Wave 2 Survey instrument

Study of Community Family Life

Wave 2 Questionnaire

Conducted as part of the Evaluation of the

Community Healthy Marriage Initiative

Sponsored by

Administration for Children and Families

U.S. Department of Health and Human Services

Prepared by

RTI International and The Urban Institute

CONTENTS

Section Page

A Introduction and Household Composition A-1

B Awareness of Media Messages and Services B-1

C Relationship Status and Attitudes C-1

D Receipt of Services D-1

E Social Ties E-1

F Relationship Quality F-1

G Child Well-Being G-1

H Respondent Characteristics and Background H-1

I Spouse/Partner Characteristics and Background I-1

J Non-Resident Parent Characteristics and Background J -1

K Household Self-Sufficiency K-1

L Conclusion L-1

INTRODUCTION

S1. IS THE RESPONDENT A PARTICIPANT OR A CONTINUING RESPONDENT?

PARTICIPANT	1	USE SCREENER TWO
CONTINUING	2	USE SCREENER ONE

SCREENER ONE (FOR CONTINUING RESPONDENTS)

SC1. Hello, my name is _____ from RTI International in North Carolina. I’d like to speak with [RESPONDENT] regarding a research study s/he helped us complete in 2007 or 2008. Is s/he available?

IF GATEKEEPER WANTS MORE INFORMATION, PROVIDE LIMITED DETAILS AS NEEDED

YES	1	GO TO SC2 and SPEAK WITH R
NO	2	GO TO SC1a
R MOVED/ NO LONGER AT ADDRESS	3	GO TO SC5

SC1a. IF UNAVAILABLE: I understand. When is a good time to catch [RESPONDENT]?

FI: ATTEMPT TO DETERMINE THE BEST WAY REACH RESPONDENT, THANK PERSON AND TERMINATE. RETURN AT APPROPRIATE DAY AND TIME.

SC2. IF AVAILABLE:

FI: ONCE YOU ARE SPEAKING WITH RESPONDENT, PROCEED.

(IF NECESSARY: Hello, my name is _____ from RTI International in North Carolina.)

You may recall speaking with us about a year ago. We conducted an interview with you on behalf of the U.S. Department of Health and Human Services, Administration for Children and Families. We asked you questions about your community, family relationships, and your opinions and attitudes. Do you remember helping us with this study?

YES	1	GO TO SC3
NO	2	GO TO SC2a

SC2a. IF R DOES NOT RECALL INTERVIEW:

FI: PROVIDE SOME ADDITIONAL INFORMATION ABOUT THE INTERVIEW TO REFRESH HIS/HER MEMORY. ATTEMPT TO ADDRESS CONCERNS OR QUESTIONS, THEN CONTINUE WITH VERIFICATION QUESTIONS BELOW:

INTERVIEWER: IS CURRENT ADDRESS THE SAME AS ADDRESS IN ROUND 1 BELOW:

<PRE-LOADED ADDRESS FROM ROUND 1>

YES, ADDRESSES ARE SAME	1	GO TO SC4
NO, ADDRESSES ARE DIFFERENT	2	GO TO SC2b

SC2b. I just need to verify that I’m speaking with the correct person. What is your date of birth?

INTERVIEWER: RECORD DOB MM/DD/YYYY

_____/_____/__________

CONTINUE

INTERVIEWER: DOES THE DOB YOU JUST RECORDED MATCH THE DOB FROM ROUND 1 BELOW:

<PRE-LOADED DOB FROM ROUND 1>

YES, DATES ARE SAME	1	GO TO SC4
NO, DATES ARE DIFFERENT	2	GO TO SC2c

SC2c. Could you please tell me the name of the street you lived on when we first interviewed you in <MONTH, YEAR OF ROUND 1 INTERVIEW>?

INTERVIEWER: RECORD STREET NAME

_____/_____/__________

CONTINUE

INTERVIEWER: DOES THE STREET NAME MATCH THE STREET NAME FROM ROUND 1 BELOW:

<PRE-LOADED STREET NAME FROM ROUND 1>

YES, STREETS ARE SAME	1	GO TO SC4
NO, STREETS ARE DIFFERENT	2	GO TO SC2d

SC2d. I’m sorry, I need to check my records before we can continue. What is the best time to reach you in the future?

RECORD TIME, THANK PERSON AND TERMINATE.

SC3. IF R RECALLS INTERVIEW:

As you may recall, we mentioned at the time that you might be selected for another interview in 18 months or so, and we are now beginning to conduct those follow-up interviews.

INTERVIEWER: IS CURRENT ADDRESS THE SAME AS ADDRESS IN ROUND 1 BELOW:

<PRE-LOADED ADDRESS FROM ROUND 1>

YES, ADDRESSES ARE SAME	1	GO TO SC4
NO, ADDRESSES ARE DIFFERENT	2	GO TO SC3a

SC3a. I just need to verify that I’m speaking with the correct person. What is your date of birth?

INTERVIEWER: RECORD DOB MM/DD/YYYY

_____/_____/__________

CONTINUE

INTERVIEWER: DOES THE DOB YOU JUST RECORDED MATCH THE DOB FROM ROUND 1 BELOW:

<PRE-LOADED DOB FROM ROUND 1>

YES, DATES ARE SAME	1	GO TO SC4
NO, DATES ARE DIFFERENT	2	GO TO SC3b

SC3b. Could you please tell me the name of the street you lived on when we first interviewed you in <MONTH, YEAR OF ROUND 1 INTERVIEW>?

INTERVIEWER: RECORD STREET NAME

_____/_____/__________

CONTINUE

INTERVIEWER: DOES THE STREET NAME MATCH THE STREET NAME FROM ROUND 1 BELOW:

<PRE-LOADED STREET NAME FROM ROUND 1>

YES, STREETS ARE SAME	1	GO TO SC4
NO, STREETS ARE DIFFERENT	2	GO TO SC3c

SC3c. I’m sorry, I need to check my records before we can continue. What is the best time to reach you in the future?

RECORD TIME, THANK PERSON AND TERMINATE.

SC4. We are asking for your help by participating in this important follow-up survey about family life in this community. Here is some information to remind you what the study is all about. HAND R COPY OF ROUND 2 LETTER/ BROCHURE.

As I said, this interview consists of questions about your community, relationships, and your opinions and attitudes. It will take about 45 minutes, and upon completion you will receive $25 for your participation.

Before we start the actual interview, I will provide you with some additional information that may help you decide whether or not you would like to participate.

I’d like to begin now, if possible. Is there a quiet place where I can set up?

FI: IF R IS NOT AVAILABLE AT THAT TIME, MAKE APPOINTMENT. OTHERWISE, PROCEED.

SC5. IF R HAS MOVED: I understand. Do you happen to have any contact information for [RESPONDENT]? Any details would be very helpful.

FI: RECORD ANY NEW CONTACT INFORMATION. PROBE FOR DETAILS. WHEN DONE, THANK PERSON AND TERMINATE.

CONTINUE TO SECTION A

SCREENER TWO (FOR PARTICIPANTS)

SC1. Hello, my name is _____ from RTI International in North Carolina. I’d like to speak with [PARTICIPANT]. Is s/he available?

IF GATEKEEPER ASKS FOR MORE INFORMATION: We are in your neighborhood conducting a study for the Administration for Children and Families. You should have received a letter explaining the study. We are asking for your help by participating in an important survey about family life in this community. [PARTICIPANT] has been randomly selected to participate. HAND R COPY OF LETTER/ BROCHURE IF NEEDED.

YES	1	GO TO SC2 and SPEAK WITH R
NO	2	GO TO SC1a
R MOVED/ NO LONGER AT ADDRESS	3	GO TO SC4

SC1a. IF UNAVAILABLE: I understand. When is a good time to catch [PARTICIPANT]?

FI: ATTEMPT TO DETERMINE THE BEST WAY REACH PARTICIPANT, THANK PERSON AND TERMINATE. RETURN AT APPROPRIATE DAY AND TIME.

SC2. IF AVAILABLE:

FI: ONCE YOU ARE SPEAKING WITH PARTICIPANT, PROCEED.

(IF NECESSARY: Hello, my name is _____ from RTI International in North Carolina.)

I’m conducting a study on behalf of the Administration for Children and Families about family life in your community. Your name was randomly selected from a list of people who recently attended classes on marriage and family relationships.

INTERVIEWER: DOES CURRENT ADDRESS MATCH THE ADDRESS LISTED BELOW:

<PRE-LOADED ADDRESS>

YES, ADDRESSES ARE THE SAME	1	GO TO SC3
NO, ADDRESSES ARE DIFFERENT	2	GO TO SC2a

SC2a. I just need to verify that I am speaking to the correct person. What is your date of birth?

INTERVIEWER: RECORD DOB MM/DD/YYYY

_____/_____/__________

CONTINUE

INTERVIEWER: DOES THE DOB YOU JUST RECORDED MATCH THE DOB 1 BELOW:

<PRE-LOADED DOB FROM LIST>

YES, DATES ARE SAME	1	GO TO SC3
NO, DATES ARE DIFFERENT	2	GO TO SC2b
NO PRE-LOADED DOB PROVIDED	3	GO TO SC2b

SC2b. Have you ever lived at:

<PRE-LOADED ADDRESS FROM LIST>

YES	1	GO TO SC3
NO	2	GO TO SC2c
DK	d	GO TO SC2c
REF	r	GO TO SC2c

SC2c. I’m sorry, but I need to check my record before I can continue. What is the best time to reach you in the future?

RECORD TIME, THANK PERSON AND TERMINATE.

SC3. Here is some information on what the study is all about. HAND R COPY OF ROUND 2 LETTER/ BROCHURE.

This interview consists of questions about your community, family relationships, and your opinions and attitudes. It will take about 45 minutes, and upon completion you will receive $25 for your participation.

Before we start the actual interview, I will provide you with some additional information that may help you decide whether or not you would like to participate.

I’d like to begin now, if possible. Is there a quiet place where I can set up?

FI: IF R IS NOT AVAILABLE AT THAT TIME, MAKE APPOINTMENT. OTHERWISE, PROCEED.

SC4. IF R HAS MOVED: I understand. Do you happen to have any contact information for [PARTICIPANT]? Any details would be very helpful.

FI: RECORD ANY NEW CONTACT INFORMATION. PROBE FOR DETAILS. WHEN DONE, THANK PERSON AND TERMINATE.

CONTINUE TO SECTION A

A. HOUSEHOLD COMPOSITION

A1. INTERVIEWER: ONCE YOU HAVE SET UP FOR THE INTERVIEW, LOOK AROUND YOU IN ALL DIRECTIONS. ARE YOU OUT OF EARSHOT OF OTHER PEOPLE INCLUDING PEOPLE WHO MAY BE IN AN ADJACENT ROOM OR OUTSIDE?

FOR AN INTERVIEW SETTING TO BE CONSIDERED PRIVATE, YOU MUST BE CERTAIN THAT THE QUESTIONS YOU READ AND THE PARTICIPANT’S ANSWERS CANNOT BE: (1) OVERHEARD, OR (2) ASCERTAINED BY SOMEONE LOOKING THROUGH A WINDOW. ARE YOU CONFIDENT THE INTERVIEW SETTING IS PRIVATE?

YES	1	A3
NO	2	A2

A2. INTERVIEWER: BECAUSE YOU HAVE INDICATED THE INTERVIEW SETTING IS NOT PRIVATE, YOU CANNOT PROCEED WITH THE INTERVIEW. YOU WILL NEED TO BREAK-OFF THE INTERVIEW AND RESCHEDULE FOR A TIME WHEN YOU CAN CONDUCT THE INTERVIEW IN PRIVATE.

A3. INTERVIEWER: HAND R INTERVIEW CONSENT FORM.

SAY: As I said, I would like to start by explaining the study and what we are asking you to do. This document is called a consent form, and I’m going to read it out loud to you. After I’m done reading it, I will answer any questions you may have.

A4. INTERVIEWER: READ THE CONSENT FORM TO THE PARTICIPANT.

IF R AGREES TO PARTICIPATE IN THE INTERVIEW, ACKNOWLEDGE AGREEMENT BELOW. GIVE R AN UNSIGNED COPY OF THE INTERVIEW CONSENT FORM.

R CONSENTED TO THE INTERVIEW	1	A5
R REFUSED THE INTERVIEW	2	A4rf

A4rf. YOU MAY NOT PROCEED WITH THE INTERVIEW BECAUSE YOU HAVE INDICATED THAT THE R DID NOT GIVE CONSENT. IF THE R IS WILLING TO DO THE INTERVIEW AT A LATER TIME, SET A NEW APPOINTMENT. IF NOT, CONSULT WITH YOUR FS REGARDING REFUSAL CONVERSION.

A5. I need to begin by asking some questions about the current status of your household. In total, how many people live in this household, including yourself? Please include children and anyone who spends at least 3 nights a week here.

NUMBER IN HOUSEHOLD	|___|___|
DK	d
REF	r

IF MORE THAN 9 RESIDENTS:

A6. Are all of these people related?

YES	1	C5
NO	2	THANK R AND CODE 141 – GROUP QUARTERS
DK	d
REF	r

A7. How many of the people living in this household are male?

MALES IN HOUSEHOLD	|___|___|
DK	d
REF	r

A8. How many are female?

FEMALES IN HOUSEHOLD	|___|___|
DK	d
REF	r

INTERVIEWER: CHECK THAT THE NUMBER OF MALES AND FEMALES EQUAL THE TOTAL IN A1. IF NOT, REVIEW WITH PARTICIPANT.

A9. I need to make a list of the people who live here. Because households are different, this information will help me to know which questions apply to you.

INTERVIEWER: RECORD RESULTS FROM A10 AND A11 IN THE ROSTER

A10. IF MALES IN HOUSEHOLD: What are the ages, from oldest to youngest, of all the males who live here? IF INFORMANT IS MALE: Please remember to include yourself.

IF LESS THAN ONE YEAR, CODE “00”

A11. IF FEMALES IN HOUSEHOLD: What are the ages, from oldest to youngest, of the females who live here? IF INFORMANT IS FEMALE: Please remember to include yourself.

IF LESS THAN ONE YEAR, CODE “00”

INTERVIEWER: REPEAT A12-A13 FOR EACH HOUSEHOLD MEMBER LISTED IN THE ROSTER

A12. What is the first name of the (GENDER) who is (AGE)? I just need to have a way of referring to (him/her).

PROBE: Initials are fine.

A13. How is (NAME) related to you? USE RELATIONSHIP CODES PROVIDED WITH ROSTER.

ROSTER

A	B	C	D	E
Roster number (WILL FILL)	Gender	Age	First Name (RECORD FIRST NAME OR INITIALS)	Relationship (Enter Code)
1	|__|	|__|__|		|__|__|
2	|__|	|__|__|		|__|__|
3	|__|	|__|__|		|__|__|
4	|__|	|__|__|		|__|__|
5	|__|	|__|__|		|__|__|
6	|__|	|__|__|		|__|__|
7	|__|	|__|__|		|__|__|
8	|__|	|__|__|		|__|__|
9	|__|	|__|__|		|__|__|
10	|__|	|__|__|		|__|__|
11	|__|	|__|__|		|__|__|
12	|__|	|__|__|		|__|__|

Relationship codes:

1. SPOUSE 11 BROTHER/ SISTER

2. PARTNER (BOY/GIRLFRIEND) 12 AUNT/ UNCLE

3. PARTICIPANT’S MOTHER 13 COUSIN

4. PARTICIPANT’S FATHER 14 GRANDMOTHER

5. PARENT-IN-LAW 15 GRANDFATHER

6. BIOLOGICAL OR ADOPTED CHILD 16 SON-IN-LAW/ DAUGHTER-IN-LAW

7. STEPCHILD 17 NOT-RELATED ADULT

8. FOSTER CHILD 18 NOT RELATED CHILD

9. GRANDCHILD 19 OTHER (SPECIFY) ____________

10. NIECE/NEPHEW

A14. I have listed...

INTERVIEWER: READ AGES AND GENDERS FROM ROSTER (E.G. MALE WHO IS 45)

REVIEW ROSTER FOR ACCURACY AND COMPLETENESS. MAKE NECESSARY CORRECTIONS.

A15. Is there anyone living at this address whom I have NOT listed?

PROBE: Do not include anyone who sleeps here less than three nights a week.

YES	1	ADD PERSON TO ROSTER
NO	2
DK	d
REF	r

A16. Just to confirm, is this primary place of residence for everyone I have listed? That is, do all of them sleep here at least three nights a week?

YES	1
NO	2	EACH INDIVIDUAL FOR WHOM THIS IS NOT THE PRIMARY RESIDENCE SHOULD BE REMOVED FROM THE ROSTER
DK	d
REF	r

A17. We are using a special quality control system on this project. The system runs on the computer and may record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work. The recordings will be used only for those purposes, and will be kept confidential. May we use this quality control system during your interview?

R CONSENTED TO CARI	1	CONTINUE
R REFUSED CARI	2	DISABLE CARI AND CONTINUE

Created

IF SPOUSE OR PARTNER IS THE SAME SEX AS PARTICIPANT:

A18. Just to confirm, are you involved in a romantic relationship with (SPOUSE/PARTNER)?

YES	1
NO	2	INTERVIEWER: RETURN TO GRID AND CORRECT RELATIONSHIP CODE
DK	d
RF	r

Created

A19. IF SPOUSE/PARTNER PRESENT IN HOUSEHOLD AND IF NUMBER OF PEOPLE IN HOUSEHOLD AGE 16+ =>4: Besides you and (SPOUSE/PARTNER), are any of the people in this household married to each other or living together in a romantic relationship?

IF SPOUSE/PARTNER NOT PRESENT IN HOUSEHOLD AND IF NUMBER OF PEOPLE IN HOUSEHOLD AGE 16+ =>3: Are any of the people in this household married to each other or living together in a romantic relationship?

YES	1
NO	2	Section B
DK	d
RF	r

Created

A20. How many (other) couples are living in this household?

NUMBER OF COUPLES	|___|___|
DK	d
RF	r

B. AWARENESS OF MEDIA MESSAGES AND SERVICES

ATS

B1. This set of questions is about how you get information. In the past 30 days, about how often have you watched television? Would you say…

Every day	1
4-6 times a week	2
2-3 times a week	3
Once a week	4
Less than once a week, or	5
Never	6
DK	d
RF	r

Created

B2. In the past 30 days, about how often have you listened to the radio? Would you say…

Every day	1
4-6 times a week	2
2-3 times a week	3
Once a week	4
Less than once a week, or	5
Never	6
DK	d
RF	r

ATS

B3. In the past 30 days, about how often have you read a newspaper? Would you say…

Every day	1
4-6 times a week	2
2-3 times a week	3
Once a week	4
Less than once a week, or	5
Never	6
DK	d
RF	r

B4. Have you ever heard of (ANY OF THE FOLLOWING/THE FOLLOWING) organization(s) in your community?

		YES	NO	DK	RF
A	IF SITE = MILWAUKEE Center for Self Sufficiency: The Milwaukee Marriage Partnership	1	2	d	r
B	IF SITE = ST. LOUIS Better Family Life: Healthy Marriage Education Project	1	2	d	r
C	IF SITE = ST LOUIS St. Louis Healthy Marriage Coalition	1	2	d	r
D	IF SITE = DALLAS Strong Families Dallas	1	2	d	r
E	IF SITE = DALLAS LIFE Matters Healthy Marriage Initiative	1	2	d	r
F	IF SITE = CLEVELAND Operation Keepsake	1	2	d	r
G	IF SITE = CLEVELAND Strong Start for Cuyahoga’s Families
H	IF SITE = KANSAS CITY Healthy Families Counseling and Support: Tender Beginnings Plus	1	2	d	r
I	IF SITE = FT. WORTH Texas Healthy Marriage Development Project	1	2	d	r

Created

B5. Are you aware of any advertising promoting healthy marriage, healthy relationships, or responsible parenting in your community?

YES	1
NO	2	B10
DK	d
RF	r

Created

B6. What was the theme or message of that advertising?

INTERVIEWER: CODE ALL MENTIONS

MARRIAGE IS GOOD/ BENEFICIAL TO CHILDREN AND ADULTS	1
BEING A RESPONSIBLE FATHER/MOTHER IS IMPORTANT	2
WE CARE ABOUT YOU AND YOUR FAMILY	3
WE CAN HELP YOU WITH MARRIAGE/ RELATIONSHIPS/ CHILDREN	4
OTHER (SPECIFY)	5
DK	d
RF	r

Created

B7. Now I’m going to ask you a few questions about the advertisement(s) you saw. Where did you see or hear (THIS ADVERTISING/THESE ADVERTISEMENTS)?

INTERVIEWER: READ LIST IF NECESSARY. CODE ALL MENTIONS.

TELEVISION	1
RADIO	2
INTERNET/WEB	3
BILLBOARD/POSTER	4
TRANSPORTATION SIGNAGE	5
FLIER/BROCHURE	6
OTHER (SPECIFY)	7
DK	d
RF	r

ATS

B9. Did you talk to someone, such as a friend, a family member or someone at work about the message of this advertising?

YES	1
NO	2
DK	d
RF	r

Created

B10. Are you aware of any groups or places in your community that offer classes or workshops to help people improve their relationships with their spouse or partner?

YES	1
MAYBE, NOT SURE, I THINK SO	2
NO	3
DK	d
RF	r

Created

B11. Are you aware of any groups or places in your community that offer classes or workshops to help people improve their relationships with their children?

YES	1
MAYBE, NOT SURE, I THINK SO	2
NO	3
DK	d
RF	r

C. RELATIONSHIP STATUS AND ATTITUDES

CHECK C1. IS A SPOUSE LISTED IN THE HOUSEHOLD GRID?

YES	1	CHECK C2
NO	2
DK	d
RF	r

TX

C1. Next, I’d like to ask you about some of the relationships you’ve had in your life. What is your marital status? Are you…

INTERVIEWER: SHOW RESPONSE CARD C1 TO R.

Married	1
Separated	2	CHECK C2
Divorced	3	CHECK C2
Widowed	4	CHECK C2
Never been married	5	CHECK C2
DK	d
RF	r

C2. What is the main reason that you and your spouse are not living together?

MARITAL PROBLEMS/NOT GETTING ALONG	1
SPOUSE WORKING IN DIFFERENT CITY	2
SPOUSE IN ARMED FORCES	3
SPOUSE LIVING IN ANOTHER COUNTRY	4
SPOUSE INCARCERATED	5
OTHER (SPECIFY)________________________	6
DK	d
RF	r

CHECK C2. IS THE RESPONDENT A PARTICIPANT OR A CONTINUING RESPONDENT?

PARTICIPANT	1	CHECK C6
CONTINUING	2

CHECK C3. IS THE CONTINUING RESPONDENT MARRIED, SEPARATED, DIVORCED, WIDOWED, OR NEVER BEEN MARRIED?

Married	1
Separated	2	CHECK C4
Divorced	3	CHECK C4
Widowed	4	CHECK C4
Never been married	5	CHECK C5
DK	d
RF	r

C2a. Are you married to the same person you were married to when we last interviewed you in (INSERT MONTH AND YEAR OF LAST INTERVIEW)?

YES	1	C7
NO	2	C7
DK	d
RF	r

CHECK C4. WAS RESPONDENT MARRIED IN ROUND 1 BUT IS NOT MARRIED IN ROUND 2?

YES	1
NO	2	CHECK C5
DK	d
RF	r

BSF (modified)

C2b. Our records show that when we last interviewed you in (INSERT MONTH AND YEAR OF LAST INTERVIEW) you were married. Why are you and your spouse no longer together?

INTERVIEWER: CODE ALL MENTIONS

CHEATED/WAS UNFAITHFUL	1
WENT TO JAIL/PRISON	2
ABUSIVE/VIOLENT	3
USED DRUGS/ALCOHOL	4
FINANCIAL PROBLEMS/COULD NOT KEEP JOB	5
NOT A GOOD PARENT	6
ARGUMENTS/FIGHTS/POOR COMMUNICATION	7
OTHER (SPECIFY)	8
DK	d
RF	r

CHECK C5. IS A PARTNER LISTED IN THE HOUSEHOLD GRID?

YES	1
NO	2	C3
DK	d
RF	r

C2c. You mentioned that (PARTNER) is living with you. Was (PARTNER) living with you when we last interviewed you in (INSERT MONTH AND YEAR OF LAST INTERVIEW)?

YES	1
NO	2
DK	d
RF	r

CHECK C6: IS THERE A SPOUSE OR PARTNER LISTED IN THE HOUSEHOLD GRID?

YES	1	CHECK C7
NO	2
DK	d
RF	r

BSF

IF NO SPOUSE OR PARTNER LISTED IN THE HOUSEHOLD GRID:

C3. Are you currently involved in a romantic relationship with someone?

YES	1
NO	2
DK	d
RF	r

CHECK C7. IS THE RESPONDENT A PARTICIPANT OR A CONTINUING RESPONDENT?

PARTICIPANT	1	C4
CONTINUING	2

C3a. Are you romantically involved with the same person you were involved with when we last interviewed you in (INSERT MONTH AND YEAR OF LAST INTERVIEW)?

YES	1
NO	2
DK	d
RF	r

BSF/FF

C4. Would you say you are romantically involved on a steady basis, or are you in an on-again, off-again relationship?

STEADY RELATIONSHIP	1
ON AGAIN, OFF AGAIN RELATIONSHIP	2
DK	d
RF	r

BSF

C5. What is your current partner’s first name?

PROBE: I just need to have some way of referring to (him/her). Initials are fine.

FIRST NAME OF PARTNER	___________________	STORE NAME
DK	d
RF	r

C5a. RECORD PARTNER’S GENDER. IF NOT OBVIOUS ASK: Just to confirm, is this person male or female?

MALE	1
FEMALE	2

BSF

C6. IF R NOT IN SAME-SEX RELATIONSHIP:

What do you think the chances are that you will marry (PARTNER) in the future? Would you say…

IF R IS IN SAME-SEX RELATIONSHIP: Assume same-sex marriages or civil unions were recognized in your state. What are the chances that you would marry (PARTNER) in the future? Would you say…

INTERVIEWER: SHOW RESPONSE CARD C6 TO R.

No chance	1
A little chance	2
A 50-50 chance	3
A pretty good chance, or	4
An almost certain chance?	5
DK	d
RF	r

Created

C7. IF CHECK C1 = 1 OR C1 = 1 (MARRIED): About how long have you and (SPOUSE) been married?

IF CHECK C2 = 1 OR C3 =1 (PARTNERED OR DATING): About how long have you and (PARTNER) been together?

YEARS AND MONTHS	|___|___| MONTHS |___|___| YEARS
DK	d
RF	r

Created

C7a. IF CHECK C1 = 1 OR C1 = 1 (MARRIED): Have you ever been married to someone else besides (SPOUSE)?

IF CHECK C5 = 1 OR C3 =1 (NOT MARRIED): Have you ever been married?

YES	1
NO	2	C7c
DK	d
RF	r

Created

C7b. How many times have you been married?

TIMES MARRIED	|___|___| TIMES
DK	d
RF	r

Created

C7c. Since you were 18 years old, how many times have you lived with a partner without being married for a period of three months or more?

TIMES LIVED TOGETHER	|___|___| TIMES
DK	d
RF	r

CHECK C7. CREATE RELATIONSHIP VARIABLE:

IF CHECK C1 = 1, THEN RESPONDENT = MARRIED AND CO-HABITATING (HENCEFORTH “MARRIED.”)

IF CHECK C5 = 1, THEN RESPONDENT = PARTNERED AND CO-HABITATING (HENCEFORTH “PARTNERED.”)

IF C3 = 1 AND C4 = 1 AND C7 = > 3 MONTHS, THEN RESPONDENT = PARTNERED BUT NOT CO-HABITATING (HENCEFORTH “DATING.”)

IF C3 = 2, THEN RESPONDENT = NOT MARRIED, PARTNERED OR CO-HABITATING (HENCEFORTH “SINGLE.”)

IF C1 = 1 OR 2, THEN RESPONDENT = MARRIED BUT LIVING APART, (HENCEFORTH “MARRIED.”)

LAFANS (modified)

C8. Next I’d like to ask about your opinions regarding marriage and relationships. For each of the following statements, please tell me if you strongly approve, approve, disapprove, or strongly disapprove. If you don’t know or aren’t sure, please just say so.

[INTERVIEWER: CODE, “IT DEPENDS” AS “NEITHER AGREE NOR DISAGREE”]

INTERVIEWER: SHOW RESPONSE CARD C8 TO R.

		Strongly Approve	Approve	VOL: NEITHER A/D	Disap- prove	Strongly Disap- prove	DK	RF
A	A couple lives together before they decide about getting married.	1	2	3	4	5	d	r
B	A couple decides to live together even though they do not intend to get married.	1	2	3	4	5	d	r
C	A woman has a baby without being married.	1	2	3	4	5	d	r
D	A man fathers a child without being married to the baby's mother.	1	2	3	4	5	d	r
E	A couple with children divorces because their marriage is not satisfying.	1	2	3	4	5	d	r
F	A couple raises their children without being married.	1	2	3	4	5	d	r
G	A couple raises their children in a marriage.	1	2	3	4	5	d	r
H	A couple facing a hard time in their relationship seeks help through their families, friends, place of worship, or counselor.	1	2	3	4	5	d	r
I	A couple facing a hard time in their relationship does not seek help.	1	2	3	4	5	d	r

LA FANS (modified)

C9. Regardless of your current situation and what you think is ideal, how likely would you be to do the following? (READ LIST) Would you say very likely, somewhat likely, somewhat unlikely, or not likely at all?

INTERVIEWER: SHOW RESPONSE CARD C9 TO R.

		Very Likely	Somewhat Likely	Somewhat Unlikely	Not Likely at All	DK	RF
A	Live with a partner before you decide about getting married.	1	2	3	4	d	r
B	Live with a partner who does not want to marry you.	1	2	3	4	d	r
C	(Have/ Father) a baby without being married.	1	2	3	4	d	r
D	Divorce if you were in an unhealthy relationship and you had children.	1	2	3	4	d	r
E	Raise your children without being married.	1	2	3	4	d	r
F	Raise your children in a marriage.	1	2	3	4	d	r
G	Seek help if facing hard times in your relationship from your families, friends, church, or counselor.	1	2	3	4	d	r
H	Participate in premarital or other relationship skills classes.	1	2	3	4	d	r

TX (modified)

C10. These next statements are about marriage and commitment. For each one, please tell me if you strongly agree, agree, disagree, or strongly disagree.

INTERVIEWER: SHOW RESPONSE CARD C10 TO R.

		Strongly Agree	Agree	Disagree	Strongly Disagree	DK	RF
A	A healthy, happy marriage is one of the most important things in life.	1	2	3	4	d	r
B	Unmarried parents living with children are not as likely to stay together as married parents.	1	2	3	4	d	r
C	Most first marriages end in divorce.	1	2	3	4	d	r
D	Even bad relationships can be improved through more effort and better skills.	1	2	3	4	d	r
E	Children do better if raised by married parents.	1	2	3	4	d	r
F	People in happy marriages do not argue.	1	2	3	4	d	r
G	Most married people will cheat on their spouse at least once.	1	2	3	4	d	r
H	Premarital and marriage education classes can improve marriages.	1	2	3	4	d	r
I	People are better off financially if they are married.	1	2	3	4	d	r
J	Needing to keep government benefits like Welfare and Food Stamps can discourage couples from getting married.	1	2	3	4	d	r

Created

C11. Sometimes couples decide not to get married so they do not lose public benefits, such as Welfare, Medicaid, Food Stamps, WIC, or the Earned Income Tax Credit. Among people you know, does this happen…

A great deal of the time	1
Some of the time	2
Hardly ever	3
Never	4
DK	d
RF	r

D. RECEIPT OF SERVICES

CHECK D1. IS RESPONDENT A PARTICIPANT OR A CONTINUING RESPONDENT?

PARTICIPANT	1	D1
CONTINUING	2	CONTINUE

CHECK D2. IS RESPONDENT MARRIED IN ROUND 2 BUT WAS NOT MARRIED IN ROUND 1?

YES	1	D1
NO	2	D2

Created

D1. IF MARRIED:

Before you were married, did you attend any classes or workshops about marriage or receive premarital counseling?

YES	1
NO	2
DK	d
RF	r

Created

D2. IF MARRIED: Since you’ve been married, have you ever attended classes about couple relationships or marriage, or have you ever received individual marriage or relationship counseling?

IF NOT MARRIED: Have you ever attended classes about couple relationships or marriage, or have you ever received individual marriage or relationship counseling?

YES	1
NO	2	D20
DK	d
RF	r

CHECK D3. IS RESPONDENT A PARTICIPANT OR A CONTINUING RESPONDENT?

PARTICIPANT	1	CONTINUE
CONTINUING	2	D3

D2a. Our records show that you attended classes about couple relationships or marriage sometime since 2006. Is that correct?

YES	1	D4
NO	2	D20
DK	d
RF	r

BSF (modified)

D3. IF MARRIED: Since we last interviewed you in (MONTH AND YEAR), have you attended any classes, workshops, or group sessions to help you improve your relationship with (SPOUSE/PARTNER)? These sessions would have included other people, not just you and (SPOUSE/PARTNER).

IF NOT MARRIED: Since we last interviewed you in (MONTH AND YEAR), have you attended any classes, workshops, or groups to help you improve your relationship with a spouse or partner? These sessions would have included other people, not just you and your partner.

YES	1
NO	2	D20
DK	d
RF	r

BSF

D4. IF CONTINUING RESPONDENT: About how many classes, workshops, or group sessions did you attend since (INSERT MONTH AND YEAR OF LAST INTERVIEW)?

IF PARTICIPANT: About how many classes, workshops, or group sessions did you attend since 2006?

PROBE: Your best estimate is fine.

NUMBER OF SESSIONS	|___|___|	IF 00, GO TO D20
DK	d
RF	r

BSF

D5. IF D4=1:

About how long did the class, workshop, or group session last?

IF D4 > 1:

About how long did each class, workshop, or group session usually last?

PROBE: In other words, for how many hours did you meet each time?

INTERVIEWER: ENTER NUMBER OF HOURS AND MINUTES

NUMBER OF HOURS	|___|___|
NUMBER OF MINUTES	|___|___|
DK	d
RF	r

Created

IF MARRIED, PARTNERED, OR DATING:

D6. Did you attend these classes with (SPOUSE/PARTNER), someone else, or by yourself?

IF SINGLE: Did you attend these classes with a partner, or by yourself?

WITH SPOUSE/PARTNER	1
SOMEONE ELSE	2	D8
BY MYSELF	3	D8
DK	d
RF	r

Created

D7. How often did your spouse or partner attend the classes with you? Would you say…

INTERVIEWER: SHOW RESPONSE CARD D7 TO R.

All of the time	1
Most of the time	2
Some of the time	3
Rarely or never	4
DK	d
RF	r

Created

D7a. Why did you (AND SPOUSE/PARTNER) attend the classes or workshops?

PROBE: For what reason did you sign up for the classes or workshops?

CODE FIRST THREE MENTIONS

REQUIRED BEFORE MARRIAGE IN RELIGIOUS INSTITUTION	1
PLANNING TO GET MARRIED/THOUGHT WOULD HELP	2
HAVING PROBLEMS IN MY MARRIAGE/RELATIONSHIP/ TO IMPROVE MARRIAGE/RELATIONSHIP	3
WANTED TO AVOID FUTURE PROBLEMS/HAVE HEALTHY MARRIAGE OR RELATIONSHIP	4
JUST CURIOUS/INTERESTED	5
RECOMMENDED BY FAMILY MEMBER, CLERGY, FRIEND	6
SIGNED UP FOR SOMETHING ELSE/ DIDN’T REALIZE CLASSES/WORKSHOPS WERE A PART	7
OFFERED CASH, PRIZES, OTHER INCENTIVES TO ENROLL	8
REQUIRED OR ENCOURAGED BY COURT	9
REQUIRED OR ENCOURAGED BY JOB/TREATMENT PROGRAM/SCHOOL/OTHER	10
CLASSES/WORKSHOPS WERE FREE	11
PROMISED REFERRAL TO OTHER SERVICES	12
OTHER (SPECIFY)__________________________________	13
DK	d
RF	r

Created

D8. Did you attend some or all of the classes or workshops that were offered or did you stop attending before the classes were over?

ATTENDED SOME OR ALL	1	D10
STOPPED ATTENDING	2
DK	d
RF	r

Created

D9. Why did you stop attending the classes or workshops?

CODE ALL THAT APPLY

NOT INTERESTED	1
NOT HELPFUL	2
SPOUSE/PARTNER OBJECTED	3
TRANSPORTATION DIFFICULTIES	4
CHILD CARE DIFFICULTIES	5
WORK INTERFERED	6
CONFLICT WITH INSTRUCTOR	7
CONFLICT WITH PARTICIPANTS	8
DON’T AGREE WITH DISCUSSIONS/MESSAGE	9
OTHER (SPECIFY)_________________________	10
DK	d
RF	r

Created

D10. Where did you attend these classes?

PROBE: Who offered or hosted the classes?

CHURCH (SPECIFY)____________	1
COMMUNITY CENTER/ REC CENTER	4
SCHOOL	5
COUNSELOR/ THERAPIST’S OFFICE	6
SOCIAL SERVICE AGENCY/ GOV’T AGENCY	7
HOSPITAL	8
JAIL/PRISON	9
OTHER (SPECIFY)______________	3
DK	d
RF	r

Created

D11. As best you can remember, what topics were discussed during the classes?

CODE ALL THAT APPLY

ANGER MANAGEMENT	1
COMMUNICATION	2
CONFLICT RESOLUTION	3
EXPECTATIONS ABOUT MARRIAGE	4
AVOIDING DIVORCE	5
FAMILY VALUES	6
CHILDREN / RESPONSIBLE PARENTING	7
DEALING WITH STRESS/ CRISES/ LIFE CHANGES	8
FINANCIAL ISSUES / MANAGING MONEY	9
EXTENDED FAMILY RELATIONSHIPS	10
SEXUAL INTIMACY / PROBLEMS	11
FORGIVENESS	12
GENDER ROLES	13
RELATIONSHIP HISTORY/ PAST RELATIONSHIPS	14
RELIGION	15
IMPORTANCE OF HAVING FRIENDS / OTHERS TO RELY ON	16
TRUST	17
OTHER (SPECIFY)_________________	18
DK	d
RF	r

Created

D12. How did you first hear about these classes?

PROBE: Who told you about the classes?

FRIEND	1	D12b
CHURCH	2	D12b
SPOUSE	3	D12b
OTHER FAMILY MEMBER	4	D12b
SAW POSTER/BILLBOARD/LITERATURE	5
INTERNET SEARCH	6
SAW/HEARD OTHER ADVERTISEMENT	7
RFERRED BY COURT	8
RFERRED BY OTHER SERVICE AGENCY	9
OTHER (SPECIFY)__________________	10
DK	d
RF	r

Created

D12a. Were you encouraged by someone in your personal life, other than your partner, to participate in these classes?

YES	1
NO	2	D13
DK	d
RF	r

Created

D12b. Who encouraged you to participate in the classes?

IF D12 = 1, 2, 3, OR 4: Who encouraged you to participate in the classes, if anyone?

CODE ALL THAT APPLY

FRIEND	1
FAMILY MEMBER	2
PASTOR OR RELIGIOUS LEADER	3
CO-WORKER	4
NO ONE	5
OTHER (SPECIFY)_________________	6
DK	d
RF	r
IF SINGLE, GO TO D16

Created

D13. IF MARRIED, PARTNERED, OR DATING: How much did your relationship with (SPOUSE/PARTNER) improve as a result of the classes or workshops? Would you say…

INTERVIEWER: SHOW RESPONSE CARD D13 TO R.

A great deal	1
Somewhat	2
Very little	3
Not at all	4	D16
DK	d
RF	r

Created

D14. What knowledge or skills did you learn that helped you improve your relationship with (SPOUSE/PARTNER)?

COMMUNICATION	1
CONFLICT RESOLUTION	2
ANGER MANAGEMENT	3
CHANGED EXPECTATIONS ABOUT RELATIONSHIPS	4
DIVORCE AVOIDANCE	5
RELIGIOUS BELIEFS OR PRACTICES	6
RAISING / MANAGING CHILDREN	7
IMPORTANCE OF FIDELITY	8
FINANCIAL MANAGEMENT	9
DEALING WITH EXTENDED FAMILY	10
FORGIVENESS	11
DEALING WITH GENDER ROLES	12
DEALING WITH SEXUAL INTIMACY/ PROBLEMS	13
DEALING WITH PAST RELATIONSHIPS	14
DEALING WITH STRESS/ CRISES/ LIFE CHANGES	15
BUILDING SOCIAL NETWORK/ HAVING PEOPLE TO RELY ON	16
DEVELOPING TRUST/ BEING MORE TRUSTWORTHY	17
DEVELOPING/ TEACHING FAMILY VALUES	18
OTHER (SPECIFY)_________________	19
DK	d
RF	r

Created

D15. Is the improvement in your relationship ongoing, did it last a little while, or not long at all?

ON-GOING	1
A LITTLE WHILE	2
NOT LONG AT ALL	3
DK	d
RF	r

Created

D16. IF SINGLE: Did you talk about what you learned in the class or workshop with any neighbors, family, or friends?

IF MARRIED, PARTNERED, OR DATING: Not including (SPOUSE/PARTNER), did you talk about what you learned in the class or workshop with any neighbors, family, or friends?

YES	1
NO	2	D18
DK	d
RF	r

Created

D17. About how many people did you talk with about what you learned?

NUMBER OF PEOPLE	|___|___|
DK	d
RF	r

Created

D18. As part of the class or workshop, did you receive help with any of the following? (READ LIST)

PROBE: Did you get help with…

		YES	NO	DK	RF
A	Getting Medicaid or health services	1	2	d	r
B	Signing up for SSI (Supplemental Security Income)	1	2	d	r
C	Finding a job	1	2	d	r
D	A financial problem	1	2	d	r
E	Buying a house	1	2	d	r
F	Finding additional services or counseling you may need	1	2	d	r
G	Anything else? (SPECIFY)____________	1	2	d	r

Created

D19. Did the classes or workshops help you improve your relationship with other people in your life, such as your friends, employer, teachers, or others in the community?

YES	1
NO	2
DK	d
RF	r

Created

IF RESPONDENT HAS BIOLOGICAL/ADOPTIVE CHILDREN:

D19a. Did the classes or workshops help you to improve your relationship with your child(ren)?

YES	1
NO	2	D19d
DK	d
RF	r

Created

D19b. Why do you think these improvements happened? Was it…

Because you learned skills in the class that changed how you parent?	1
Because you learned skills that improved your relationship with your spouse or partner?	2
Both of the above?	3
DK	d
RF	r

Created

D19c. What knowledge or skills did you learn that helped you improve your relationship with your child(ren)?

CODE ALL THAT APPLY

COMMUNICATION WITH PARTNER	1
CONFLICT RESOLUTION WITH PARTNER	2
ANGER MANAGEMENT WITH PARTNER	3
CHANGED EXPECTATIONS ABOUT RELATIONSHIPS	4
COMMUNICATION WITH CHILDREN	5
CONFLICT RESOLUTION WITH CHILDREN	6
ANGER MANAGEMENT WITH CHILDREN	7
DEALING WITH STRESS/ CRISES/ LIFE CHANGES	8
BUILDING SOCIAL NETWORK/ HAVING PEOPLE TO RELY ON	9
DEVELOPING TRUST/ BEING MORE TRUSTWORTHY	10
DEVELOPING/ TEACHING FAMILY VALUES	11
OTHER (SPECIFY)______________________________________	12
DK	d
RF	r

HRME Evaluation

D19d. Overall, would you say the classes or workshop was too long, about right, or too short?

TOO LONG	1
ABOUT RIGHT	2
TOO SHORT	3
DK	d
RF	r

Created

D19e. How would you rate the teacher or facilitator of the classes? Would you say he or she was…

Excellent	1
Good	2
Only Fair	3
Poor	4
DK	d
RF	r

HRME Evaluation

D19f. Would you recommend these classes to others?

YES	1
NO	2
DK	d
RF	r

Created

D20. IF SINGLE: Suppose that you could attend classes or workshops in your neighborhood free of charge that would help you have a healthy relationship with a spouse or partner. How interested would you be in attending?

IF MARRIED OR PARTNERED: Suppose that you could attend classes or workshops in your neighborhood free of charge that would help you [strengthen your marriage with (SPOUSE)/improve your relationship with (PARTNER)]. How interested would you be in attending? Would you say…

INTERVIEWER: SHOW RESPONSE CARD D20 TO R.

Very interested	1
Somewhat interested	2
Not very interested	3
Not interested at all	4
DK/NOT SURE/IT DEPENDS	d
RF	r

Created

IF D20=NOT VERY INTERESTED OR NOT INTERESTED AT ALL:

D21. Why would you (HAVE LITTLE INTEREST/NO INTEREST) in attending these classes?

CODE ALL THAT APPLY

NEED TO WATCH CHILDREN	1
OTHER FAMILY RESPONSIBILITIES	2
NO TIME	3
LACK TRANSPORTATION	4
WORK INTERFERES	5
PRIVACY CONCERNS/MY OWN BUSINESS	6
SPOUSE NOT INTERESTED/ WOULD OBJECT	7
DON’T NEED/WANT SERVICES/RELATIONSHIP FINE	8
CURRENTLY RECEIVING MARRIAGE/ RELATIONSHIP SERVICES FROM ANOTHER SOURCE	9
JUST NOT INTERESTED	10
OTHER (SPECIFY)____________	11
DK	d
RF	r

Created

IF BIOLOGICAL/ADOPTIVE CHILDREN IN HOUSEHOLD:

D22. Suppose that you could attend classes or workshops free of charge in your neighborhood that would help you strengthen your relationship with your (child/ children). How interested would you be in attending? Would you say…

INTERVIEWER: SHOW RESPONSE CARD D22 TO R.

Very interested	1	CHECK D1 D4
Somewhat interested	2	CHECK D1 D4
Not very interested	3
Not interested at all	4
DK/NOT SURE/IT DEPENDS	d	CHECK D1 D4
RF	r

Created

IF D22=NOT VERY INTERESTED OR NOT INTERESTED AT ALL:

D23. Why would you (HAVE LITTLE INTEREST/NO INTEREST) in attending these classes?

CODE ALL THAT APPLY

NEED TO WATCH CHILDREN	1
OTHER FAMILY RESPONSIBILITIES	2
NO TIME	3
LACK TRANSPORTATION	4
WORK INTERFERES	5
PRIVACY CONCERNS/MY OWN BUSINESS	6
SPOUSE NOT INTERESTED/ WOULD OBJECT	7
DON’T NEED/WANT SERVICES/RELATIONSHIP WITH CHILDREN FINE	8
CURRENTLY RECEIVING PARENTHOOD SERVICES FROM ANOTHER SOURCE	9
JUST NOT INTERESTED	10
OTHER (SPECIFY)____________	11
DK	d
RF	r

CHECK D4: DOES D2 = NO?

YES	1	D28
NO	2
DK	d
RF	r

BSF

D24. IF CONTINUING RESPONDENT AND MARRIED, PARTNERED, OR DATING: Since we last interviewed you in (MONTH AND YEAR), did you meet with a counselor, psychologist, psychiatrist, social worker or clergy member to work on your relationship with (SPOUSE/PARTNER) in sessions that were not part of a workshop, class, or group? In other words, sessions that did not include other people besides you and (SPOUSE/PARTNER).

IF CONTINUING RESPONDENT AND SINGLE: Since we last interviewed you in (MONTH and YEAR), did you meet with a counselor, psychologist, psychiatrist, social worker or clergy member to work on your relationship with a spouse or partner in sessions that were not part of a workshop, class, or group.

IF PARTICIPANT AND MARRIED, PARTNERED, AND DATING: Since 2006, did you meet with a counselor, psychologist, psychiatrist, social worker or clergy member to work on your relationship with a spouse or partner in sessions that were not part of a workshop, class, or group? In other words, sessions that did not include other people besides you and (SPOUSE/PARTNER).

IF PARTICIPANT AND SINGLE: Since 2006, did you meet with a counselor, psychologist, psychiatrist, social worker or clergy member to work on your relationship with a spouse or partner in sessions that were not part of a workshop, class, or group?

YES	1
NO	2	D28
DK	d
RF	r

BSF

D25. Since (INSERT MONTH AND YEAR OF LAST INTERVIEW), about how many times did you meet with this person to work on your (marriage/relationship)?

IF PARTICIPANT, TIME FRAME IS “SINCE 2006…”

NUMBER OF TIMES	|___|___|
DK	d
RF	r

BSF

D26. IF D25 = 1:

About how long did the session with this person last?

IF D25>1:

About how long did each session with this person usually last?

INTERVIEWER: ENTER NUMBER OF HOURS AND MINUTES

NUMBER OF HOURS	|___|___|
NUMBER OF MINUTES	|___|___|
DK	d
RF	r

Created

D27. Did you attend these sessions with (SPOUSE/PARTNER), someone else, or by yourself?

WITH SPOUSE/PARTNER	1
SOMEONE ELSE	2
BY MYSELF	3
DK	d
RF	r

Created

D28. Since (INSERT MONTH AND YEAR OF LAST INTERVIEW), have you suggested to anyone that they attend classes or get help to improve their relationship with their spouse, partner, or children?

IF PARTICIPANT, TIME FRAME IS “SINCE 2006…”

YES	1
NO	2
DK	d
RF	r

BSF

D29. Since (INSERT MONTH AND YEAR OF LAST INTERVIEW), did you receive regular visits to your home from someone working for an agency or program?

IF PARTICIPANT, TIME FRAME IS “SINCE 2006…”

YES	1
NO	2
DK	d
RF	r

BSF

D30. Since (INSERT MONTH AND YEAR OF LAST INTERVIEW), have you participated in any classes, groups, or workshops to help you improve your parenting skills?

IF PARTICIPANT, TIME FRAME IS “SINCE 2006…”

YES	1
NO	2
DK	d
RF	r

BSF

D31. Since (INSERT MONTH AND YEAR OF LAST INTERVIEW), have you taken any classes to finish high school, get a GED, or learn English?

IF PARTICIPANT, TIME FRAME IS “SINCE 2006…”

YES	1
NO	2
DK	d
RF	r

BSF

D32. Since (INSERT MONTH AND YEAR OF LAST INTERVIEW), have you received services to help you manage your anger or avoid committing domestic violence?

IF PARTICIPANT, TIME FRAME IS “SINCE 2006…”

YES	1
NO	2
DK	d
RF	r

E. SOCIAL TIES

Created

E1. IF SINGLE: In the past six months, have you talked with anyone about marriage, divorce, having children or relationship issues? This could be about marriage or relationships in general or about your own marriage or relationship.

IF MARRIED/ PARTNERED: In the past six months, have you talked with anyone besides (SPOUSE/PARTNER) about marriage, divorce, having children or relationship issues? This could be about marriage or relationships in general or about your own marriage or relationship.

YES	1
NO	2	E15
DK	d
RF	r

Created

E2. About how many people did you talk with about marriage or relationships in the past six months?

NUMBER OF PEOPLE	|___|___|
DK	d
RF	r

Created

E3. Think about the person you talked with most about marriage and relationships. As far as you know, has this person participated in any classes or workshops about marriage or relationships in the past 18 months, that is since (FILL DATE)?

PROBE: Do not include sessions that were not part of a workshop, class, or group.

YES	1
NO	2
DK	d
RF	r

Created

E4. We will not contact this person, but we do need a general way of knowing how close this person lives to you. In what city and state does this person live? (RECORD CITY)

CITY	________________________
DK	d
RF	r

E4a. RECORD STATE (ENTER STATE OR USE LOOKUP TOOL)

STATE	________________________
DK	d
RF	r

Created

IF CITY AND STATE IN SAMPLE AREA:

E5. What street does this person live on?

STREET NAME	________________________
DK	d
RF	r

Created

E6. And what is the name of the nearest crossing street?

PROBE: By crossing street, I mean the street that forms the nearest intersection to this person.

CROSSING STREET NAME	________________________
DK	d
RF	r

Created

E7. IFMORE THAN ONE PERSON MENTIONED IN E2: Now I’d like you to think about the person you talked with the second most often about marriage or relationships. As far as you know, has this person participated in any classes or workshops about marriage or relationships in the past 18 months?

PROBE: Do not include sessions that were not part of a workshop, class, or group.

YES	1
NO	2
DK	d
RF	r

Created

E8. We will not contact this person, but we do need a general way of knowing how close this person lives to you. In what city and state does this person live? (RECORD CITY)

CITY	________________________
DK	d
RF	r

E8a. RECORD STATE (ENTER STATE OR USE LOOKUP TOOL)

STATE	________________________
DK	d
RF	r

Created

E9. IF CITY AND STATE IN SAMPLE AREA: What street does this person live on?

STREET NAME	________________________
DK	d
RF	r

Created

E10. And what is the name of the nearest crossing street?

PROBE: By crossing street, I mean the street that forms the nearest intersection to this person.

CROSSING STREET NAME	________________________
DK	d
RF	r

Created

E11. Now I have some additional questions about the person you talked with most about marriage and relationships in the past six months. What is this person’s first name? I just need a way of referring to him or her.

PERSON’S FIRST NAME	___________________
DK	d
RF	r

OMI (modified)

E12. How is (NAME) related to you? For example, mother, father, friend, neighbor, someone you work with, a clergy person, or someone else?

MOTHER	1
FATHER	2
DAUGHTER	3
SON	4
SISTER	5
BROTHER	6
MOTHER-IN-LAW	7
FATHER-IN-LAW	8
GRANDMOTHER	9
GRANDFATHER	10
OTHER RELATIVE	11
FRIEND	12
NEIGHBOR	13
CO-WORKER	14
CHURCH/CLERGY	15
PSYCOLOGIST/PSYCHIATRIST/OTHER COUNSELOR	16
OTHER (SPECIFY)____________	17
DK	d
RF	r

OMI (modified)

E13. Now I have some questions about how (NAME) would react if you made certain choices or decisions in life. Even if you think it is extremely unlikely that you would do these things, try to imagine how (NAME) would react if you did. If you have already made these choices, tell me how (NAME) did react. How do you think (NAME) would react if you decided to …(READ LIST)?

INTERVIEWER: SHOW RESPONSE CARD E13 TO R.

		Strongly Approve	Approve	VOL: NEITHER A/D	Disap- prove	Strongly Disap- prove	DK	RF
A	Live with a partner before you decide about getting married.	1	2	3	4	5	d	r
B	Live with a partner who does not want to marry you.	1	2	3	4	5	d	r
C	Have or father a baby without being married.	1	2	3	4	5	d	r
D	Divorce if you were in an unhealthy relationship and you had children.	1	2	3	4	5	d	r
E	Raise your children without being married.	1	2	3	4	5	d	r
F	Raise your children in a marriage.	1	2	3	4	5	d	r
G	Seek help if facing hard times in your relationship from your family, friends, place of worship, or counselor.	1	2	3	4	5	d	r
H	Participate in premarital or other relationship skills classes.	1	2	3	4	5	d	r

Created

E14. When you talked with (NAME) about marriage and relationships, did you ever talk about specific problems you were having?

YES	1
NO	2
DK	d
RF	r

Created

E15. IF SINGLE: When it comes to personal choices about things like marriage, living together, and having children, how much does the opinion of others, not including a spouse or partner, affect your behavior or decisions? Would you say…

IF MARRIED/ PARTNERED: When it comes to personal choices about things like marriage, living together, and having children, how much does the opinion of others, not including (SPOUSE/PARTNER), affect your behavior or decisions? Would you say…

INTERVIEWER: SHOW RESPONSE CARD E15 TO R.

A great deal	1
Somewhat	2
Very little	3
Not at all	4	E18
DK	d
RF	r

Created

E16. Not including a spouse or partner, whose opinion regarding your personal choices affects your behavior and decisions?

INTERVIEWER: IF RESPONDENT ANSWERS “GOD” PROBE, “WHOSE OPINION BESIDES GOD”S AFFECTS YOUR BEHAVIOR OR DECISIONS?

IF RESPONDENT ANSWERS “ME” OR “SELF”, PROBE, “WHOSE OPINION BESIDES YOUR OWN AFFECTS YOUR BEHAVIOR OR DECISIONS?

CODE ALL THAT APPLY

MOTHER	1
FATHER	2
DAUGHTER	3
SON	4
SISTER	5
BROTHER	6
MOTHER-IN-LAW	7
FATHER-IN-LAW	8
GRANDMOTHER	9
GRANDFATHER	10
OTHER RELATIVE (SPECIFY) _____________________	11
FRIEND	12
NEIGHBOR	13
CO-WORKER	14
CHURCH/CLERGY	15
PSYCHOLOGIST /PSYCHIATRIST/OTHER COUNSELOR	16
OTHER (SPECIFY)_________________	17
NO ONE/NOBODY	18
DK	d
RF	r

Created

E17. Regardless of your current situation, how do you think these people would react if you told them you planned to raise a child without ever marrying the child’s (INSERT mother/ father)? Would your (INSERT MENTION FROM E16) strongly approve, approve, disapprove, or strongly disapprove?

INTERVIEWER: SHOW RESPONSE CARD E17 TO R.

		Strongly Approve	Approve	VOL: NEITHER A/D	Disap- prove	Strongly Disapprove	DK	RF
A	MOTHER	1	2	3	4	5	d	r
B	FATHER	1	2	3	4	5	d	r
C	DAUGHTER	1	2	3	4	5	d	r
D	SON	1	2	3	4	5	d	r
E	SISTER	1	2	3	4	5	d	r
F	BROTHER	1	2	3	4	5	d	r
G	MOTHER-IN-LAW	1	2	3	4	5	d	r
H	FATHER-IN-LAW	1	2	3	4	5	d	r
I	GRANDMOTHER	1	2	3	4	5	d	r
J	GRANDFATHER	1	2	3	4	5	d	r
K	OTHER RELATIVE	1	2	3	4	5	d	r
L	FRIEND	1	2	3	4	5	d	r
M	NEIGHBOR	1	2	3	4	5	d	r
N	CO-WORKER	1	2	3	4	5	d	r
O	CHURCH/ CLERGY	1	2	3	4	5	d	r
P	PSYCHOLOGIST/ PSYCHIATRIST/ OTHER COUNSELOR	1	2	3	4	5	d	r
Q	OTHER (SPECIFY)______	1	2	3	4	5	d	r

Created

E18. IF MARRIED, PARTNERED, OR DATING: When you have concerns about your relationship, how often do you (READ LIST). Would you say frequently, sometimes, seldom, or never?

INTERVIEWER: SHOW RESPONSE CARD E18 TO R.

		FREQUENTLY	SOMETIMES	SELDOM	NEVER	DK	RF
A	Share concerns with family or friends	1	2	3	4	d	r
B	Seek advice from family or friends	1	2	3	4	d	r
C	Seek professional counseling	1	2	3	4	d	r
D	Speak to your pastor or religious leader	1	2	3	4	d	r

LA FANS (modified)

E19. Now I’m going to read you some statements which may or may not be true of your community. For each statement tell me whether you strongly agree, agree, disagree, or strongly disagree.

PROBE: By community, I mean the people around you.

INTERVIEWER: SHOW RESPONSE CARD E19 TO R.

		STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE	DK	RF
A	People in this community marry before having children.	1	2	3	4	d	r
B	People in this community see few people in happy marriages that their children can look up to.	1	2	3	4	d	r
C	Men in the community are not good role models or mentors.	1	2	3	4	d	r
D	In this community, grandparents and other relatives help parents to raise families.	1	2	3	4	d	r
E	I feel safe in this community.	1	2	3	4	d	r
F	You can count on adults in this community to watch out that children are safe and do not get into trouble.	1	2	3	4	d	r
G	People in this community ask each other for advice about personal things such as relationships and parenting.	1	2	3	4	d	r

SIPP

E20. If you or someone in your household had a problem with which you needed help, for example, sickness or moving…(READ LIST) Would you say all the help needed, most of the help needed, very little of the help needed, or no help?

INTERVIEWER: SHOW RESPONSE CARD E20 TO R.

		All the help needed	Most of the help needed	Very little of the help needed	No help	DK	RF
A	How much help would you expect to get from family?	1	2	3	4	d	r
B	How much help would you expect to get from friends?	1	2	3	4	d	r
C	How much help would you expect to get from other people in the community besides family and friends, such as a social agency or a church?	1	2	3	4	d	r

Created

E21. About how many people would turn to you for help or advice if they had a problem? IF MARRIED OR PARTNERED: Do not include (SPOUSE/PARTNER) in this number.

NUMBER OF PEOPLE	|___|___|
DK
RF

Created

E22. Now I would like you to think about your family and close friends. How many of them are married? Would you say…

INTERVIEWER: SHOW RESPONSE CARD E22 TO R.

All of them	1
Most of them	2
Some of them	3
None of them	4
DK	d
RF	r

Created

E23. How many of your family and close friends have children but were never married?

INTERVIEWER: SHOW RESPONSE CARD E22 TO R.

All of them	1
Most of them	2
Some of them	3
None of them	4
DK	d
RF	r

Created

E24. How many of your family and close friends have ever participated in classes or workshops about marriage or relationships?

PROBE: Do not include sessions that were not part of a workshop, class, or group.

INTERVIEWER: SHOW RESPONSE CARD E22 TO R.

All of them	1
Most of them	2
Some of them	3
None of them	4
DK	d
RF	r

Created

E25. How many of your family and close friends are employed?

INTERVIEWER: SHOW RESPONSE CARD E22 TO R.

All of them	1
Most of them	2
Some of them	3
None of them	4
DK	d
RF	r

F. RELATIONSHIP QUALITY

CHECK F1: IS RESPONDENT SINGLE?

YES	1	Section G
NO	2
DK	d
RF	r

QMI Index (edited)

F1. The next questions are about your relationship with (SPOUSE/PARTNER). Please think about (SPOUSE/PARTNER) and tell me if you strongly agree, agree, disagree, or strongly disagree with the following statements:

INTERVIEWER: SHOW RESPONSE CARD F1 TO R.

		Strongly Agree	Agree	VOL: NEITHER A/D	Dis-agree	Strongly Disagree	DK	RF
A	We have a good relationship.	1	2	3	4	5	d	r
B	My relationship with (SPOUSE/PARTNER) is very stable.	1	2	3	4	5	d	r
C	My relationship with (SPOUSE/PARTNER) is strong.	1	2	3	4	5	d	r
D	My relationship with (SPOUSE/PARTNER) makes me happy.	1	2	3	4	5	d	r
E	I really feel like part of a team with (SPOUSE/PARTNER).	1	2	3	4	5	d	r

Quality of Marriage Index

F2. On the scale from 1 to 10 where 1 means not at all happy and 10 means perfectly happy, which number best describes your happiness with your relationship?

NOT AT ALL HAPPY	1
	2
	3
	4
	5
	6
	7
	8
	9
PERFECTLY HAPPY	10
DK	d
RF	r

SHM

F3. There are good sides and bad sides to most relationships. First, thinking only about the good side of your relationship, on a scale from 1 to 5, where 1 is not at all good and 5 is completely good, how would you rate the good side of your relationship?

NOT AT ALL GOOD	1
	2
	3
	4
COMPLETELY GOOD	5
DK	d
RF	r

SHM

F4. Now, thinking about only the bad side of your relationship, on a scale from 1 to 5, where 1 is completely bad and 5 is not at all bad, how would you rate the bad side of your relationship?

COMPLETELY BAD	1
	2
	3
	4
NOT AT ALL BAD	5
DK	d
RF	r

BSF

F5. In the past month, about how many times did you and (SPOUSE/PARTNER) go out together—just the two of you—to do something fun?

NUMBER OF TIMES	|___|___|
DK	d
RF	r

BSF

F6. Now, I am going to read you some statements about things couples may experience when they are together. For each one, tell me if it happens often, sometimes, rarely, or never. When I have problems, (SPOUSE/PARTNER) really understands what I’m going through. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

BSF

F7. Even when arguing we can keep a sense of humor. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

BSF

F8. (SPOUSE/PARTNER) is good at calming me when I get upset. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

Created

F9. When we argue, our fights sometimes turn ugly and we grab or push each other. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

KY BHMP

F10. After we argue, (SPOUSE/PARTNER) is able to truly let go of bad feelings toward me. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

KY BHMP

F11. (SPOUSE/PARTNER) makes personal sacrifices for the good of the relationship. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

NLSY

F12. (SPOUSE/PARTNER) blames me for (his/her) problems. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

TX HM edited

F13. (SPOUSE/PARTNER) controls access to money. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

TX HM

F14. (SPOUSE/PARTNER) becomes jealous or possessive. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

TX HM

F15. (SPOUSE/PARTNER) makes me feel like I’m not good enough. Would you say…

INTERVIEWER: SHOW RESPONSE CARD F6 TO R.

Often	1
Sometimes	2
Rarely	3
Never	4
DK	d
RF	r

NFSH

F16. The following is a list of subjects on which couples often have disagreements. How often, if at all, in the last year have you and (SPOUSE/PARTNER) had disagreements about the following? (READ LIST)

Would you say never, less than once a month, several times a month, once a week or almost every day?

INTERVIEWER: SHOW RESPONSE CARD F16 TO R.

		NEVER	LESS THAN ONCE A MONTH	SEVERAL TIMES A MONTH	ONCE A WEEK	ALMOST EVERY DAY	DK	RF
A	IF MARRIED / PARTNERED: Household tasks	1	2	3	4	5	d	r
B	Money	1	2	3	4	5	d	r
C	Spending time together	1	2	3	4	5	d	r
D	Having a(nother) child	1	2	3	4	5	d	r
E	Sex	1	2	3	4	5	d	r
F	IF MARRIED: In-laws	1	2	3	4	5	d	r
G	IF CHILDREN IN HH: The children	1	2	3	4	5	d	r

DAS-8

F17. For each of these questions, please tell me how often it is true for you and (SPOUSE/PARTNER)? (READ LIST)

Would you say always, most of the time, more often than not, occasionally, rarely, or never?

INTERVIEWER: SHOW RESPONSE CARD F17 TO R.

		Always	Most of the time	More often than not	Occasion-ally	Rarely	Never	DK	RF
A	How often do you and your partner agree on displays of affection?	1	2	3	4	5	6	d	r
B	How often have you discussed or considered divorce, separation, or ending your current relationship?	1	2	3	4	5	6	d	r
C	In general, how often do you think that things between you and your partner are going well?	1	2	3	4	5	6	d	r
D	How often do you confide in your partner?	1	2	3	4	5	6	d	r
E	How often you regret getting into your current relationship?	1	2	3	4	5	6	d	r
F	How often do you and your partner calmly discuss something?	1	2	3	4	5	6	d	r
G	How often do you and your partner work together on something?	1	2	3	4	5	6	d	r

CTS 2 (edited)

F18. No matter how well a couple gets along, there are times when they disagree, get annoyed, want different things from each other, or just have spats or fights. Please tell me how often each of the following happened in the last year. If any of the following did not happen please say never.

In the past year, how often did (SPOUSE/PARTNER)…

INTERVIEWER: SHOW RESPONSE CARD F18 TO R.

		Often	Sometimes	Rarely	Never	DK	RF
A	Show you (he/she) cared even though you disagreed	1	2	3	4	d	r
B	Show respect for your feelings about an issue	1	2	3	4	d	r
C	Say (he/she) was sure you could work out a problem	1	2	3	4	d	r
D	Explain (his/her) side of a disagreement to you	1	2	3	4	d	r
E	Suggest a compromise to a disagreement	1	2	3	4	d	r
F	Agree to try a solution to a disagreement that you suggested	1	2	3	4	d	r

Partner Violence Screen

F19. Sometimes couples have fights that turn physical. In the past year, how often did any of these things happen? (READ LIST) Would you say often, sometimes, rarely, or never?

INTERVIEWER: SHOW RESPONSE CARD F18 TO R.

		Often	Sometimes	Rarely	Never	DK	RF
A	In the past year, how often have you been hit, kicked, punched or otherwise hurt by (SPOUSE/PARTNER)?	1	2	3	4	d	r
B	In the past year, how often have you hit, kicked, punched or otherwise hurt (SPOUSE/PARTNER)?	1	2	3	4	d	r

Partner Violence Screen

F20. How often do you feel safe in your relationship with (SPOUSE/PARTNER)? Would you say…

INTERVIEWER: SHOW RESPONSE CARD F20 TO R.

All of the time	1
Most of the time	2
Some of the time	3
Never	4
DK	d
RF	r

Partner Violence Screen

F21. Is there a partner from a previous relationship making you feel unsafe now?

YES	1
NO	2
DK	d
RF	r

BSF modified

F22. In the past year, did you need to see a doctor because of a fight with (SPOUSE/ PARTNER)? Please include times when you needed to see a doctor, even if you didn’t go.

YES	1
NO	2
DK	d
RF	r

BSF

F23. Here are some statements about relationships and marriage. For each one, please tell me if you strongly agree, agree, disagree, or strongly disagree.

(SPOUSE/PARTNER) encourages or helps me to do things that are important to me.

INTERVIEWER: SHOW RESPONSE CARD F18 TO R.

Strongly agree	1
Agree	2
Disagree	3
Strongly disagree	4
DK	d
RF	r

BSF

F24. I am satisfied with my sexual relationship with (SPOUSE/PARTNER).

INTERVIEWER: SHOW RESPONSE CARD F18 TO R.

Strongly agree	1
Agree	2
Disagree	3
Strongly disagree	4
DK	d
RF	r

BSF

F25. My friends and relatives support my relationship with (SPOUSE/ PARTNER).

INTERVIEWER: SHOW RESPONSE CARD F18 TO R.

Strongly agree	1
Agree	2
Disagree	3
Strongly disagree	4
DK	d
RF	r

Kurdek

F26. I’ve put a lot of energy and effort into my (MARRIAGE/RELATIONSHIP).

INTERVIEWER: SHOW RESPONSE CARD F18 TO R.

Strongly agree	1
Agree	2
Disagree	3
Strongly disagree	4
DK	d
RF	r

Kurdek

F27. My current relationship comes close to matching what I would consider to be my ideal (MARRIAGE/RELATIONSHIP).

INTERVIEWER: SHOW RESPONSE CARD F18 TO R.

Strongly agree	1
Agree	2
Disagree	3
Strongly disagree	4
DK	d
RF	r

Nock

F28. I would find it difficult to leave (SPOUSE/PARTNER) because of pressure to stay together.

INTERVIEWER: SHOW RESPONSE CARD F18 TO R.

Strongly agree	1
Agree	2
Disagree	3
Strongly disagree	4
DK	d
RF	r

BSF

F29. Sometimes couples are not always faithful to each other. Has (SPOUSE/PARTNER) ever cheated on you with someone else? Is that…

PROBE: “Cheating” is whatever it means to you.

IF RESPONDENT ANSWERS “DON’T KNOW” DO NOT PROBE.

INTERVIEWER: SHOW RESPONSE CARD F29 TO R.

Definitely yes,	1
Probably yes	2
Probably no	3
Definitely no?	4
DK	d
RF	r

BSF modified

F30. Have you cheated on (SPOUSE/PARTNER) with someone else?

YES	1
NO	2
DK	d
RF	r

BSF

F31. Do you think (SPOUSE/PARTNER) will cheat on you in the future? Would you say…

INTERVIEWER: SHOW RESPONSE CARD F29 TO R.

Definitely yes,	1
Probably yes	2
Probably no	3
Definitely no	4
DK	d
RF	r

BSF modified

F32. Do you think you will cheat on (SPOUSE/PARTNER) in the future?

INTERVIEWER: SHOW RESPONSE CARD F29 TO R.

Definitely yes,	1
Probably yes	2
Probably no	3
Definitely no	4
DK	d
RF	r

G. CHILD WELL-BEING

CHECK G1. IS RESPONDENT A PARTICIPANT OR A CONTINUING RESPONDENT?

PARTICIPANT	1	CONTINUE
CONTINUING	2	G7a

CHECK G2. ARE THERE CHILDREN UNDER 18 LIVING IN THE HOUSEHOLD?

YES	1
NO	2	SKIP TO SECTION H
DK	d
RF	r

G2. Just to confirm, are you or (SPOUSE/ PARTNER) the biological or adoptive parent of (the child/ at least one of the children) in this household?

YES	1
NO	2	SKIP TO SECTION H
DK	d
RF	r

G3 Is respondent Biological/adoptive parent?	G4 Gender	G5 Age	G6 Is spouse/partner biological/adoptive parent?
Are you the biological or adoptive (MOTHER/FATHER) of (NAME)?	IF MISSING: Is this child male or female?	IF MISSING: What is this child’s age? INTERVIEWER: ENTER “00” IF CHILD < 1	IF MARRIED/ PARTNERED/ DATING: Is (SPOUSE/ PARTNER) the biological or adoptive (MOTHER/ FATHER) of (NAME)?
1. YES 2. NO d. DK r. RF	WILL FILL FROM ROSTER	WILL FILL FROM ROSTER	1. YES 2. NO d. DK r. RF
1. YES 2. NO d. DK r. RF	FILL	FILL	1. YES 2. NO d. DK r. RF
1. YES 2. NO d. DK r. RF	FILL	FILL	1. YES 2. NO d. DK r. RF
1. YES 2. NO d. DK r. RF	FILL	FILL	1. YES 2. NO d. DK r. RF
1. YES 2. NO d. DK r. RF	FILL	FILL	1. YES 2. NO d. DK r. RF
1. YES 2. NO d. DK r. RF	FILL	FILL	1. YES 2. NO d. DK r. RF
New Child 1. YES 2. NO d. DK r. RF	1 MALE 2 FEMALE d DK r RF	|___|___|	1. YES 2. NO d. DK r. RF
New Child 1. YES 2. NO d. DK r. RF	1 MALE 2 FEMALE d DK r RF	|___|___|	1. YES 2. NO d. DK r. RF

COMPUTER WILL RANDOMLY SELECT ONE CHILD FROM AMONG THOSE OF WHOM RESPONDENT OR SPOUSE/PARTNER IS THE BIOLOGICAL OR ADOPTIVE PARENT.

G7. IF MORE THAN ONE CHILD IN HH: The computer has selected (NAME) for me to ask about.

CONTINUE

1

CHECK G3. IS RESPONDENT A PARTICIPANT OR A CONTINUING RESPONDENT?

PARTICIPANT	1	SKIP TO G7f
CONTINUING	2	CONTINUE

Created

G7a. When we last interviewed you in (MONTH AND YEAR), we asked you some questions about your child, (CHILD’S NAME). (CHILD) is a (MALE/FEMALE) who was (AGE AT FIRST INTERVIEW) at that time. Does (CHILD) still live with you?

YES	1	SKIP TO G7f
NO		CONTINUE
CHILD DIED	2	SKIP TO SECTION H
NO SUCH CHILD		SKIP TO SECTION H
DK	d
RF	r

Created

G7b. Where does (CHILD) live?

WITH OTHER PARENT	1	CONTINUE
GRANDPARENT	2	CONTINUE
WITH OTHER RELATIVE	3	CONTINUE
FOSTER PARENTS	4	SKIP TO G7f
WITH HIS/HER SPOUSE	5	SKIP TO G7f
WITH HIS/HER BOYFRIEND/ GIRLFRIEND	6	SKIP TO G7f
WITH HIS/HER FRIENDS	7	SKIP TO G7f
ON HIS/HER OWN	8	SKIP TO G7f
COLLEGE/UNIVERSITY	9	SKIP TO G7f
IN JAIL	10	SKIP TO G7f
MILITARY	11	SKIP TO G7f
CHILD DECEASED	12	SKIP TO G7f
OTHER (SPECIFY)	13	CONTINUE
DK	d	d
RF	r	r

Created

G7c. Why does (CHILD) no longer live with you?

________________________________________________________________________

________________________________________________________________________

BSF

G7d. In the past month, how often have you spent one or more hours a day with (CHILD)? Was it…

Everyday or almost every day	1
A few times a week	2
A few times in the past month	3
Once or twice, or	4
Never	5
DK	d
RF	r

NSFH

G7e. How much influence do you have in making major decisions about (CHILD), such as (HIS/HER) education, medical care, and religion. Would you say…

A great deal	1
Some	2
None	3
DK	d
RF	r

CHECK G4: IS RESPONDENT THE BIOLOGICAL PARENT OF FOCAL CHILD?

YES	1	CONTINUE
NO		SKIP TO G7g
DK	d
RF	r

Created

G7f. Thinking back to when (CHILD) was born, what was the status of your relationship with (CHILD’s) biological (MOTHER/FATHER)? Were you…

PROBE: By “biological,” I mean (HIS/HER) “natural” or “birth” (MOTHER/FATHER).

Married	1
Living together	2
Dating	3
Separated or divorced, or	4
Something else?	5
DK	d
RF	r
IF PARTICIPANT GO TO G8

Created

G7g. IF CONTINUING: Is (SPOUSE/PARTNER) the biological (MOTHER/FATHER) of (CHILD)?

PROBE: By “biological,” I mean the “natural” or “birth” (MOTHER/FATHER).

YES	1	SKIP TO CHECK G5
NO	2	CONTINUE
DK	d
RF	r

CHECK G4a: IS RESPONDENT THE BIOLOGICAL PARENT OF FOCAL CHILD?

YES	1	CONTINUE
NO		SKIP TO CHECK G5
DK	d
RF	r

Created

C7h. Were you ever married to (CHILD’s) biological (MOTHER/FATHER)?

YES	1
NO	2
DK	d
RF	r

CHECK G5: FROM G7b: DOES CHILD LIVE:

WITH RESPONDENT	0	SKIP TO G8
WITH OTHER PARENT	1	CONTINUE
GRANDPARENT	2	CONTINUE
WITH OTHER RELATIVE	3	CONTINUE
FOSTER PARENTS	4	SKIP TO G8
WITH HIS/HER SPOUSE	5	SKIP TO G8a
WITH HIS/HER BOYFRIEND/ GIRLFRIEND	6	SKIP TO G8a
WITH HIS/HER FRIENDS	7	SKIP TO G8a
ON HIS/HER OWN	8	SKIP TO G8a
COLLEGE/UNIVERSITY	9	SKIP TO G8a
IN JAIL	10	SKIP TO G8a
MILITARY	11	SKIP TO G8a
CHILD DECEASED	12	SKIP TO SECTION H
OTHER (SPECIFY)	13	CONTINUE
DK	d	d
RF	r	r

CHECK 6: Is G7d = 1, 2, 3 (THAT IS, THE RESPONDENT SPENDS TIME WITH THE CHILD AT LEAST A FEW DAYS A MONTH)

YES	1	CONTINUE
NO	2	SKIP TO SECTION H
DK	d
RF	r

Created

G8. These next questions are about (CHILD). Does (CHILD) attend school?

PROBE: By school I mean kindergarten through college.

YES	1	G9
NO	2	G16 CONTINUE
DK	d
RF	r

CHECK 7: IS (CHILD) 14 OR OLDER?

YES	1	CONTINUE
NO	2	G17
DK	d
RF	r

G8a. Did (CHILD) graduate from high school or does (CHILD) have a GED degree?

YES, HIGH SCHOOL GRAD	1
YES, GED	2
WORKING ON GED	3
NO	4
DK	d
RF	r

G8b. What is (CHILD) doing now? Is (CHILD)…

	YES	NO	DK	RF
G8b1. Working at a job for pay?	1	2	d	r
G8b2. Working on a GED degree?	1	2	d	r
G8b3. In the military?	1	2	d	r
G8b4 Caring for family members?	1	2	d	r
G8b5. Something else? (SPECIFY)	1	2	d	r
G8b6. IN JAIL/PRISON (VOLUNTEERED)	1	2	d	r
GO TO CHECK G10

Created

G9. What grade is (CHILD) in?

KINDERGARTEN	0
ENTER GRADE 1-12	|___|___|
SPECIAL EDUCATION (NOT GRADED)	13
COLLEGE	14	G28
OTHER (SPECIFY)_______________	15
DK	d
RF	r

LAFANS

G10. How many schools has (CHILD) attended in total since (HE/SHE) first started school?

PROBE: Include current school and all other schools attended this year and in other school years. If applicable, also include schools outside the U.S.

NUMBER OF SCHOOLS	|___|___|	IF 01 SKIP TO CHECK G2 G8
DK	d
RF	r

Created

IF G10 > 1:

G11. How many schools has (CHILD) attended in the past two years?

PROBE: Include current school and all other schools attended in the past two years. If applicable, also include schools outside the U.S.

NUMBER OF SCHOOLS	|___|___|
DK	d
RF	r

CHECK G8. IS CHILD’S GRADE > K?

YES	1
NO	2	G16
DK	d
RF	r

LAFANS

G12. During the current school year did you participate in any of the following activities at (CHILD)'s school?

Did you… (READ LIST)?

		YES	NO	DK	RF
A	Volunteer in the classroom, school office, or library?	1	2	d	r
B	Request a conference with (CHILD)'s teacher?	1	2	d	r
C	Attend a school event in which (CHILD) participated?	1	2	d	r
D	Volunteer to help at a school event such as a field trip, dance, fund-raising event, or other activity?	1	2	d	r
E	Attend a PTA, PTO, or other such meeting?	1	2	d	r

LA FANS

G13. These next questions are about (CHILD).

		YES	NO	DK	RF
A	Has (CHILD) ever repeated a grade?	1	2	d	r
B	Has (CHILD) ever been suspended or expelled from school?	1	2	d	r
C	Is (CHILD) currently involved in any clubs, teams, extracurricular programs or groups, either at school or outside of school?	1	2	d	r

New Hope (modified)

G14. Based on your knowledge of (CHILDS)’s school work, including (HIS/HER) most recent report cards, how is (HE/SHE) doing in school overall? Would you say not well at all, below average, average, well, or very well?

INTERVIEWER: SHOW RESPONSE CARD G14 TO R.

NOT WELL AT ALL	1
BELOW AVERAGE	2
AVERAGE	3
WELL	4
VERY WELL	5
DK	d
RF	r

Created

G15. Please think about the last year of school that (CHILD) completed. About how many days was (HE/SHE) absent? Would you say…

PROBE: This could be due to sickness, family emergencies, vacations, or other circumstances.

INTERVIEWER: SHOW RESPONSE CARD G15 TO R.

0 days	1
1-5 days	2
6-10 days	3
11-15 days	4
More than 15 days	5
DK	d
RF	r

LA FANS

G17. In the past week, about how many times have you praised or shown physical affection to (CHILD) for doing something worthwhile? Would that be never, once, several times, or almost every day?

INTERVIEWER: SHOW RESPONSE CARD G17 TO R.

NEVER	1
ONCE	2
SEVERAL TIMES	3
ALMOST EVERY DAY	4
DK	d
RF	r

LA FANS

G18. In the past week, how many times have you told another adult for example, a friend or relative something positive about (CHILD)? Would that be never, once, several times, or almost every day? 

INTERVIEWER: SHOW RESPONSE CARD G17 TO R.

NEVER	1
ONCE	2
SEVERAL TIMES	3
ALMOST EVERY DAY	4
DK	d
RF	r

LA FANS

IF CHILD = 1 -10 YEARS OF AGE:

G19. How often in the past week, did you or other family members get a chance to read to (CHILD)?

INTERVIEWER: SHOW RESPONSE CARD G17 TO R.

NEVER	1
ONCE	2
SEVERAL TIMES	3
ALMOST EVERY DAY	4
VOLUNTERED: CHILD READS INDEPENDENTLY	5
DK	d
RF	r

Moore

G20. In a typical week, how many days do you eat at least one meal with (CHILD)?

One day	1
Two days	2
Three days	3
Four days	4
Five days	5
Six days	6
Seven days	7
DK	d
RF	r

LAFANS (modified)

IF CHILD AGE 1+

G21. Sometimes children misbehave. When (CHILD) misbehaves, what do you do? In other words, how do you punish or discipline (CHILD)?

CODE ALL THAT APPLY

GROUND CHILD/ DON'T LET HIM/HER GO OUT OR GO OUT TO PLAY	1
SPANK CHILD	2
TALK WITH CHILD	3
SCOLD OR YELL AT CHILD	4
GIVE HIM/HER HOUSEHOLD CHORES	5
IGNORE IT	6
PUT CHILD IN ROOM/ SEND CHILD TO ROOM FOR LESS THAN 1 HOUR	7
PUT CHILD IN ROOM/ SEND CHILD TO ROOM FOR MORE THAN 1 HOUR	8
MAKE CHILD GO TO BED	9
TELL OTHER PARENT	10
TAKE AWAY ALLOWANCE	11
TAKE AWAY TV OR OTHER PRIVILEGES	12
GIVE CHILD A "TIME OUT"	13
HOLD CHILD UNTIL (HE/SHE) IS CALM	14
OTHER (SPECIFY)	15
DK	d
RF	r

Created

IF G21 = SPANK, ASK G22. ELSE, SKIP TO G23

G22. In the past week, how often have you had to spank (CHILD)?

INTERVIEWER: SHOW RESPONSE CARD G17 TO R.

Never	1
Once	2
Several Times	3
Almost Every Day	4
DK	d
RF	r

 

Created

G23. IF G21 = SPANK, FILL:

In the past week, how often have you had to discipline (CHILD) in other ways?

IF G21 IS NOT EQUAL TO SPANK, FILL:

In the past week, how often have you had to discipline (CHILD)?

INTERVIEWER: SHOW RESPONSE CARD G17 TO R.

Never	1
Once	2
Several Times	3
Almost Every Day	4
DK	d
RF	r

  

CHECK G9. IS CHILD 6 YEARS OF AGE OR OLDER?

YES	1
NO	2	G30
DK	d
RF	r

LAFANS

G24. How many of (CHILD)’s friends’ names do you know? Would you say you know all of the names of (HIS/HER) friends, most, some, or none?

INTERVIEWER: SHOW RESPONSE CARD G24 TO R.

ALL	1
MOST	2
SOME	3
NONE	4
NO FRIENDS	5	G26
DK	d
RF	r

LAFANS

G25. Think about the parents of (CHILD)'s friends. How many of them do you know? Would you say you know all of their parents, most, some or none?

INTERVIEWER: SHOW RESPONSE CARD G25 TO R.

ALL	1
MOST	2
SOME	3
NONE	4
DK	d
RF	r

LAFANS

G26. How often do you know who (CHILD) is with when (HE/SHE) is not at home? Would that be…

INTERVIEWER: SHOW RESPONSE CARD G26 TO R.

All of the time	1
Most of the time	2
Some of the time	3
None of the time	4
DK	d
RF	r

LAFANS

IF CHILD IS IN SCHOOL (G8 = 1)

G27. How often do you check to make sure (CHILD) has completed (HIS/HER) homework? Would that be…

INTERVIEWER: SHOW RESPONSE CARD G27 TO R.

Less than once a month or never	1
About once a month	2
A few times a month	3
At least a few times a week	4
Every day or every night	5
Every time child has homework assigned	6
DK	d
RF	r

CHECK G10. IS CHILD 14 YEARS OF AGE OR OLDER?

YES	1
NO	2	G30
DK	d
RF	r

New Hope

G28. Raising children can be difficult these days. Have there ever been any of the following problems with (CHILD)?

					IF YES, Has this happened in the past two years?
A	Being suspended, excluded, or expelled from school?	YES NO DK RF	1 2 d r	A1	YES NO DK RF	1 2 d r
B	Having to go to juvenile court?	YES NO DK RF	1 2 d r	B1	YES NO DK RF	1 2 d r
C	Having a problem with alcohol or drugs?	YES NO DK RF	1 2 d r	C1	YES NO DK RF	1 2 d r
D	Getting into trouble with the police?	YES NO DF RF	1 2 d r	D1	YES NO DK RF	1 2 d r
E	Doing something illegal to get money?	YES NO DK RF	1 2 d r	E1	YES NO DK RF	1 2 d r
F	Dropping out of school before graduating?	YES NO DK RF	1 2 d r	F1	YES NO DK RF	1 2 d r
G	Getting pregnant or getting someone pregnant?	YES NO DK RF	1 2 d r	G1	YES NO DK RF	1 2 d r

Created

G29. For each of the following statements, please tell me if you strongly agree, agree, disagree, or strongly disagree.

INTERVIEWER: SHOW RESPONSE CARD G29 TO R.

		Strongly Agree	Agree	Disagree	Strongly Disagree	DK	RF
A	I don't really talk about marriage or relationships with (CHILD).	1	2	3	4	d	r
B	I strongly discourage (CHILD) from having children before marriage.	1	2	3	4	d	r
C	I think (CHILD) will probably have or father a baby before getting married.	1	2	3	4	d	r
D	I think (CHILD) will probably get married.	1	2	3	4	d	r
E	I think (CHILD) will probably have a good job.	1	2	3	4	d	r
F	I am confident that (CHILD) knows about dating in a healthy way.	1	2	3	4	d	r
G	I am confident that (CHILD)’s romantic relationships will be stable and healthy.	1	2	3	4	d	r

Created

G29a. Does (CHILD) have any children of (HIS/HER) own?

YES	1
NO	2
DK	d
RF	r

Created

G29b. As far as you know, has (CHILD) ever attended any classes about healthy dating or healthy relationships? These classes could have been at school, at church, or somewhere else.

YES	1
NO	2
DK	d
RF	r

G30. For this statement, please tell me if you strongly agree, agree, disagree, or strongly disagree: Overall, I am satisfied with my relationship with (CHILD).

INTERVIEWER: SHOW RESPONSE CARD G29 TO R.

Strongly Agree	1
Agree	2
Disagree	1
Strongly disagree	2
DK	d
RF	r

FF

G31. Now I’m going to read some statements about being a parent. Please tell me if you strongly agree, agree, disagree, or strongly disagree with each one.

INTERVIEWER: SHOW RESPONSE CARD G29 TO R.

		Strongly Agree	Agree	Disagree	Strongly Disagree	DK	RF
A	Being a parent is harder than I thought it would be.	1	2	3	4	d	r
B	I feel trapped by my responsibilities as a parent.	1	2	3	4	d	r
C	I find that taking care of my child(ren) is much more work than pleasure.	1	2	3	4	d	r
D	I often feel tired, worn out, or exhausted from raising a family.	1	2	3	4	d	r

H. RESPONDENT CHARACTERISTICS AND BACKGROUND

CHECK H1: IS RESPONDENT A PARTICIPANT OR CONTINUING RESPONDENT?

PARTICIPANT	1	CONTINUE
CONTINUING	2	SKIP TO H5

SHM (modified)

H1. These next questions are about your background. Do you consider yourself Hispanic, Latino(a) or Spanish?

YES	1
NO	2
DK	d
RF	r

SHM/NSAF/Census 2010

H2. Do you consider yourself…

INTERVIEWER: CHOOSE ONE OR MORE RACES TO INDICATE WHAT THE RESPONDENT REPORTS ABOUT HIM OR HERSELF. IF R SAYS “NATIVE AMERICAN,” VERIFY BY ASKING: “I am recording this as ‘American Indian’—is that right?” (IF YES, CODE “3”) ]

White or Caucasian	1
Black or African American	2
American Indian or Alaskan Native	3
Asian	4
Native Hawaiian or Other Pacific Islander	5
Some other race	6
DK	d
RF	r

NSAF

H3. In what country were you born?

UNITED STATES	1	H5
PUERTO RICO	2	H5
OTHER U.S. TERRITORY (AMERICAN SAMOA, GUAM, MARSHALL ISLANDS, NORTHERN MARIANAS ISLANDS, OR U.S. VIRGIN ISLANDS)	3	H5
Mexico	4
Philippines	5
India	6
China	7
Vietnam	8
Cuba	9
Korea	10
Canada	11
El Salvador	12
Germany	13
Dominican Republic	14
United Kingdom	15
Jamaica	16
Colombia	17
Guatemala	18
OTHER COUNTRY (SPECIFY)________________	19
DK	d
RF	r

NSAF (modified)

H4. In what year did you first come to live in the United States?

SPECIFIC YEAR	|__|__|__|__|
DK	d
RF	r

H4a. IF H4= DK: How many years ago did you first come to live in the United States?

# OF YEARS AGO	|__|__|
DK	d
RF	r

NSAF (modified)

H5. IF PARTICIPANT: What is the highest grade or level of school you have ever completed?

IF CONTINUING: These next questions are about your background. What is the highest grade or level of school you have ever completed?

IF ANSWER IS HIGH SCHOOL DIPLOMA, PROBE: Do you have a high school diploma or GED?

NONE	1
8TH GRADE OR LESS	2
SOME HIGH SCHOOL	3
GED	4
HIGH SCHOOL DIPLOMA	5
VOCATIONAL/TECHNICAL/BUSINESS CERTIFICATE OR DIPLOMA	6
SOME COLLEGE	7
ASSOCIATE’S DEGREE (AA; AS)	8
BACHELOR’S DEGREE (BA; BS)	9
GRADUATE/PROFESSIONAL DEGREE (MA; MS; PHD; EDD; MEDICINE/MD; DENTISTRY/DDS; LAW/JJ/LLB; ETC.)	10
DK	d
RF	r

NSAF

H6. Now I’d like to ask a few questions about your employment. Are you now employed at a job or business?

INTERVIEWER: IF R HAS A JOB BUT IS TEMPORARILY NOT WORKING BECAUSE OF SICKNESS, VACATION, STRIKE, BAD WEATHER, ETC, COUNT AS EMPLOYED.

YES	1	H9
NO	2
DK	d
RF	r

NSAF

H7. During the past four weeks, have you taken steps to look for work?

YES	1
NO	2
DK	d
RF	r

NSAF

H8. What is the main reason you are not working now?

ILL OR DISABLED AND UNABLE TO WORK	1
RETIRED	2
TAKING CARE OF HOME/FAMILY/CHILDREN	3
GOING TO SCHOOL	4
CANNOT FIND WORK	5
SUITABLE JOB NOT AVAILABLE	6
NOT INTERESTED IN WORKING	7
PREGNANCY/CHILDBIRTH	8
ON LAYOFF (TEMPORARY OR INDEFINITE)	9
JOB ENDED	10
NEW JOB TO BEGIN WITHIN 30 DAYS	11
OTHER (SPECIFY)______________________________	12
DK	d
RF	r
ALL RESPONSES GO TO H16

NSAF

IF WORKING:

H9. How many jobs do you have?

NUMBER OF JOBS	|___|___|
DK	d
RF	r

NSAF (modified)

H10. IF H9=1 (ONE JOB): What kind of work do you do, that is, what is your occupation?

IF H9 = >1 (MORE THAN ONE JOB): Let’s talk about your main job – the job at which you work the most hours. What kind of work do you do, that is, what is your occupation?

OCCUPATION	_______________________________
DK	d
RF	r

NSAF (modified)

H11. IF H9=1: How long have you been working at your current job?

IF H9>1: How long have you been working at your main job?

INTERVIEWER: IF LESS THAN ONE YEAR, PROBE FOR NUMBER OF MONTHS. IF LESS THAN ONE MONTH, ENTER 1 MONTH.

	RECORD YEARS AND MONTHS:
YEARS	|___|___|
MONTHS	|___|___|
DK	d
RF	r

CPS

H12. Including overtime pay, tips and commissions, what are your usual monthly earnings on this job, before taxes and other deductions?

PROBE: What is your best estimate of your monthly earnings before taxes or other deductions?

MONTHLY EARNINGS	$|___|___|,|___|___|___|
DK	d
RF	r

BSF

H14. IF H12 = DK/RF: I just need to know a range. Can you tell me if it was…

$500 or less	1
$501 - $750	2
$751 - $1000	3
$1001 - $1250	4
$1251 - $1500	5
$1501 - $1750	6
$1751 - $2000	7
$2001 - $2500	8
$2501 - $3000	9
$3001 - $3500	10
$3501 - $4000	11
$4001 - $4500	12
$4501 - $5000	13
$5001 - $6000	14
More than $6000	15
DK	d
RF	r

CPS

H15. IF H9=1: How many hours per week do you usually work at your job?

IF H9>1: How many hours per week do you usually work at your main job?

HOURS WORKED	|___|___|
DK	d
RF	r

Created

H16. What were your total earnings in 2006 2008 before taxes and other deductions? Please include tips, commissions, overtime pay and government benefits such as TANF or disability payments.

PROBE: If you had more than one job, include your total earnings from all your jobs during 2006 2008.

PROBE: I can help you add it up if you want to think out loud.

INSTRUCTION: IF RESPONDENT CAN ONLY REPORT EARNINGS AFTER TAXES, ENTER THAT AMOUNT

AMOUNT	$|___|___|___|, |___|___|___|.00
DK	d	H18
RF	r	H18

BSF

H18. IF H16 = DK/RF: I just need to know a range. Can you tell me if it was…

INSTRUCTION: STOP READING WHEN RESPONDENT PROVIDES RANGE

$1000 or less	1
$1,001 - $5,000	2
$5,001 - $10,000	3
$10,001 - $30,000	4
$30,001 - $40,000	5
$40,001 - $50,000	6
$50,001 - $60,000	7
$60,001 - $70,000	8
$70,001 - $80,000	9
$80,001 - $90,000	10
$90,001 - $100,000	11
More than $100,000	12
DK	d
RF	r

CHECK H2: IS RESPONDENT A PARTICIPANT OR CONTINUING RESPONDENT?

PARTICIPANT	1	CONTINUE
CONTINUING	2	SKIP TO H22

BSF

H19. Now I have some questions about your family when you were growing up. Before you turned 18, most of the time did you live with…

INTERVIEWER: SHOW RESPONSE CARD H19 TO R.

Both your biological or adoptive mother and your biological or adoptive father	1
Your biological or adoptive mother only	2
Your biological or adoptive father only	3
Neither of your biological or adoptive parents	4
DK	d
RF	r

BSF

H20. Were your biological or adoptive parents ever married to each other?

YES	1
NO	2
DK	d
RF	r

Created

H22. Do you have any children, either biological or adopted, who are not living with you?

YES	1
NO	2	SKIP TO H24
DK	d
RF	r

Created

H23. How many of your children not living with you are under age 18?

NUMBER OF CHILDREN LIVING APART	|___|___|
DK	d
RF	r

Nock

H24. The next few questions ask about your religious beliefs and practices. About how often do you attend religious services? Would you say…

INTERVIEWER: SHOW RESPONSE CARD H24 TO R.

Never	1	H27
Less than once a year	2
About once or twice a year	3
Several times a year	4
About once a month	5
Nearly every week	6
Every week	7
Several times a week	8
DK	d
RF	r
IF R = SINGLE, GO TO H26

Nock (modified)

H25. IF MARRIED OR PARTNERED: How often do you and (SPOUSE/PARTNER) attend services together? Would you say…

INTERVIEWER: SHOW RESPONSE CARD H25 TO R.

Never	1
From time to time	2
Usually	3
Always	4
DK	d
RF	r

Created

H26. Does your place of worship offer premarital counseling, marriage counseling, or marriage education classes to people who are interested in these services?

YES	1
NO	2
DK	d
RF	r

I. SPOUSE/PARTNER CHARACTERISTICS AND BACKGROUND

CHECK I1. IS RESPONDENT A PARTICIPANT OR CONTINUING RESPONDENT?

PARTICIPANT	1	SKIP TO I1
CONTINUING	2	CONTINUE

CHECK I2. IS RESPONDENT MARRIED TO, PARTNERED WITH, OR DATING A DIFFERENT PERSON THAN IN ROUND 1?

YES	1	CONTINUE
NO	2	SKIP TO I5

SHM (modified)

I1. Now I have some questions about (SPOUSE/PARTNER). Is (SPOUSE/PARTNER) Hispanic, Latino(a) or Spanish?

YES	1
NO	2
DK	d
RF	r

SHM/NSAF/Census 2010

I2. Is (SPOUSE/PARTNER)…

INTERVIEWER: CHOOSE ONE OR MORE RACES TO INDICATE WHAT THE RESPONDENT REPORTS ABOUT SPOUSE/PARTNER. IF R SAYS “NATIVE AMERICAN,” VERIFY BY ASKING: “I am recording this as ‘American Indian’—is that right?” (IF YES, CODE “3”) ]

White or Caucasian	1
Black or African American	2
American Indian or Alaskan Native	3
Asian	4
Native Hawaiian or Other Pacific Islander	5
Some other race	6
DK	d
RF	r

NSAF

I3. In what country was (SPOUSE/PARTNER) born?

PROBE: What area of the world is (SPOUSE/PARTNER) from? For example: Mexico, Central America, South America, Middle East, Asia, Africa, Europe, Caribbean, or Canada.

UNITED STATES	1	I5
PUERTO RICO	2	I5
OTHER U.S. TERRITORY (AMERICAN SAMOA, GUAM, MARSHALL ISLANDS, NORTHERN MARIANAS ISLANDS, OR U.S. VIRGIN ISLANDS)	3	I5
Mexico	4
Philippines	5
India	6
China	7
Vietnam	8
Cuba	9
Korea	10
Canada	11
El Salvador	12
Germany	13
Dominican Republic	14
United Kingdom	15
Jamaica	16
Colombia	17
Guatemala	18
OTHER COUNTRY (SPECIFY)________________	19
DK	d
RF	r

NSAF (modified)

I4. In what year did (SPOUSE/PARTNER) first come to live in the United States?

SPECIFIC YEAR	|__|__|__|__|
DK	d
RF	r

I4a. IF I4=DK: How many years ago did (SPOUSE/PARTNER) first come to live in the United States?

# OF YEARS AGO	|__|__|
DK	d
RF	r

NSAF (modified)

I5. What is the highest grade or level of school (SPOUSE/PARTNER) has ever completed?

IF ANSWER IS HIGH SCHOOL DIPLOMA, PROBE: Does (SPOUSE/PARTNER) have a high school diploma or GED?

NONE	1
8TH GRADE OR LESS	2
SOME HIGH SCHOOL	3
GED	4
HIGH SCHOOL DIPLOMA	5
VOCATIONAL/TECHNICAL/BUSINESS CERTIFICATE OR DIPLOMA	6
SOME COLLEGE	7
ASSOCIATE’S DEGREE (AA; AS)	8
BACHELOR’S DEGREE (BA; BS)	9
GRADUATE/PROFESSIONAL DEGREE (MA; MS; PHD; EDD; MEDICINE/MD; DENTISTRY/DDS; LAW/JJ/LLB; ETC.)	10
DK	d
RF	r

NSAF

I6. Now I’d like to ask a few questions about (SPOUSE/PARTNER)’s employment. Is (SPOUSE/PARTNER) now employed at a job or business?

INTERVIEWER: IF SPOUSE/PARTNER HAS A JOB BUT IS TEMPORARILY NOT WORKING BECAUSE OF SICKNESS, VACATION, STRIKE, BAD WEATHER, ETC, COUNT AS EMPLOYED.

YES	1	I10
NO	2
DK	d
RF	r

NSAF

I7. During the past four weeks, has (SPOUSE/PARTNER) taken steps to look for work?

YES	1
NO	2
DK	d
RF	r

NSAF

I8. What is the main reason (SPOUSE/PARTNER) is not working now?

ILL OR DISABLED AND UNABLE TO WORK	1
RETIRED	2
TAKING CARE OF HOME/FAMILY/CHILDREN	3
GOING TO SCHOOL	4
CANNOT FIND WORK	5
SUITABLE JOB NOT AVAILABLE	6
NOT INTERESTED IN WORKING	7
PREGNANCY/CHILDBIRTH	8
ON LAYOFF (TEMPORARY OR INDEFINITE)	9
JOB ENDED	10
NEW JOB TO BEGIN WITHIN 30 DAYS	11
SPOUSE/ PARTNER INCARCERATED	12
OTHER (SPECIFY)______________________________	13
DK	d
RF	r
ALL RESPONSES GO TO I16

NSAF

IF WORKING:

I9. How many jobs does (SPOUSE/PARTNER) have?

NUMBER OF JOBS	|___|___|
DK	d
RF	r

NSAF

I10. IF I9=1: What kind of work does (HE/SHE) do; that is, what is (HIS/HER) occupation?

IF I9>1: Now, let’s talk about (SPOUSE/PARTNER)’s main job – the job at which (HE/SHE) works the most hours. What kind of work does (HE/SHE) do; that is, what is (HIS/HER) occupation?

OCCUPATION	_______________________________
DK	d
RF	r

I11. IF I9=1: How long has (SPOUSE/PARTNER) been working at (HIS/HER) current job?

IF I9>1: How long has (SPOUSE/PARTNER) been working at (HIS/HER) main job?

INTERVIEWER: IF LESS THAN ONE YEAR, PROBE FOR NUMBER OF MONTHS. IF LESS THAN ONE MONTH, ENTER 1 MONTH.

	RECORD YEARS AND MONTHS:
YEARS	|___|___|
MONTHS	|___|___|
DK	d
RF	r

CPS

I12. Including overtime pay, tips and commissions, what are (SPOUSE/PARTNER’S) usual monthly earnings on this job, before taxes and other deductions?

PROBE: What is your best estimate of (HIS/HER) monthly earnings before taxes or other deductions?

MONTHLY EARNINGS	$|___|___|,|___|___|___|
DK	d
RF	r

BSF

I13. INTERVIEWER: PLEASE ENTER HOW RESPONDENT PROVIDED THE AMOUNT

BEFORE TAXES WITHOUT PROBING	1
BEFORE TAXES AFTER PROBING	2
AFTER TAXES	3
NOT SURE	4

BSF

I14. IF I12 = DK/RF: I just need to know a range. Can you tell me if it was…

$500 or less	1
$501 - $750	2
$751 - $1000	3
$1001 - $1250	4
$1251 - $1500	5
$1501 - $1750	6
$1751 - $2000	7
$2001 - $2500	8
$2501 - $3000	9
$3001 - $3500	10
$3501 - $4000	11
$4001 - $4500	12
$4501 - $5000	13
$5001 - $6000	14
More than $6000	15
DK	d
RF	r

CPS

I15. How many hours per week does (SPOUSE/PARTNER) usually work at (HIS/HER) main job?

HOURS WORKED	|___|___|
DK	d
RF	r

Created

I16. What were (SPOUSE/PARTNER’S) total earnings in 2008 before taxes and other deductions? Please include tips, commissions, overtime pay and government benefits such as TANF or disability payments.

PROBE: If (SPOUSE/PARTNER) had more than one job, include (HIS/HER) total earnings from all jobs during 2008.

PROBE: I can help you add it up if you want to think out loud.

INSTRUCTION: IF RESPONDENT CAN ONLY REPORT EARNINGS AFTER TAXES, ENTER THAT AMOUNT

AMOUNT	$|___|___|___|, |___|___|___|.00
DK	d
RF	r

BSF

I18. IF I16 = DK/RF: I just need to know a range. Can you tell me if it was…

INSTRUCTION: STOP READING WHEN RESPONDENT PROVIDES RANGE

$1000 or less	1
$1,001 - $5,000	2
$5,001 - $10,000	3
$10,001 - $30,000	4
$30,001 - $40,000	5
$40,001 - $50,000	6
$50,001 - $60,000	7
$60,001 - $70,000	8
$70,001 - $80,000	9
$80,001 - $90,000	10
$90,001 - $100,000	11
More than $100,000	12
DK	d
RF	r

CHECK I3. IS RESPONDENT A PARTICIPANT OR CONTINUING RESPONDENT?

PARTICIPANT	1	SKIP TO I19
CONTINUING	2	CONTINUE

CHECK I4. IS RESPONDENT MARRIED TO, PARTNERED WITH, OR DATING A DIFFERENT PERSON THAN IN ROUND 1?

YES	1	CONTINUE
NO	2	SKIP TO CHECK I5

BSF

I19. Now I have some questions about (SPOUSE/PARTNER’S) family when (HE/SHE) was growing up. Before (SPOUSE/PARTNER) turned 18, most of the time did (HE/SHE) live with…

INTERVIEWER: SHOW RESPONSE CARD I19 TO R.

Both (HIS/HER) biological or adoptive mother and (his/her) biological or adoptive father,	1
(HIS/HER) biological or adoptive mother only	2
(HIS/HER) biological or adoptive father only	3
Neither of (HIS/HER) biological or adoptive parents?	4
DK	d
RF	r

BSF

I20. Were (HIS/HER) biological or adoptive parents ever married to each other?

YES	1
NO	2
DK	d
RF	r

CHECK 15. IS SPOUSE/PARTNER THE BIOLOGICAL OR ADOPTIVE PARENT OF (CHILD)?

YES	1	I21
NO	2
NO FOCAL CHILD	3	I23
DK	d
RF	r

CHECK I6. INTERVIEWER: IS SPOUSE/PARTNER CO-HABITATING WITH RESPONDENT OR IS SPOUSE/PARTNER THE BIOLOGICAL/ ADOPTIVE PARENT OF (CHILD)?

YES	1
NO	2	I23
DK	d
RF	r

I21. How satisfied are you with the relationship (SPOUSE/PARTNER) has with (CHILD)? Would you say…

INTERVIEWER: SHOW RESPONSE CARD I21 TO R.

Very satisfied	1
Somewhat satisfied	2
Somewhat dissatisfied	3
Very dissatisfied	4
DK	d
RF	r

I22. Now I have some questions about (SPOUSE/PARTNER’S) relationship with (CHILD). For each of the following statements, please tell me if you strongly agree, agree, disagree, or strongly disagree.

INTERVIEWER: SHOW RESPONSE CARD I22 TO R.

		STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE	DK	RF
A	BSF IF SPOUSE IS BIOLOGICAL/ADOPTIVE PARENT: I believe (SPOUSE/ PARTNER) is a good parent.	1	2	4	5	d	r
B	FF I am critical of the things (SPOUSE/ PARTNER) does with (CHILD).	1	2	4	5	d	r
C	BSF I feel good about (SPOUSE/ PARTNER)’s judgment about what is right for (CHILD).	1	2	4	5	d	r
D	FF If I had to go away for one week and could not take (CHILD) with me, I would trust (SPOUSE/ PARTNER) to take care of (CHILD).	1	2	4	5	d	r

Created

I23. These next questions are about (SPOUSE/PARTNER).

IF MARRIED:

How many times has (SPOUSE) been married, including your present marriage?

IF COHABITATING OR DATING:

How many times has (PARTNER) been married, if at all?

NUMBER OF MARRIAGES	|___|___|
DK
RF

TX

I24. Does (SPOUSE/PARTNER) have any children, either biological or adopted, from any previous relationships?

YES	1
NO	2
DK	d
RF	r

J. NON-RESIDENTIAL PARENT CHARACTERISTICS AND BACKGROUND

CHECK J1. HAS A FOCAL CHILD BEEN SELECTED?

YES	1
NO	2	SKIP TO SECTION K
DK	d
RF	r

CHECK J2a. IS R THE BIOLOGICAL OR ADOPTIVE PARENT OF FOCAL CHILD?

YES	1
NO	2
DK	d
RF	r

CHECK J2b. IS SPOUSE/PARTNER THE BIOLOGICAL OR ADOPTIVE PARENT OF FOCAL CHILD?

YES	1
NO	2
DK	d
RF	r

CHECK J3. IS SPOUSE/PARTNER LIVING WITH RESPONDENT?

YES	1	SKIP TO SECTION K
NO	2
DK	d
RF	r

IF J2b = 1 AND J3 =1 (S/P IS BIO PARENT AND LIVING WITH R) GO TO SECTION K

IF J2b = 1 AND J3 =2 (S/P IS BIO PARENT BUT NOT LIVING WITH R) GO TO J1a

IF J2a = 2 (R IS NOT BIO PARENT) GO TO J1a

IF J2b = 2 (S/P IS NOT BIO PARENT) GO TO J1a

J1a. Next I would like to ask some questions about (CHILD’s) biological (MOTHER/ FATHER). Is this person currently living or deceased?

LIVING	1	CONTINUE
DECEASED	2	SKIP TO SECTION K
DK	d	SKIP TO SECTION K
RF	r	SKIP TO SECTION K

Created

J1. What is the first name of (CHILD’S) biological (MOTHER/FATHER). I just need a way of referring to (HIM/HER) in the next few questions. If you don’t know, please just say so.

BIOLOGICAL PARENT’S NAME	________________
DK	d	SECTION K
RF	r

BSF

J2. IF R IS MALE AND IS THE BIOLOGICAL/ ADOPTIVE PARENT OF (CHILD):

Did you and (NON-RESIDENT BIOLOGICAL PARENT’S NAME) ever sign a birth certificate or document that identifies you as the legal father of (CHILD)? Or, has a court ruled that you are (CHILD)’s father?

IF R IS FEMALE AND IS THE BIOLOGICAL/ ADOPTIVE PARENT OF (CHILD):

Did you and (NON-RESIDENT BIOLOGICAL PARENT’S NAME) ever sign a birth certificate or document that identifies him as the legal father of (CHILD)? Or, has a court ruled that he is (CHILD)’s father?

IF (SPOUSE/PARTNER) IS MALE AND IS THE BIOLOGICAL/ ADOPTIVE PARENT OF (CHILD): Did (SPOUSE/PARTNER) and (NON-RESIDENT BIOLOGICAL PARENT’S NAME) ever sign a birth certificate or document that identifies him as the legal father of (CHILD)? Or, has a court ruled that he is (CHILD)’s father?

IF R IS FEMALE AND IS THE BIOLOGICAL/ ADOPTIVE PARENT OF (CHILD):

Did (SPOUSE/ PARTNER) and (NON-RESIDENT BIOLOGICAL PARENT’S NAME) ever sign a birth certificate or document that identifies him as the legal father of (CHILD)? Or, has a court ruled that he is (CHILD)’s father?

IF NECESSARY, SAY: You usually sign a birth certificate in the hospital shortly after the

baby is born or sometimes a little bit later.

YES	1
NO	2
DOESN’T KNOW WHO BIOLOGICAL PARENT IS	3	SECTION K
DK	d
RF	r

FF

J3. The next question is about time (NON-RESIDENT BIOLOGICAL PARENT’S NAME) spends with (CHILD). In the past month, how often has (NON-RESIDENT BIOLOGICAL PARENT’S NAME) spent one or more hours a day with (CHILD)? Was it…

INTERVIEWER: SHOW RESPONSE CARD J3 TO R.

Everyday or almost every day,	1
A few times a week,	2
A few times in the past month,	3
Once or twice, or	4
Never	5
DK	d
RF	r

NSFH

J4. How much influence does (NON-RESIDENT BIOLOGICAL PARENT’S NAME) have in making major decisions about (CHILD), such as (HIS/HER) education, medical care, and religion? Would you say…

A great deal	1
Some	2
None	3
DK	d
REF	r

BSF

J5. Do you have a legal agreement or child support order that requires (NON-RESIDENT BIOLOGICAL PARENT’S NAME) to provide financial support for (CHILD)?

YES	1
NO	2
DK	d
RF	r

Created

J6. Overall, how satisfied are you with amount of money that (NON-RESIDENT BIOLOGICAL PARENT’S NAME) contributes to the cost of raising (CHILD)? Would you say…

INTERVIEWER: SHOW RESPONSE CARD J6 TO R.

Very satisfied	1
Somewhat satisfied	2
Somewhat dissatisfied	3
Very dissatisfied	4
DK	d
RF	r

11. HOUSEHOLD SELF-SUFFICIENCY

NSAF/Census 2010 (modified)

K1. I’d like to ask a few questions about your current living arrangement. Is this home or apartment...

owned by you or someone in this household with a mortgage or loan?	1
owned by you or someone in this household free and clear (without a mortgage or loan)?	2
rented, or	3
occupied without payment of rent?	4
DK	d
RF	r

NSAF

K2. How long have you lived in this home?

INTERVIEWER: RECORD NUMBER OF YEARS AND MONTHS.

MONTHS	|__|__|
YEARS	|__|__|
DK	d
RF	r

Standard

K3. What language is spoken most often in this home?

ENGLISH	1
SPANISH	2
OTHER (SPECIFY)__________________	3
DK	d
RF	r

BSF

K4. The next questions are about financial difficulties you may have experienced in the past 12 months. Please tell me if there has been a time during the past 12 months when…

		YES	NO	DK	RF
A	IF RENTING OR OWN WITH MORTAGE: You could not pay the full amount of the (rent/ mortgage) that you were supposed to pay?	1	2	d	r
B	You had service turned off by the water, gas, or electric company, or the oil company would not deliver oil because you could not afford to pay the bill?	1	2	d	r
C	IF RENTING OR OWN WITH MORTGAGE: You were evicted from your home or apartment because you could not pay the (rent/ mortgage)?	1	2	d	r

Created

K5. For the purpose of this study, it is important to learn the total income received by all members of your household in (PAST MONTH). This includes money from jobs and any other sources. What was your household’s total income last month before taxes and other deductions? Please include tips, commissions, overtime pay and government benefits such as TANF or disability payments.

PROBE: I can help you add it up if you want to think out loud.

INSTRUCTION: IF RESPONDENT CAN ONLY REPORT EARNINGS AFTER TAXES, ENTER THAT AMOUNT

AMOUNT	$|___|___|, |___|___|___|.00
DK	d
RF	r

BSF

K7. IF K5 = DK OR RF: I just need to know a range. Can you tell me if it was…

INSTRUCTION: STOP READING WHEN RESPONDENT PROVIDES RANGE

$500 or less	1
$501 - $750	2
$751 - $1000	3
$1001 - $1250	4
$1251 - $1500	5
$1501 - $1750	6
$1751 - $2000	7
$2001 - $2500	8
$2501 - $3000	9
$3001 - $3500	10
$3501 - $4000	11
$4001 - $4500	12
$4501 - $5000	13
$5001 - $6000	14
More than $6000	15
DK	d
RF	r

BSF (modified)

K8. Next I’m going to read a list of income sources. For each, tell me if anyone in your household received income from this source in the past month.

PROBE: Did you or anyone in your household receive income from this source in the past month?

INTERVIEWER: FOLLOW UP WITH K9-K10 AS DIRECTED.

				K9. Was this income received by you or by someone else in your household?		K10. How much did (you/ that person) receive in (FILL INCOME SOURCE) in the past month?
A	Cash welfare, also known as TANF, or Temporary Aid for Needy Families? You may have received this benefit as an electronic transfer, a check or on a bank or debit card.	YES→ K9a NO→ K8b DK→ K8b RF→ K8b	1 2 d r	R Someone else DK RF All go to K10a	1 2 d r	$|___|___|, |___|___|___|.00 DK RF
B	Food stamp benefits? You may have received this benefit as coupons or as an EBT or debit card.	YES→ K9b NO→ K8c DK→ K8c RF→ K8c	1 2 d r	R Someone else DK RF All go to K10b	1 2 d r	$|___|___|, |___|___|___|.00 DK RF
C	Disability insurance such as Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI)? Please include electronically transferred benefits or debit cards.	YES→ K9c NO→ K8d DK→ K8d RF→ K8d	1 2 d r	R Someone else DK RF All go to K10c	1 2 d r	$|___|___|, |___|___|___|.00 DK RF
D	Unemployment insurance benefits or UI?	YES→ K9d NO→ K8e DK→ K8e RF→ K8e	1 2 d r	R Someone else DK RF All go to K10d	1 2 d r	$|___|___|, |___|___|___|.00 DK RF
E	Child support payments that are part of a legal agreement or court order? These are payments that the child’s parent is legally required to pay.	YES→ K9e NO→ K8f DK→ K8f RF→ K8f	1 2 d r	R Someone else DK RF All go to K10e	1 2 d r	$|___|___|, |___|___|___|.00 DK RF
F	Money from friends or relatives who do not live with you?	YES→ K9f NO→ K11 DK→ K11 RF→ K11	1 2 d r	R Someone else DK RF All go to K10f	1 2 d r	$|___|___|, |___|___|___|.00 DK RF

BSF

K11. IF SINGLE/DATING: Do you own a car, truck, or other vehicle?

IF MARRIED/PARTNERED: Do you or (SPOUSE/PARTNER) own a car, truck or other vehicle?

YES	1
NO	2
DK	d
RF	r

Created

IF CHILDREN IN HOUSEHOLD:

K13. (Is the child/ Are any of the children) in this household covered by Medicaid, the Children’s Health Insurance Program (FILL STATE/LOCAL NAMES), or any other government program that pays for medical care?

YES	1
NO	2
DK	d
RF	r

BSF

K12. Are you currently covered by Medicaid, CHILDREN’S HEALTH INSURANCE (FILL STATE/LOCAL NAMES), or any other government program that pays for medical care?

YES	1
NO	2
DK	d
RF	r

IF CHILDREN IN HOUSEHOLD:

K14. Are any of the children in this household limited in the kind or amount of activities or school work they can do because of a physical, mental, or emotional problem?

YES	1
NO	2
DK	d
RF	r

BSF

K15. In general, would you say your health is…

INTERVIEWER: SHOW RESPONSE CARD K15 TO R.

Excellent	1
Very good	2
Good	3
Fair, or	4
Poor	5
DK	d
RF	r
IF SINGLE, GO TO SECTION L

BSF

K16. IF MARRIED, PARTNERED, OR DATING: In general, would you say (SPOUSE/ PARTNER’S) health is…

INTERVIEWER: SHOW RESPONSE CARD K15 TO R.

Excellent	1
Very good	2
Good	3
Fair, or	4
Poor	5
DK	d
RF	r

L. CONCLUSION

L_end. That was our last question. Thank you for your participation in this study!

Someone from RTI might contact you by phone or by mail to briefly verify the quality of my work.

Before I leave, I want to give you this card with toll-free helpline numbers. Some people have found these to be useful.

I also need to give you your $25 incentive payment, and I need to ask you to initial a receipt.