SECTION I: INTIMATE | Johns Hopkins Center for Prevention and Early Intervention

MOST OF THE TIME

I4. How often does (INITIALS FROM I3a) regularly go to religious services? Would you say never, rarely, sometimes, often, most of the time, or always?

I5. How often does (INITIALS FROM I3a) regularly have a job?

READ CATEGORIES IF NECESSARY

I6. How often does (INITIALS FROM I3a) regularly volunteer (his/her) time for charitable activities and organizations that benefit the community?

PROBE: For example, The Salvation Army, Retirement Home/Nursing Home, Fraternities and Sororities, Neighborhood Beautification, Soup kitchen, Tutoring/Mentor, Big Brother/Big Sister, Boys and Girls Club, YMCA & YWCA, Church Organization, Athletic Coaching, Boy Scouts, Hospital Volunteer, etc?

READ CATEGORIES IF NECESSARY

I7. How often does (INITIALS FROM I3a) regularly get involved in political causes or activities?

PROBE: such as Voter Registration, Protest/Boycott, Petitioning, Public Hearing, Political Rallies, etc.]
such as Voter Registration, Protest/Boycott, Petitioning, Public Hearing, Political Rallies, etc.]
READ CATEGORIES IF NECESSARY

I8. How often does (INITIALS FROM I3a) regularly attend school?

READ CATEGORIES IF NECESSARY

|___|___| : |___|___|

Time

Think about the first time you had an intimate relationship.

NEVER HAD INTIMATE RELATIONSHIP, CODE 99 GO TO I37 (last question in section) |___|___|

|___|___|

I1a. What are the initials of the person with whom you first had an intimate relationship?

|____|____|____|

Initials

I1b. How old were you when your relationship with (INITIALS FROM I1a) began?

|___|___|

Years

I1d. What is (INITIALS FROM I1a) gender?

MALE 01

FEMALE 02

I1e. What is (INITIALS FROM I1a) race or ethnicity?

BLACK/AFRICAN AMERICAN 01

WHITE/EURO-AMERICAN 02

ASIAN OR PACIFIC ISLANDER 03

NATIVE AMERICAN 04

HISPANIC/LATINO 05

OTHER (SPECIFY) 06

_________________________________

I1f. Is (INITIALS FROM I1a)...

About the same age as you? 01

5 or more years older than you? 02

5 or more years younger than you? 03

I1g. How would you characterize your relationship with (INITIALS FROM I1a)? Would you say...

One night stand 01

Casual dating 02

Regularly dating 03

Seeing only this person 04

Committed to marriage 05

Married 06

I2a. How many people have you been involved with or dated since this relationship?

IF NO OTHER RELATIONSHIPS CODE N/A IN I2b-e, I3a-g ASK I3h (education).

YOUR BEST ESTIMATE IS FINE

|____|____|____|

I2b. How many of these people were...

Male |___|___|

Female |___|___|

N/A 09

I2e. How many of these relationships were...

YOUR BEST ESTIMATE IS FINE

One night stand |___|___|

Casual dating |___|___|

Regularly dating |___|___|

Seeing only this person |___|___|

Committed to marriage |___|___|

Married |___|___|

N/A 09

Now think of the person with whom you are currently involved with or dating.

IF RESPONDENT NOT INVOLVED IN A CURRENT RELATIONSHIP, ASK i*1

IF R SAYS, IN MORE THAN ONE RELATIONSHIP; "Please tell me about the relationship you consider the most serious." SKIP TO I3a

I*1. How long ago did it end? CODE IN MONTHS

|___|___|___|

# OF MONTHS

GO TO SECTION X,

SEXUAL BEHAVIOR

I3a. What are the initials of this person?

|____|____|____|

INITIALS

I3b. How old were you when the relationship began?

|___|___|

YEARS

I3d. What is (INITIALS FROM I3a) gender?

MALE 01

FEMALE 02

I3e. What is (INITIALS FROM I3a) race or ethnicity?

BLACK/AFRICAN AMERICAN 01

WHITE/EURO-AMERICAN 02

ASIAN OR PACIFIC ISLANDER 03

NATIVE AMERICAN 04

LATINO 05

OTHER (SPECIFY) 06

_________________________________

I3f. Is (INITIALS FROM I3a)...

About the same age as you? 01

5 or more years older than you? 02

5 or more years younger? 07

I3g. How would you characterize your relationship with (INITIALS FROM I3a)?

READ CATEGORIES

One night stand 01

Casual dating 02

Regularly dating 03

Seeing only this person 04

Committed to marriage 05

Married 06

N/A 09

I3h. What is the highest level of school (INITIALS FROM I3a) completed?

READ CATEGORIES IF NECESSARY

NINTH GRADE 01

TENTH GRADE 02

ELEVENTH GRADE 03

TWELFTH GRADE 04

HIGH SCHOOL DIPLOMA 05

G.E.D. 06

JUNIOR COLLEGE TOWARDS AA DEGREE 07

SOME COLLEGE TOWARDS BA

DEGREE 08

VOCATIONAL/TECHNICAL/BUSINESS 09

AA DEGREE 10

BA DEGREE 11

SOME GRADUATE SCHOOL; NO

DEGREE 12

MASTERS 13

PHD 14

PROFESSIONAL (LAW, MEDICAL) 15

Now I’m going to ask you some questions about (INITIALS FROM I3a) . How often does (INITIALS FROM I3a) do the following things:

Let’s talk a little bit about some of the things (INITIALS FROM I3a) does. Once again I will ask you to pick from one of the following responses.

Please tell me how often does (INITIALS FROM I3a) do the following things:

	NEVER	RARELY	SOMETIMES	OFTEN	MOST OF THE TIME	ALWAYS
I9. How often does (INITIALS FROM I3a) smoke cigarettes? Would you say never, rarely, sometimes, often, most of the time or always?	01	02	03	04	05	06
I10. How often does (INITIALS FROM I3a) drink alcohol heavily? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I11. How often does (INITIALS FROM I3a) use marijuana? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I12. How often does (INITIALS FROM I3a) use other illegal drugs such as; heroin, cocaine, uppers, LSD? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I13. How often does (INITIALS FROM I3a) sell illegal drugs? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I14. How often does (INITIALS FROM I3a) carry a gun? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I15. How often does (INITIALS FROM I3a) physically beat or seriously hurt other people? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I16. How often does (INITIALS FROM I3a) get picked up or arrested by the police? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I17. How often does (INITIALS FROM I3a) commit crimes? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06

Now I’d like to talk a bit about the relationship between you and (INITIALS FROM I3a), particularly how much you exchange affection with each other. How much of the time do you and (INITIALS FROM I3a) do each of the following?

	NEVER	RARELY	SOMETIMES	OFTEN	MOST OF THE TIME	ALWAYS
I18. How much of the time do you and (INITIALS FROM I3a) do things together, like going to the movies? Would you say never, rarely, sometimes, often, most of the time or always?	01	02	03	04	05	06
I19. How much of the time do you and (INITIALS FROM I3a) share warm feelings of affection? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I20. How much of the time do you share your private thoughts and feelings with (INITIALS FROM I3a) ? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I21. How much of the time does (INITIALS FROM I3a) speak to you with a warm and friendly voice? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I22. How much of the time does (INITIALS FROM I3a) seem emotionally cold to you? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I23. How much of the time (is/was) (INITIALS FROM I3a) affectionate with you? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I24. How much of the time does (INITIALS FROM I3a) enjoy talking things over with you? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I25. How much of the time can (INITIALS FROM I3a) make you feel better when you are/were upset? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I26. How much of the time does (INITIALS FROM I3a) seem to understand your problems or worries? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06

People handle disagreements in many different ways. We talked a little about this when we were discussing your friends, remember? Now let’s talk about how you and (INITIALS FROM I3a) handle disagreements.

When you and (INITIALS FROM I3a) have a disagreement, how often do the following things occur?

	NEVER	RARELY	SOMETIMES	OFTEN	MOST OF THE TIME	ALWAYS
I27. How often do the two of you talk about the issue? Would you say never, rarely, sometimes, often, most of the time, always?	01	02	03	04	05	06
I28. How often do the two of you avoid the issue? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I29. How often do the two of you insult, swear, or yell at each other? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I30. How often do the two of you threaten to end your relationship with each other? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I31. How often do the two of you threaten to hit each other? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I32. How often do the two of you push, grab, slap or shove each other? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I33. How often do the two of you threaten each other with a weapon? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I34. How often do the two of you hit each other hard enough to cause a bruise? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06
I35. How often do the two of you hit each hard enough to cause bleeding or break a bone? READ CATEGORIES IF NECESSARY	01	02	03	04	05	06

I37. How important is it to you to be in and maintain an intimate relationship? Would you say...

Not at all 01

Very little 02

A little 03

Somewhat 04

Pretty much 05

Very much 06