††††††††††† FORM IDM9

 

 

RELATIONSHIP

CHARACTERISTICS STUDY

 

 

Thank you for contributing your time to help us with this important study.

 

What we are doing

We are a group of researchers at???????.We are studying relationships that students have with a dating partner and their attitudes about relationships.There are also questions about you own family background and personality.Some of the questions are about sexual relations, but you do not have to be sexually active in order to participate.†† We want to find out some new and better ways to identify the strengths and weaknesses in peoplesí relationships and we hope this information will be used to help people with relationship problems.

 

The Questionnaire is Confidential and Voluntary

ALL of your responses will be completely confidential and anonymous.We will NOT ask you for your name, and the answers to these questions will never be associated with you in any way.PLEASE DO NOT PUT YOUR NAME ANYWHERE.

 

††††††††††† Participation in this study is strictly voluntary, and you are not obligated to complete the questionnaire.†† If you decide to answer the questionnaire, after you have finished, you can put the questionnaire in the box near the exit door and leave.If you choose not to answer, you can put the blank questionnaire in the same box at the front of the room and leave and no one will know that you decided not to answer the questionnaire.

 

You may omit any questions or discontinue at any time. but you will help us the most by answering every question that you can.

 

††††††††††† You must be at least 18 years old to participate in this study.If you not at least 18, please do not answer.Instead put the blank questionnaire in the box at the front of the room.

 

Your comments

You can write comments on the questionnaires, but not on the answer sheets. In fact, we hope that you will write lots of comments on the questionnaire!But PLEASE do not make any extra marks on the answer sheets; because otherwise the computer will not be able score them.

 

More information about the study

We will give you an information sheet when you are finished with the questionnaire.You can also contact us at????.The contact person is ???? at phone ???and email ????.


PART 1.Background Information

 

 

TO USE THIS ANSWER SHEET:

1. USE DARK BLACK LEAD PENCIL Ė DO NOT USE PEN

2. MAKE HEAVY BLACK MARKS TO FILL IN THE CIRCLE COMPLETELY

3. ERASE CLEARLY ANY ANSWER YOU WANT TO CHANGE

4. IF A QUESTION DOES NOT APPLY TO YOU, YOU CAN LEAVE IT BLANK

5. START ANSWERING IN ROW 1 ON THE LEFT SIDE OF THE ANSWER SHEET

 

1. What is your sex?†† On the answer form, please blacken the circle under the number 1 if you are a male, andblacken the circle under 2 if you are a female.

1=Male

2=Female

 

2. What is your year at the university?

1= Freshman

2= Sophomore

3= Junior

4= Senior

 

3. How old are you?

1=18

2=19

3=20

4=21

5=22-24

6=25-29

7=30-39

8=40 or older

 

4.How many years of education did your father complete?

SITE CO-INVESTIGATORS:You may need to change the wording to fit local circumstances, but you must not exceed 8 answer categories because the computer program to score the answer sheets from all the sites has 8categories for this variable

1 = Less than high school

2 = High school graduate

3 = Some college

4 = Two-year college graduate (for example, community college)

5 = Four-year college graduate

6 = Some graduate school

7 = Post-graduate degree

 

5. How many years of education did your mother complete?

SITE CO-INVESTIGATORS: You may need to change the wording to fit local circumstances, but you must not exceed 8 categories.

††††††††††† 1 = Less than high school

2 = High school graduate

3 = Some college

4 = Two-year college graduate (for example, community college)

5 = Four-year college graduate

6 = Some graduate school

7 = Post-graduate degree

 

6. What is your familyís yearly income? (Make your best estimate)

SITE CO-INVESTIGATORS: Use categories that are locally appropriate.However, you must use exactly nine (8) categories because the computer program to score the answer sheet from all the sites has 8 categories for this variable.To choose the categories, I suggest that you consult with a colleague in the Economics Department.

1 = $??? to $???

2 =

3 =

4 =

5 =

6 =

7 =

8 =

 

7. What is your parentsí current marital status?

1 = married to each other

2 = separated

3 = divorced

4 = never married to each other and not living together

5 = never married to each other and living together

6 = one or both parents have died

 

8. Indicate which of the following applies to you.

1 = I am currently in a dating ???? relationship that has lasted at least one month.

2 = I have been in a dating ???? relationship that has lasted at least one month, but am not now.Answer the rest of the questions about your most recent relationship (that lasted one month or more).

3 = I have never been in a dating ???? relationship that has lasted at least one month.If you answer 3, skip to Part 2.

 

NOTE:The words ďpartnerĒ and ďyour partnerĒ refer to the person in the ???? relationship you will describe on the next questions.Answer every question for your current partner or most recent partner (and always answer about the same person).

 

9. Who are you living with?

1 = With my partner (or was living with him/her before the relationship ended)

2 = In a room or apartment of my own.No one shares my room.

3 = Wth a roommate who is not my partner

4 = With my parents

5 = Other

 

10. What is your relationship with your partner (or what was it while you were together)?

1 = Dating????

2 = Engaged

3 = Married

4 = Cohabiting

 

11. How long have you been in this relationship (or how long did the most recent relationship last)?†††††††††

1= Less than one month

2= About 1 month

3= About 2 months

4= Three to five months

5= Six months to eleven months

6= About a year

7= More than a year, but less than 2 years

8 = Two or more years

 

12. How long ago did this relationship end?

1= It has not ended

2= Less than one month ago

3= About 1 month ago

4= About 2 months ago

5= Three to five months ago

6= Six months to eleven months ago

7= About a year ago

8 = More than a year ago

 

13. What is (was) your partnerís gender?

1 = male

2 = female

 

14. Is (was) sex a part of your relationship?

1 = no

2 = yes


PART 2.ABOUT YOU AND YOUR PARTNER

 

The following statements are about you or about the relationship between you and someone else such as your parents or a partner.Please read each statement and fill in one of the circles to indicate how much you agree or disagree with it.

F

For questions about your partner in a relationship:

 

If you are currently in a relationship that has lasted one month or more, answer about that relationship.

If you are not now in a relationship, but have been in a relationship that lasted one month or more in the past, answer about what went on during the most recent relationship of that length.

If you have not been in a relationship that lasted one month or more, omit the question about partners and relationships.

 

1 = Strongly Disagree

2 = Disagree

3 = Agree

4 = Strongly Agree

 

15.       My relationship with my partner is the most important relationship I have

16.       My parents made sure I went to school

17.       I would give up almost anything for my partner

18.       My partner doesnít have enough sense to make important decisions

19.       I often feel empty

20.       I often break things that belong to others on purpose

21.       People usually like my partner

22.       Iíd do almost anything to keep people from leaving me

23.       I can calm myself down when I am upset with my partner

24.       Before I let myself get really mad at my partner, I think about what will happen if I lose my temper

25.       My parents did not keep me clean

26.       A woman who has been raped probably asked for it

27.       I have family members who would help me out if I had a problem

28.       Men are more dishonest than women

29.       My partner often nags me

30.       I rarely have anything to do with religious activities

31.       My partner is basically a good person

32.       I am always courteous, even to people who are disagreeable

33.       Sometimes I canít remember what happened the night before because of drinking

34.       I can't bring myself to say nice things to my partner even when I'm thinking them

35.       Since age 15, I have stolen or tried to steal something worth more than $50.00 ??

36.       When I was a kid, I saw my mother or father kick, punch, or beat up their partner

37.       I often feel resentful of women

1 = Strongly Disagree

2 = Disagree

3 = Agree

4 = Strongly Agree

 

38.       I can feel my blood rising when I start to get mad at my partner

39.       I lie to make myself look better

40.       I enjoy my day-to-day life

41.       I try not to think about terrible things that happened to me

42.       I usually wake up feeling pretty good

43.       Since age 15, I have stolen money (from anyone, including family)

44.       When I was a kid, people (adults or kids) who were not part of my family pushed, shoved, or slapped

††††††††††††† me, or threw things at me

45.       I make excuses when I've said something to my partner I shouldn't have

46.       Men treat women badly

47.       My life is generally going well

48.       A boy who is hit by another boy should hit back

49.       My partner does things just to annoy me

50.       There have been occasions when I took advantage of someone

51.       When I was a kid, people (adults or kids) who were not part of my family told me to hit back if

†††††††††††† someone hit me or insulted me

52.       My relationships have big ups and downs

53.       Before I was 18, an adult in my family had sex with me (vaginal, anal, or oral)

54.       Men irritate me a lot

55.       Sometimes I have doubts that my relationship with my partner will last

56.       My partner and I disagree about what types of affection are okay in public

57.       Men respect women

58.       My parents did not comfort me when I was upset

59.       Women treat men badly

60.       I worry that I have a drug problem

61.       I donít think about how what I do will affect other people

62.       I give up easily on difficult projects

63.       Marriage is forever

64.       I donít like my work or classes

65.       Once sex gets past a certain point, a man canít stop himself until he is satisfied

66.       No matter who I am talking to I am always a good listener

67.       I donít tell my partner when I disagree about important things

68.       I have a right to know everything my partner does

1 = Strongly Disagree

2 = Disagree

3 = Agree

4 = Strongly Agree

 

69.       I can usually tell when I am about to lose my temper at my partner

70.       When I was a teenager, I was hit a lot by my mother or father

71.       Before I was 18, another kid in my family made me look at or touch their private parts (sex organs), or

†††††††††††† looked at or touched mine

72.       Before age 15, I stole or tried to steal something worth more than $50.00 ??

73.       Itís all right to break the law as long as you donít get hurt

74.       My father or mother told me to hit back if someone hit me or insulted me

75.       I avoid doing anything that reminds me of terrible things that happened to me

76.       I have never been irked when people expressed ideas very different from my own

77.       When I was a kid, I often saw kids who were not in my family get into fights and hit each other

78.       I am generally in a good mood

79.       I can think of a situation when I would approve of a wife slapping a husbandís face

80.       I am sometimes irritated by people who ask favors of me

81.       I spend time with friends who have been in trouble with the law

82.       I have goals in life that I try to reach

83.       I would feel betrayed if my partner was too busy to spend time with me

84.       I often do things that are against the law

85.       I think good things will happen to me in the future

86.       If a wife refuses to have sex, there are times when it may be okay to make her do it

87.       When I am drinking I usually have five or more drinks at a time

88.       I would hate it if my partner confided in someone besides me

89.       I sometimes drink five or more drinks at a time, but only on weekends

90.       I have friends who have committed crimes

91.       When a boy is growing up, itís important for him to have a few fist fights

92.       There is nothing I can do to control my feelings when my partner hassles me

93.       When I was a kid, I saw a member of my family who was not my mother or father, push, shove, slap,

†††††††††††† or throw something at someone

94.       Before I was 18, an adult in my family made me look at or touch their private parts (sex organs), or

†††††††††††† looked at or touched mine

95.       I have thought seriously about ending my relationship with my partner

96.       I am constantly looking for signs of danger

97.       I go back and forth between thinking my partner is perfect or terrible

98.       I can think of a situation when I would approve ofa husband slapping a wifeís face

1 = Strongly Disagree

2 = Disagree

3 = Agree

4 = Strongly Agree

 

99.       To get ahead, I have done some things which are not right

100.   I am easily frustrated by women

101.   My partner likes to make me mad

102.   It is sometimes hard for me to go on with my work if I am not encouraged

103.   I often do things that other people think are dangerous

104.   Caring for my partner means more to me than caring for myself

105.   When I was less than 12 years old, I was spanked or hit a lot by my mother or father

106.   I recognize when I am beginning to get angry at my partner

107.   My partner needs to remember that I am in charge

108.   My partner and I disagree about each otherís irritating habits

109.   When my partner says something mean, I usually say something mean back

110.   It is usually my partner's fault when I get mad

111.   People often interrupt me when Iím trying to get things done

112.   I am easily startled

113.   My partner and I disagree about whether it is okay to tell each other we disagree

114.   Before I was 18, an adult who was not part of my family had sex with me (vaginal, anal, or oral)

115.   I sometimes drink enough to feel really high or drunk

116.   Since age 15, I hit or threatened to hit someone who is not a member of my famly

117.   I generally have the final say when my partner and I disagree

118.   My partner treats me well

119.   Women irritate me a lot

120.   I donít have enough money for my daily needs

121.   My partner and I disagree about his or her friends and family

122.   My parents did not help me to do my best

123.   Iím always willing to admit it when I make a mistake

124.   I can set up a time out break during an argument with my partner

125.   I sometimes feel resentful when I donít get my way

126.   Men are rude

127.   My relationship with my partner is worth the effort I put into it

128.   I attend a church, synagogue, or mosque once a month or more

129.   A man should not walk away from a physical fight with another man

130.   I have had thoughts of cutting or burning myself

131.   In the past, I used coke, crack, or harder drugs (like uppers, heroin, or opiates) more than once or

†††††††††† twice

1 = Strongly Disagree

2 = Disagree

3 = Agree

4 = Strongly Agree

132.   My sex life with my partner is good

133.   I get hassled because of who I am

134.   My parents did not care if I got into trouble in school

135.   I often get hurt by things that I do

136.   I have overdosed on drugs or had a severe health problem because of taking drugs to get high

137.   Before I was 18, another kid who was not part of my family made me look at or touch their private

††††††††††† parts (sex organs), or looked at or touched mine

138.   When I feel myself getting angry at my partner, I try to tell myself to calm down

139.   Itís sometimes necessary for parents to slap a teen who talks back or is getting into trouble

140.   I have a right to be involved with anything my partner does

141.   I am so sad, sometimes I wonder why I bother to go on living

142.   Before I was 18, an adult who was not part of my family made me look at or touch their private parts

†††††††††††† (sex organs), or looked at or touched mine

143.   There have been times when I was quite jealous of the good fortune of others

144.   Since age 15, I have physically attacked someone with the idea of seriously hurting them

145.   Terrible things happened to me that made me feel helpless and horrified

146.   I would hate it if my partner paid a lot of attention to someone besides me

147.   When I don't understand what my partner means I ask for more explanation

148.   I wish my partner and I got along better than we do

149.   When my partner and I have problems, I blame him or her

150.   My housing is not satisfactory (e.g., too much noise, heating problems, run-down, problems with

††††††††††††† neighbors)

151.   I would be upset if my partner hugged someone a little too long

152.   My partner and I disagree about when to have sex

153.   I share my thoughts with a family member

154.   I sometimes try to get even rather than forgive and forget

155.   I feel sad quite often

156.   I'd feel jealous if my partner were helpful to someone of the opposite sex

157.   Women are rude

158.   When my partner is nice to me I wonder what my partner wants

159.   I only treat people badly if they deserve it

160.   Before I was 18, another kid in my family did things to me that I now think was sexual abuse

161.   When my partner wants to talk about our problems, I try to avoid talking about them

162.   I have trouble following the rules at work or in school

1 = Strongly Disagree

2 = Disagree

3 = Agree

4 = Strongly Agree

 

163.   I often lie to get what I want

164.   Finding time for meals is hard for me

165.   There have been times when I have felt like rebelling against people in authority even though I knew

††††††††††† they were right

166.   I insist on knowing where my partner is at all times

167.   My partner and I disagree about my friends and family

168.   When I'm mad at my partner, I say what I think without thinking about the consequences

169.   My parents gave me enough clothes to keep me warm

170.   My partner and I disagree about how much money to spend when we go places

171.   Before age 15, I hit or threatened to hit my parents

172.   I say mean things to my partner, but then tell him or her "I'm only kidding"

173.   Before I was 18, another kid who was not part ofmy family did things to me that I now think was

††††††††††† sexual abuse

174.   On a few occasions, I have given up doing something because I have thought too little of my ability

175.   It is sometimes necessary to discipline a child with a good, hard spanking

176.   My mood is always changing

177.   My parents helped me with homework if I needed help

178.   My friends pressure me to do things I donít want to do

179.   I change suddenly from being one kind of person to another

180.   Sometimes I have to remind my partner of whoís boss

181.   There are more bad things than good things in my relationship with my partner

182.   My partner and I disagree about how much time we should spend together

183.   My parents helped me when I had problems

184.   I have considered leaving my partner

185.   Terrible things have happened to me that I remember over and over

186.   Before age 15, I physically attacked someone with the idea of seriously hurting them

187.   I have never deliberately said something that hurt someoneís feelings

188.   Iíve been terrified by things that have happened to me

189.   Iíve told others I will kill myself

190.   I would be upset if someone hugged my partner a little too long

191.   I would hate it if someone else paid a lot of attention to my partner

192.   Before age 15, I stole money (from anyone, including family)

193.   My partner and I have a very good relationship

194.   I have a good social life with my partner

1 = Strongly Disagree

2 = Disagree

3 = Agree

4 = Strongly Agree

 

195.   I feel sorry when I hurt someone

196.   I have thought about killing myself

197.   People at work or school donít get along with me

198.   I have been treated for a drug problem

199.   My partner and I disagree about telling other people about things that happen between us

200.   I would be mad if my partner flirted with someone else

201.   I have bad dreams about terrible things that happened to me

 

PART 3.RELATIONSHIP BEHAVIORS

If you have never been in a relationship that lasted at least one month, skip to Part 4.

 

No matter how well a couple gets along, there are times when they disagree, get annoyed with the other person, want different things from each other, or just have spats or fights because they are in a bad mood, are tired or for some other reason.Couples also have many different ways of trying to settle their differences. This is a list of things that might happen when you have differences.Please mark how many times you did each to these things in the past year, and how many times your partner did them in the past year.If you or your partner did not do one of these things in the past year, but it happened before that, mark a ď7" on your answer sheet for that question. If it never happened, mark an A8" on your answer sheet.

 

How often did this happen?

1 = Once in the past year

2 = Twice in the past year

3 = 3-5 times in the past year

4 = 6-10 times in the past year

5 = 11-20 times in the past year

6 = More than 20 times in the past year

†††††††† 7 = Not in the past year, but it did happen before

†††††††††††††† 8 = This has never happened

 

202.          I showed my partner I cared even though we disagreed†††††††††††

203.          My partner showed care for me even though we disagreed††††††

 

204.          I explained my side of a disagreement to my partner††††††††††††††††††††††

205.          My partner explained his or her side of a disagreement to me††††††††

 

206.          I insulted or swore at my partner††††††††††††††††††††††††††††††††††††††††††††††††††††††

207.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

208.          I threw something at my partner that could hurt †††††††††††††††††††††††

209.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

210.          I twisted my partnerís arm or hair††††††††††††††††††††††††††††††††††††††††††††††††††††

211.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

212.          I had a sprain, bruise, or small cut because of a fight with my partner

213.          My partner had a sprain, bruise, or small cut because of a fight with me

 

How often did this happen?

1 = Once in the past year

2 = Twice in the past year

3 = 3-5 times in the past year

4 = 6-10 times in the past year

5 = 11-20 times in the past year

6 = More than 20 times in the past year

†††††††† 7 = Not in the past year, but it did happen before

†††††††††††††† 8 = This has never happened

 

214.          I showed respect for my partnerís feelings about an issue†††††††

215.          My partner showed respect for my feelings about an issue††††††

 

216.          I made my partner have sex without a condom†† †† †††††††††††††††††††

217.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

218.          I pushed or shoved my partner††††††††††††††††††††††††††††††††††††††††††††††††††††††††

219.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

220.          I used force (like hitting, holding down, or using a weapon) to make my partner have oral or anal ††††††† sex†††††

221.          My partner did this to me

 

222.          I used a knife or gun on my partner††††††††††††††††††††††††††††††††††††††††††††††††††

223.          My partner did this to me†††††††††††††

 

224.          I passed out from being hit on the head by my partner in a fight††††††††††

225.          My partner passed out from a hit on the head in a fight with me††††††††††

 

226.          I called my partner fat or ugly††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

227.          My partner called me fat or ugly†††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

228.          I punched or hit my partner with something that could hurt†††††††

229.          My partner did this to me†††††††††††††††††††††† †††††††††††††††††††††††††††††††††††††††††††

 

230.          I destroyed something belonging to my partner†††††††††††††††††††††††††

231.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

232.          I went to a doctor (M.D.) because of a fight with my partner†††††

233.          My partner went to a doctor (M.D.) because of a fight with me†††††††

 

234.          I choked my partner††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

235.          My partner did this to me

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

236.          I shouted or yelled at my partner††††††††††††††††††††††††††††††††††††††††††††††††††††††

237.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

238.          I slammed my partner against a wall†††††††††††††††††††††††††††††††††††††††††††††††

239.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

240.          I said I was sure we could work out a problem††††††††††††††††††††††††††††††††

241.          My partner was sure we could work it out††††††††††††††††††††††††††††††††††††††††

 

242.          I needed to see a doctor (M.D.) because of a fight with my partner, but I didnít††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

243.          My partner needed to see a doctor (M.D.) because of a fight with me, but didnít††† †††††††††††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††

 

How often did this happen?

1 = Once in the past year

2 = Twice in the past year

3 = 3-5 times in the past year

4 = 6-10 times in the past year

5 = 11-20 times in the past year

6 = More than 20 times in the past year

†††††††† 7 = Not in the past year, but it did happen before

†††††††††††††† 8 = This has never happened

 

244.          I beat up my partner†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

245.          My partner did this to me††††††††††††††††††††††

 

246.          I grabbed my partner††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

247.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

248.          I used force (like hitting, holding down, or using a weapon) to make my partner have sex with me

249.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

250.          I stomped out of the room or house or yard during a disagreement †††

251.          My partner did this to me††††

†††††††††††††††††††††††††††††

252.          I insisted on sex when my partner did not want to (but did not use physical force)

253.          My partner did this to me

††††††††††††††††††††††††††

254.          I slapped my partner†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

255.          My partner did this to me†††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

256.          I had a broken bone from a fight with my partner†††††††††††††††††††††††

257.          My partner had a broken bone from a fight with me ††††††††††††††††††††††††

 

258.          I used threats to make my partner have oral or anal sex†††††††††††††††††

259.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

260.          I suggested a compromise to a disagreement††††††††††††††††††††††††††††††††

261.          My partner suggested a compromise††††††††††††††††††††††††††††††††††††††††††††††

 

262.          I burned or scalded my partner on purpose†††††††††††††††††††††††††††††††††††††

263.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

264.          I insisted my partner have oral or anal sex (but did not use physical force)†††††††††††††††††††††††††††††††††††††††††††

265.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

266.          I accused my partner of being a lousy lover††††††††††††††††††††††††††††††††††††

267.          My partner accused me of this†††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

268.          I did something to spite my partner††††††††††††††††††††††††††††††††††††††††††††††††††††††

269.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

270.          I threatened to hit or throw something at my partner†††††††††††††††††††††††

271.          My partner did this to me

 

272.          I felt physical pain that still hurt the next day because of a fight with my partner††††††††††††††††††††††††

273.          My partner still felt physical pain the next day because of a fight we had†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

How often did this happen?

1 = Once in the past year

2 = Twice in the past year

3 = 3-5 times in the past year

4 = 6-10 times in the past year

5 = 11-20 times in the past year

6 = More than 20 times in the past year

†††††††† 7 = Not in the past year, but it did happen before

†††††††††††††† 8 = This has never happened

 

274.          I kicked my partner†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

275.          My partner kicked me

 

276.          I used threats to make my partner have sex††††††††††††††††††††††††††††††††††††

277.          My partner did this to me††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

278.          I agreed to try a solution to a disagreement my partner suggested ††

279.          My partner agreed to try a solution I suggested

 

280.          If you ever slapped, grabbed, shoved, or hit your partner, or if your partner has ever slapped,††††††††††††† grabbed, shoved, or hit you, who was the first one to do this the last time it happened?

††††††††††††††††††††††† 1 = I hit first†††† 2 = My partner hit first†††††† 3 = This never happened

 

 

 

PART 4

 

SITE CO-INVESTIGATORS: USE THIS SECTION TO ADD UP TO 10 QUESTIONS THAT ARE IMPORTANT FOR YOUR SITE OR YOUR INTERESTS

 

††††††††††† THE 10 QUESTION LIMIT IS NEEDED TO STAY WITHIN THE ONE HOUR TIME

 

  1.  

282.           

283.           

284.           

285.           

286.           

287.           

288.           

289.           

290.           

 

 

THANK YOU VERY MUCH FOR PARTICIPATING IN THIS STUDY