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About You
Q1 What is your Birthday?
DOB
Q5 What is your sex?
Male
2
Female
1
Q9 In your home, do you speak....
Only English
1
Mostly English
2
English and another language equally
3
Mostly another language
4
Only another language
5
I prefer not to answer
-­‐9
Q10 With your friends, do you speak...
Only English
1
Mostly English
2
English and another language equally
3
Mostly another language
4
Only another language
5
I prefer not to answer
-­‐9
Q11 With your parents, guardians or the person who raised you, do you speak...
Only English
1
Mostly English
2
English and another language equally
3
Mostly another language
4
Only another language
5
I prefer not to answer
-­‐9
Q12 What is the Zip Code of the home where you spend most of your time?
Don’t know
888
I prefer not to answer
-­‐9
Tobacco, Alcohol, and Marijuana
Q13 Have you ever tried cigarette smoking, even one or two puffs?
No
1
Yes
2
I prefer not to answer
-­‐9
Q14 During the past 30 days, on how many days did you smoke cigarettes?
0 days
1
1 or 2 days
2
3 to 5 days
3
6 to 9 days
4
10 to 19 days
5
20 to 29 days
6
All 30 days
7
I prefer not to answer
-­‐9
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I prefer not to answer
-­‐9
Q15 During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?
I did not smoke cigarettes in the past 30 days
1
Less than 1 cigarette per day
2
1 cigarette per day
3
2 to 5 cigarettes per day
4
6 to 10 cigarettes per day
5
11 to 20 cigarettes per day
6
More than 20 cigarettes per day
7
I prefer not to answer
-­‐9
Q16 At any time in the next year (12 months), do you think you will smoke a cigarette?
Yes, definitely
1
Maybe yes
2
Maybe no
3
No, definitely not
4
I prefer not to answer
-­‐9
Q17 During your life, on how many days have you had at least one drink of alcohol? (please do not count drinking alcohol for religious purposes
like communion wine)
0 days
1
1 or 2 days
2
3 to 9 days
3
10 to 19 days
4
20 to 39 days
5
40 to 99 days
6
100 or more days
7
I prefer not to answer
-­‐9
Q18 During the past 30 days, on how many days did you have at least one drink of alcohol?
0 days
1
1 or 2 days
2
3 to 5 days
3
6 to 9 days
4
10 to 19 days
5
20 to 29 days
6
All 30 days
7
Q19 During the past 30 days, on how many days did you have five or more drinks of alcohol in a row, that is, within a couple of hours?
0 days
1
1 day
2
2 days
3
3 to 5 days
4
6 to 9 days
5
10 to 19 days
6
20 or more days
7
I prefer not to answer
-­‐9
Q20 At any time in the next year (12 months), do you think you will drink alcohol?
Yes, definitely
1
Maybe yes
2
Maybe no
3
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No, definitely not
4
I prefer not to answer
-­‐9
Q21 At any time in the next year (12 months), do you think you will use marijuana?
Yes, definitely
1
Maybe yes
2
Maybe no
3
No, definitely not
4
I prefer not to answer
-­‐9
Q23 How difficult would it be for you to get marijuana if you wanted some?
Very easy
1
Fairly easy
2
Fairly difficult
3
Very difficult
4
Probably impossible
5
I prefer not to answer
-­‐9
Q24 How difficult would it be for you to get other drugs like methamphetamines if you wanted some?
Very easy
1
Fairly easy
2
Fairly difficult
3
Very difficult
4
Probably impossible
5
I prefer not to answer
-­‐9
Q25 Out of every 100 people your age, how many do you think smoke cigarettes once a month or more?
None of them
1
About 10
2
About 20
3
About 30
4
About 40
5
About 50
6
About 60
7
About 70
8
About 80
9
About 90
10
About 100
11
I prefer not to answer
-­‐9
Q26 Out of every 100 people your age, how many do you think drink alcohol once a month or more?
None of them
1
About 10
2
About 20
3
About 30
4
About 40
5
About 50
6
About 60
7
About 70
8
About 80
9
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About 80
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9
About 90
10
About 100
11
I prefer not to answer
-­‐9
Q27 Out of every 100 people your age, how many do you think smoke marijuana once a month or more?
None of them
1
About 10
2
About 20
3
About 30
4
About 40
5
About 50
6
About 60
7
About 70
8
About 80
9
About 90
10
About 100
11
I prefer not to answer
-­‐9
Q62 Think of your five closest friends... How many of your 5 closest friends smoke cigarettes?
None of them
1
1 or 2 friends
2
3 or 4 friends
3
All 5 friends
4
I prefer not to answer
-­‐9
Q63 How many of your 5 closest friends drink alcohol?
None of them
1
1 or 2 friends
2
3 or 4 friends
3
All 5 friends
4
I prefer not to answer
-­‐9
Q64 How many of your 5 closest friends smoke marijuana?
None of them
1
1 or 2 friends
2
3 or 4 friends
3
All 5 friends
4
I prefer not to answer
-­‐9
Q65 How many of your 5 closest friends do other drugs like meth, cocaine, etc?
None of them
1
1 or 2 friends
2
3 or 4 friends
3
All 5 friends
4
I prefer not to answer
-­‐9
Drugs
Q29 These are more questions about other kinds of drugs. In YOUR LIFETIME, how many times have you ever used....?
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0 times
1 or 2
3 to 9
10 to
20 to
40 or
I prefer not
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0 times
(Never)
1 or 2
times
3 to 9
times
10 to
19
times
20 to
39
times
40 or
more
times
I prefer not
to answer
Q29_1
Marijuana (grass, pot, weed)
1
2
3
4
5
6
-­‐9
Q29_2
Cocaine (including powder, crack, or freebase)
1
2
3
4
5
6
-­‐9
Q29_3
Methamphetamines (speed, crystal, meth, crank, ice)
1
2
3
4
5
6
-­‐9
Q29_4
Ecstasy (MDMA)
1
2
3
4
5
6
-­‐9
Q29_5
Hallucinogens (mushrooms, sherm, or LSD)
1
2
3
4
5
6
-­‐9
Q29_6
Inhalants (glue, paint, or anything that can be huffed)
1
2
3
4
5
6
-­‐9
Q29_7
Prescription drugs without a doctor’s advice (Oxycontin, 1
Ritalin, Xanax, painkillers, etc.)
2
3
4
5
6
-­‐9
Q29_8
Diet pills without a doctor’s advice
1
2
3
4
5
6
-­‐9
Q29_9
Salvia (Spice, Maria Pastora, Sage of the Seers, Diviner's 1
Sage, Sally-­‐D, Magic Mint)
2
3
4
5
6
-­‐9
Q29_10 Bathsalts (MDPV, Ivory wave, Hurricane Charlie, etc.)
1
2
3
4
5
6
-­‐9
Q29_11 A needle to inject any illegal drug into your body
1
2
3
4
5
6
-­‐9
Q29_12 Any other drug that you may have taken without a
doctor’s advice to get "high" or "relax":
1
2
3
4
5
6
-­‐9
Q30 DURING THE PAST 30 DAYS, how many times have you used...?
0 times
(Never)
1 or 2
times
3 to 9
times
10 to 19
times
20 to 39
times
40 or more
times
I prefer not to
answer
Q30_1 Marijuana (grass, pot, weed)
1
2
3
4
5
6
-­‐9
Q30_2 Cocaine (including powder, crack, or
freebase)
1
2
3
4
5
6
-­‐9
Q30_3 Methamphetamines (speed, crystal,
meth, crank. ice)
1
2
3
4
5
6
-­‐9
Q30_4 Ecstasy (MDMA)
1
2
3
4
5
6
-­‐9
Q30_5 Hallucinogens (mushrooms, sherm, or
LSD)
1
2
3
4
5
6
-­‐9
Q30_6 Inhalants (glue, paint, or anything that
can be huffed)
1
2
3
4
5
6
-­‐9
Q31 Please list any other drugs that you have ever used in your lifetime?
320px
240px
Q32 Different things can happen to people while they are drinking ALCOHOL or using DRUGS. WITHIN THE LAST MONTH, how many times have
each of these things happened to you when drinking alcohol or using drugs?
Never
Once or
twice
Sometimes
(3-­‐5 times)
Often (more
than 5 times)
I prefer not
to answer
Q32_1 Got into fights with other people (friends, relatives, strangers)
1
2
3
4
-­‐9
Q32_2 Neglected your responsibilities
1
2
3
4
-­‐9
Q32_3 Felt that you needed more alcohol (or drugs) than you used to in
1
2
3
4
-­‐9
Q32_4 Felt that you had a problem with alcohol or drug use
1
2
3
4
-­‐9
Q32_5 Kept drinking or using drugs even when you promised yourself
not to
1
2
3
4
-­‐9
Q32_6 Felt physically or psychologically dependent on alcohol or drugs
1
2
3
4
-­‐9
Q32_7 Not able to do homework or study for a quiz/test
1
2
3
4
-­‐9
order to get the same effect
My Actions
Q34 During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club?
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0 days
1
1 day
2
2 or 3 days
3
4 or 5 days
4
6 or more days
5
I prefer not to answer
-­‐9
Q35 During the past 12 months, how many times were you in a physical fight?
0 times
1
1 time
2
2 or 3 times
3
4 or 5 times
4
6 or 7 times
5
8 or 9 times
6
10 or 11 times
7
12 or more fights
8
I prefer not to answer
-­‐9
Q106 For the following questions the answer choices are: Within the past month,Between 1 and 6 months ago,Between 6 months and 1 year
ago,Over 1 year ago,Never, or I prefer not to answer.
When was the last time you...
Within the
past month
1 Damaged or destroyed property that
Between 1 and 6
months ago
Between 6 months
and 1 year ago
Over 1
year ago
Never
I prefer
not to
answer
1
2
3
4
5
-­‐9
2 Stole something?
1
2
3
4
5
-­‐9
3 Were detained or arrested by the police?
1
2
3
4
5
-­‐9
4 Were required to appear in court for
something you had done?
1
2
3
4
5
-­‐9
5 Were fired from a job?
1
2
3
4
5
-­‐9
didn’t belong to you?
Sexual Behavior
Q37 The next section asks about personal issues such as your relationships and your sexual behaviors. Please remember that the information
you provide is confidential.
During your lifetime, with how many people have you had sexual intercourse?
None
1
1 person
2
2 people
3
3 people
4
4 people
5
5 people
6
6 or more people
7
I prefer not to answer
-­‐9
Q36 How old were you when you had sexual intercourse for the first time?
I have never had sexual intercourse
1
11 years old or younger
2
12 years old
3
13 years old
4
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13 years old
4
14 years old
5
15 years old
6
16 years old
7
17 years old
8
18 years old
9
19 years old
10
20 years or more
11
I prefer not to answer
-­‐9
Q38 Did you drink alcohol or use drugs before you had sexual intercourse the last time?
Yes
1
No
2
I prefer not to answer
-­‐9
Q39 The last time you had sexual intercourse, did you or your partner use a condom?
Yes
1
No
2
I prefer not to answer
-­‐9
Q90 During the past 3 months, with how many people did you have sexual intercourse?
I have never had sexual intercourse
1
I have had sexual intercourse, but not during the past 3 months
2
1 person
3
2 people
4
3 people
5
4 people
6
5 people
7
6 or more people
8
Don’t know
9
I prefer not to answer
-­‐9
Q91 Thinking about all the times that you have had sexual intercourse in the past three months, how often have you or your sexual partner
used a condom?
Never
1
Less than half the time
2
Half the time
3
More than half the time
4
Every time
5
Don’t know
888
I prefer not to answer
-­‐9
Q92 Some things people do to keep from getting pregnant include not having sex at certain times, using birth control methods such as the pill,
implants, shots, condoms, diaphragm, foam, IUD, having their tubes tied or having a vasectomy. Are you or your partner doing anything now to
keep from getting pregnant?
Yes
1
No
2
No partner/not sexually active
3
Same sex partner
4
Don’t know/Not sure
5
I prefer not to answer
-­‐9
Q93 What are you or your partner doing now to keep (you/her) from getting pregnant
(check all that apply)?
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(check all that apply)?
Not sexually active/Same sex partner
1
Birth control pills, any kind
2
Male condoms
3
Female condoms
4
Contraceptive implant (for example, Implanon)
5
Shots (for example, Depo Provera)
6
Contraceptive ring (for example, Nuvaring)
7
Contraceptive patch (for example, Ortho Evra)
8
Diaphragm, cervical cap, or sponge
9
Foam, jelly or cream
10
IUD (for example, Mirena)
11
Emergency contraceptive (morning after pill)
12
Withdrawal (or pulling out)
13
Tubes tied (or female sterilization)
14
Vasectomy (or male sterilization)
15
Other method. Specify:
16
Don’t Know/Not sure
17
I prefer not to answer
-­‐9
Q94 Are you pregnant now? (Is your partner pregnant now?)
Yes
1
No
2
I Don’t know
3
I prefer not to answer
-­‐9
Q95 Are you (and your partner currently) trying to get pregnant?
Yes
1
No
2
I Don’t know
3
I prefer not to answer
-­‐9
Q99 How many times have you been pregnant in your life?
Don’t know
888
I prefer not to answer
-­‐9
Q100 How many times have you given birth?
Don’t know
888
I prefer not to answer
-­‐9
Q101 To the best of your knowledge, how many times have you ever made someone pregnant?
Don’t know
888
I prefer not to answer
-­‐9
Q102 To the best of your knowledge, how many of these pregnancies resulted in a baby being born?
Don’t know
888
I prefer not to answer
-­‐9
Q104 What is your current marital status?
Married
1
Never been married
2
Not married but living together with a partner
3
Widowed
4
Divorced
5
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Divorced
5
Separated, because you and your spouse are not getting along
6
Don't know
7
I prefer not to answer
-­‐9
Q40 This question is about your sexual identity. Do you consider yourself to be…
Heterosexual or straight
1
Homosexual, gay, or lesbian
2
Bisexual
3
I prefer not to answer
-­‐9
Your Culture
Q41 This section is about your culture or your ethnic background... In this country, people come from many different countries and cultures,
and there are many different words to describe the different backgrounds or ethnic groups that people come from. Some examples of the
names of ethnic groups are : Hispanic or Latino, Black or African American, Asian American, Chinese, Caucasian or White, and many others.
Please fill: In terms of ethnic group, I consider myself to be:
Q42 Please indicate whether you strongly disagree, disagree, agree or strongly agree with the following statements.
Strongly
disagree
Disagree
Agree
Strongly
Agree
I prefer
not to
answer
Q42_1
I have spent time trying to find out more about my ethnic group, such as its
history, traditions, and customs.
1
2
3
4
-­‐9
Q42_2
I am active in organizations or social groups that include mostly members of
my own ethnic group.
1
2
3
4
-­‐9
Q42_3
I have a clear sense of my ethnic background and what it means for me.
1
2
3
4
-­‐9
Q42_4
I think a lot about how my life will be affected by my ethnic group
membership.
1
2
3
4
-­‐9
Q42_5
I am happy that I am a member of the group I belong to.
1
2
3
4
-­‐9
Q42_6
I have a strong sense of belonging to my own ethnic group.
1
2
3
4
-­‐9
Q42_7
I understand pretty well what my ethnic group membership means to me.
1
2
3
4
-­‐9
Q42_8
In order to learn more about my ethnic background, I have often talked to
other people about my ethnic group.
1
2
3
4
-­‐9
Q42_9
I have a lot of pride in my ethnic group.
1
2
3
4
-­‐9
Q42_10 I participitate in cultural practices of my own group, such as special food,
music, or customs.
1
2
3
4
-­‐9
Q42_11 I feel a strong attachment towards my own ethnic group.
1
2
3
4
-­‐9
Q42_12 I feel good about my cultural or ethnic background.
1
2
3
4
-­‐9
Q43 Many people in the United States have ancestors who came from another country. Maybe you and your parents moved to the U.S. Maybe
your parents came to the U.S. when they were kids. Maybe your grandparents were the ones who came to the U.S.
Type the name(s) of the country (or countries) that your family came from:
320px
180px
Q48 When you think about this country…
The United
States
The country my family is
from
Both
Other /
Neither
I prefer not to
answer
1 I am most comfortable being with people from
1
2
3
4
-­‐9
2 My best friends are from
1
2
3
4
-­‐9
3 The people I fit in with best are from
1
2
3
4
-­‐9
4 My favorite music is from
1
2
3
4
-­‐9
5 My favorite TV shows are from
1
2
3
4
-­‐9
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6 The holidays I celebrate are from
1
2
3
4
-­‐9
7 The food I eat at home is from
1
2
3
4
-­‐9
8 The way I do things and the way I think about things 1
are from
2
3
4
-­‐9
Q49 Do you live by or follow....
Strongly disagree
Disagree
Agree
Strongly Agree
I prefer not to answer
Q49_1
The American-­‐Indian way of life
1
2
3
4
-­‐9
Q49_2
The African-­‐American way of life
1
2
3
4
-­‐9
Q49_3
The Asian-­‐American way of life
1
2
3
4
-­‐9
Q49_4
The White-­‐American way of life
1
2
3
4
-­‐9
Q49_5
The Latino or Hispanic way of life
1
2
3
4
-­‐9
Q51 For these statements you can select: not at all, very little, moderately, very much or almost always.
Not
at all
Very little/ Not
very much
Moderately
Very much/
Very often
Almost always/
Extremely often
I prefer not to
answer
1
I speak Spanish
1
2
3
4
5
-­‐9
2
I speak English
1
2
3
4
5
-­‐9
3
I enjoy speaking Spanish
1
2
3
4
5
-­‐9
4
I associate with Anglos or
Whites
1
2
3
4
5
-­‐9
5
I enjoy English language movies
1
2
3
4
5
-­‐9
6
I enjoy listening to English
language music
1
2
3
4
5
-­‐9
7
I enjoy Spanish language TV
1
2
3
4
5
-­‐9
8
I enjoy Spanish language movies 1
2
3
4
5
-­‐9
9
I enjoy reading books in Spanish 1
2
3
4
5
-­‐9
10 I write letters in English
1
2
3
4
5
-­‐9
11 My thinking is done in the
English language
1
2
3
4
5
-­‐9
12 My thinking is done in Spanish
language
1
2
3
4
5
-­‐9
13 My friends are of Anglo or White 1
origin
2
3
4
5
-­‐9
Family Communications
Q56 How often do you talk to your parents about what's on your mind?
Never
1
Hardly ever
2
Sometimes
3
Very often
4
I prefer not to answer
-­‐9
Q57 How often do you ask your parents for advice?
Never
1
Hardly ever
2
Sometimes
3
Very often
4
I prefer not to answer
-­‐9
Q58 How often do you tell your parents your secrets?
Never
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Never
1
Hardly ever
2
Sometimes
3
Very often
4
I prefer not to answer
-­‐9
Q59 If you had a problem, would you be able to talk to your parents about it?
Definitely no
1
Probably no
2
Probably yes
3
Definitely yes
4
I prefer not to answer
-­‐9
Culture & Immigration
Q60 Sometimes people feel that they are treated differently because of their ethnic or cultural background. How do people treat you?
Never
Rarely
Sometimes
Often
I prefer not to answer
Q60_1
You are treated with less respect than other people.
1
2
3
4
-­‐9
Q60_2
You are treated with less courtesy than other people.
1
2
3
4
-­‐9
Q60_3
People act as if they think you’re not smart.
1
2
3
4
-­‐9
Q60_4
People act as if they are better than you.
1
2
3
4
-­‐9
Q60_5
You receive poorer service than other people at restaurants or stores.
1
2
3
4
-­‐9
Q60_6
People ignore you or act as if you are not there.
1
2
3
4
-­‐9
Q60_7
You are threatened or harassed.
1
2
3
4
-­‐9
Q60_8
You or your family members are called names or insulted.
1
2
3
4
-­‐9
Q60_9
People act as if they think you are dishonest.
1
2
3
4
-­‐9
1
2
3
4
-­‐9
Q60_10 People act as if they are afraid of you.
Relationships
Q107 The following questions are about relationships with your partner, please remember all of your answers are confidential.
How often does your partner?
I don't have a partner
Never
Rarely
Sometimes
Fairly
Frequently
I prefer not to answer
1 Physically hurt you
0
1
2
3
4
5
-­‐9
2 Insult or talk down to you
0
1
2
3
4
5
-­‐9
3 Threaten you with harm
0
1
2
3
4
5
-­‐9
4 Scream or curse at you
0
1
2
3
4
5
-­‐9
Personal Experiences
Q108
The next set of questions will be about events that may have happened to you while growing up in the first 18 years of life. Some of these
experiences are very personal so please remember your answers are completely confidential. You can skip any question that you do not want to
answer.
At the end of the survey there is contact information for hotlines that you can call if you´d like to talk with a trained professional about these
experiences. Are you ready to continue with these questions?
These questions are about your personal experiences with your parents during the first 18 years of life. Please remember all of your answers are
completely confidential.
never
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once
or
twice
sometimes
often
very
often
I
prefer
not to
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twice
not to
answer
1 While you were growing up, that is, in your first 18 years of life, how often did a parent, 1
stepparent, or adult living in your home swear at you, insult you, or put you down?
2
3
4
5
-­‐9
2 While you were growing up, that is, in your first 18 years of life, how often did a parent, 1
stepparent, or adult living in your home threaten to hit you or throw something at you,
but didn’t do it?
2
3
4
5
-­‐9
Q109 Sometimes parents or other adults hurt children. While you were growing up, that is, in your first 18 years of life, how often did a parent,
stepparent, or adult living in your home:
never
once or twice
sometimes
often
very often
I prefer not to answer
1 Push, grab, slap, or throw something at you?
1
2
3
4
5
-­‐9
2 Hit you so hard that you had marks or were injured?
1
2
3
4
5
-­‐9
Q111 Sometimes physical blows occur between parents. While you were growing up in your first 18 years of life, how often did your father (or
stepfather) or mother’s boyfriend do any of these things to your mother (or stepmother):
never
once or
twice
sometimes
often
very
often
I prefer not to
answer
1 ...push, grab, slap, or throw something at her?
1
2
3
4
5
-­‐9
2 ...kick, bite, hit her with a fist, or hit her with something hard?
1
2
3
4
5
-­‐9
3 ...repeatedly hit her over at least a few minutes?
1
2
3
4
5
-­‐9
4 ...threaten her with a knife or gun, or use a knife or gun to hurt 1
her?
2
3
4
5
-­‐9
Q112 Please answer the questions below.
Yes
No
I prefer not to answer
1 During your first 18 years of life, did you live with anyone who was a problem drinker or alcoholic?
1
2
-­‐9
2 During your first 18 years of life, did you live with anyone who used street drugs?
1
2
-­‐9
Yes
No
Q113 Please answer the questions below.
I prefer not to answer
1 During your first 18 years of life, was anyone in your household depressed or mentally ill?
1
2
-­‐9
2 During your first 18 years of life, did anyone in your household attempt to commit suicide?
1
2
-­‐9
Q114 Were your parents ever separated or divorced?
yes
1
no
2
I prefer not to answer
-­‐9
Q115 While you were growing up, that is, in your first 18 years of life, did anyone in your household go to prison?
yes
1
no
2
I prefer not to answer
-­‐9
Q110
Some people, while they are growing up in their first 18 years of life, had a sexual experience with an adult or someone at least 5 years older
than themselves. These experiences may have involved a relative, family friend, or stranger. Please remember your answers are completely
confidential. During the first 18 years of life, did an adult, relative, family friend, or stranger ever...
Yes
No
I prefer not to answer
1 ...touch or fondle your body in a sexual way?
1
2
-­‐9
2 ...have you touch their body in a sexual way?
1
2
-­‐9
3 ...attempt to have any type of sexual intercourse with you (oral, anal, or vaginal)?
1
2
-­‐9
4 ...actually have any type of sexual intercourse with you (oral, anal, or vaginal)?
1
2
-­‐9
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Emerging Adulthood
Q66 Please think about this time in your life. By “time in your life,” we are referring to the present time, plus the last few years that have gone
by, and the next few years to come, as you see them. In short, you should think about a roughly five-­‐year period, with the present time right in
the middle.
Is this time in your life a…
Strongly
disagree
Somewhat
disagree
Agree
Strongly
Agree
I prefer not to
answer
1
time of many possibilities?
1
2
3
4
5
2
time of exploration?
1
2
3
4
5
3
time of confusion?
1
2
3
4
5
4
time of experimentation?
1
2
3
4
5
5
time of personal freedom?
1
2
3
4
5
6
time of feeling restricted?
1
2
3
4
5
7
time of responsibility for yourself?
1
2
3
4
5
8
time of feeling stressed out?
1
2
3
4
5
9
time of instability?
1
2
3
4
5
10 time of optimism?
1
2
3
4
5
11 time of high pressure?
1
2
3
4
5
12 time of finding out who you are?
1
2
3
4
5
13 time of settling down?
1
2
3
4
5
14 time of responsibility for others?
1
2
3
4
5
15 time of independence?
1
2
3
4
5
16 time of open choices?
1
2
3
4
5
17 time of unpredictability?
1
2
3
4
5
18 time of commitment to others?
1
2
3
4
5
19 time of self-­‐sufficiency?
1
2
3
4
5
20 time of many worries?
1
2
3
4
5
21 time of trying out new things?
1
2
3
4
5
22 time of focusing on yourself?
1
2
3
4
5
23 time of separating from parents?
1
2
3
4
5
24 time of defining yourself?
1
2
3
4
5
25 time of planning for the future?
1
2
3
4
5
26 time of seeking a sense of meaning?
1
2
3
4
5
27 time of deciding on your own beliefs and values?
1
2
3
4
5
28 time of learning to think for yourself?
1
2
3
4
5
29 time of feeling adult in some ways but not in others?
1
2
3
4
5
30 time of gradually becoming an adult?
1
2
3
4
5
31 time of being not sure whether you have reached full
adulthood?
1
2
3
4
5
Q67 For these next questions, tell me how true each statement is for you.
Are you financially independent from your parents?
Yes
1
No
2
I prefer not to answer
-­‐9
Q68 Do you live with your parents?
Yes
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No
2
I prefer not to answer
-­‐9
Q69 Are you done with your education?
Yes
1
No
2
I prefer not to answer
-­‐9
Q70 Have you settled into a long-­‐term career?
Yes
1
No
2
I prefer not to answer
-­‐9
Q73 Are you employed full-­‐time?
Yes
1
No
2
I prefer not to answer
-­‐9
Q74 Have you served in the military?
Yes
1
No
2
I prefer not to answer
-­‐9
Your Feelings
Q75 These next questions are about how you have felt in the past week. You can answer that you felt a certain way, almost every day, 5 to 7
days, most days 3 to 4 days, some days like 1 or 2 days, or never/less than one day. IN THE PAST WEEK…
Less than 1 day or never
1-­‐2 days
3-­‐4 days
5-­‐7 days
I prefer not to answer
1
I felt depressed.
1
2
3
4
-­‐9
2
I felt that everything I did was difficult.
1
2
3
4
-­‐9
3
I felt fearful.
1
2
3
4
-­‐9
4
I didn't sleep well.
1
2
3
4
-­‐9
5
I was happy.
1
2
3
4
-­‐9
6
I felt lonely.
1
2
3
4
-­‐9
7
People were unfriendly.
1
2
3
4
-­‐9
8
I enjoyed life.
1
2
3
4
-­‐9
9
I felt sad.
1
2
3
4
-­‐9
10 I felt people disliked me.
1
2
3
4
-­‐9
11 I could not "get going".
1
2
3
4
-­‐9
Almost
never
Sometimes
Q76 In the last month, how often have you...
Never
Fairly
often
Very
often
I prefer not to
answer
Q76_1 Been upset because of something that happened
unexpectedly?
1
2
3
4
5
-­‐9
Q76_2 Felt that you were unable to control the important things in
your life?
1
2
3
4
5
-­‐9
Q76_3 Felt nervous and "stressed"?
1
2
3
4
5
-­‐9
Q76_4 Felt confident about your ability to handle your personal
problems?
1
2
3
4
5
-­‐9
Q76_5 Found that you could not cope with all of the things that you
had to do?
1
2
3
4
5
-­‐9
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Q76_6 Been able to control the irritations in your life?
1
2
3
4
5
-­‐9
Q76_7 Felt that you were on top of things?
1
2
3
4
5
-­‐9
Q76_8 Been angered because of things that were outside of your
control?
1
2
3
4
5
-­‐9
Q76_9 Felt difficulties were piling up so high that you could not
overcome them?
1
2
3
4
5
-­‐9
Beliefs and Values
Q77 This section is about your opinions... ABOUT FAMILY…
Definitely
No
Probably
No
Probably
Yes
Definitely
Yes
I prefer not to
answer
1 If one of my relatives needed a place to stay for a few months, my family
would let them stay with us.
1
2
3
4
-­‐9
2 I expect my relatives to help me when I need them.
1
2
3
4
-­‐9
3 When a family makes an important decision, they should talk about it with
their close relatives.
1
2
3
4
-­‐9
4 If anyone in my family needed help, we would all be there to help them.
1
2
3
4
-­‐9
Q78 ABOUT PARENTS...
Definitely
No
Probably
No
Probably
Yes
Definitely
Yes
I prefer not to
answer
1 I will take care of my parents when they are old.
1
2
3
4
-­‐9
2 It is important to honor my parents.
1
2
3
4
-­‐9
3 It is important to respect my parents.
1
2
3
4
-­‐9
4 I want to be a good person so that people know that my parents
raised me well.
1
2
3
4
-­‐9
Q79 ABOUT LIFE…
Definitely
No
Probably
No
Probably
Yes
Definitely
Yes
I prefer not to
answer
1 It's more important to enjoy life now than to plan for the future.
1
2
3
4
-­‐9
2 People can't really do much to change what happens in life. You just
have to accept things.
1
2
3
4
-­‐9
3 I live for today because I don't know what will happen in the future.
1
2
3
4
-­‐9
4 I don't plan ahead because most things in life are a matter of luck.
1
2
3
4
-­‐9
Q80 Do you feel like you have reached adulthood?
Yes
1
No
2
In some ways yes, in some ways no
3
I prefer not to answer
-­‐9
Residential Mobility
Q82 How often have you moved in the last 12 months?
0 times
1
1 time
2
2 times
3
3 times
4
More than 3 times
5
I prefer not to answer
-­‐9
Q83 Please select all the places where you have ever lived. (Select all that apply)
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Q83 Please select all the places where you have ever lived. (Select all that apply)
Parents’ home or apartment
1
Own home
2
Own apartment
3
Dorm
4
Military housing
5
An apartment or home with roommates
6
An apartment or home with a boyfriend or girlfriend
7
An apartment or home with my wife or husband
8
Other
9
I prefer not to answer
-­‐9
Q84 Where do you live most of the time?
Parents home
1
Alone in an apartment
2
With roommates in an apartment
3
In a dorm
4
Other
5
I prefer not to answer
-­‐9
Role Transitions
Q85 Has this happened to you in the last year?
Yes
No
I prefer not to answer
1
Started a new romantic relationship
1
2
-­‐9
2
Got engaged
1
2
-­‐9
3
Moved in with boyfriend or girlfriend
1
2
-­‐9
4
Broke up with boyfriend or girlfriend
1
2
-­‐9
5
Had a baby
1
2
-­‐9
6
Got a new job
1
2
-­‐9
7
You were unemployed, seeking work but unable to find it
1
2
-­‐9
8
Started college or new school or classes
1
2
-­‐9
9
Had to care for a parent or relative
1
2
-­‐9
10
Had to baby sit siblings or family members
1
2
-­‐9
11
Got extremely ill
1
2
-­‐9
Q86 Have any of these other things happened to you in the last year?
Yes
No
I prefer not to answer
1 Lost your home
1
2
-­‐9
2 Family separated because of immigration issues
1
2
-­‐9
3 Had to move in with or had family move in with you because of money
1
2
-­‐9
4 Couldn't afford to go to the doctor
1
2
-­‐9
5 Waited or avoided going to the doctor because of money worries
1
2
-­‐9
Your financial position
Q87 Do you own a home or condo in your name or rent from a landlord?
Own
1
Rent
2
I dont know
3
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I dont know
3
I prefer not to answer
-­‐9
Q88 Do your parents own a home or condo or rent from a landlord?
Own
1
Rent
2
I dont know
3
I prefer not to answer
-­‐9
Q89 Imagine a ladder that represents where people stand in the US. At the very top of the ladder are the people who are the best off, have the
most money, the best education and the most respected jobs. At the bottom are the people who are the worst off , have the least money, the
worst education and the least respected jobs or no job. Where would you place yourself?
At the very top of the ladder
1
Just below the top of the ladder
2
Just above the middle of the ladder
3
The middle of the ladder
4
Just below the middle of the ladder
5
Just above the very bottom of the ladder
6
At the bottom of the ladder
7
I prefer not to answer
-­‐9
Comments
Q116 (Optional) Comments /Suggestions
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End
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