ask you some questions about things you’ve been doing and how you’ve been
feeling lately. I am going to read you statements that describe things that kids sometimes think,
feel, or do. Please tell me how often you have done or felt each of the following things in the last
month.
In the last month, how often have you been [read item]….. would you say not at all, sometimes,
often, or very often.” [Repeat response scale as necessary]
For KTSC1 – KTSC38 response options are:

22 10/19/2015
1 Not at all
2 Sometimes
3 Often
4 Very often
KTSC1. Arguing too much
KTSC2. Feeling lonely
KTSC3. Feeling sad or unhappy
KTSC4. Crying
KTSC5. Getting scared all of a sudden and don’t know why
KTSC6. Getting mad and can’t calm down
KTSC7. Wanting to yell at people
KTSC8. Wanting to hurt yourself
KTSC9. Wanting to hurt other people
KTSC10. Feeling stupid or bad
KTSC11. Feeling like you did something wrong
KTSC12. Feeling nervous or jumpy inside
KTSC13. Feeling afraid
KTSC14. Feeling mean
KTSC15. Worrying about things
KTSC16. Feeling like nobody likes you
KTSC17. Feeling like you hate people
KTSC18. Wanting to kill yourself
KTSC19. Going away in your mind, trying not to think
KTSC20. Forgetting things, or you can’t remember things
KTSC21. Pretending you’re somewhere else
KTSC22. Your mind going empty or blank
KTSC23. Trying not to have feelings
KTSC24. Having bad dreams or nightmares

23 10/19/2015
KTSC25. Having scary ideas or pictures just pop into your head
KTSC26. Remembering things that happened that you didn’t like
KTSC27. Wishing bad things had never happened
KTSC28. Remembering things that happened that you didn't like
[SKIP TSCY1 – TSCY25 for children 10 and older.]
SECTION 6: NATSCEV SUPPLEMENTAL SCREENER QUESTIONS [SELF-REPORT 10-17]
Now I’d like to ask you about experiences people close to you, like family members or friends,
might have had.
MODULE F: EXPOSURE TO COMMUNITY VIOLENCE
KECV1. At any time in your life, did you know anyone close to you, like a family member or good
friend, who was forced to have sex, or touched in their private parts when they didn’t want
it?
1 Yes
2 No
KECV2. At any time in your life, did you know anyone close to you, like a family member or good
friend, who was robbed or mugged? By robbed we mean forced to give someone their
money or something else they were carrying or wearing.
1 Yes
2 No
KECV3. At any time in your life, did you know anyone close, like a family member or good friend,
who was threatened with a gun or knife?
1 Yes
2 No
MODULE G: EXPOSURE TO FAMILY VIOLENCE AND ABUSE
The next set of questions are about people who have taken care of you – that would include your
parents, stepparents, and their parents’ boyfriends or girlfriends, whether you lived with them or
not. It would also include other grown-ups, like grandparents or foster parents if they took care of
you on a regular basis. When we say “parent” in these next questions, we mean any of these
people.
KEF1. At any time in your life, did one of your parents threaten to hurt another parent and it
seemed they might really get hurt?
1 Yes
2 No
24 10/19/2015
KEF2. At any time in your life, did one of your parents, because of an argument, break or ruin
anything belonging to another parent, punch the wall, or throw something?
1 Yes
2 No
KEF3. At any time in your life, did one of your parents get pushed by another parent?
1 Yes
2 No
KEF4. At any time in your life, did one of your parents get hit or slapped by another parent?
1 Yes
2 No
KEF5. At any time in your life, did one of your parents get kicked, chocked, or beat up by another
parent?
1 Yes
2 No
KEF6. Now we want to ask you about fights between any grown-ups and teens, not just between
your parents. At any time in your life, did any grown-up or teen who lives with you push, hit,
or beat up someone else who lives with you, like a parent, brother, grandparent, or other
relative?
1 Yes
2 No
MODULE H: SCHOOL VIOLENCE AND THREAT
Now we’d like to know about your school. Just as with other questions, we want to know about
anything that happened in your whole life, including at the school you go to now and any schools
you went to when you were younger.
KSC1. Have you ever gone to a school where someone said there was going to be a bomb or
attack on the school and you thought they might really mean it?
1 Yes
2 No
KSC2. Have you ever gone to a school where someone damaged the school or started a fire in the
school on purpose? Or did anyone break or ruin other school property like buses, windows,
or sports equipment?
1 Yes
2 No
[IF NO TO ALL INCIDENTS IN KC1 - KW9 and KECV1 - KSC4, SKIP TO LIFE EVENTS
SECTION]
25 10/19/2015
SECTION 7: JVQ & NATSCEV SCREENER FOLLOW-UP QUESTIONS
O.K. Now I just have a few more questions about some of the event(s) you told me about earlier.
MODULE A: CONVENTIONAL CRIME FOLLOW-UPS
IF YES TO KC1, SAY: “Earlier you said that at some time in your life someone used force to take
something from you that you were carrying or wearing.”
IF NO TO KC1, SKIP TO KC2 INTRODUCTION.
KC1a. SKIP
KC1b. SKIP
KC1c. How many times did this happen to you in your whole life?
[Interviewer: If respondent is unsure, say “Would you say it was closer to 10 times, closer to
50 times, or more than that?” Assist respondent in pinpointing number of times. If more
than one time, say “Answer the next questions about the last time this happened.”]
_____ times [Range: 0-96; 97 = 97 or more; 98 = Not sure; 99 = Refused]
KC1d. Thinking of (the last time/when) this happened to you…did it happen within the last year?
By the last year we mean between (current month) when you were (current age – 1) and
now?
1 Yes
2 No
KC1e. How old were you (the last time/when) this happened? [Interviewer: Use age/grade chart to
assist respondent if needed]
_____ years old
KC1f. SKIP
KC1g. Were you physically hurt when this happened?
[Interviewer: Read definition when this question is asked the first time and then as many
times as needed].: “Hurt means you could still feel pain in your body the next day. You are
also hurt when you have a bruise, a cut that bleeds, or a broken bone.”]
1 Yes
2 No [SKIP TO KC1j]
KC1h. What kind of an injury was it?
[Interviewer: Indicate all that apply.]
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KC1j.]
2 Large bruise, major cut, or black eye
26 10/19/2015
3 Sprain, broken bone, or broken teeth

4 Injury inside your body
5 Knocked-out or hit unconscious
6 Other (specify): _____________________
KC1i. Did you go to the hospital, a doctor’s office, or some kind of health clinic to get treated for
this injury?
1 Yes
2 No
KC1j. Who did this? [Interviewer: Try to categorize from open-ended responses. Read
categories only if respondent needs help.]
1 Brother, sister, or other child who lives with you (cousin, foster sibling, etc.)
2 Father (including step-father, foster father, or live-in boyfriend)
3 Mother (including step-mother, foster mother, or live-in girlfriend)
4 A relative who lives in your home (uncle, grandparent, etc.)
5 A relative who does not live with you
6 Your boyfriend, girlfriend, date, or ex-boyfriend or ex-girlfriend
7 Grown-up you know from some organization, such as a teacher, coach, or youth
group leader
8 Anyone else you know such as a friend or neighbor
9 Stranger (a stranger is someone you don’t know)
10 Other ___________ (write in who it was)
KC1k. Was this person a man, woman, boy, or girl?
[Interviewer: Ask only for perpetrators when the gender is not clear but always code
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KC1l. Where were you when this happened?
1 Inside or near home

2 At school (inside, in school yard, or on bus) [SKIP FOR 0-4 YEAR OLDS]
3 At daycare or an after school program [SKIP FOR 12+ YEAR OLDS]
4 Somewhere else
KC1m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KC1n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

27 10/19/2015
2 A little bad
3 Very bad
KC1o. Do any of these people know about what happened?

[Interviewer: Read each response and code all that apply.]
a. A parent
1 Yes
2 No
3 Don’t Know / Refused
b. A teacher, counselor, or other adult at your school or daycare
1 Yes
2 No
c. A police officer or some other law official
1 Yes
2 No
KC1p. What was taken? ________________________
KC1q. How much money did that cost when it was new? Would you say under $100 or more than
that?
1 Under $100
2 $100 or more
3 Don’t know
KC1r. SKIP
KC1s. SKIP
KC1t. SKIP
KC1u. SKIP
KC1v. SKIP
KC1w. SKIP
KC1x. SKIP
KC1y. SKIP
KC1z. SKIP
KC1aa. SKIP
KC1bb. SKIP
KC1cc. SKIP
28 10/19/2015
KC1dd. SKIP
KC1ee. SKIP
KC1ff. SKIP
KC1gg. SKIP
KC1hh. SKIP
KC1ii. SKIP
KC1jj. SKIP
KC1kk. SKIP
KC1ll. SKIP
KC1mm. We’ve been talking about the last time this happened. Now, I want you to think about the
very first time someone used force to take something away from you that you were
carrying or wearing? How old were you the very first time this happened? [Only ask if
respondent indicated the event occurred 2 or more times.]
__________________ years old
[Interviewer: Use age/grade chart to assist respondent]
IF YES TO KC2, SAY: “Earlier you said that at some time in your life someone stole something
from you and never gave it back. Something like a backpack, money, watch, clothing, bike, stereo,
or something else.”
KC2a. SKIP
KC2b. SKIP
By the last year we mean between (current month) and when you were (current age – 1)
and now?
1 Yes
2 No
29 10/19/2015
KC2e. How old were you (the last time/when) this happened?
[Interviewer: Use grade/age chart to assist respondent.]
_____ years old
KC2f. IF YES TO ANY PREVIOUS VICTIMIZATION, SAY: Is this part of some other time you
have already given me details about?
1 Yes If Yes, ask “Which time was that?” [Record item number here: ________]
[SKIP TO KC3 introduction]
2 No [GO TO KC2j]
KC2g. SKIP
KC2h. SKIP
KC2i. SKIP
7 Grown-up you know through some organization, such as a teacher, coach, or youth
group leader
8 Someone else you know such as a friend or neighbor
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
30 10/19/2015
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KC1p. What was taken? ________________________
that?
1 Under $100
2 $100 or more
3 Don’t know
KC2r. SKIP
KC2s. SKIP
KC2t. SKIP
KC2u. SKIP
KC2v. SKIP
KC2w. SKIP
KC2x. SKIP
KC2y. SKIP
KC2z. SKIP
31 10/19/2015
KC2aa. SKIP
KC2bb. SKIP
KC2cc. SKIP
KC2dd. SKIP
KC2ee. SKIP
KC2ff. SKIP
KC2gg. SKIP
KC2hh. SKIP
KC2ii. SKIP
KC2jj. SKIP
KC2kk. SKIP
KC2ll. SKIP
very first time someone stole something from you and never gave it back? How old
were you the very first time this happened? [Only ask if respondent indicated the event
occurred 2 or more times.]
__________________ years old
IF YES TO KC3, SAY: “Earlier you said that at some time in your life someone broke or ruined
your things on purpose.”
KC3a. SKIP
KC3b. SKIP

32 10/19/2015
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KC3j]
KC3g. SKIP
KC3h. SKIP
KC3i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

33 10/19/2015

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent (Don’t include option for parent report?)

1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KC3p. SKIP
that?
1 Under $100
2 $100 or more
3 Don’t know
KC3r. SKIP
KC3s. SKIP
KC3t. SKIP
KC3u. SKIP
KC3v. SKIP
34 10/19/2015
KC3w. SKIP
KC3x. SKIP
KC3y. SKIP
KC3z. SKIP
KC3aa. SKIP
KC3bb. SKIP
KC3cc. SKIP
KC3dd. SKIP
KC3ee. SKIP
KC3ff. SKIP
KC3gg. SKIP
KC3hh. SKIP
KC3ii. SKIP
KC3jj. SKIP
KC3kk. SKIP
KC3ll. SKIP
KC3mm.We’ve been talking about the last time this happened. Now, I want you to think about the
very first time someone broke or ruined your things on purpose. How old were you the
very first time this happened? [Only ask if respondent indicated the event occurred 2 or
more times.]
__________________ years old
IF YES TO KC4, SAY: “Earlier you said that at some time in your life someone hit or attacked you
on purpose with a stick, rock, gun, knife or something that would hurt.”
KC4a. SKIP
KC4b. SKIP
35 10/19/2015
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KC4g]
[Interviewer: If this is the first time the injury question is asked, read definition.: “Hurt means
you could still feel pain in your body the next day. You are also hurt when you have a
bruise, a cut that bleeds, or a broken bone.”]
1 Yes
2 No [SKIP TO KC4j]
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KC4h.]
4 Injury inside his/her body
6 Other (specify): _____________________
this injury?
1 Yes
2 No
36 10/19/2015
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
37 10/19/2015
1 Yes
2 No
1 Yes
2 No
KC4p. SKIP
KC4q. SKIP
KC4r. Did the person use any of these, either to hurt or scare you?
1 Gun
2 Knife
3 Stick
4 Rock
5 Other (Specify: _____________)
KC4s. SKIP
KC4t. SKIP
KC4u. SKIP
KC4v. SKIP
KC4w. SKIP
KC4x. SKIP
KC4y. SKIP
KC4z. SKIP
KC4aa. SKIP
KC4bb. SKIP
KC4cc. SKIP
KC4dd. SKIP
KC4ee. SKIP
KC4ff. SKIP
KC4gg. SKIP
KC4hh. SKIP
38 10/19/2015
KC4ii. SKIP
KC4jj. SKIP
KC4kk. SKIP
KC4ll. SKIP
very first time someone hit or attacked you on purpose with a stick, rock, gun, knife or
something that would hurt. How old were you the very first time this happened? [Only
ask if respondent indicated the event occurred 2 or more times.]
__________________ years old
IF YES TO KC5 SAY: “Earlier you said that at some time in your life someone hit or attacked you
without using a stick, rock, gun, knife, or some thing that would hurt.”
KC5a. SKIP
KC5b. SKIP
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KC5g]
39 10/19/2015
1 Yes
2 No [SKIP TO KC5j]
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KC5i.]
6 Other (specify): _____________________
this injury?
1 Yes
2 No
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl
40 10/19/2015

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KC5p. SKIP
KC5p. SKIP
KC5q. SKIP
KC5r. SKIP
KC5s. SKIP
KC5t. SKIP
KC5u. SKIP
KC5v. SKIP
KC5w. SKIP
41 10/19/2015
KC5x. SKIP
KC5y. SKIP
KC5z. SKIP
KC5aa. SKIP
KC5bb. SKIP
KC5cc. SKIP
KC5dd. SKIP
KC5ee. SKIP
KC5ff. SKIP
KC5gg. SKIP
KC5hh. SKIP
KC5ii. SKIP
KC5jj. SKIP
KC5kk. SKIP
KC5ll. SKIP
very first time someone hit or attacked you without using a stick, rock, gun, knife, or
some thing that would hurt. How old were you the very first time this happened? [Only
__________________ years old
IF YES TO KC6, SAY: “Earlier you said that at some time in your life someone started to attack
you but for some reason it didn’t happen. For example, someone helped you or you got away.”
KC6a. SKIP
KC6b. SKIP
42 10/19/2015
and now?
1 Yes
2 No
_____ years old
KC6f. [IF YES TO ANY PREVIOUS VICTIMIZATION, SAY]: Is this part of some other time you
2 No [GO TO KC6j]
KC6g. SKIP
KC6h. SKIP
KC6i. SKIP
group leader
gender.]
1 Man
43 10/19/2015
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KC6p. SKIP
KC6q. SKIP
KC6r. SKIP
KC6s. SKIP
KC6t. SKIP
KC6u. SKIP
KC6v. SKIP
44 10/19/2015
KC6w. SKIP
KC6x. SKIP
KC6y. SKIP
KC6z. SKIP
KC6aa. SKIP
KC6bb. SKIP
KC6cc. SKIP
KC6dd. SKIP
KC6ee. SKIP
KC6ff. SKIP
KC6gg. SKIP
KC6hh. SKIP
KC6ii. SKIP
KC6jj. SKIP
KC6kk. SKIP
KC6ll. SKIP
very first time someone started to attack you but for some reason it didn’t happen? .
How old were you the very first time this happened? [Only ask if respondent indicated the
event occurred 2 or more times.]
__________________ years old
IF YES TO KC7, SAY: “Earlier you said that at some time in your life someone threatened to hurt
you when it seemed like they might really do it.”
KC7a. SKIP
KC7b. SKIP
45 10/19/2015
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KC7j]
KC7g. SKIP
KC7h. SKIP
KC7i. SKIP
group leader
gender.]
46 10/19/2015
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KC7p. SKIP
KC7q. SKIP
KC7r. SKIP
KC7s. SKIP
KC7t. SKIP
KC7u. SKIP
47 10/19/2015
KC7v. SKIP
KC7w. SKIP
KC7x. SKIP
KC7y. SKIP
KC7z. SKIP
KC7aa. SKIP
KC7bb. SKIP
KC7cc. SKIP
KC7dd. SKIP
KC7ee. SKIP
kC7ff. SKIP
KC7gg. SKIP
KC7hh. SKIP
KC7ii. SKIP
KC7jj. SKIP
KC7kk. SKIP
KC7ll. SKIP
very first time someone threatened to hurt you when it seemed like they might really
do it. How old were you the very first time this happened? [Only ask if respondent
indicated the event occurred 2 or more times.]
__________________ years old
IF YES TO KC8, SAY: “Earlier you said that at some time in your life someone tried to kidnap
you.”
KC8a. SKIP
KC8b. SKIP
48 10/19/2015
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KC8g]
1 Yes
2 No [SKIP TO KC8j]
6 Other (specify): _____________________
this injury?
1 Yes
2 No
49 10/19/2015
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
50 10/19/2015

1 Yes
2 No
1 Yes
2 No
KC8p. SKIP
KC8q. SKIP
KC8r. SKIP
KC8s. Did they force you to go somewhere?
1 Yes
2 No
KC8t. SKIP
KC8u. SKIP
KC8v. SKIP
KC8w. SKIP
KC8x. SKIP
KC8y. SKIP
KC8z. SKIP
KC8aa. SKIP
KC8bb. SKIP
KC8cc. SKIP
KC8dd. SKIP
KC8ee. SKIP
KC8ff. SKIP
KC8gg. SKIP
KC8hh. SKIP
KC8ii. SKIP
51 10/19/2015
KC8jj. SKIP
KC8kk. SKIP
KC8ll. SKIP
very first time someone tried to kidnap you. How old were you the very first time this
happened? [Only ask if respondent indicated the event occurred 2 or more times.]
__________________ years old
IF YES TO KC9 SAY: “Earlier you said that at some time in your life you had been hit or attacked
because of your skin color, religion, where your family comes from, because of a physical problem
or because someone said you were gay.”
IF NO TO KC9, SKIP TO KM1 INTRODUCTION.
KC8a. SKIP
KC9b. SKIP
and now?
1 Yes
2 No
_____ years old
[SKIP TO KM1 introduction]
2 No [GO TO KC9g]

52 10/19/2015
1 Yes
2 No [SKIP TO KC9j]
6 Other (specify): _____________________
this injury?
1 Yes
2 No
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

53 10/19/2015

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KC9p. SKIP
KC9q. SKIP
KC9r. SKIP
KC9s. SKIP
KC9t. What was the reason? Was it because of:
1 Your skin color

2 Your religion
3 Where your family comes from
4 Because of some physical problem you have
5 Because someone said you were gay
KC9u. SKIP
KC9v. SKIP
54 10/19/2015
KC9w. SKIP
KC9x. SKIP
KC9y. SKIP
KC9z. SKIP
KC9aa. SKIP
KC9bb. SKIP
KC9cc. SKIP
KC9dd. SKIP
KC9ee. SKIP
KC9ff. SKIP
KC9gg. SKIP
KC9hh. SKIP
KC9ii. SKIP
KC9jj. SKIP
KC9kk. SKIP
KC9ll. SKIP
very first time you were hit or attacked because of your skin color, religion, where
your family comes from, because of a physical problem or because someone said
you were gay. How old were you the very first time this happened? [Only ask if
__________________ years old
MODULE B: CHILD MALTREATMENT FOLLOW-UPS
IF YES TO KM1, SAY: “Earlier you said that at some time in your life a grown-up in your life hit,
beat, kicked or physically hurt you, not including a spanking on the bottom.”
IF NO TO KM1, SKIP TO KM2 INTRODUCTION.
KM1a. SKIP
55 10/19/2015
KM1b. SKIP
KM1c. How many times did this happen to you in your whole life?
KM1d. Thinking of (the last time/when) this happened to you …did it happen within the last year?
and now?
1 Yes
2 No
KM1e. How old were you (the last time/when) this happened?
_____ years old
KM1f. [IF YES TO ANY PREVIOUS VICTIMIZATION, SAY]: Is this part of some other time you
2 No [GO TO KM1g]
KM1g. Were you physically hurt when this happened?
1 Yes
2 No [SKIP TO KM1j]
KM1h. What kind of an injury was it?
6 Other (specify): _____________________
KM1i. Did you go to the hospital, a doctor’s office, or some kind of health clinic to get treated for
this injury?
56 10/19/2015
1 Yes
2 No
KM1j. Who did this? [Interviewer: Try to categorize from open-ended responses. Read
group leader
KM1k. Was this person a man, woman, boy, or girl?
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KM1l. Where were you when this happened?

4 Somewhere else
KM1m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KM1n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

2 A little bad
3 Very bad
KM1o. Do any of these people know about what happened?

a. A parent
1 Yes
57 10/19/2015
2 No
1 Yes
2 No
1 Yes
2 No
KM1p. SKIP
KM1q. SKIP
KM1r. Did the person use any of these, either to hurt or scare you?
1 Gun
2 Knife
3 Stick
4 Rock
5 Other (Specify: _____________)
KM1s. SKIP
KM1t. SKIP
KM1u. SKIP
KM1v. SKIP
KM1w. SKIP
KM1x. SKIP
KM1y. SKIP
KM1z. SKIP
KM1aa. SKIP
KM1bb. SKIP
KM1cc. SKIP
KM1dd. SKIP
KM1ee. SKIP
KM1ff. SKIP
KM1gg. SKIP
58 10/19/2015
KM1hh. SKIP
KM1ii. SKIP
KM1jj. SKIP
KM1kk. SKIP
KM1ll. SKIP
KM1mm. We’ve been talking about the last time this happened. Now, I want you to think about the
very first time a grown-up in your life hit, beat, kicked or physically hurt you, not
including a spanking on the bottom? Were you inside or near his/her home? . How
old were you the very first time this happened? [Only ask if respondent indicated the event
__________________ years old
IF YES TO KM2 SAY: “Earlier you said that at some time in your life you got scared or felt really
bad because a grown-up in your life called you names, said mean things to you, or said they didn’t
want you.”
KM2a. SKIP
KM2b. SKIP
KM2d. Thinking of (the last time/when) this happened to you…did it happen within the last year?
and now?
1 Yes
2 No
_____ years old

59 10/19/2015
2 No [GO TO KM2j]
KM2g. SKIP
KM2h. SKIP
KM2i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
60 10/19/2015
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KM2p. SKIP
KM2q. SKIP
KM2r. SKIP
KM2s. SKIP
KM2t. SKIP
KM2u. SKIP
KM2v. SKIP
KM2w. SKIP
KM2x. SKIP
KM2y. SKIP
KM2z. SKIP
KM2aa. SKIP
KM2bb. SKIP
KM2cc. SKIP
KM2dd. SKIP
KM2ee. SKIP
61 10/19/2015
KM2ff. SKIP
KM2gg. SKIP
KM2hh. SKIP
KM2ii. SKIP
KM2jj. SKIP
KM2kk. SKIP
KM2ll. SKIP
very first time you got scared or felt really bad because a grown-up in your life called
you names, said mean things to you, or said they didn’t want you. How old were you
the very first time this happened? [Only ask if respondent indicated the event occurred 2 or
more times.]
__________________ years old
IF YES TO KM3, SAY: “Earlier you said that at some time in your life you were neglected – that
grown-ups did not take care of you the way they should.”
KM3a. SKIP
KM3b. SKIP
and now?
1 Yes
2 No
62 10/19/2015
_____ years old
2 No [GO TO KM3j]
KM3g. SKIP
KM3h. SKIP
KM3i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
63 10/19/2015
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KM3p. SKIP
KM3q. SKIP
KM3r. SKIP
KM3s. SKIP
KM3t. SKIP
KM3u. Did you get sick when this happened?
1 Yes
2 No
KM3v. SKIP
KM3w. SKIP
KM3x. SKIP
KM3y. SKIP
KM3z. SKIP
KM3aa. SKIP
KM3bb. SKIP
64 10/19/2015
KM3cc. SKIP
KM3dd. SKIP
KM3ee. SKIP
KM3ff. SKIP
KM3gg. SKIP
KM3hh. SKIP
KM3ii. SKIP
KM3jj. SKIP
KM3kk. SKIP
KM3ll. SKIP
KM3qq. We’ve been talking about the last time this happened. Now, I want you to think about the
very first time you were neglected. How old were you the very first time this happened?
[Only ask if respondent indicated the event occurred 2 or more times.]
__________________ years old
IF YES TO KM4 SAY: “Earlier you said that at some time in your life a parent took, kept or hid you
to stop you from being with another parent.”
IF NO TO KM4, SKIP TO KP1 INTRODUCTION.
KM4a. SKIP
KM4b. SKIP
and now?
1 Yes
2 No
65 10/19/2015
_____ years old
[SKIP TO KP1 introduction]
2 No [GO TO KM4g]
KM4g. Were you physically hurt when this happened?
1 Yes
2 No [SKIP TO KM4j]
KM4h. What kind of an injury was it?
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KM4j.]
6 Other (specify): _____________________
KM4i. Did you go to the hospital, a doctor’s office, or some kind of health clinic to get treated for
this injury?
1 Yes
2 No
group leader
66 10/19/2015
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KM4p. SKIP
KM4q. SKIP
KM4r. SKIP
67 10/19/2015
KM4s. SKIP
KM4t. SKIP
KM4u. SKIP
KM4v. Did this person take, keep, or hide you to try to keep you from ever living with this other
parent?
1 Yes
2 No
KM4w. SKIP
KM4x. SKIP
KM4y. SKIP
KM4z. SKIP
KM4aa. SKIP
KM4bb. SKIP
KM4cc. SKIP
KM4dd. SKIP
KM4ee. SKIP
KM4ff. SKIP
KM4gg. SKIP
KM4hh. SKIP
KM4ii. SKIP
KM4jj. SKIP
KM4kk. SKIP
KM4ll. SKIP
very first time a parent took, kept or hid you to stop you from being with another
parent. How old were you the very first time this happened? [Only ask if respondent
__________________ years old

68 10/19/2015
MODULE C: PEER AND SIBLING VICTIMIZATION FOLLOW-UP QUESTIONS
IF YES TO KP1, SAY: “Earlier you said that at some time in your life a group of kids or a gang hit,
jumped or attacked you.”
IF NO TO KP1, SKIP TO KP2 INTRODUCTION.
KP1a. SKIP
KP1b. SKIP
KP1c. How many times did this happen to you in your whole life?
KP1d. Thinking of (the last time/when) this happened to you…did it happen within the last year?
and now?
1 Yes
2 No
KP1e. How old were you (the last time/when) this happened?
_____ years old
KP1f. [IF YES TO ANY PREVIOUS VICTIMIZATION, SAY]: Is this part of some other time you
2 No [GO TO KP1g]
KP1g. Were you physically hurt when this happened?
1 Yes
2 No [SKIP TO KP1j]
KP1h. What kind of an injury was it?

69 10/19/2015
6 Other (specify): _____________________
KP1i. Did you go to the hospital, a doctor’s office, or some kind of health clinic to get treated for
this injury?
1 Yes
2 No
KP1j. SKIP
KP1k. SKIP
KP1l. Where were you when this happened?

4 Somewhere else
KP1m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KP1n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

2 A little bad
3 Very bad
KP1o. Do any of these people know about what happened?

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
70 10/19/2015
KP1p. SKIP
KP1q. SKIP
KP1r. Did the person use any of these, either to hurt or scare you? (Check all that apply)
1 Gun
2 Knife
3 Stick
4 Rock
5 Other (Specify): ________________
KP1s. SKIP
KP1t. SKIP
KP1u. SKIP
KP1v. SKIP
KP1w. Was this an organized gang, a group of kids, or something else?
1 A group of kids
2 One or more people from an organized gang
3 Other (Write in who it was and recode answer if not gang-related)
4 Not sure
5 Refused
KP1x. How many of them were boys?
__________ boys
KP1y. How many of them were girls?
__________ girls
KP1z. SKIP
KP1aa. SKIP
KP1bb. SKIP
KP1cc. SKIP
KP1dd. SKIP
KP1ee. SKIP
KP1ff. SKIP
KP1gg. SKIP
71 10/19/2015
KP1hh. SKIP
KP1ii. SKIP
KP1jj. SKIP
KP1kk. SKIP
KP1ll. SKIP
KP1mm. We’ve been talking about the last time this happened. Now, I want you to think about the
very first time a group of kids or a gang hit, jumped or attacked you. How old were you
more times.]
__________________ years old
IF YES TO KP2, SAY: “Earlier you said that at some time in your life, a kid, even if it was a brother
or sister, hit you.”
KP2a. SKIP
KP2b. SKIP
and now?
1 Yes
2 No
_____ years old
72 10/19/2015
2 No [GO TO KP2g]
1 Yes
2 No [SKIP TO KP2j]
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KP2j.]
6 Other (specify): _____________________
this injury?
1 Yes
2 No
KP2j. Who did this? [Interviewer: Try to categorize from open-ended responses. Read
group leader
KP2k. Was this person a man, woman, boy, or girl? [Do not read man or woman for KP2k]
gender.]
1 Man
2 Woman
73 10/19/2015
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KP2p. SKIP
KP2q. SKIP
KP2r. SKIP
KP2s. SKIP
KP2t. SKIP
KP2u. SKIP
KP2v. SKIP
74 10/19/2015
KP2w. SKIP
KP2x. SKIP
KP2y. SKIP
KP2z. How old was the kid who hit you?
_______________ years old
[Interviewer: If the respondent doesn’t know, ask him/her to guess. At a minimum

determine whether the person was 18 or older.]
KP2aa. SKIP
KP2bb. SKIP
KP2cc. SKIP
KP2dd. SKIP
KP2ee. SKIP
KP2ff. SKIP
KP2gg. SKIP
KP2hh. SKIP
KP2ii. SKIP
KP2jj. SKIP
KP2kk. SKIP
KP2ll. SKIP
KP2mm.We’ve been talking about the last time this happened. Now, I want you to think about the
very first time a kid, even if it was a brother or sister, hit you. How old were you the very
first time this happened? [Only ask if respondent indicated the event occurred 2 or more
times.]
__________________ years old
IF YES TO KP3, SAY: “Earlier you said that at some time in your life a kid tried to hurt your private
parts on purpose by hitting or kicking you there.”

75 10/19/2015
KP3a. SKIP
KP3b. SKIP
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KP3g]
1 Yes
2 No [SKIP TO KP3j]
6 Other (specify): _____________________
76 10/19/2015
this injury?
1 Yes
2 No
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

77 10/19/2015
a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KP3p. SKIP
KP3q. SKIP
1 Gun
2 Knife
3 Stick
4 Rock
5 Other (Specify): ______________
KP3s. SKIP
KP3t. SKIP
KP3u. SKIP
KP3v. SKIP
KP3w. SKIP
KP3x. SKIP
KP3y. SKIP
KP3z. SKIP
KP3aa. SKIP
KP3bb. SKIP
KP3cc. SKIP
KP3dd. SKIP
KP3ee. SKIP
78 10/19/2015
KP3ff. SKIP
KP3gg. SKIP
KP3hh. SKIP
KP3ii. SKIP
KP3jj. SKIP
KP3kk. SKIP
KP3ll. SKIP
very first time kids tried to hurt your private parts on purpose by hitting or kicking you
there? How old were you the very first time this happened? [Only ask if respondent
__________________ years old
IF YES TO KP4 SAY: “Earlier you said that at some time in your life a kid picked on you by
chasing you, grabbing you, or making you do something you did not want to do.”
KP4a. SKIP
KP4b. SKIP
and now?
1 Yes
2 No
_____ years old

79 10/19/2015
2 No [GO TO KP4g]
1 Yes
2 No [SKIP TO KP4j]
6 Other (specify): _____________________
this injury?
1 Yes
2 No
group leader
gender.]
80 10/19/2015
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KP4p. SKIP
KP4q. SKIP
KP4r. SKIP
KP4s. SKIP
KP4t. SKIP
KP4u. SKIP
81 10/19/2015
KP4v. SKIP
KP4w. SKIP
KP4x. SKIP
KP4y. SKIP
KP4z. How old was the kid who picked on you?
_______________ years old
[Interviewer: If the respondent doesn’t know, ask him/her to guess. At a minimum

determine whether the person was 18 or older.]
KP4aa. SKIP
KP4bb. SKIP
KP4cc. SKIP
KP4dd. SKIP
KP4ee. SKIP
KP4ff. SKIP
KP4gg. SKIP
KP4hh. SKIP
KP4ii. SKIP
KP4jj. SKIP
KP4kk. SKIP
KP4ll. SKIP
very first time any kids, even a brother or sister, picked on you. How old were you the
more times.]
__________________ years old
IF YES TO KP5, SAY: “Earlier you said that at some time in your life you got scared or felt really
bad because other kids were calling you names, saying mean things to you, or saying they didn’t
want you around.”
82 10/19/2015
IF NO TO KP5, SKIP TO KP6 INTRODUCTION, IF APPLICABLE.
KP5a. SKIP
KP5b. SKIP
and now?
1 Yes
2 No
_____ years old
[SKIP TO KP6 introduction, IF APPLICABLE]
2 No [GO TO KP5g]
KP5g. SKIP
KP5h. SKIP
KP5i. SKIP
group leader
83 10/19/2015

gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KP5p. SKIP
KP5q. SKIP
84 10/19/2015
KP5r. SKIP
KP5s. SKIP
KP5t. SKIP
KP5u. SKIP
KP5v. SKIP
KP5w. SKIP
KP5x. SKIP
KP5y. SKIP
KP5z. SKIP
KP5aa. SKIP
KP5bb. SKIP
KP5cc. SKIP
KP5dd. SKIP
KP5ee. SKIP
KP5ff. SKIP
KP5gg. SKIP
KP5hh. SKIP
KP5ii. SKIP
KP5jj. SKIP
KP5kk. SKIP
KP5ll. SKIP
very first time you got scared or felt really bad because kids were calling you names,
saying mean things to you, or saying they didn’t want you around. How old were you
more times.]
__________________ years old

85 10/19/2015
IF YES TO KP6, SAY: “Earlier you said that at some time in your life a boyfriend or a girlfriend or
anyone you went on a date with slapped or hit you.”
IF NO TO KP6, SKIP TO KS1 INTRODUCTION.
KP6a. SKIP
KP6b. SKIP
and now?
1 Yes
2 No
_____ years old
[SKIP TO KS1 introduction]
2 No [GO TO KP6g]
1 Yes
2 No [SKIP TO KP6j]
86 10/19/2015

6 Other (specify): _____________________
this injury?
1 Yes
2 No
group leader
KP6k. Was this person a man, woman, boy, or girl?
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
87 10/19/2015
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KP6p. SKIP
KP6q. SKIP
1 Gun
2 Knife
3 Stick
4 Rock
5 Other (Specify): _____________________
KP6s. SKIP
KP6t. SKIP
KP6u. SKIP
KP6v. SKIP
KP6w. SKIP
KP6x. SKIP
KP6y. SKIP
KP6z. SKIP
KP6aa. SKIP
KP6bb. SKIP
KP6cc. SKIP
88 10/19/2015
KP6dd. SKIP
KP6ee. SKIP
KP6ff. SKIP
KP6gg. SKIP
KP6hh. SKIP
KP6ii. SKIP
KP6jj. SKIP
KP6kk. SKIP
KP6ll. SKIP
very first time a boyfriend or girlfriend or anyone you went on a date with slapped or
hit you. How old were you the very first time this happened? [Only ask if respondent
__________________ years old
MODULE D: SEXUAL ASSAULT FOLLOW-UPS
IF YES TO KS1, SAY: “Earlier you said that at some time in your life a grown-up you know
touched your private parts when they shouldn’t have, or made you touch their private parts or
forced you to have sex.”
IF NO TO KS1, SKIP TO KS2 INTRODUCTION.
KS1a. SKIP
KS1b. SKIP
KS1c. How many times did this happen to you in your whole life?
KS1d. Thinking of (the last time/when) this happened to you…did it happen within the last year?
and now?
1 Yes
89 10/19/2015
2 No
KS1e. How old were you (the last time/when) this happened?
_____ years old
KS1f. [IF YES TO ANY PREVIOUS VICTIMIZATION, SAY]: Is this part of some other time you
2 No [GO TO KS1g]
KS1g. Were you physically hurt when this happened?
1 Yes
2 No [SKIP TO KS1j]
KS1h. What kind of an injury was it?
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KS1j.]
6 Other (specify): _____________________
KS1i. Did you go to the hospital, a doctor’s office, or some kind of health clinic to get treated for
this injury?
1 Yes
2 No
KS1j. Who did this? [Interviewer: Try to categorize from open-ended responses. Read
group leader
90 10/19/2015

KS1k. Was this person a man, woman, boy, or girl? [Do not read boy or girl for KS1k]
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KS1l. Where were you when this happened?

4 Somewhere else
KS1m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KS1n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

2 A little bad
3 Very bad
KS1o. Do any of these people know about what happened?

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KS1p. SKIP
KS1q. SKIP
91 10/19/2015
KS1r. SKIP
KS1s. SKIP
KS1t. SKIP
KS1u. SKIP
KS1v. SKIP
KS1w. SKIP
KS1x. SKIP
KS1y. SKIP
KS1z. SKIP
KS1aa. Did this person (persons) put any part of (her/his) body inside you?
1 Yes [SKIP TO KS1MM]

2 No [GO TO KS1BB]
KS1bb. Did this (these) person (persons) try to do that?
1 Yes
2 No
KS1cc. SKIP
KS1dd. SKIP
KS1ee. SKIP
KS1ff. SKIP
KS1gg. SKIP
KS1hh. SKIP
KS1ii. SKIP
KS1jj. SKIP
KS1kk. SKIP
KS1ll. SKIP
KS1mm.We’ve been talking about the last time this happened. Now, I want you to think about the
very first time a grown-up you know touched your private parts, made you touch their
private parts, or forced you to have sex. How old were you the very first time this
92 10/19/2015
__________________ years old
IF YES TO KS2 SAY: “Earlier you said that, in the last year, a grown-up you did not know touched
your private parts when they shouldn’t have, made you touch their private parts, or forced you to
have sex.”
KS2a. SKIP
KS2b. SKIP
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KS2g]
1 Yes
2 No [SKIP TO KS2k]

93 10/19/2015
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KS2k.]
6 Other (specify): _____________________
this injury?
1 Yes
2 No
KS2j. SKIP
KS2k. Was this person a man, woman, boy, or girl? [Do not read boy or girl for KS2k]
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
94 10/19/2015
2 No
1 Yes
2 No
1 Yes
2 No
KS2p. SKIP
KS2q. SKIP
KS2r. SKIP
KS2s. SKIP
KS2t. SKIP
KS2u. SKIP
KS2v. SKIP
KS2w. SKIP
KS2x. SKIP
KS2y. SKIP
KS2z. SKIP
KS2aa. Did this person (persons) put any part of (her/his) body inside yours?

2 No [GO TO KS2BB]
1 Yes
2 No
KS2cc. SKIP
KS2dd. SKIP
KS2ee. SKIP
KS2ff. SKIP
KS2gg. SKIP
95 10/19/2015
KS2hh. SKIP
KS2ii. SKIP
KS2jj. SKIP
KS2kk. SKIP
KS2ll. SKIP
KS2mm. We’ve been talking about the last time this happened. Now, I want you to think about the
very first time a grown-up you did not know touched your private parts, made you
touch their private parts, or forced you to have sex? How old were you the very first
time this happened? [Only ask if respondent indicated the event occurred 2 or more times.]
__________________ years old
IF YES TO KS3, SAY: “Earlier you said that at some time in your life another child made you do
sexual things.”
KS3a. SKIP
KS3b. SKIP
and now?
1 Yes
2 No
_____ years old
96 10/19/2015
2 No [GO TO KS3g]
1 Yes
2 No [SKIP TO KS3j]
6 Other (specify): _____________________
this injury?
1 Yes
2 No
group leader
KS3k. Was this person a man, woman, boy, or girl? [Do not read man or woman for KS3k]
gender.]
1 Man [Not included as a response option for this item]

2 Woman [Not included as a response option for this item]
97 10/19/2015
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KS3p. SKIP
KS3q. SKIP
KS3r. SKIP
KS3s. SKIP
KS3t. SKIP
KS3u. SKIP
KS3v. SKIP
98 10/19/2015
KS3w. SKIP
KS3x. SKIP
KS3y. SKIP
KS3z. How old was the kid who forced you to do something sexual?
________________________ years old
[Interviewer: If respondent doesn’t know, ask him/her to guess; at a minimum determine

whether the person was 18 or older.]

2 No [GO TO KS3BB]
1 Yes
2 No
KS3cc. SKIP
KS3dd. SKIP
KS3ee. SKIP
KS3ff. SKIP
KS3gg. SKIP
KS3hh. SKIP
KS3ii. SKIP
KS3jj. SKIP
KS3kk. SKIP
KS3ll. SKIP
very first time another child or teen made you do sexual things. How old were you the
more times.]
__________________ years old

99 10/19/2015
IF YES TO KS4 SAY: “Earlier you said that at some time in your life someone tried to force you to
have sexual intercourse, even if it didn’t happen.”
KS4a. SKIP
KS4b. SKIP
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KS4g]
1 Yes
2 No [SKIP TO KS4j]
100
10/19/2015
6 Other (specify): _____________________
this injury?
1 Yes
2 No
group leader
KS4k. Was this person a man, woman, boy, or girl?
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

101
10/19/2015
2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KS4p. SKIP
KS4q. SKIP
KS4r. SKIP
KS4s. SKIP
KS4t. SKIP
KS4u. SKIP
KS4v. SKIP
KS4w. SKIP
KS4x. SKIP
KS4y. SKIP
KS4z. SKIP
1 Yes
2 No
KS4bb. SKIP
KS4cc. When this happened did someone actually use physical force by pushing, grabbing, hitting
or threatening you with a weapon?
1 Yes
102
10/19/2015
2 No
KS4dd. SKIP
KS4ee. SKIP
KS4ff. SKIP
KS4gg. SKIP
KS4hh. SKIP
KS4ii. SKIP
KS4jj. SKIP
KS4kk. SKIP
KS4ll. SKIP
very first time someone tried to force you to have sex, even if it didn’t happen. How
__________________ years old
IF YES TO KS5, SAY, “Earlier you said that at some time in your life someone made you look at
their private parts by using force, surprise, or by “flashing” you.”
KS1a. SKIP
KS1b. SKIP
and now?
1 Yes
2 No
103
10/19/2015
_____ years old
2 No [GO TO KS5j]
KS5g. SKIP
KS5h. SKIP
KS5i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
104
10/19/2015
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KS5p. SKIP
KS5q. SKIP
KS5r. SKIP
KS5s. SKIP
KS5t. SKIP
KS5u. SKIP
KS5v. SKIP
KS5w. SKIP
KS5x. SKIP
KS5y. SKIP
KS5z. How old was the person who made you look at their private parts?
___________ years old

105
10/19/2015
[Interviewer: If respondent doesn’t know, ask him/her to guess. At a minimum determine
KS5aa. SKIP
KS5bb. SKIP
KS5cc. SKIP
KS5dd. SKIP
KS5ee. SKIP
KS5ff. SKIP
KS5gg. SKIP
KS5hh. SKIP
KS5ii. SKIP
KS5jj. SKIP
KS5kk. SKIP
KS5ll. SKIP
very first time someone made you look at their private parts by using force or
surprise, or by “flashing” you. How old were you the very first time this happened? [Only
__________________ years old
IF YES TO KS6, SAY, “Earlier you said that at some time in your life someone hurt your feelings
by saying or writing something sexual about you or your body.”
KS6a. SKIP
KS6b. SKIP

106
10/19/2015
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KS6j]
KS6g. SKIP
KS6h. SKIP
KS6i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

107
10/19/2015

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KS6p. SKIP
KS6q. SKIP
KS6r. SKIP
KS6s. SKIP
KS6t. SKIP
KS6u. SKIP
KS6v. SKIP
KS6w. SKIP
KS6x. SKIP
108
10/19/2015
KS6y. SKIP
KS6z. How old was the person who said or wrote something sexual about you or your body?
___________ years old

KS6aa. SKIP
KS6bb. SKIP
KS6cc. SKIP
KS6dd. SKIP
KS6ee. SKIP
KS6ff. SKIP
KS6gg. SKIP
KS6hh. SKIP
KS6ii. SKIP
KS6jj. SKIP
KS6kk. SKIP
KS6ll. SKIP
very first time someone hurt your feelings by saying or writing something sexual
about you or your body. How old were you the very first time this happened? [Only ask if
__________________ years old
IF YES TO KS7 SAY: “Earlier you said that at some time in your life you did sexual things with
someone 18 or older, even things you wanted.”
IF NO TO KS7, SKIP TO KW1 INTRODUCTION.
KS7a. SKIP
KS7b. SKIP
109
10/19/2015
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KS4j]
KS7g. SKIP
KS7h. SKIP
KS7i. SKIP
group leader
gender.]
110
10/19/2015
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KS7p. SKIP
KS7q. SKIP
KS7r. SKIP
KS7s. SKIP
KS7t. SKIP
KS7u. SKIP
111
10/19/2015
KS7v. SKIP
KS7w. SKIP
KS7x. How old was the person who you did sexual things with?
___________ years old


2 No
1 Yes
2 No
KS7cc. SKIP
KS7dd. SKIP
KS7ee. SKIP
KS7ff. SKIP
KS7gg. SKIP
KS7hh. SKIP
KS7ii. SKIP
KS7jj. SKIP
KS7kk. SKIP
KS7ll. SKIP
KS7mm.We’ve been talking about the last time this happened. Now, I want you to think about the
very first time you did sexual things with someone 18 older, even things you wanted.
__________________ years old
MODULE E: WITNESSING AND INDIRECT VICTIMIZATIONS FOLLOW-UPS

112
10/19/2015
IF YES TO KW1, SAY: “Earlier you said that at some time in your life you saw a parent get
pushed, slapped, hit, punched or beat up by another parent, boyfriend or girlfriend.”
IF NO TO KW1, SKIP TO KW2 INTRODUCTION.
KW1a. SKIP
KW1b. SKIP
KW1c. How many times did this happen to you in your whole life?
KW1d. Thinking of (the last time/when) this happened to you…did it happen within the last year?
and now?
1 Yes
2 No
KW1e. How old were you (the last time/when) this happened?
_____ years old
KW1f. [IF YES TO ANY PREVIOUS VICTIMIZATION, SAY]: Is this part of some other time you
[SKIP TO KW2 introduction]
2 No [GO TO KW1j]
KW1g. SKIP
KW1h. SKIP
KW1i. SKIP
KW1j. Who did this? [Interviewer: Try to categorize from open-ended responses. Read
113
10/19/2015
group leader
KW1k. Was this person a man, woman, boy, or girl? [Do not read boy or girl for KW1k]
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KW1l. Where were you when this happened?

4 Somewhere else
KW1m.Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KW1n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

2 A little bad
3 Very bad
KW1o.Do any of these people know about what happened?

a. A parent [Do not include for KW1n]

1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KW1o. SKIP
114
10/19/2015
KW1p. SKIP
KW1q. SKIP
KW1r. SKIP
KW1s. SKIP
KW1t. SKIP
KW1u. SKIP
KW1v. SKIP
KW1w. SKIP
KW1x. SKIP
KW1y. SKIP
KW1z. SKIP
KW1aa. SKIP
KW1bb. SKIP
KW1cc. SKIP
KW1dd. Who did this happen to? How do you know this person?
[Interviewer: Try to categorize from open-ended response. Read categories if respondent

needs help. Make sure to get relationship of child to victim, not perpetrator to victim.
Multiple responses are possible.]
group leader
KW1ee. Was this person a man, woman, boy, or girl?
[Interviewer: Ask only if gender is not clear.]
1 Man
115
10/19/2015
2 Woman
3 Boy
4 Girl
KW1ff. When this happened, did you yell at them to stop?
1 Yes
2 No
KW1gg. When this happened, did you call someone else for help, like calling someone on the
phone or going next door?
1 Yes
2 No
KW1hh. When this happened, did you try to get away from the fighting by hiding or leaving the
house?
1 Yes
2 No
KW1ii. SKIP
KW1jj. SKIP
KW1kk. SKIP
KW1ll. SKIP
KW1mm. We’ve been talking about the last time this happened. Now, I want you to think about the
very first time you saw a parent get hit by another parent or their boyfriend or
girlfriend. How old were you the very first time this happened? [Only ask if respondent
__________________ years old
IF YES TO KW2, SAY: “Earlier you said that at some time in your life you saw a parent beat, kick
or physically hurt your brothers or sisters, not including a spanking on the bottom.”
KW2a. SKIP
KW2b. SKIP
116
10/19/2015
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KW2j]
KW2g. SKIP
KW2h. SKIP
KW2i. SKIP
group leader
KW2k. Was this person a man, woman, boy, or girl? [Do not read boy or girl for KS2k]
gender.]
1 Man
2 Woman
3 Boy
4 Girl
117
10/19/2015

4 Somewhere else
1 Not at all afraid

2 A little afraid
4 Very afraid
1 Not at all bad

2 A little bad
3 Very bad
KW2o. Do any of these people know about what happened?

a. A parent [Do not include for KW2o]

1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KW2p. SKIP
KW2q. SKIP
KW2r. SKIP
KW2s. SKIP
KW2t. SKIP
KW2u. SKIP
KW2v. SKIP
KW2w. SKIP
118
10/19/2015
KW2x. SKIP
KW2y. SKIP
KW2z. SKIP
KW2aa. SKIP
KW2bb. SKIP
KW2cc. SKIP

group leader
1 Man
2 Woman
3 Boy
4 Girl
KW2ff. When this happened, did you yell at them to stop?
1 Yes
2 No
KW2gg. When this happened, did you call someone else for help, like calling someone on the
1 Yes
2 No
KW2hh. When this happened, did you try to get away from the fighting by hiding or leaving the
house?
119
10/19/2015
1 Yes
2 No
KW2ii. SKIP
KW2jj. SKIP
KW2kk. SKIP
KW2ll. SKIP
KW2ll. We’ve been talking about the last time this happened. Now, I want you to think about the
very first time you saw a parent hit, beat, kick or physically hurt your brothers or
sisters. How old were you the very first time this happened? [Only ask if respondent
__________________ years old
IF YES TO KW3, SAY: “Earlier you said that at some time in your life you saw someone get
attacked or hit on purpose with a stick, rock, gun, knife or other thing that would hurt.”
KS3a. SKIP
KS3b. SKIP
and now?
1 Yes
2 No
_____ years old
120
10/19/2015
2 No [GO TO KW3j]
KW3g. SKIP
KW3h. SKIP
KW3i. SKIP
group leader
KW3k. Was this person a man, woman, boy, or girl?
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
5 Very afraid
1 Not at all bad

121
10/19/2015
2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KW3p. SKIP
KW3q. SKIP
KW3r. Did the person use any of these, either to hurt or scare you? [Check all that apply.]
1 Gun
2 Knife
3 Stick
4 Rock
5 Other (Specify: _________)
KW3s. SKIP
KW3t. SKIP
KW3u. SKIP
KW3v. SKIP
KW3w. SKIP
KW3x. SKIP
KW3y. SKIP
KW3z. SKIP
KW3aa. SKIP
KW3bb. SKIP
KW3cc. SKIP
122
10/19/2015

group leader
[Interviewer: Ask only when the gender is not clear.]
1 Man
2 Woman
3 Boy
4 Girl
KW3ff. SKIP
KW3gg. SKIP
KW3hh. SKIP
KW3ii. SKIP
KW3jj. SKIP
KW3kk. SKIP
KW3ll. SKIP
KW3mm.We’ve been talking about the last time this happened. Now, I want you to think about the
very first time you saw someone get attacked on purpose with a stick, rock, gun, knife,
or other thing that would hurt. How old were you the very first time this happened? [Only
__________________ years old
IF YES TO KW4, SAY: “Earlier you said that at some time in your life you saw someone get
123
10/19/2015
attacked or hit on purpose without using a stick, rock, gun, knife or something that would hurt.”
KW4a. SKIP
KW4b. SKIP
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KW4j]
KW4g. SKIP
KW4h. SKIP
KW4i. SKIP
group leader
124
10/19/2015
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KW4p. SKIP
KW4q. SKIP
125
10/19/2015
KW4r. SKIP
KW4s. SKIP
KW4t. SKIP
KW4u. SKIP
KW4v. SKIP
KW4w. SKIP
KW4x. SKIP
KW4y. SKIP
KW4z. SKIP
KW4aa. SKIP
KW4bb. SKIP
KW4cc. SKIP

group leader
1 Man
2 Woman
3 Boy
4 Girl
126
10/19/2015
KW4ff. SKIP
KW4gg. SKIP
KW4hh. SKIP
KW4ii. SKIP
KW4jj. SKIP
KW4kk. SKIP
KW4ll. SKIP
very first time this happened in your whole life. How old were you the very first time this
__________________ years old
IF YES TO KW5, SAY: “Earlier you said that at some time in your life someone stole something
from your house.”
KW5a. SKIP
KW5b. SKIP
and now?
1 Yes
2 No
_____ years old

127
10/19/2015
2 No [GO TO KW5j]
KW5g. SKIP
KW5h. SKIP
KW5i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
1 Not at all afraid

2 A little afraid
3 Very afraid
128
10/19/2015
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KW5p. What was taken?
_______________________________________
KW5q. How much money did it cost when it was new? Would you say under $100 or more than
that?
1 Under $100
2 $100 or more
3 Don’t know
KW5r. SKIP
KW5s. SKIP
KW5t. SKIP
KW5u. SKIP
KW5v. SKIP
KW5w. SKIP
KW5x. SKIP
KW5y. SKIP
KW5z. SKIP
KW5aa. SKIP
129
10/19/2015
KW5bb. SKIP
KW5cc. SKIP
group leader
1 Man
2 Woman
3 Boy
4 Girl
KW5ff. SKIP
KW5gg. SKIP
KW5hh. SKIP
KW5ii. SKIP
KW5jj. SKIP
KW5kk. SKIP
KW5ll. SKIP
very first time someone stole something from your house. How old were you the very
first time this happened? [Only ask if respondent indicated the event occurred 2 or more
times.]
__________________ years old
IF YES TO KW6, SAY: “Earlier you said that at some time in your life someone close to you had
been murdered.”
130
10/19/2015
KW6a. SKIP
KW6b. SKIP
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KW6j]
KW6g. SKIP
KW6h. SKIP
KW6i. SKIP
group leader
131
10/19/2015
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KW6l. SKIP
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KW6p. SKIP
KW6q. SKIP
KW6r. SKIP
KW6s. SKIP
KW6t. SKIP
132
10/19/2015
KW6u. SKIP
KW6v. SKIP
KW6w. SKIP
KW6x. SKIP
KW6y. SKIP
KW6z. SKIP
KW6aa. SKIP
KW6bb. SKIP
KW6cc. SKIP

group leader
1 Man
2 Woman
3 Boy
4 Girl
KW6ff. SKIP
KW6gg. SKIP
KW6hh. SKIP
133
10/19/2015
KW6ii. How close do you feel to the person this happened to?
1 Very close
2 A little close
3 Not close at all
KW6jj. SKIP
KW6kk. SKIP
KW6ll. SKIP
very first time someone close to you was murdered. How old were you the very first time
this happened? [Only ask if respondent indicated the event occurred 2 or more times.]
__________________ years old
IF YES TO KW7, SAY: “Earlier you said that, at some time in your life you saw someone
murdered.”
KW7a. SKIP
KW7b. SKIP
and now?
1 Yes
2 No
_____ years old
134
10/19/2015
2 No [GO TO KW7j]
KW7g. SKIP
KW7h. SKIP
KW7i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
KW7m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
135
10/19/2015
3 Very bad
KW7o. SKIP
KW7p. SKIP
KW7q. SKIP
KW7r. SKIP
KW7s. SKIP
KW7t. SKIP
KW7u. SKIP
KW7v. SKIP
KW7w. SKIP
KW7x. SKIP
KW7y. SKIP
KW7z. SKIP
KW7aa. SKIP
KW7bb. SKIP
KW7cc. SKIP
KW7dd. SKIP

group leader
136
10/19/2015
3 Man
4 Woman
3 Boy
4 Girl
KW7gg. SKIP
KW7hh. SKIP
KW7ii. SKIP
KW7jj. SKIP
KW7kk. SKIP
KW7ll. SKIP
very first time you saw someone be murdered. How old were you the very first time this
__________________ years old
IF YES TO KW8, SAY: “Earlier you said that at some time in your life you were in a place where
you could see or hear people being shot, bombs going off or street riots.”
KW8a. SKIP
KW8b. SKIP
and now?
1 Yes
2 No
137
10/19/2015
_____ years old
2 No [GO TO KW8g]
KW8g. Was you physically hurt when this happened?
1 Yes
2 No [SKIP TO KW8l]
KW8h. What kind of an injury was it?
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KW8j.]
6 Other (specify): _____________________
KW8i. Did you go to the hospital, a doctor’s office, or some kind of health clinic to get treated for
this injury?
1 Yes
2 No
KW8j. SKIP
KW8k. SKIP

4 Somewhere else
138
10/19/2015
1 Not at all afraid
2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KW8p. SKIP
KW8q. SKIP
KW8r. SKIP
KW8s. SKIP
KW8t. SKIP
KW8u. SKIP
KW8v. SKIP
KW8w. SKIP
KW8x. SKIP
KW8y. SKIP
KW8z. SKIP
KW8aa. SKIP
KW8bb. SKIP
139
10/19/2015
KW8cc. SKIP
KW8dd. SKIP
KW8ee. SKIP
KW8ff. SKIP
KW8gg. SKIP
KW8hh. SKIP
KW8ii. SKIP
KW8jj. SKIP
KW8kk. SKIP
KW8ll. SKIP
very first time you were in a place where you could see or hear people being shot,
bombs going off or street riots. How old were you the very first time this happened?
__________________ years old
IF YES TO KW9, SAY: “Earlier you said that at some time in your life you were in the middle of a
war.”
IF NO TO KW9, SKIP TO KECV1 INTRODUCTION.
KW9a. SKIP
KW9b. SKIP
and now?
1 Yes
2 No
140
10/19/2015
_____ years old
[SKIP TO KECV1 introduction]
2 No [GO TO KW9g]
KW9g. Were you physically hurt when this happened?
1 Yes
2 No [SKIP TO KW9m]
KW9h. What kind of an injury was it?
1 Small bruise, scrape, or cut [Interviewer: If only this one applies skip to KW9m.]
6 Other (specify): _____________________
KW9i. Did you go to the hospital, a doctor’s office, or some kind of health clinic to get treated for
this injury?
1 Yes
2 No
KW9j. SKIP
KW9k. SKIP
KW9l. SKIP
1 Not at all afraid

2 A little afraid
3 Very afraid
141
10/19/2015
1 Not at all bad

2 A little bad
3 Very bad
KW9o. SKIP
KW9p. SKIP
KW9q. SKIP
KW9r. SKIP
KW9s. SKIP
KW9t. SKIP
KW9u. SKIP
KW9v. SKIP
KW9w. SKIP
KW9x. SKIP
KW9y. SKIP
KW9z. SKIP
KW9aa. SKIP
KW9bb. SKIP
KW9cc. SKIP
KW9dd. SKIP
KW9ee. SKIP
KW9ff. SKIP
KW9gg. SKIP
KW9hh. SKIP
KW9ii. SKIP
KW9jj. SKIP
KW9kk. SKIP
KW9ll. SKIP
142
10/19/2015
very first time you were in the middle of a war. How old were you the very first time this
__________________ years old
MODULE F: EXPOSURE TO COMMUNITY VIOLENCE FOLLOW-UPS
IF YES TO KECV1, SAY: “Earlier you said that at some time in your life you knew
someone close to you, like a family member or good friend, who was forced to have sex, or
touched in their private parts when they didn’t want it.”
IF NO TO KECV1, SKIP TO KECV2 INTRODUCTION.
KECV1a. How did you know it happened?
1 Did you see it?

2 Did you hear it, but not see it?
3 Did you not see or hear it, but see the person’s bruise or injury?
4 Did you not see or hear anything, but someone told you about it?
[If respondent answers yes to #4, go to KECV1b and then skip to KECV2
introduction.]
KECV1b. Did you find out about it in the last year?
1 Yes
2 No
KECV1c. How many times did this happen to you in your whole life?
KECV1d. Thinking of (the last time/when) this happened to you…did it happen within the last year?
and now?
1 Yes
2 No
KECV1e.How old were you (the last time/when) this happened?

_____ years old

143
10/19/2015
KECV1f.[IF YES TO ANY PREVIOUS VICTIMIZATION, SAY]: Is this part of some other time you
2 No [GO TO KECV1j]
KECV1g. SKIP
KECV1h. SKIP
KECV1i. SKIP
KECV1j. Who did this? [Interviewer: Try to categorize from open-ended responses. Read
group leader
KECV1k. Was this person a man, woman, boy, or girl?
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KECV1l. Where were you when this happened?

4 Somewhere else
KECV1m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KECV1n. When this happened, how bad did you feel? Would you say you felt…
144
10/19/2015
1 Not at all bad

2 A little bad
3 Very bad
KECV1o. Do any of these people know about what happened?

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KECV1p. SKIP
KECV1q. SKIP
KECV1r. SKIP
KECV1s. SKIP
KECV1t. SKIP
KECV1u. SKIP
KECV1v. SKIP
KECV1w. SKIP
KECV1x. SKIP
KECV1y. SKIP
KECV1z. SKIP
KECV1aa. SKIP
KECV1bb. SKIP
KECV1cc. SKIP
KECV1dd. Who did this happen to? How do you know this person?
145
10/19/2015
group leader
KECV1ee. Was this person a man, woman, boy, or girl?
1 Man
2 Woman
3 Boy
4 Girl
KECV1ff. SKIP
KECV1gg. SKIP
KECV1hh. SKIP
KECV1ii. SKIP
KECV1jj. SKIP
KECV1kk. SKIP
KECV1ll. SKIP
KECV1mm.We’ve been talking about the last time this happened. Now, I want you to think about
the very first time someone close to you was forced to have sex or touched in their
private parts when they didn’t want it. How old were you the very first time this
__________________ years old
someone close to you, like a family member or good friend, who was robbed or mugged.
IF NO TO KECV2, SKIP TO KECV3 INTRODUCTION.

146
10/19/2015
1 Did you see it?

[If respondent answers yes to #4, go to KECV2b and then skip to KECV3
introduction.]
1 Yes
2 No
and now?
1 Yes
2 No
KECV2e. How old were you (the last time/when) this happened?
_____ years old
2 No [GO TO KECV2j]
KECV2g. SKIP
KECV2h. SKIP
KECV2i. SKIP
147
10/19/2015
group leader
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
KECV2m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad
KECV2o.Do any of these people know about what happened?

a. A parent
1 Yes
2 No
1 Yes
2 No
148
10/19/2015
1 Yes
2 No
KECV2p. What was taken?
____________________________________
KECV2q. How much money did it cost when it was new? Would you say under $100 or more
than that?
1 Under $100
2 $100 or more
3 Don’t know
KECV2r. SKIP
KECV2s. SKIP
KECV2t. SKIP
KECV2u. SKIP
KECV2v. SKIP
KECV2w. SKIP
KECV2x. SKIP
KECV2y. SKIP
KECV2z. SKIP
KECV2aa. SKIP
KECV2bb. SKIP
KECV2cc. SKIP

149
10/19/2015
group leader
[Ask only if gender is not clear]
1 Man
2 Woman
3 Boy
4 Girl
KECV2ff. SKIP
KECV2gg. SKIP
KECV2hh. SKIP
KECV2ii. SKIP
KECV2jj. SKIP
KECV2kk. SKIP
KECV2ll. SKIP
the very first time someone close to you was robbed or mugged. How old were you the
more times.]
__________________ years old
someone close, like a family member or good friend, who was threatened with a gun or
knife.”
IF NO TO KECV3, SKIP TO KEF1 INTRODUCTION.
1 Did you see it?

150
10/19/2015
[If respondent answers yes only to #4, go to KECV3b and then skip to KEF1
introduction.]
1 Yes
2 No
and now?
1 Yes
2 No
KECV3e.How old were you (the last time/when) this happened?

_____ years old
[SKIP TO KEF1 introduction]
2 No [GO TO KECV3j]
KECV3g. SKIP
KECV3h. SKIP
KECV3i. SKIP
group leader
151
10/19/2015
1 Man
2 Woman
3 Boy
4 Girl

4 Somewhere else
KKECV3m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad
KECV3o.Do any of these people know about what happened?

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KECV3p. SKIP
KECV3q. SKIP
152
10/19/2015
KECV3r. SKIP
KECV3s. SKIP
KECV3t. SKIP
KECV3u. SKIP
KECV3v. SKIP
KECV3w. SKIP
KECV3x. SKIP
KECV3y. SKIP
KECV3z. SKIP
KECV3aa. SKIP
KECV3bb. SKIP
KECV3cc. SKIP

group leader
1 Man
2 Woman
3 Boy
4 Girl
KECV3ff. SKIP
153
10/19/2015
KECV3gg. SKIP
KECV3hh. SKIP
KECV3ii. SKIP
KECV3jj. SKIP
KECV3kk. SKIP
KECV3ll. SKIP
the very first time you knew someone close who was threatened with a gun or knife.
__________________ years old
MODULE G: EXPOSURE TO FAMILY VIOLENCE AND ABUSE FOLLOW-UPS
IF YES TO KEF1, SAY: “Earlier you said that at some time in your life one of your parents
threatened to hurt another parent when it seemed they might really get hurt.”
IF NO TO KEF1, SKIP TO KEF2 INTRODUCTION.
KEF1a. How did you know it happened?
1 Did you see it?

[If respondent answers yes to #4, go to KEF1b and then skip to KEF2 introduction.]
KEF1b. Did you find out about it in the last year?
1 Yes
2 No
KEF1c. How many times did this happen to you in your whole life?

154
10/19/2015
KEF1d. Thinking of (the last time/when) this happened to you…did it happen within the last year?
and now?
1 Yes
2 No
KEF1e. How old were you (the last time/when) this happened?
_____ years old
KEF1f. [IF YES TO ANY PREVIOUS VICTIMIZATION, SAY]: Is this part of some other time you
2 No [GO TO KEF3j]
KEF1g. SKIP
KEF1h. SKIP
KEF1i. SKIP
KEF1j. Who did this? [Interviewer: Try to categorize from open-ended responses. Read
group leader
KEF1k. Was this person a man, woman, boy, or girl? [Do not read boy or girl for KEF1k]
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KEF1l. SKIP
155
10/19/2015
KEF1m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KEF1n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

2 A little bad
3 Very bad
KEF1o. Do any of these people know about what happened?

a. A parent [Do not include for KEF1o]

1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KEF1p. SKIP
KEF1q. SKIP
KEF1r. SKIP
KEF1s. SKIP
KEF1t. SKIP
KEF1u. SKIP
KEF1v. SKIP
KEF1w. SKIP
KEF1x. SKIP
KEF1y. SKIP
KEF1z. SKIP
KEF1aa. SKIP
156
10/19/2015
KEF1bb. SKIP
KEF1cc. SKIP
KEF1dd. Who did this happen to? How do you know this person?

group leader
KEF1ee. Was this person a man, woman, boy, or girl? [Do not read boy or girl for KEF1ee]
[Interviewer: Ask only for when the gender is not clear.]
1 Man
2 Woman
3 Boy
4 Girl
KEF1ff. When this happened, did you yell at them to stop?
3 Yes
4 No
KEF1gg. When this happened, did you call someone else for help, like calling someone on the
3 Yes
4 No
KEF1hh. When this happened, did you try to get away from the fighting by hiding or leaving the
house?
3 Yes
4 No
KEF1ii. How close did you feel to the person that this happened to?
1 Very close
2 A little close
157
10/19/2015
3 Not close at all
KEF1jj. SKIP
KEF1kk. SKIP
KEF1ll. SKIP
KEF1mm. We’ve been talking about the last time this happened. Now, I want you to think about
the very first time one of your parents threatened to hurt another parent when it
seemed they might really get hurt. How old were you the very first time this happened?
__________________ years old
IF YES TO KEF2, SAY: “Earlier you said that at some point in your life one of your parents,
because of an argument, broke or ruined something belonging to another parent, punched the wall,
or threw something.”
1 Did you see it?

1 Yes
2 No
and now?
1 Yes
2 No
158
10/19/2015
_____ years old
KEF2f.[IF YES TO ANY PREVIOUS VICTIMIZATION, SAY]: Is this part of some other time you
2 No [GO TO KEF2j]
KEF2g. SKIP
KEF2h. SKIP
KEF2i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KEF2l. SKIP
1 Not at all afraid

2 A little afraid
3 Very afraid
159
10/19/2015
1 Not at all bad

2 A little bad
3 Very bad


1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KEF2p. SKIP
KEF2q. SKIP
KEF2r. SKIP
KEF2s. SKIP
KEF2t. SKIP
KEF2u. SKIP
KEF2v. SKIP
KEF2w. SKIP
KEF2x. SKIP
KEF2y. SKIP
KEF2z. SKIP
KEF2aa. SKIP
KEF2bb. SKIP
KEF2cc. SKIP
160
10/19/2015
group leader
1 Man
2 Woman
3 Boy
4 Girl
1 Yes
2 No
KEF2gg.When this happened, did you call someone else for help, like calling someone on the
1 Yes
2 No
house?
1 Yes
2 No
1 Very close
2 A little close
3 Not close at all
KEF2jj. SKIP
KEF2kk. SKIP
161
10/19/2015
KEF2ll. SKIP
the very first time one of your parents, because of an argument, broke or ruined
something belonging to another parent, punched the wall, or threw something. How
__________________ years old
IF YES TO KEF3, SAY: “Earlier you said that at some time in your life one of your parents
got pushed by another parent.”
1 Did you see it?

1 Yes
2 No
KEF3c.How many times did this happen to you in your whole life?
and now?
1 Yes
2 No
_____ years old
162
10/19/2015
2 No [GO TO KEF3j]
KEF3g. SKIP
KEF3h. SKIP
KEF3i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KEF3l. SKIP
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

163
10/19/2015

1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KEF3p. SKIP
KEF3q. SKIP
KEF3r. SKIP
KEF3s. SKIP
KEF3t. SKIP
KEF3u. SKIP
KEF3v. SKIP
KEF3w. SKIP
KEF3x. SKIP
KEF3y. SKIP
KEF3z. SKIP
KEF3aa. SKIP
KEF3bb. SKIP
KEF3cc. SKIP

164
10/19/2015
group leader
[Ask only when the gender is unclear but always code gender]
1 Man
2 Woman
3 Not sure
4 Refused
1 Yes
2 No
KEF3gg. When this happened, did you call someone else for help, like calling someone on the
1 Yes
2 No
house?
1 Yes
2 No
1 Very close
2 A little close
3 Not close at all
KEF3jj. SKIP
KEF3kk. SKIP
KEF3ll. SKIP
the very first time you saw one of your parents get pushed by another parent. How old
165
10/19/2015
__________________ years old
IF YES TO KEF4, SAY: “Earlier you said that at some time in your life, one of your parents got hit
or slapped by another parent.”
1 Did you see it?

1 Yes
2 No
and now?
1 Yes
2 No
KEF4e.How old were you (the last time/when) this happened?

_____ years old
2 No [GO TO KEF4j]
KEF4g. SKIP
166
10/19/2015
KEF4h. SKIP
KEF4i. SKIP
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KEF4l. SKIP
KF4m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KF4n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

2 A little bad
3 Very bad


1 Yes
2 No
1 Yes
167
10/19/2015
2 No
1 Yes
2 No
KEF4p. SKIP
KEF4q. SKIP
KEF4r. SKIP
KEF4s. SKIP
KEF4t. SKIP
KEF4u. SKIP
KEF4v. SKIP
KEF4w. SKIP
KEF4x. SKIP
KEF4y. SKIP
KEF4z. SKIP
KEF4aa. SKIP
KEF4bb. SKIP
KEF4cc. SKIP

group leader
168
10/19/2015
1 Man
2 Woman
3 Boy
4 Girl
1 Yes
2 No
1 Yes
2 No
house?
1 Yes
2 No
1 Very close
2 A little close
3 Not close at all
KEF4jj. SKIP
KEF4kk. SKIP
KEF4ll. SKIP
the very first time one of your parents got hit or slapped by another parent. How old
__________________ years old
IF YES TO KEF5, SAY: “Earlier you said that at some time in your life, one of your parents
got kicked, chocked, or beat up by another parent.”

169
10/19/2015
1 Did you see it?

1 Yes
2 No
and now?
1 Yes
2 No
_____ years old
2 No [GO TO KEF5j]
KEF5g. SKIP
KEF5h. SKIP
KEF5i. SKIP
170
10/19/2015
group leader
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KEF5l. SKIP
KF5m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KEF5p. SKIP
171
10/19/2015
KEF5q. SKIP
KEF5r. SKIP
KEF5s. SKIP
KEF5t. SKIP
KEF5u. SKIP
KEF5v. SKIP
KEF5w. SKIP
KEF5x. SKIP
KEF5y. SKIP
KEF5z. SKIP
KEF5aa. SKIP
KEF5bb. SKIP
KEF5cc. SKIP

group leader
[Only ask if gender is unclear.]
1 Man
2 Woman
3 Boy
172
10/19/2015
4 Girl
KEF5ff.When this happened, did you yell at them to stop?
1 Yes
2 No
1 Yes
2 No
house?
1 Yes
2 No
1 Very close
2 A little close
3 Not close at all
KEF5jj. SKIP
KEF5kk. SKIP
KEF5ll. SKIP
the very first time one of your parents got kicked, chocked, or beat up by another
parent. How old were you the very first time this happened? [Only ask if respondent
__________________ years old
IF YES TO KEF6, SAY: “Earlier you said that at some time in your life a grown-up or teen who
lives with you pushed, hit, or beat up someone else who lives with you.”
IF NO TO KEF6, SKIP TO KSC1 INTRODUCTION.
1 Did you see it?

173
10/19/2015
[If respondent answers yes to #4, go to KEF6b and then skip to KSC1 introduction.]
1 Yes
2 No
and now?
1 Yes
2 No
_____ years old
[SKIP TO KSC1 introduction]
2 No [GO TO KEF8j]
KEF6g. SKIP
KEF6h. SKIP
KEF6i. SKIP
group leader
174
10/19/2015
KEF6k. Was this person a man, woman, boy, or girl?
gender.]
1 Man
2 Woman
3 Boy
4 Girl
KEF6l. SKIP
KF6m.Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
1 Not at all bad

2 A little bad
3 Very bad

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KEF6p. SKIP
KEF6q. SKIP
KEF6r. SKIP
KEF6s. SKIP
KEF6t. SKIP
175
10/19/2015
KEF6u. SKIP
KEF6v. SKIP
KEF6w. SKIP
KEF6x. SKIP
KEF6y. SKIP
KEF6z. SKIP
KEF6aa. SKIP
KEF6bb. SKIP
KEF6cc. SKIP

group leader
KEF6ee. Was this person a man, woman, boy, or girl?
1 Man
2 Woman
3 Boy
4 Girl
KEF6ff.When this happened, did you yell at them to stop?
1 Yes
2 No
176
10/19/2015
1 Yes
2 No
house?
1 Yes
2 No
1 Very close
2 A little close
3 Not close at all
KEF5jj. SKIP
KEF5kk. SKIP
KEF5ll. SKIP
the very first time a grown-up or teen who lives with you pushed, hit, or beat up
someone else who lives with you. How old were you the very first time this happened?
__________________ years old
MODULE H: SCHOOL VIOLENCE AND THREAT
IF YES TO KSC1, SAY: “Earlier you said that at some time in your life you went to a school where
someone said there was going to be a bomb or attack on the school and you thought they might
really mean it.”
IF NO TO KSC1, SKIP TO KSC2 INTRODUCTION.
KSC1a. SKIP
KSC1b. SKIP
KSC1c. How many times did this happen to you in your whole life?

177
10/19/2015
KSC1d.Thinking of (the last time/when) this happened to you…did it happen within the last year?
and now?
1 Yes
2 No
KSC1e. How old were you (the last time/when) this happened?
_____ years old
KSC1f. SKIP
KSC1g. SKIP
KSC1h. SKIP
KSC1i. SKIP
KSC1j. SKIP
KSC1k. SKIP
KSC1l. SKIP
KSC1m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KSC1n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

2 A little bad
3 Very bad
KSC1o. Do any of these people know about what happened?

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
178
10/19/2015
2 No
KSC1p. SKIP
KSC1q. SKIP
KSC1r. SKIP
KSC1s. SKIP
KSC1t. SKIP
KSC1u. SKIP
KSC1v. SKIP
KSC1w. SKIP
KSC1x. SKIP
KSC1y. SKIP
KSC1z. SKIP
KSC1aa. SKIP
KSC1bb. SKIP
KSC1cc. SKIP
KSC1dd. SKIP
KSC1ee. SKIP
KSC1ff. SKIP
KSC1gg. SKIP
KSC1hh. SKIP
KSC1ii. SKIP
KSC1jj. Did everyone have to leave the school while they looked for the bomb or the attacker?
1 Yes
2 No
KSC1kk. Was school cancelled when this happened?
1 Yes
2 No
179
10/19/2015
KSC1ll. Was anyone physically hurt when this happened?
1 Yes
2 No
KSC1mm. We’ve been talking about the last time this happened. Now, I want you to think about
the very first time you went to a school where someone said there was going to be a
bomb or attack on the school and you thought they might really mean it. How old
__________________ years old
IF YES TO KSC2, SAY: “Earlier you said that at some time in your life you went to a school where
someone damaged the school, started a fire in the school on purpose, or broke or ruined other
school property.”
IF NO TO KSC2, SKIP TO KLE1.
KSC2a. SKIP
KSC2b. SKIP
KSC2c. How many times did this happen to you in your whole life?
KSC2d. Thinking of (the last time/when) this happened to you…did it happen within the last year?
and now?
1 Yes
2 No
KSC2e. How old were you (the last time/when) this happened?
_____ years old
KSC2f. SKIP
KSC2g. SKIP
KSC2h. SKIP
180
10/19/2015
KSC2i. SKIP
KSC2j. SKIP
KSC2k. SKIP
KSC2l. SKIP
KSC2m. Thinking back to when it happened, how afraid did you feel? Would you say you felt…
1 Not at all afraid

2 A little afraid
3 Very afraid
KSC2n. When this happened, how bad did you feel? Would you say you felt…
1 Not at all bad

2 A little bad
3 Very bad
KSC2o. Do any of these people know about what happened?

a. A parent
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
KSC2p. SKIP
KSC2q. SKIP
KSC2r. SKIP
KSC2s. SKIP
KSC2t. SKIP
KSC2u. SKIP
KSC2v. SKIP
KSC2w. SKIP
181
10/19/2015
KSC2x. SKIP
KSC2y. SKIP
KSC2z. SKIP
KSC2aa. SKIP
KSC2bb. SKIP
KSC2cc. SKIP
KSC2dd. SKIP
KSC2ee. SKIP
KSC2ff. SKIP
KSC2gg. SKIP
KSC2hh. SKIP
KSC2ii. SKIP
KSC2jj. Did everyone have to leave the school because of what happened?
1 Yes
2 No
KSC2kk. Was school cancelled when this happened?
1 Yes
2 No
KSC2ll. Was anyone physically hurt when this happened?
1 Yes
2 No
KSC2mm. We’ve been talking about the last time this happened. Now, I want you to think about
the very first time you went to a school where someone damaged the school, started a
fire in the school on purpose, or broke or ruined other school property. How old were
you the very first time this happened? [Only ask if respondent indicated the event occurred
2 or more times.]
__________________ years old
SECTION 8: LIFETIME & PAST YEAR ADVERSITY

182
10/19/2015
Now I’d like to ask you about some other experiences that you or someone in your family may
have had. Some of these things happen to most people at one time or another, while some
happen to only a few people. I’d like to know about things that have happened to you in your
lifetime.
KLE1. In your whole life, were you ever in a VERY BAD fire, flood, tornado, hurricane, earthquake
or other disaster? This would be a time that your home or apartment was damaged and you
might have had to live somewhere else for a while.
1 Yes [GO TO KLE1a]

2 No [SKIP TO KLE2]
KLE1a. [If yes to KLE1]: Did this happen in the last year?
1 Yes
2 No
KLE2. Were you ever in a VERY BAD accident (at home, school, or in a car) where you had to go
to the hospital? This would be a time that you were very hurt and needed to spend a long
time in the hospital. Has that ever happened?
1 Yes [GO TO KLE2a]

2 No [SKIP TO KLE3]
1 Yes
2 No
KLE3. Did you ever have a VERY BAD illness where you had to go to the hospital? This could be
a time when you were so sick that you had to be in the hospital a lot? Has that ever
happened?
1 Yes [GO TO KLE3a]

2 No [SKIP TO KLE4]
1 Yes
2 No
KLE4. Has someone you were really close to ever had a VERY BAD accident where he or she
had to spend a long time in the hospital? This would be someone important to you, like a
parent, brother or sister, or best friend.
1 Yes [GO TO KLE4a]

2 No [SKIP TO KLE5]
1 Yes
2 No
183
10/19/2015
KLE5. Has someone you were really close to ever had a VERY BAD illness where he or she had
to be in the hospital a lot? Again, this would be someone important to you, like a parent,
brother or sister, or best friend.
1 Yes [GO TO KLE5a]

2 No [SKIP TO KLE6]
1 Yes
2 No
KLE6. Was there ever a time in your life when your family had to live on the street or in a shelter
because they had no other place to stay?
1 Yes [GO TO KLE6a]

2 No [SKIP TO KLE7]
1 Yes
2 No
KLE7. Did you ever have to do a school year over again? [Interviewer: Children may refer to this
as “being held back”]
1 Yes [GO TO KLE7a]

2 No [SKIP TO KLE8]
1 Yes
2 No
KLE8. Have there ever been any times when your mother, father, or guardian lost a job or couldn’t
find work?
1 Yes [GO TO KLE8a]

2 No [SKIP TO KLE9]
1 Yes
2 No
KLE9. Were you ever sent away or taken away from your family for any reason?
1 Yes [GO TO KLE9a]

2 No [SKIP TO KLE10]
184
10/19/2015
1 Yes
2 No
KLE10.At any time in your life did either of your parents, a stepparent, or guardian ever have to go
to prison?
1 Yes [GO TO KLE10a]

1 Yes
2 No
KLE12.Has there ever been a time that a family member of yours drank or used drugs so often that
it caused problems?

1 Yes
2 No
KLE13.Has there ever been a time when your parents or stepparents were ALWAYS arguing,
yelling, and angry at one another a lot of the time?

1 Yes
2 No
KLE14.Has someone close to you ever tried to kill him or herself on purpose (like by shooting or
cutting him or herself, or taking too many pills or drugs)?

1 Yes
2 No
KLE15.Did a parent or someone who takes care of you ever have to leave the country to fight in a
war, when he or she had to be away for several months or longer?

185
10/19/2015
1 Yes
2 No
KLE16.Did you ever have anyone close to you die because of an illness or an accident?
1 Yes [GO TO KLE6a]

2 No [SKIP TO KINT1]
1 Yes
2 No
SECTION 9: INTERNET VICTIMIZATION
KINT1. Has anyone ever used the Internet to bother or harass you or to spread mean words or
pictures about you?
1 Yes [GO TO KINT1a]

2 No [SKIP TO KINT2]
KINT1a. [If yes to KINT1]: Did this happen in the last year?
1 Yes
2 No
KINT2. Did anyone on the Internet ever ask you sexual questions about yourself or try to get you to
talk online about sex when you did not want to talk about those things?
1 Yes [GO TO KINT2a]

2 No [SKIP TO KCD1]
KINT2a. [If yes to KINT2]: Did this happen in the last year?
1 Yes
2 No
SECTION 10: COMMUNITY DISORDER
KCD1. At any time in your life, did you ever see someone selling marijuana, cocaine, meth, or
other illegal drugs to someone else?
1 Yes [GO TO KCD1a]

2 No [SKIP TO KCD2]
KCD1a. [If yes to KCD1]: Did this happen in the last year?
1 Yes
186
10/19/2015
2 No
KCD2. At any time in your life, did you ever see the police arrest someone in your neighborhood
and take that person to jail in a police car?
1 Yes [GO TO KCD2a]

2 No {SKIP TO KCD3]
1 Yes
2 No
KCD3. Have you ever lived in a neighborhood where there were gangs?
1 Yes [GO TO KCD3a]

2 No [SKIP TO KCD4]
KCD3a. [If yes to KCD3]: Was this true in the last year?
1 Yes
2 No
KCD4. At any time in your life, did you ever see graffiti in your neighborhood that had gang signs or
warnings?
1 Yes [GO TO KCD4a]

2 No [SKIP TO KCD5]
1 Yes
2 No
KCD5. At any time in your life, have you ever seen the police raid or enter a house in your
neighborhood looking for a criminal or block of a place in your neighborhood because a
crime happened there?
1 Yes [GO TO KCD5a]

2 No [SKIP TO KCD6]
1 Yes
2 No
KCD6. At any time in your life, have you ever seen the police block off a place in your
neighborhood because a crime happened there?
1 Yes [GO TO KCD6a]

2 No [SKIP TO KCD7]
187
10/19/2015
1 Yes
2 No
KCD7. At any time in your life, did you ever live in a house where your parents didn’t like to let you
play outside because of crime around your house [MH – change “around your house” to “in
your neighborhood for consistency?]?
1 Yes [GO TO KCD7a]

2 No [SKIP TO KCD8]
1 Yes
2 No
KCD8. In some neighborhoods, because of lack of money or for other reasons, no one seems to
fix things that break—houses don’t get fixed, signs don’t get fixed, trash doesn’t get picked
up. Sometimes heat or water doesn’t work for a really long time. At any time in your life,
did you ever live in a neighborhood like that?
1 Yes [GO TO KCD8a]

2 No [SKIP TO KCD9]
1 Yes
2 No
KCD9. Gangs or crews are groups that use a name, colors, or signs to let people know which kids
are in the gang. Sometimes they get in fights and sell drugs. Have you ever gone to a
school where there were kids in gangs?
1 Yes [GO TO KCD9a]

2 No [SKIP TO KCD10]
1 Yes
2 No
KCD10. Have you ever gone to a school where a kid brought a gun or knife to school?
1 Yes [GO TO KCD10a]

2 No [SKIP TO KD1]
KCD10a. Was this true in the last year?
1 Yes
2 No
188
10/19/2015
SECTION 11: DELINQUENCY
[Ask D1 – D19 questions only if the child is 6-12. If the child is younger than 6, skip to G1]
Now I’m going to ask you about some things that you might have done in the last year. It is
common for kids, even young kids, to do things that they are not supposed to or that get them into
trouble. Tell me whether your have done any of the following things in the last year.
In the last year did you….
[INTERVIEWER: Repeat above phrase until the participant gets the pattern.]
KD1. On purpose break, damage or destroy something that belonged to someone else?
1 Yes
2 No
3 Don’t Know
4 Refused
KD2. Hit, slap or push other kids or get into a physical fight with them?
1 Yes
2 No
3 Don’t Know
4 Refused
KD3. Hit, slap, or push a parent or other grown-up?
1 Yes
2 No
3 Don’t Know
4 Refused
KD4. Take anything at school from other kids or a teacher that did not belong to you?
1 Yes
2 No
3 Don’t Know
4 Refused
KD5. Take money at home that did not belong to you like from your mother’s purse or a parent’s
dresser?
1 Yes
2 No
3 Don’t Know
4 Refused
KD6. Take something from a store without paying for it?
1 Yes
2 No
189
10/19/2015
3 Don’t Know
4 Refused
KD7. Cheat on school tests?
1 Yes
2 No
3 Don’t Know
4 Refused
KD8. Skip school without an excuse?
1 Yes
2 No
3 Don’t Know
4 Refused
KD9. Write things or spray paint on walls or sidewalks or cars, where you were not supposed
to do that?
1 Yes
2 No
3 Don’t Know
4 Refused
KD10. Carry a weapon with you?
1 Yes
2 No
3 Don’t Know
4 Refused
KD11. Avoid paying for things such as movies, bus or subway rides, or food?
1 Yes
2 No
3 Don’t Know
4 Refused
KD12. Smoke or chew tobacco?
1 Yes
2 No
3 Don’t Know
4 Refused
KD13. Smoke marijuana?
1 Yes
2 No
3 Don’t Know
4 Refused
190
10/19/2015
KD14. Take any other drugs (that were not prescribed medication)?
1 Yes
2 No
3 Don’t Know
4 Refused
KD15. Hurt someone badly enough to need bandages or care from a doctor?
1 Yes
2 No
3 Don’t Know
4 Refused
We’re almost done. Just a few more questions.
SECTION 12: SELF-CONCEPT
Now I’m going to read some sentences that describe how people sometimes feel about
themselves. Please listen carefully to each sentence and tell me how much it describes how YOU
feel about YOURSELF. Tell\ me whether it is very true about you, a little true, or not true. [Read
response categories after each statement]
For KSC1 – KSC15, response options are:
1 Very true
2 A little true
3 Not true
KSC1. You are happy with yourself.
KSC2. You have a lot to be proud of.
KSC3. You take a positive attitude toward yourself.
KSC4. You sometimes feel useless.
KSC5. You often feel helpless in dealing with problems.
KSC6. Sometimes you feel that you are being pushed around in life.
KSC7. You cannot change important things in your life.
KSC8. When you make plans you know you can make them work.
KSC9. You have little control over the things that happen to you.
KSC10. You think you are a failure.
KSC11. There is no way you can solve some of the problems you have.
191
10/19/2015
SECTION 13: PARENTAL CONFLICT
In every family there are times when the parents don’t get along. Tell me whether the next two
sentences are very true for you, a little true, or not true.
CON1. I often see my parents arguing.
1 Very true
2 A little true
3 Not true
CON2. My parents get really mad when they argue.
1 Very true
2 A little true
3 Not true
SECTION 14: ALCOHOL USE
The next questions are about how often you drink alcohol. By a “drink” we mean either a bottle of
beer, a glass of wine, a wine cooler, a shot of liquor (something like vodka, rum, or whisky), or a
mixed drink (something like rum and coke or vodka and orange juice).
ALC1. Have you ever had an alcoholic drink? That is, a whole drink by yourself -- not a sip of
someone else’s drink.
1 Yes
2 No [skip to end]
3 Don’t Know
4 Refused
ALC2. How old were you the very first time you ever had an alcoholic drink - a whole drink by
yourself?
_______________________ record age
ALC3. Thinking of the last month [since (month) when you were (age)], about how many days
did you drink alcohol?
1 0 days
2 1 or 2 days
3 3 to 9 days
4 10 to 19 days
5 20 to 39 days
6 40 to 99 days
7 100 days or more
ALC4. On how many of those days in the last month did you drink a lot – say five or more drinks
within a few hours?
1 0 days
2 1 day
192
10/19/2015
3 2 days
4 3 to 5 days
5 6 to 9 days
6 10 to 19 days
7 20 days or more
END OF SURVEY
F1. That completes the interview. Thank you very much for answering these questions. We know
these can be difficult things to talk about, and we really appreciate your help. Your help will give us
important information about young people’s lives.
F2. I have a phone number to the Girls and Boys Town hotline. This is a number that you can call
to have a private conversation about anything having to do with your kids. Would you like the
number? [IF YES: The number is 1-800-448-3000. It is a free call.]
F3. INTERVIEWER: Is child possibly at risk from comments or other observations made during \
interview?
No [SKIP to F4]
Yes
F3b INTERVIEWER Describe nature of the risk (child abuse, hurting themselves, etc.)
____________________________________________________________________
[Patricia – we will need to confirm fagged items once questionnaire is finalized]
CONFIRM CORRECT FLAGS ONCE RESPONSE CATEGORIES ARE FINALIZED

[Flagged Case if M1i=7-13 perpetrator is parent or guardian]
[Flagged Case if M3i=7-13 perpetrator is parent or guardian]
[Flagged Case if O1i=7-13 perpetrator is parent or guardian]
[Flagged Case if W2i=7-13 perpetrator is parent or guardian]
[Flagged Case if G22=3,4]
F4. [CATI check point: These computer algorithms will flag the respondent as a possible child in
danger: If the computer algorithm flags the respondent as a possible child in danger, or the
interviewer has concerns based on comments or other observations during interview:]
Someone may need to contact you again. When is the best time to call you back? [Get
time and check telephone number.]
F5 . We may be doing another survey like this in a year or two. If we do, would you be willing to
be interviewed again?
1 Yes [ASK F5B]
2 No [SKIP TO F6]
3 Don’t Know [SKIP TO F6]
F5b. In order to be able to re-contact you in a year or two and ask how you are doing, it would
be extremely helpful to get your first name. Would you give me just your first name? [It will
be kept confidential and only used to help find you again for a follow-up interview.] [Other important
tracking information? What about asking for email address?]
________________ (First name)

193
10/19/2015
F6. OK. Now I just need to get your name and address to send you the $20 check. It will be kept
confidential and only be used to send you this check.
What is the first and last name, so we can write it on the check?
What is the address (record house number and street)?
City?
State?
Zip?
You should receive your check within the next 4 weeks. If you do not receive it you can call us at
XXX and ask for XXX.
Thank you for your time. Good-bye.

Natscev Yrs

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NATSCEV YOUTH SURVEY

Parent Screen and Consent ....................................................................................................... 1

NATSCEV SURVEY: YOUTH INTERVIEW

PARENT SCREEN AND CONSENT

________ persons in household

1 Speaking [GO TO CONSENT6]

CON4. Could I send you a letter explaining the study?

1 Yes [CODE DISPOSITION AS WANTING LETTER AND SET CALLBACK FOR 7

9 Refusal [CODE CONSENT5 CODE AS QUALIFIED]

[IF NEW ADULT IN HOUSEHOLD COMES TO PHONE, READ:]

Hello, I’m __________________________ from SRBI, calling on behalf of University of New

___________ number currently living in household

[IF 0 SCREEN OUT]

Child 1 age (years)______________

IF MORE THAN ONE CHILD IS IN ELIGIBLE AGE RANGE, SAY:

. __________age of designated child [IN YEARS]

CON9. Is the child a boy or a girl?

IF CHILD IS 0-9 GO TO ‘PARENT CONSENT TO CONTINUE WITH PARENT-REPORT

PARENT CONSENT TO CONTINUE WITH PARENT-REPORT INTERVIEW FOR CHILD 0-9

PI1. Could we begin?

1 Yes [SKIP TO PI3]

PARENT CONSENT TO CONTINUE WITH PARENT INTERVIEW FOR ADOLESCENTS AGE

PI2. Could we begin?

1 Yes [GO TO PI3]

SECTION 1: PARENT SCREENER INTERVIEW

PI3. Parent Gender [Do not ask unless unclear]

PI4. What is your child’s date of birth?

PI5. In what grade or year of school is your [CHILD’S AGE]-year-old?

[INTERVIEWER: Ask only of children 5 and older]

________________grade/year of school (list kindergarten to college, dropout, GED)

1 Pay more attention

2 Pay less attention

____ persons in household (including respondent)

[Interviewer: Count marriage or live-in to same partner only once]

__________________ (code number)

1 Yes CONTINUE WITH PI16a

[Code in weeks. Less than 1 week = 1.]

___________ weeks (Range 1-52)

[Code in months. Less than 1 month = 1.]

IF LESS THAN 12 MONTHS, GO TO PI18.

4 Unemployed and looking for work

PI21. What is the highest level of school that you completed?

1 Grade school or lower

PI22. [ASK PI22 AND PI23 ONLY IF PI11=1 through 10]

PI23. What is the highest level of school that he/she completed?

1 Grade school or lower

1 American Indian or Alaska Native

PI25. Do you consider yourself to be Hispanic or Latino?

1 American Indian or Alaska Native

1 Less than $20,000 ASK PI28a

1 Large city (population over 300,000)

1 Yes [GO TO PI35]

1 A psychologist or other counselor in the community, like at a community mental

FOR ALL RESPONSES BELOW, USE CODING OF:

a. Post-traumatic stress disorder (PTSD)

FOR ALL RESPONSES BELOW, USE CODING OF:

a. Major Depressive Disorder

[Ask PI36 only if child is 6 or younger]

1 Quite a bit behind

1 Taller than average

1 Thinner than average

FOR ALL RESPONSES BELOW USE CODING OF:

PI42. You encouraged your child to talk about his/her troubles.