| 62944-4 |
PhenX - exposures to violence - adult protocol 181401 |
|
|
|
| Indent66886-3 |
Have you ever been involved in a natural disaster, such as a tornado, hurricane, flood, or earthquake? |
|
|
|
| Indent66887-1 |
How old were you the first time it happened? |
|
|
a |
| Indent66888-9 |
Were you in danger of death or serious injury? |
|
|
|
| Indent66889-7 |
Did you feel intense fear, helplessness, or horror? |
|
|
|
| Indent66890-5 |
Was there another time this happened [LTVH] |
|
|
|
| Indent66891-3 |
Have you ever been involved in a man-made disaster, such as a fire, train crash, car accident, or building collapse? |
|
|
|
| Indent66892-1 |
Have you ever been involved in direct combat experience in a war? |
|
|
|
| Indent66893-9 |
Have you ever lived in a war zone? (For example, the Persian Gulf or Bosnia). |
|
|
|
| Indent66894-7 |
Have you ever had a serious accident at home, at work, or somewhere else? |
|
|
|
| Indent66895-4 |
Have you ever been exposed to dangerous chemicals or radioactivity? |
|
|
|
| Indent66896-2 |
Have you ever been shot at, stabbed, struck, kicked, beaten, punched, slapped around, or otherwise physically harmed? |
|
|
|
| Indent66897-0 |
How many times did this person do this to you? |
|
|
{#} |
| Indent66898-8 |
How old were you the last time this person did this to you? |
|
|
a |
| Indent66930-9 |
Did anyone else ever do this to you [LTVH] |
|
|
|
| Indent66899-6 |
Have you ever been threatened with any kind of a weapon, like a knife, gun, baseball bat, frying pan, scissors, stick, rock or bottle? |
|
|
|
| Indent66900-2 |
Has anyone ever threatened you in a face-to-face confrontation? |
|
|
|
| Indent66901-0 |
Have you ever been actually assaulted with any kind of a weapon, like a knife, gun, baseball bat, frying pan, scissors, stick, rock, or bottle? |
|
|
|
| Indent66902-8 |
When you were a child--that is, when you were in elementary or middle school, before about age 12--were you ever struck, kicked, beaten, punched, slapped around, or otherwise physically harmed? |
|
|
|
| Indent66904-4 |
When you were a child- that is, when you were in elementary or middle school, before about age 12-were you ever physically abused? |
|
|
|
| Indent66905-1 |
Has anyone--male or female--ever forced or coerced you to engage in unwanted sexual activity? |
|
|
|
| Indent66906-9 |
Other than what we just talked about, did anyone, male or female ever attempt to--but not actually-- force you to engage in unwanted sexual activity? |
|
|
|
| Indent67106-5 |
Other than what we just talked about, has anyone ever actually touched private parts of your body or made you touch theirs against your wishes? |
|
|
|
| Indent66909-3 |
Have you ever had an immediate family member, romantic partner, or very close friend who was murdered? |
|
|
|
| Indent66910-1 |
Have you ever seen or been present when someone was murdered or seriously injured? |
|
|
|
| Indent66911-9 |
Have you ever had an immediate family member, romantic partner, or very close friend commit suicide? |
|
|
|
| Indent66912-7 |
Have you ever seen a dead or mutilated body? Other than at a funeral, in the movies or newspaper? |
|
|
|
| Indent66913-5 |
Have you ever seen or been present when another person was shot at, stabbed, struck, kicked, beaten, slapped around, or otherwise physically harmed? |
|
|
|
| Indent66914-3 |
Have you ever seen or been present when another person was raped, sexually attacked, or made to engage in unwanted sexual activity? |
|
|
|
| Indent66915-0 |
Has anyone ever intentionally damaged or destroyed property owned by you or by someone in your household? |
|
|
|
| Indent66916-8 |
Has anyone ever stolen something from you by using force or the threat of force like in a stick-up, mugging, or car-jacking? |
|
|
|
| Indent66917-6 |
Has anyone ever tried to--but not actually--steal something from you by using force or the threat of force like in a stick-up, mugging, or car-jacking? |
|
|
|
| Indent66918-4 |
Has anyone ever tried to or actually broken in to your house, garage, shed, or storage room when you were not there? |
|
|
|
| Indent66919-2 |
Has anyone ever tried to or actually broken in to your house, garage, shed, or storage room when you were there? |
|
|
|
| Indent66920-0 |
Has anyone ever stolen something directly from you without the threat or use of force (for example purse-snatching or pick-pocket)? |
|
|
|
| Indent66922-6 |
Have you ever been kidnapped or held captive? |
|
|
|
| Indent67091-9 |
How long were you held or not allowed to leave? |
|
|
d;wk;mo;a |
| Indent66923-4 |
Have you ever been stalked by anyone? |
|
|
|
| Indent66924-2 |
Have you ever been in any other situation in which you were in danger of death or serious physical injury, or in which you felt intense fear, helplessness, or horror? |
|
|
|
| Indent66925-9 |
Have you ever been in any other situation in which you were in danger of death or serious physical injury, or in which you felt intense fear, helplessness, or horror? |
|
|
|
