Philadelphia Expanded ACE Questions - English & Spanish Versions : simplebooklet.com

!! ! ! Philadelphia!ACE!Telephone!Survey!Questions FOR$Qs1-4:$While$you$were$growing$up,$that$is$during$your$first$18$years$of$life…)$$1. Did$you$feel$safe$in$your$neighborhood$(READ$LIST)?$(IF$RESPONDENT$MENTIONS$HAVING$LIVED$IN$MULTIPLE$NEIGHBORHOODS$WHILE$GROWING$UP$ASK:$Overall,$did$you$feel$safe$in$the$neighborhoods$you$grew$up$in?)$$$ $ 1$ All$of$the$time$$$ $ 2$ Most$of$the$time$$ $ 3$ Some$of$the$time,$or$$ $ 4$ None$of$the$time$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$$ 2.$ Did$you$feel$people$in$your$neighborhood$looked$out$for$each$other,$stood$up$for$each$other,$and$could$be$trusted$(READ$LIST,$IF$NECESSARY)?$(IF$RESPONDENT$MENTIONS$HAVING$LIVED$IN$MULTIPLE$NEIGHBORHOODS$WHILE$GROWING$UP$ASK:$Overall,$did$you$feel$people$in$the$neighborhoods$you$grew$up$in$looked$out$for$each$other…?)$$$ $ 1$ All$of$the$time$$$ $ 2$ Most$of$the$time$$ $ 3$ Some$of$the$time,$or$$ $ 4$ None$of$the$time$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ 3.$ How$often$were$you$bullied$by$a$peer$or$classmate?$$(READ$LIST,$IF$NECESSARY)?$$$ $ 1$ All$of$the$time$$$ $ 2$ Most$of$the$time$$ $ 3$ Some$of$the$time,$or$$ $ 4$ None$of$the$time$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$4.$ How$often,$if$ever$did$you$see$or$hear$someone$being$beaten$up,$stabbed,$or$shot$in$real$life?$$Would$you$say$(READ$LIST)?$$$ $ 1$ Many$times$$ $ 2$ A$few$times$$ $ 3$ Once,$or$$ $ 4$ Never$$ $ R$ (DO$NOT$READ)$Refused$

Page 2

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$2$of$11$$$$$$$$ $ 160407$ $$Now$please$think$about$your$childhood,$in$general,$not$just$your$neighborhood$or$community.$$FOR$Q5-6:While$you$were$growing$up,$during$your$first$18$years$of$life,$how$true$were$each$of$the$following$statements?$$$ 5.$ There$was$someone$in$your$life$who$helped$you$feel$important$or$special.$$Was$this$(READ$LIST)?$$$ $ 1$ Very$often$true$$ $ 2$ Often$true$$ $ 3$ Sometimes$true$$ $ 4$ Rarely$true,$or$$ $ 5$ Never$true$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ 6.$ Your$family$sometimes$cut$the$size$of$meals$or$skipped$meals$because$there$was$not$enough$money$in$the$budget$for$food.$Was$this$(READ$LIST)?$$$ $ 1$ Very$often$true$$ $ 2$ Often$true$$ $ 3$ Sometimes$true$$ $ 4$ Rarely$true,$or$$ $ 5$ Never$true$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$Sometimes$people$are$treated$badly,$not$given$respect,$or$are$considered$inferior$because$of$the$color$of$their$skin,$because$they$speak$a$different$language$or$have$an$accent,$or$because$they$come$from$a$different$country$or$culture.$$$ 7.$ While$you$were$growing$up$during$your$first$18$years$of$life$how$often$did$you$feel$that$you$were$treated$badly$or$unfairly$because$of$your$race$or$ethnicity?$$$Would$you$say…?$$ $ (READ$LIST)$$$ $ 1$ Very$often$true$$ $ 2$ Often$true$$ $ 3$ Sometimes$true$$ $ 4$ Rarely$true,$or$$$ $ 5$ Never$true$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$$$$

Page 3

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$3$of$11$$$$$$$$ $ 160407$ $Again,$I$want$to$remind$you$that$the$next$questions$refer$to$the$time$period$while$you$were$growing$up$in$your$first$18$years$of$life.$$During$your$first$18$years$of$life:$$$ 8.$ Did$you$live$with$anyone$who$was$depressed$or$mentally$ill?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$$ $$ 9.$ Did$you$live$with$anyone$who$was$suicidal$(IF$NECESSARY:$during$your$first$18$$$ $ years$of$life)?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$$ 10.$ Did$you$live$with$anyone$who$was$a$problem$drinker$or$alcoholic$(IF$NECESSARY:$$$ $ during$your$first$18$years$of$life)?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$Still$looking$back$to$your$first$18$years$of$life…$$$ 11.$ Did$you$live$with$anyone$who$used$illegal$street$drugs$or$who$abused$prescription$medications?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$$ 12.$ Did$you$live$with$anyone$who$served$time$or$was$sentenced$to$serve$time$in$a$prison,$jail,$or$other$correctional$facility?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$$ $$$$

Page 4

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$4$of$11$$$$$$$$ $ 160407$ $13.$ Were$you$ever$in$foster$care?$(IF$NECESSARY:$during$your$first$18$years$of$life)?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$Sometimes$physical$blows$occur$between$parents$or$other$adults$in$the$house.$$FOR$Q14-Q16:$While$you$were$growing$up,$that$is$during$your$first$18$years$of$life…$$$ 14.$ How$often,$if$ever,$did$you$see$or$hear$a$parent,$step$parent$or$another$adult$who$was$helping$to$raise$you$being$yelled$at,$screamed$at,$sworn$at,$insulted$or$humiliated?$Would$you$say…(READ$LIST)$$$ $ 1$ Many$times$$ $ 2$ A$few$times$$ $ 3$ Once,$or$$ $ 4$ Never$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$$ 15.$ How$often,$if$ever,$did$you$see$or$hear$in$your$home$a$parent,$step$parent$or$another$adult$who$was$helping$raise$you$being$slapped,$kicked,$punched$or$beaten$up?$(READ$LIST)$$ $ 1$ Many$times$$ $ 2$ A$few$times$$ $ 3$ Once,$or$$ $ 4$ Never$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$ $$ 16.$ How$often,$if$ever,$did$you$see$or$hear$a$parent,$step$parent$or$another$adult$who$was$helping$to$raise$you$being$hit$or$cut$with$an$object,$such$as$a$stick$or$cane,$bottle,$$$ $ club,$knife,$or$gun?$(READ$LIST,$IF$NECESSARY)$$$ $ 1$ Many$times$$ $ 2$ A$few$times$$ $ 3$ Once,$or$$ $ 4$ Never$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$

Page 5

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$5$of$11$$$$$$$$ $ 160407$ $Sometimes$parents$or$other$adults$hurt$children.$$While$you$were$growing$up,$that$is$during$your$first$18$years$of$life,$how$often,$if$ever,$did$a$parent,$step-parent,$or$another$adult$living$in$your$home…$$$ 17.$ Swear$at$you,$insult$you,$or$put$you$down?$(READ$LIST)$$$ $ 1$ More$than$once$$ $ 2$ Once,$or$$ $ 3$ Never$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$How$often,$if$ever,$did$a$parent,$step-parent,$or$another$adult$living$in$your$home…$$$ 18.$ Push,$grab,$shove,$or$slap$you?$(READ$LIST)$$$ $ 1$ More$than$once$$ $ 2$ Once,$or$$ $ 3$ Never$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$$ 19.$ Hit$you$so$hard$that$you$had$marks$or$were$injured?$(READ$LIST)$$$ $ 1$ More$than$once$$ $ 2$ Once,$or$$ $ 3$ Never$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$$ 20.$ Act$in$a$way$that$made$you$afraid$that$you$would$be$physically$hurt?$(READ$LIST)$$$ $ 1$ More$than$once$$ $ 2$ Once,$or$$ $ 3$ Never$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$

Page 6

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$6$of$11$$$$$$$$ $ 160407$ $$Some$people,$while$growing$up$in$their$first$18$years$of$life,$had$a$sexual$experience$with$an$adult$or$someone$at$least$five$years$older$than$themselves.$$These$experiences$may$have$involved$a$relative,$family$friend,$or$stranger.$$During$the$first$18$years$of$life,$did$an$adult$or$older$relative,$family$friend$or$stranger$who$was$at!least!five!years!older!than!yourself!ever…?$$$$$ 21.$ Touch$or$fondle$you$in$a$sexual$way$or$have$you$touch$their$body$in$a$sexual$way?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$$ 22.$ Attempt$to$have$or$actually$have$any$type$of$sexual$intercourse,$oral,$anal,$or$vaginal,$with$you?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$We$are$almost$done$with$the$interview$but$have$a$few$more$questions$about$your$health$and$well-being$over$your$entire$lifetime.$$Have$you$EVER$been$told$by$a$doctor$or$other$health$professional$that$you$have$or$had$any$of$these$medical$conditions$or$illnesses?$$How$about…?$23.$ Angina,$coronary$heart$disease,$or$a$heart$attack$also$called$a$myocardial$infarction?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ 24.$ A$stroke$or$“small$stroke?”$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ $$$$$

Page 7

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$7$of$11$$$$$$$$ $ 160407$ $25.$ Chronic$bronchitis$or$emphysema?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ 26.$ Broken$any$bones?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ 27.$ Yellow$jaundice,$hepatitis,$or$any$liver$trouble?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ 28.$ A$sexually$transmitted$infection,$such$as$chlamydia,$gonorrhea,$syphilis,$or$trichamoniasis$(also$known$as$Trich)?$$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$

Page 8

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$8$of$11$$$$$$$$ $ 160407$ $$Our$next$few$questions$are$about$your$sexual$relationships$and$practices.$Remember$that$your$answers$will$be$kept$strictly$confidential.$$When$we $ta lk$a bo u t$a$s ex $pa rtn e r,$w e$mean$a ny $p ers on ,$m a le $or $female,$with $w h o m $y o u$had$sex,$even$if$it$was$just$once.$By$sex,$we$mean$oral$sex,$vaginal$sex,$or$anal$sex.$$The$next$questions$are$about$your$VOLUNTARY$sex$experiences.$$$ 29.$ How$old$were$you$the$first$time$you$had$sex?$$$ $ ___________(age$9-60)$$ $ N$ (DO$NOT$READ)$Never$had$sex(GO$TO$Q.35)$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ $$ 31.$ How$many$different$sex$partners$have$you$ever$had?$$Remember,$we$are$talking$about$people$you$had$oral,$vaginal$or$anal$sex$with.$$If$you$don’t$know$the$exact$number,$please$give$your$best$estimate.$$$ $ ____________$(RANGE$1-100)$$ $ 101$More$than$100$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$31a.$I$am$going$to$read$some$ranges.$$You$can$just$stop$me$when$I$get$to$the$right$category.$$$ $ $ Can$you$tell$me$if$you$have$had:$$ $ $$ $ $ 1$Five$or$fewer$$ $ $ 2$Six$to$ten$$ $ $ 3$Eleven$to$29,$or$$ $ $ 4$Thirty$or$more$sexual$partners$$ $ $ D$(DO$NOT$READ)$Don’t$know$$ $ $ R$(DO$NOT$READ)$Refused$$Again$I$want$to$remind$you$that$these$questions$are$asking$about$your$sexual$relationships$and$practices$over$your$entire$lifetime.$$$ 32.$ Female:$Have$you$ever$been$pregnant?/Male:$Have$you$ever$gotten$someone$pregnant?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$$$$

Page 9

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$9$of$11$$$$$$$$ $ 160407$ $(ASK$Q33$IF$Q32$=$1)$$$ 33.$ Female:$When$your$first$pregnancy$began,$did$you$intend$to$get$pregnant$at$that$time$in$your$life?/$Male:$When$you$got$someone$pregnant$for$the$first$time,$did$you$intend$to$get$them$pregnant$at$that$time$in$your$life?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ (ASK$Q34$IF$Q32$=$1)$$ $ 34.$ Female:$How$old$were$you$when$you$first$became$pregnant?/$Male:$How$old$were$you$when$you$first$got$someone$pregnant?$$$ $ ________$(age$9-60)$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ (ASK$Q34a$IF$Q34$=$D)$$ 34a.$ We$understand$that$you$may$not$remember$your$exact$age.$$Please$try$to$recall$your$$$ $ age$range.Were$you…(READ$LIST)?$$$ $ 1$ Less$than$15$years$old$$ $ 2$ Between$15$and$19$years$$ $ 3$ Between$20$and$24$years$$ $ 4$ Between$25$and$29$years$$ $ 5$ Between$30$and$34$years$$ $ 6$ 35$years$or$older$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$Now,$a$few$questions$about$various$personal$health$behaviors.$$$ 35.$ Have$you$ever$used$or$injected$illicit$drugs,$such$as$marijuana,$cocaine,$including$crack,$hallucinogens,$inhalants,$heroin,$or$prescription$drugs$that$were$not$prescribed$for$you,$including$OxyContin,$Xanax,$or$Adderall?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$$ 36.$ In$the$past$year,$have$you$had$two$or$more$weeks$of$being$in$a$depressed$mood,$that$is$feeling$down,$depressed,$or$hopeless,$or$had$little$interest$in$doing$things?$$$ $ 1$ Yes$

Page 10

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$10$of$11$$$$$$$$ $ 160407$ $$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ 37.$ Have$you$ever$attempted$to$commit$suicide?$$$ $ 1$ Yes$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$ And$now,$a$couple$general$questions:$38. Did$you$grow$up$in$the$city$of$Philadelphia?$(PROBE,$IF$RESPONDENT$IS$UNSURE:$Did$you$live$in$Philadelphia$for$at$least$a$significant$amount$of$time,$when$you$were$growing$up,$during$the$first$18$years$of$your$life?)$$$ $ 1$ Yes,$grew$up$or$spent$a$significant$part$of$first$18$years$of$life$in$Philadelphia$$ $ 2$ No$$ $ D$ (DO$NOT$READ)$Don’t$know/Not$Sure$$ $ R$ (DO$NOT$READ)$Refused$$(ASK$Q39$IF$Q38$=$2,D,R)$39. What$State$did$you$grow$up$in?$(PROBE,$IF$RESPONDENT$IS$UNSURE:$What$state$did$you$live$in$for$most$of$the$first$18$years$of$your$life?)$$$ $ 01$______________$(State)$$ $ 6$$ (DO$NOT$READ)$Grew$up$in$another$country$(Specify)$__________________$$ $ N$ (DO$NOT$READ)$Moved$around$all$of$the$time$–$didn’t$grow$up$any$particular$place$$ $ D$ (DO$NOT$READ)$Don’t$know$$ $ R$ (DO$NOT$READ)$Refused$$$$$$$$$$$$$$$$$$$

Page 11

Philadelphia$ACE$Survey$Questions$with$Acknowledgements$ $ $$$$Page$11$of$11$$$$$$$$ $ 160407$ $40. And$what$city$or$county$did$you$grow$up$in?$$01$$ Baltimore,$MD$02$$ Boston,$MA$03$ Camden,$NJ$04$ Chicago,$IL$05$ Las$Vegas,$NV$$06$$ Los$Angeles,$CA$07$ New$York,$NJ$$08$ Newark,$NJ$09$ Norristown,$PA$ $10$ Seattle,$WA$11$ Trenton,$NJ$$12$$ Wilmington,$DE$13$ Washington,$DC$$97$$$______________$(Specify$city$$or$county)$NN$ $Moved$around$all$of$the$time$–$didn’t$grow$up$any$particular$city$or$county$DD$ don’t$know$$RR$ refused$$$For!information!about!the!Philadelphia!ACE!Survey,!contact:!!Carolyn!Smith-Brown!Philadelphia!ACE!Project!Health!Federation!of!Philadelphia!801!Chestnut!Street,!Suite!801!Philadelphia,!PA!19107!!215-567-8001!x3058!csmith-brown@healthfederation.org!www.healthfederation.org!!!!If$you$are$interested$in$using$the$survey,$please$let$us$know$and$advise$us$of$your$planned$use.$Documenting$the$use$of$the$survey$helps$support$future$developments$of$ACE$Surveys.$$$Recommended!Acknowledgement!The$Philadelphia$ACE$Survey$was$used$with$permission$from$the$Health$Federation$of$Philadelphia$and$Philadelphia$ACE$Research$and$Data$Committee.$Funding$for$the$Philadelphia$ACE$Survey$was$provided$by$the$Robert$Wood$Johnson$Foundation,$with$additional$support$from$the$Thomas$Scattergood$Behavioral$Health$Foundation,$and$the$Stoneleigh$Foundation.$Data$were$provided$by$the$Public$Health$Management$Corporation’s$Center$for$Data$Innovation,$Southeastern$Pennsylvania$Household$Health$Survey,$2012$!

Page 12

!! ! ! Philadelphia!ACE!Telephone!Survey!Questions!–!Spanish!Language! !Philadelphia!ACE!follow-up!Survey!Source!!!Prepared!by!Public!Health!Management!Corporation!!!!(ASK!IF!RESPONDENT!NAME!OR!INITIALS!AVAILABLE!FROM!L1028)!INTRO1.!Hola,!me!llamo!______!y!estoy!llamando!de!parte!de!PHMC!y!el!Instituto!de!Familias!Seguras.!Hace!unos!meses,!uno!de!mis!compañeros!de!investigación!entrevistó!a!un!adulto!en!su!hogar!para!la!Encuesta!Sobre!la!Salud!en!su!Hogar!que!examina!el!estado!de!la!salud!en!el!Valle!de!Delaware!del!punto!de!vista!de!sus!residentes.!Ahora!estamos!haciendo!un!estudio!de!seguimiento!para!hablar!con!los!participantes!acerca!de!sus!experiencias!mientras!estaban!creciendo.!Esta!información!nos!permitirá!mejor!comprender!los!problemas!que!ocurren!temprano!en!la!vida!para!poder!ayudar!a!otros!en!el!futuro.!!En!la!previa!entrevista,!hablamos!con!(INSERT!NAME/INITIALS)!¿Es!usted!la!misma!persona!con!quien!hablamos!previamente?!!(IF!TWO!OR!MORE!MEMBERS!IN!HOUSEHOLD!WITH!SAME!INITIALS!READ!“En!la!previa!entrevista,!hablamos!con!(un!hombre/una!mujer)!quien!en!ese!momento!tenia![INSERT!AGE/entre!las!edades!de!(AGE!RANGE!FROM!SAMPLE)]”.!!IF!NECESSARY:!No!estoy!vendiendo!nada.!!!IF!NECESSARY:!Sus!respuestas,!junto!con!las!respuestas!de!otros!residentes!son!cruciales!para!!comprender!como!las!experiencias!de!la!infancia!afectan!la!salud.!!IF!ASKED!WHAT!“PHMC”!STANDS!FOR!SAY!“Public!Health!Management!Corporation”.!!![INTERVIEWER:!IF!RESPONDENT!SAYS!IT!IS!NOT!A!GOOD!TIME,!TRY!TO!ARRANGE!A!!CALLBACK.!OFFER!TOLL-FREE!NUMBER!THEY!CAN!USE!TO!CALL!BACK!TO!COMPLETE!THE!!SURVEY!-!866-961-4147]!!!! 1! Yes!(Qualified!respondent!is!on!phone)! [GO!TO!S1]!!! 2! Qualified!respondent!is!available!(not!on!phone)! [ASK!TO!SPEAK!WITH!THIS!!! ! ! ! ! ! ! ! ! ! ! ! ! ! (MALE/FEMALE)!AND!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! REPEAT!INTRO1]!!! 3! Qualified!respondent!is!not!available!at!this!time! [SET!UP!CALLBACK!WITH!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! THAT!ADULT]!!! 4! No!one!by!this!name!in!HH/at!this!number![GO!TO!INTRO2]!!! 9! Refused! ! ! ! ! ! ! ! ! ! [THANK!&!TERM,!!! ! ! ! ! ! ! ! ! ! ! ! ! ! RECORD!AS!INTRO1R]!

Page 13

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!2!of!18!!!!!!!! ! 160407! !!(ASK!IF!INTRO1=4!OR!NO!NAME!RECORDED!IN!L1028)!(READ!TEXT!IN!FIRST!PARENS!IF!NO!NAME!RECORDED!IN!L1028;!IF!INTRO1=4,!TEXT!SHOULD!START!WITH!“En!el!momento!de!la!previa!entrevista…”)!(PN:!INSERT!GENDER!FROM!L1028!(S11.3)!IN!FIRST!PARENS;!INSERT!AGE!(S12)!IF!GIVEN!IN!L1028,!INSERT!‘entre!las!edades!de![RANGE!FROM!L1028!(S12r)]!IF!AGE!IS!REFUSED!IN!L1028)!!INTRO2.!(Hola,!me!llamo!______!y!estoy!llamando!de!parte!de!PHMC!y!el!Instituto!de!Familias!Seguras.!Hace!unos!meses,!uno!de!mis!compañeros!de!investigación!entrevistó!a!un!adulto!en!su!hogar!para!la!Encuesta!Sobre!la!Salud!en!su!Hogar!que!examina!el!estado!de!la!salud!en!el!Valle!de!Delaware!del!punto!de!vista!de!sus!residentes.!Ahora!estamos!haciendo!un!estudio!de!seguimiento!para!hablar!con!los!participantes!acerca!de!sus!experiencias!mientras!estaban!creciendo.!Esta!información!nos!permitirá!mejor!comprender!los!problemas!que!ocurren!temprano!en!la!vida!para!poder!ayudar!a!otros!en!el!futuro.)!!En!la!previa!entrevista,!hablamos!con!(un!hombre/una!mujer)!quien!en!ese!momento!tenia![INSERT!AGE/entre!las!edades!de!(AGE!RANGE!FROM!SAMPLE)].!Puedo!hablar!con!la!misma!persona!para!hacerle!unas!cuantas!preguntas!más?!!IF!NECESSARY:!No!estoy!vendiendo!nada.!!IF!NECESSARY:!Sus!respuestas,!junto!con!las!respuestas!de!otros!residentes!son!cruciales!para!!comprender!como!las!experiencias!de!la!infancia!afectan!la!salud.!!IF!ASKED!WHAT!“PHMC”!STANDS!FOR!SAY!“Public!Health!Management!Corporation”.!!![INTERVIEWER:!IF!RESPONDENT!SAYS!IT!IS!NOT!A!GOOD!TIME,!TRY!TO!ARRANGE!A!!CALLBACK.!OFFER!TOLL-FREE!NUMBER!THEY!CAN!USE!TO!CALL!BACK!TO!COMPLETE!THE!!SURVEY!-!866-961-4147]!!!! 1! Yes!(Qualified!respondent!is!on!phone)! [GO!TO!S1]!!! 2! Qualified!respondent!is!available,!coming!to!phone! [ASK!TO!SPEAK!WITH!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! THIS!(MALE/FEMALE)!AND!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! GO!TO!INTRO3]!!! 3! Qualified!respondent!is!not!available!at!this!time! [SET!UP!CALLBACK!WITH!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! THAT!ADULT,!ASK!FOR!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! NAME]!!! 4! No!one!by!this!name!in!HH/at!this!number![THANK!&!TERM,!RECORD!AS!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! TQINTRO2]!!! 9! Refused! ! ! ! ! ! ! ! ! ! [THANK!&!TERM,!!! ! ! ! ! ! ! ! ! ! ! ! ! ! RECORD!AS!RQINTRO2]!!

Page 14

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!3!of!18!!!!!!!! ! 160407! !!(ASK!IF!INTRO2=2)!!(PN:!INSERT!GENDER!FROM!L1028!(S11.3)!IN!FIRST!PARENS;!INSERT!AGE!(S12)!IF!GIVEN!IN!L1028,!INSERT!‘entre!las!edades!de![RANGE!FROM!L1028!(S12r)]!IF!AGE!IS!REFUSED!IN!L1028)!!INTRO3.!Hola,!me!llamo!______!y!estoy!llamando!de!parte!de!PHMC!y!el!Instituto!de!Familias!Seguras.!Hace!unos!meses,!uno!de!mis!compañeros!de!investigación!entrevistó!a!un!adulto!en!su!hogar!para!la!Encuesta!Sobre!la!Salud!en!su!Hogar!que!examina!el!estado!de!la!salud!en!el!Valle!de!Delaware!del!punto!de!vista!de!sus!residentes.!Ahora!estamos!haciendo!un!estudio!de!seguimiento!para!hablar!con!los!participantes!acerca!de!sus!experiencias!mientras!estaban!creciendo.!Esta!información!nos!permitirá!mejor!comprender!los!problemas!que!ocurren!temprano!en!la!vida!para!poder!ayudar!a!otros!en!el!futuro.!!Nos!gustaría!darle!las!gracias!por!participar!de!nuevo!y!nos!gustaría!hacerle!unas!cuantas!preguntas!más.!!(Sólo!para!confirmar,!usted!tiene![INSERT!AGE!–!años!de!edad!y!es!(INSERT!GENDER)])?!(Sólo!para!confirmar,!usted!tiene!entre!las!edades!de!(AGE!RANGE!FROM!SAMPLE)].)!!(INTERVIEWER!NOTE:!RESPONDENT!MAY!BE!1!YEAR!OLDER!BECAUSE!OF!LAPSE!IN!TIME!SINCE!LAST!INTERVIEW)!!!! 1! Yes,!willing!to!continue!! ! ! ! ! [GO!TO!S1]!!! 2! Yes,!but!wants!to!be!called!back!! ! [SET!UP!CALLBACK!WITH!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! THAT!ADULT]!!! 3! No!(but!person!is!available/living!in!HH)! ! (RE-ASK!INTRO2)!! ! ! ! ! ! ! ! ! !!! 4! No!one!with!this!age/gender!in!HH/at!this!number![THANK!&!TERM,!RECORD!AS!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! TQINTRO3]!!! 9! Refused! ! ! ! ! ! ! ! ! ! [THANK!&!TERM,!!! ! ! ! ! ! ! ! ! ! ! ! ! ! RECORD!AS!RQINTRO3]!!!(ASK!EVERYONE)!!(INSERT!‘este’!FOR!LANDLINE!SAMPLE;!INSERT!‘su!FOR!CELL!PHONE!SAMPLE)!!(Please!keep!code!’06’!for!other)!!S1.! En!primer!lugar,!en!qué!condado!s e!encuentra!este!hogar?!!!! 1! Bucks!! ! ! ! ! THANK!AND!TERM,!TS1!!! 2! Chester! ! ! ! ! ! THANK!AND!TERM,!TS1!!! 3! Delaware! ! ! ! ! ! THANK!AND!TERM,!TS1!!! 4! Montgomery! ! ! ! ! THANK!AND!TERM,!TS1!!! 5! Philadelphia! ! ! ! LL!SAMPLE!–!GO!TO!Q1,!CELL!SAMPLE!–!GO!TO!C1!!! 6! Other!! ! ! ! ! THANK!AND!TERM,!TS1!!! D! (DO!NOT!READ)!Don’t!know!THANK!AND!TERM,!TS1!!! R! (DO!NOT!READ)!Refused! ! THANK!AND!TERM,!RECORD!AS!RQS1!!(ASK!IF!CELL!SAMPLE)!C1.! Antes!de!continuar,!está!usted!manejando?!(OPTIONAL:!y!no!puede!completar!el!!!! estudio?)!!

Page 15

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!4!of!18!!!!!!!! ! 160407! !!! 1! Yes,!respondent!is!driving/doing!something! ! SCHEDULE!CALLBACK!!! 2! No,!respondent!is!not!driving/doing!something! GO!TO!Q1!!! 3! This!is!not!a!cell!phone!! ! ! ! ! GO!TO!Q1!!! R! (DO!NOT!READ)!Refused! ! ! ! ! THANK!&!TERM!!!(PN!-!SHOW!IN!SAME!SCREEN!AS!QC1!FOR!RECORDS!WITH!CELLPHONE!PUNCH!ONLY)!!(INTERVIEWER:!ONLY!IF!RESPONDENT!EXPRESSES!CONCERNS!ABOUT!MINUTES!!!ON!THEIR!CELL!PHONE!AND!REQUESTS!COMPENSATION,!READ:!Podemos!enviarle!un!cheque!de!$5!para!reembolsarle!sus!minutos!celulares!una!vez!terminemos!la!encuesta.!Obtendré!su!información!de!contacto!al!final!de!la!encuesta.!![PROGRAMMER!NOTE:!PLEASE!SHOW!THIS!TEXT!FOR!INITIAL!REFUSALS!UPON!CALLING!BACK!(S1),!REFUSED!DURING!(S3),!SECOND!INITIAL!REFUSALS!(S5);!SECOND!REFUSALS!DURING!(S7)![IRs!DEFINED!AS!REFUSALS!AT!OR!PRIOR!TO!S1;!REFUSALS!DURING!DEFINED!AS!REFUSALS!PAST!QS1].--!INSERT!TEXT!IN!FIRST!PARENS!IF!REFUSED!BEFORE!Q.S1!!Nos!gustaría!mucho!que!participara!en!este!estudio.!(Si!califica,)!podemos!enviarle!un!cheque!de!$5!cuando!terminemos!la!encuesta.!!Obtendré!su!información!de!contacto!al!final!de!la!encuesta.!IF!NECESSARY:!Sus!respuestas!son!muy!importantes!y!ayudaran!a!mejorar!la!salud!en!Philadelphia.!No!estamos!vendiendo!nada.!!!!

Page 16

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!5!of!18!!!!!!!! ! 160407! !!(READ!TO!ALL)!Vamos!a!comenzar!con!algunas!preguntas!acerca!de!los!eventos!que!sucedieron!durante!su!infancia.!Sabemos!que!algunas!de!estas!preguntas!pueden!ser!sensibles!y!queremos!recordarle!que!usted!puede!no!contestar!cualquier!pregunta!en!cualquier!momento.!Ahora!o!al!final!de!la!entrevista,!le!daré!un!número!telefónico!de!una!organización!que!puede!proporcionar!información!y!referencias!para!muchos!de!los!temas!tratados!en!esta!entrevista.!!(IF!RESPONDENT!ASKS!FOR!INFORMATION!NOW:!Para!información!y!referencias!sobre!cualquiera!de!los!temas!que!discutimos!en!esta!entrevista,!por!favor!póngase!en!contacto!con!Asociación!de!Salud!Mental!de!Sureste!de!Pennsylvania.!Su!número!de!teléfono!es!(215)!751-1800.)!!!Permítanme!asegurarle!que!sus!respuestas!se!mantendrán!estrictamente!confidenciales!y!sólo!se!utilizarán!junto!con!las!respuestas!de!otros!residentes!de!la!comunidad.!!Las!primeras!preguntas!se!refieren!al!período!de!tiempo!mientras!usted!estaba!creciendo,!es!decir,!en!sus!primeros!18!años!de!vida.!Mirando!hacia!atrás!a!sus!primeros!18!años!de!vida,!por!favor!piense!en!el!VECINDARIO!o!COMUNIDAD!en!donde!creció.!!Por!favor,!que!tan!frecuentemente!cuando!usted!era!un!niño!(una!niña),!usted!vio,!escuchó,!o!vivió!ciertas!cosas!en!su!barrio!o!comunidad!(no!en!su!casa!o!en!la!televisión,!el!cine!o!la!radio).!!(PN:!KEEP!THIS!ON!TOP!OF!EACH!SCREEN!FOR!Qs1-4;!SHOW!WITHOUT!PARENS!FOR!Q1!AND!WITH!PARENS!FOR!Qs!2-4:!Mientras!usted!estaba!creciendo,!es!decir,!durante!los!primeros!18!años!de!vida!…)!

Page 17

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!6!of!18!!!!!!!! ! 160407! !!!!1.! Se!sentía!seguro!en!su!vecindario!o!comunidad!(READ!LIST)?!!!!!!! (IF!RESPONDENT!MENTIONS!HAVING!LIVED!IN!MULTIPLE!NEIGHBORHOODS!WHILE!!GROWING!UP!ASK:!En!general,!se!sentía!seguro!en!los!vecindarios!o!comunidades!donde!usted!creció?)!!!!! 1! Todo!el!tiempo!!!! 2! La!mayoría!del!tiempo!!! 3! Parte!del!tiempo,!o!!! 4! Nunca!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!!2.! Usted!sentía,!que!la!gente!de!su!vecindario!se!preocupaba!por!el!uno!al!otro,!defendía!el!uno!al!otro,!y!podía!confiar!en!ellos!(READ!LIST,!IF!NECESSARY)?!!! (IF!RESPONDENT!MENTIONS!HAVING!LIVED!IN!MULTIPLE!NEIGHBORHOODS!WHILE!!!! GROWING!UP!ASK:!En!general,!sentía!que!la!gente!en!sus!vecindarios!se!preocupaba!por!el!uno!al!otro...?)!!!! 1! Todo!el!tiempo!!!! 2! La!mayoría!del!tiempo!!! 3! Parte!del!tiempo,!o!!! 4! Nunca!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!3.! Que!tan!frecuente!fue!intimidado!por!un!compañero!o!compañera!de!clase?!!(READ!LIST,!IF!NECESSARY)?!!!! 1! Todo!el!tiempo!!!! 2! La!mayoría!del!tiempo!!! 3! Parte!del!tiempo,!o!!! 4! Nunca!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!4.! Cuántas!veces,!vio!o!escucho!a!alguien!ser!golpeado,!apuñalado!o!disparado!en!la!vida!real?!!Diría!usted!que!fueron!(READ!LIST)?!!!! 1! Muchas!veces!!! 2! Pocas!veces!!! 3! Una!vez,!o!!! 4! Nunca!!! R! (DO!NOT!READ)!Refused!!

Page 18

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!7!of!18!!!!!!!! ! 160407! !Ahora!piense!en!su!infancia,!y!no!solamente!en!su!barrio!o!comunidad.!(PN:!KEEP!THIS!ON!TOP!OF!EACH!SCREEN!FOR!Q5-6,!SHOW!WITHOUT!PARENS!FOR!Q5!AND!WITH!PARENS!FOR!Q6:!Mientras!crecía,!durante!sus!primeros!18!años!de!vida,!que!tan!cierto!era!cada!una!de!las!siguientes!declaraciones?)!!!5.! Había!alguien!en!su!vida!que!le!ayudó!a!sentirse!importante!o!especial.!Diría!que!fue!(READ!LIST)?!!!! 1! Muy!a!menudo!cierto!!! 2! A!menudo!cierto!!! 3! A!veces!cierto!!! 4! Raramente!cierto,!o!!! 5! Nunca!cierto!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!6.! Su!familia!a!veces!redujo!el!tamaño!de!las!comidas!o!se!salto!alguna!comida!debido!a!!!! que!no!había!dinero!suficiente!en!el!presupuesto!para!la!alimentación.!Diría!que!fue!!!! (READ!LIST)?!!!! 1! Muy!a!menudo!cierto!!! 2! A!menudo!cierto!!! 3! A!veces!cierto!!! 4! Raramente!cierto,!o!!! 5! Nunca!cierto!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!A!veces!a!la!gente!se!le!trata!mal,!no!se!le!da!respeto,!o!se!le!considera!inferiores!por!el!color!de!su!piel,!porque!hablan!un!idioma!diferente,!porque!tienen!un!acento,!o!porque!vienen!de!otro!país!o!cultura.!!!7.! Mientras!usted!crecía,!durante!sus!primeros!18!años!de!vida,!¿con!qué!frecuencia!sintió!que!se!le!trato!mal!o!injustamente!debido!a!su!raza!o!grupo!étnico?!¿Diría!usted!qué...?!!! (READ!LIST)!!!! 1! Muy!a!menudo!cierto!!! 2! A!menudo!cierto!!! 3! A!veces!cierto!!! 4! Raramente!cierto,!o!!! 5! Nunca!cierto!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!!!!!

Page 19

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!8!of!18!!!!!!!! ! 160407! !!Una!vez!más,!quiero!recordarle!que!las!siguientes!preguntas!se!refieren!al!período!de!tiempo!mientras!usted!crecía!en!sus!primeros!18!años!de!vida.!Durante!sus!primeros!18!años!de!vida:!!!8.! Vivió!con!alguien!que!estaba!deprimido!o!enfermo!mental?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!! 9.! Vivió!con!alguien!que!tenía!tendencias!suicid as!(IF !NECESS ARY:!durante!l os!!!! ! primeros!18!años!de!vida)?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!10.! V ivi ó!con !algui en!qu e!bebía!mu cho!o !era!alcohól ico !(IF!NECE SS ARY:!durante!sus!!!! primeros!18!años!de!vida)?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!(PN:!SHOW!THIS!TEXT!AT!TOP!OF!SCREEN!FOR!Q.11:!Sin!dejar!de!recordar!los!primeros!18!!!años!de!vida…)!!!11.! V ivi ó!con !algui en!qu e!usaba!d rogas!il egales!o!callejeras!o!q ue!abus aba!de!!!! medicamentos!recetados?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!12.! V ivi ó!con !algui en!qu e!cumpli ó!o !fue!sentenciad o!a!cu mpli r!una!co ndena! en!una! prisi ón,!cárcel!u!otra!institución!correccional?!(IF!NECESSARY:!durante!los!primeros!18!años!de!vida)?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!!

Page 20

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!9!of!18!!!!!!!! ! 160407! !!!13.! Alguna!vez!estuvo!en!cuidado!de!crianza!(o!foster!care)?!(IF!NECESSARY:!durante!los!!!! primeros!18!años!de!vida)?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!A!veces!los!golpes!físicos!ocurren!entre!los!padres!u!otros!adultos!en!la!casa!(PN:!KEEP!THIS!ON!TOP!OF!EACH!SCREEN!FOR!Q14-Q16;!SHOW!WITHOUT!PARENS!FOR!Q.14!AND!WITH!PARENS!FOR!Qs!15!AND!16:!Mientras!usted!crecía!en!sus!primeros!18!años!de!vida.!(Durante!sus!primeros!18!años!de!vida…)!!14.! Cuántas!veces,!si!acaso!alguna!vez,!vio!o!escucho!en!su!casa!que!le!gritaran,!maldijeran,!insultaran,!o!humillaran!a!un!padre,!padrastro!u!otro!adulto!que!le!cuidaba?!Diría!usted!que...!READ!LIST)!!!! 1! Muchas!veces!!! 2! Pocas!veces!!! 3! Una!vez,!o!!! 4! Nunca!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!15.! C uántas !veces,!si!acaso!alguna!vez,!vio!o!escuch o!en!su !casa!qu e!abofetearan,!patearan,!golpearan,!o!maltrataran!físicamente!a!un!padre,!padrastro!u!otro!adulto!que!le!cuidaba?!!! !!! 1! Muchas!veces!!! 2! Pocas!veces!!! 3! Una!vez,!o!!! 4! Nunca!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!16.! C uántas !veces,!si!acaso!alguna!vez,!vio!o!escuch o!en!su !casa!qu e!le!golpearan!o!!!! cortaran!con!un!objeto!como!un!palo,!una!caña!(cane),!una!botella,!un!cuchillo,!o!una!!!! arma!!de!fuego!a!un!padre,!padrastro!u!otro!adulto!que!le!cuidaba?!(READ!LIST,!IF!!!! NECESSARY)!!!! 1! Muchas!veces!!! 2! Pocas!veces!!! 3! Una!vez,!o!!! 4! Nunca!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!

Page 21

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!10!of!18!!!!!!!! ! 160407! !!!!A!veces!los!padres!u!otros!adultos!lastiman!a!los!niños.!!PN:!PLEASE!SHOW!THIS!TEXT!AT!TOP!OF!SCREEN!FOR!Q17,!WITHOUT!PARENTHESIS:!Mientras!usted!estaba!creciendo,!es!decir,!durante!los!primeros!18!años!de!vida,!¿cuántas!veces,!o!nunca,!un!padre,!padrastro!u!otro!adulto!en!su!casa!...!!!17.! L e!maldi jo,!te!in sul to!o!l e!hizo !sentir!menos? !(READ!L IST) !!!!! 1! Más!de!una!vez!!! 2! Una!vez,!o!!! 3! Nunca!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!(PN:!KEEP!THIS!ON!TOP!OF!EACH!SCREEN!FOR!Qs!18-20:!(IF!NECESSARY:!Mientras!crecia,!es!decir,!durante!los!primeros!18!años!de!vida)!!Cuántas!veces,!o!nunca,!un!padre,!padrastro!u!otro!adulto!que!vivía!en!su!casa!hizo!algo!de!lo!siguiente...!!!18.! L e!empujó,!agarró,!golpeó,!o!cacheteó?!(READ!L IST)!!!!! 1! Más!de!una!vez!!! 2! Una!vez,!o!!! 3! Nunca!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!19.! L e!pego!tan!fu erte!que!tuvo!marcas!o!heridas? !(READ!LIS T)!!!! 1! Más!de!una!vez!!! 2! Una!vez,!o!!! 3! Nunca!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!20.! Actuó !de!un a!manera!que!le!hi zo!senti r!miedo!d e!que!le!l astimarían! físi camente?!!!! (READ!LIST)!!!! 1! Más!de!una!vez!!! 2! Una!vez,!o!!! 3! Nunca!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!

Page 22

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!11!of!18!!!!!!!! ! 160407! !!!!Algunas!personas,!mientras!crecían!en!sus!primeros!18!años!de!vida,!tuvieron!una!experiencia!sexual!con!un!adulto!o!alguien!por!lo!menos!cinco!años!mayores!que!ellos.!Estas!experiencias!pueden!haber!sido!con!un!pariente,!amigo!de!la!familia,!o!un!desconocido.!!(PN:!KEEP!THIS!ON!TOP!OF!EACH!SCREEN!FOR!Q21-Q22;!SHOW!WITHOUT!PARENS!FOR!Q.21!AND!WITH!PARENS!FOR!Q22:!Durante!los!primeros!18!años!de!vida,!acaso!alguna!vez!un!adulto!u!otro!pariente,!un!amigo!de!familia!o!un!desconocido!que!era!por!lo!menos!cinco!años!mayor!que!usted…)!!!!!21.! L e!toco!o! acaricio!d e!una!man era!sexual!o!hi zo!q ue!usted!l e!tocara!su!cuerpo!d e!una!!!! manera!sexual?!!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!22.! T rato!de!tener!o!tuvo!al gún!tip o!d e!relación!sexual ,!oral,!anal! o!vaginal !con! usted?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!Ya!casi!terminamos!con!la!entrevista,!pero!todavía!tenemos!algunas!preguntas!sobre!su!salud!y!su!bienestar!durante!su!vida!entera.!!(PN:!KEEP!THIS!ON!TOP!OF!EACH!SCREEN!FOR!Q23-Q28;!SHOW!WITHOUT!PARENS!FOR!Q.23!AND!WITH!PARENS!FOR!Qs24-28:!¿Alguna!vez!le!ha!dicho!un!médico!u!otro!profesional!de!la!salud!que!usted!tiene!o!ha!tenido!alguna!de!estas!condiciones!médicas!o!enfermedades?)!!Como…?!!(PN:!SHOW!INTERVIEWER!NOTE!FOR!Q24-Q.28,!DO!NOT!SHOW!FOR!Q.23)!(INTERVIEWER!NOTE:!REREAD!FULL!QUESTION!ON!TOP!OF!SCREEN,!AS!NEEDED)!!23.! La!angina!de!pecho,!enfermedad!coronaria,!o!un!ataque!cardiaco!que!también!se!llama!un!infarto!miocardio?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!

Page 23

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!12!of!18!!!!!!!! ! 160407! !!24.! Un! accidente!cerebrovascular!también!con ocid o!como! un!d errame!cerebral?!!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!25.! Bron qui tis !crónica!o !enfis ema?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!26.! Ro to!al gún!h ueso?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!27.! Ictericia,!hepati tis !o!prob lemas!de!hí gado?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!28.! Una! inf ección!d e!transmisió n!sexual ,!como!la! clamid ia,!gonorrea,!sífil is,!o!trico moni asis?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!!!!!!!!!!!!

Page 24

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!13!of!18!!!!!!!! ! 160407! !!!!!!Nuestras!siguientes!preguntas!son!acerca!de!sus!relaciones!y!prácticas!sexuales.!Recuerde!que!sus!respuestas!se!mantendrán!estrictamente!confidenciales.!Cuando!hablamos!de!una!pareja!sexual,!nos!referimos!a!cualquier!persona,!hombre!o!mujer,!con!quien!ha!tenido!relaciones!sexuales,!aunque!fuera!sólo!una!vez.!Por!relaciones!sexuales,!queremos!decir!sexo!oral,!vaginal,!o!sexo!anal.!Las!siguientes!preguntas!son!sobre!sus!experiencias!sexuales!voluntarias.!!!29.! Qu e!edad!tenía! usted!l a!primera!vez!que!usted!tuvo!relacio nes!sexual es?!!!! ___________(age!9-60)!!! N! (DO!NOT!READ)!Never!had!sex!(GO!TO!Q.35)!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!!31.! C uántas !parejas!sexuales!d iferentes!has!tenid o? !Recuerde,!estamos!hablando !de!gente!que!ha!teni do !sexo!oral,!vaginal,!o!anal.!Si!usted!no!sabe!el!número!exacto,!por!favor!dígame!su!mejor!estimado.!!!! ____________!(RANGE!1-100)!!! 101!Más!de!100!!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!!!!(ASK!Q31a!IF!Q31=D!OR!R)! !!31a.! Voy!a!leer!algunos!rangos.!Me!puede!detener!cuando!llegue!a!la!categoría!correcta.!!!! Me!puede!decir!si!usted!ha!tenido![READ!LIST]?!!!! 1! Cinco!o!menos!de!cinco!!! 2! Seis!a!diez!!! 3!! Once!a!29,!o!!! 4! Treinta!o!más!parejas!sexuales!!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!SHOW!IN!SAME!SCREEN!AS!Q32!WITHOUT!PARENTHESIS:!Nuevamente,!quisiera!recordarle!que!estas!preguntas!son!sobre!sus!relaciones!y!prácticas!sexuales!durante!su!vida!entera.!!!(INSERT!1ST!ITEM!IF!FEMALE,!INSERT!2nd!ITEM!IF!MALE)!!32.! Al guna!vez!ha!estado! usted!embarazada?!/ !¿Alguna! vez!usted!ha!embarazado!a!!!! alguien?!

Page 25

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!14!of!18!!!!!!!! ! 160407! !!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!(ASK!Q33!IF!Q32!=!1)!!(INSERT!1ST!ITEM!IF!GENDER=FEMALE;!INSERT!2NDGENDER=MALE)!!33.! C uand o!su !primer!embarazo!comenzó,!tenía!la!i ntenci ón!d e!embarazarse!en!ese!!!! momento!en!su!vida?!/!Cuando!usted!embarazo!a!alguien!por!primera!vez,!tenía!la!!!! intención!de!embarazar!a!alguien!en!ese!momento!en!su!vida?)!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!(ASK!Q34!IF!Q32!=!1)!!(INSERT!1ST!ITEM!IF!FEMALE;!INSERT!2ND!ITEM!IF!MALE)!!34.! Qu é!edad!tenía! la!p rimera!vez!que!quedó!embarazada?!/!¿ Cuán tos!añ os!tení a!la!p rimera!vez!que!embarazo!a!alguien?)!!!! ________!(age!9-60)!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!(ASK!Q34a!IF!Q34!=!D)!!34a.! Entendemos!que!usted!no!recuerda!su!edad!exacta.!Por!favor,!intente!de!recordar!más!o!menos!su!edad.!¿Tenia!...!READ!LIST)?!!(LEER!LISTA)?!!!! 1! Menos!de!!15!años!!! 2! De!!15!a!19!años!!! 3! De!!20!a!24!años!!! 4! De!!25!a!29!años!!! 5! De!!30!a!34!años!!! 6! 35!años!o!más!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!PN:!SHOW!THIS!TEXT!AT!THE!TOP!OF!THE!SCREEN!FOR!Q35:!Ahora,!algunas!preguntas!acerca!de!diversas!conductas!de!salud!personales.!!PN:!MAKE!TEXT!OF!QUESTION!BOLD!!35.! Alguna!vez!ha!utilizado!o!se!inyecto!drogas!ilegales,!como!la!marihuana,!la!cocaína,!incluyendo!crack,!alucinógenos,!los!inhalantes,!heroína,!o!medicamentos!recetados!que!no!fueron!recetados!para!usted,!incluyendo!OxyContin,!Xanax,!o!Adderall?!

Page 26

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!15!of!18!!!!!!!! ! 160407! !!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!36.! E n!el!ú lti mo!año ,!¿tuvo!d os!o! más!semanas!que!se!si ntió !en!un !estado!d e!ánimo! deprimid o,!es!decir!se!sentía!triste,!sin!energía!o!sin!esperanza,!o!que!tenía!poco!interés!en!hacer!las!cosas?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!37.! Al guna!vez!ha!i ntentado !sui cid arse?!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!Y!ahora,!un!par!de!preguntas!generales:!!!38.! C reció!en!la!ci ud ad!de!F il adelfia? !!! (PROBE,!IF!RESPONDENT!IS!UNSURE:!Vivió!en!Filadelfia!por!lo!menos!por!una!!!! significativa!cantidad!de!tiempo,!cuando!usted!estaba!creciendo,!durante!los!primeros!!!! 18!años!de!su!vida?)!!!! 1! Si!!! 2! No!!! D! (DO!NOT!READ)!Don’t!know/Not!Sure!!! R! (DO!NOT!READ)!Refused!!!(ASK!Q39!IF!Q38!=!2,D,R)!!39.! E n!q ué!estado!creció?!!! (PROBE,!IF!RESPONDENT!IS!UNSURE:!En!qué!estado!vivió!la!mayor!parte!de!los!!!! primeros!18!años!de!su!vida?;!IF!RESPONDENT!IS!STILL!UNSURE,!SELECT!CODE!N)!!!! 01! ______________!(PN:!PROVIDE!PRELIST!OF!50!STATES)!!! 6! (DO!NOT!READ)!Grew!up!in!another!country!(Specify)__________!!! N! (DO!NOT!READ)!Moved!aroun d!al l!o f!the!ti me!–!didn ’t!grow!up!any!particu lar!pl ace!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!

Page 27

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!16!of!18!!!!!!!! ! 160407! !!!(ASK!Q40!IF!STATE!PROVIDED!IN!Q39=01)!!40.! Y !en!qu é!ciud ad!o! cond ado!creció?!(PROBE,!IF!RESPONDENT!IS!UNSURE:!En!qué!ciudad!o!condado!vivió!la!mayor!parte!de!los!primeros!18!años!de!su!vida?;!IF!RESPONDENT!IS!STILL!UNSURE,!SELECT!CODE!N)!!!! (DO!NOT!READ!LIST)!!!! 01! Baltimore,!MD!!! 02! Boston,!MA!!! 03! Camden,!NJ!!! 04! Chicago,!IL!!! 05! Las!Vegas,!NV!!! 06! Los!Angeles,!CA!!! 07! New!York,!NY!!! 08! Newark,!NJ!!! 09! Norristown,!PA!!! 10! Seattle,!WA!!! 11! Trenton,!NJ!!! 12! Wilmington,!DE!!! 13! Washington,!CD!!! 97! ______________!(SPECIFY!CITY!OR!COUNTY)!!! NN! Se!mudó!a!diversos!lugares!todo!el!tiempo!–!no!creció!en!una!ciudad!o!condado!en!!!! ! particular!!! DD! Don’t!know!!! RR! Refused!!V1.! Sólo!para!confirmar,!¿podría!decirme!su!edad?!!!! _____________!(18-110)!!! RRR!(DO!NOT!READ)! No!quiso!contestar!!!(ASK!V2!IF!V1!=!RR)!!V2.! ¿Podría!por!favor!decirme!si!usted!está!entre!las!edades!de!...?!!! (READ!LIST.!!ENTER!ONE!ONLY)!!!! 1! 18!a!29!años!!! 2! 30!a!59!años!!! 3! 60!a!74!años,!o!!! 4! 75!años!o!más!!! R! (DO!NOT!READ)!No!quiso!contestar!!!V3.! Record!RESPONDENT’S!gender!!!! 1! Male!!! 2! Female!!!

Page 28

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!17!of!18!!!!!!!! ! 160407! !!(IF!ANY!INFORMATION!IN!Q.V1!OR!Q.V2!OR!Q.V3!DOES!NOT!MATCH!INFORMATION!IN!!L1028!Q.S12,!Q.S12r!OR!Q.S11.3,!ASK!Q.V4)!(PN-!PLEASE!COPY!QV1-QV4!INTO!FONEFILE,!AND!ALERT!PD!OF!AMOUNT!OF!PEOPLE!WHO!SELECT!V4=2!THROUGH!FIELD!PERIOD)!!V4.! Y!para!confirmar,!usted!era!la!persona!que!participó!en!nuestro!estudio!que!llevamos!a!cabo!hace!unos!meses,!¿correcto?!!!! 1! Yes,!original!respondent!!! 2! No,!not!original!respondent!!! D! (DO!NOT!READ)!Don’t!know!!! R! (DO!NOT!READ)!Refused!!!(ASK!IF!S1,S3,S5,S7):!Nos!gustaría!enviarle!$!5!por!su!tiempo.!¿Por!favor!me!puede!dar!su!nombre!completo!y!una!dirección!postal!donde!le!podemos!enviar!el!dinero?!INTERVIEWER!NOTE:!If!R!does!not!want!to!give!full!name,!explain!we!only!need!it!so!we!can!send!the!$5!to!them!personally.!!!!! 1! [ENTER!FULL!NAME]!–!INTERVIEWER:!PLEASE!VERIFY!!!! ! ! SPELLING!!! 2! [ENTER!MAILING!ADDRESS]!!! 3! [City]!!! 4! [State]!!! 5! CONFIRM!ZIP!from!above!!! R! (VOL.)!Respondent!does!not!want!the!money!!!FOR!INTERVIEWER!(PN!–!ASKED!IF!CELL!PHONE!SAMPLE!ONLY!AND!NOT!S1,S3,S5,S7):!!INT1.!DO!NOT!READ.!Did!respondent!request!money!for!using!their!cell!phone!minutes?!!!! 1! Yes,!requested!money!!! 2! No,!did!not!request!money!–!GO!TO!END!OF!INTERVIEW!!!!!(ASK!CELL!PHONE!RESPONDENTS!WHO!REQUESTED!FOR!MONEY!(INT1=1)):!Nos!gustaría!enviarle!$!5!por!su!tiempo.!¿Por!favor!me!puede!dar!su!nombre!completo!y!una!dirección!postal!donde!le!podemos!enviar!el!dinero?!!!INTERVIEWER!NOTE:!If!R!does!not!want!to!give!full!name,!explain!we!only!need!it!so!we!can!!!send!the!$5!to!them!personally.!!!!! 1! [ENTER!FULL!NAME]!–!INTERVIEWER:!PLEASE!VERIFY!!!! ! ! SPELLING!!! 2! [ENTER!MAILING!ADDRESS]!!! 3! [City]!!! 4! [State]!

Page 29

Philadelphia!ACE!Survey!Questions!with!Acknowledgements! -!Spanish! !!!!Page!18!of!18!!!!!!!! ! 160407! !!! 5! CONFIRM!ZIP!from!above!!Esa!fue!nuestra!última!pregunta.!Gracias!por!su!tiempo!y!colaboración.!Muchísimas!gracias.!Les!ofrecemos!a!todos!los!participantes!en!nuestro!estudio!un!número!telefónico!de!una!organización!que!puede!proporcionar!información!y!referencias!para!cualquiera!de!los!temas!que!discutimos!en!esta!entrevista.!Esa!organización!es!la!Asociación!de!Salud!Mental!de!Sureste!de!Pennsylvania!y!su!número!de!teléfono!es!(215)!751-1800.!!Gracias!de!nuevo.!!SI!ES!NECESARIO:!Otros!números!de!emergencia:!!Suicidio:!Greater!Philadelphia!215-355-6000!o!National!Suicide!Prevention!Hotline!1-800-273-TALK!(8255)!!Violencia!doméstica!/!violencia!infligida!por!la!pareja:!Philadelphia!Domestic!Violence!Hotline!al!866.723.3014!!Abuso!Infantil:!Sospecho!de!abuso!o!negligencia!de!niños!puede!ser!reportado!24!horas!al!día,!siete!días!a!la!semana,!llamando!al!(215)!683-6100!!For!information!about!the!Philadelphia!ACE!Survey,!contact:!!Carolyn!Smith-Brown!Philadelphia!ACE!Project!Health!Federation!of!Philadelphia!801!Chestnut!Street,!Suite!801!Philadelphia,!PA!19107!!215-567-8001!x3058!csmith-brown@healthfederation.org!www.healthfederation.org!!!!If!you!are!interested!in!using!the!survey,!please!let!us!know!and!advise!us!of!your!planned!use.!Documenting!the!use!of!the!survey!helps!support!future!developments!of!ACE!Surveys.!!Recommended!Acknowledgement!The!Philadelphia!ACE!Survey!was!used!with!permission!from!the!Health!Federation!of!Philadelphia!and!Philadelphia!ACE!Research!and!Data!Committee.!Funding!for!the!Philadelphia!ACE!Survey!was!provided!by!the!Robert!Wood!Johnson!Foundation,!with!additional!support!from!the!Thomas!Scattergood!Behavioral!Health!Foundation,!and!the!Stoneleigh!Foundation.!Data!were!provided!by!the!Public!Health!Management!Corporation’s!Center!for!Data!Innovation,!Southeastern!Pennsylvania!Household!Health!Survey,!2012!!