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 peoples’ 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 – 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, and blacken 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 family’s 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 parents’ 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 “partner” and “your partner” 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 partner’s gender?
1 = male
2 = female
14. Is (was) sex a part of your relationship?
1 = no
2 = yes
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 doesn’t 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. I’d 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 can’t 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 don’t think about how what I do will affect other people
62. I give up easily on difficult projects
63. Marriage is forever
64. I don’t like my work or classes
65. Once sex gets past a certain point, a man can’t stop himself until he is satisfied
66. No matter who I am talking to I am always a good listener
67. I don’t 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. It’s all right to break the law as long as you don’t 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 husband’s 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, it’s 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 of a husband slapping a wife’s 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 other’s 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 I’m 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 don’t 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. I’m 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 don’t 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. It’s 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 of my 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 don’t want to do
179. I change suddenly from being one kind of person to another
180. Sometimes I have to remind my partner of who’s 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 someone’s feelings
188. I’ve been terrified by things that have happened to me
189. I’ve 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 don’t 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 “7" 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 partner’s 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 partner’s 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 didn’t
243. My partner needed to see a doctor (M.D.) because of a fight with me, but didn’t
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
THE 10 QUESTION LIMIT IS NEEDED TO STAY WITHIN THE ONE
HOUR TIME