IDENTIFICATION

COUNTY ________

DISTRICT ________

LOCATION/TOWN _________

SUBLOCATION __________

NASSEP CLUSTER NUMBER _____

KDHS CLUSTER NUMBER _____

NAME OF HOUSEHOLD HEAD ___________

NAME AND LINE NUMBER OF MAN _________

CHECK 101B IN HOUSEHOLD QUESTIONNAIRE: IS MAN SELECTED FOR SECTION 10?

INTERVIEWER VISITS

FIRST INTERVIEW
DATE _____
INTERVIEWER'S NAME ________
RESULT* _______

SECOND INTERVIEW
DATE _____
INTERVIEWER'S NAME ________
RESULT* _______

THIRD INTERVIEW
DATE _____
INTERVIEWER'S NAME ________
RESULT* _______

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH ______
YEAR ______
INTERVIEW NUMBER _______
RESULT* _____

*RESULT CODES:

TOTAL NUMBER OF VISITS ______

LANGUAGE OF QUESTIONNAIRE: 17 ENGLISH

LANGUAGE OF INTERVIEW _____

TRANSLATOR USED

SUPERVISOR NAME _________

FIELD EDITOR NAME __________

OFFICE EDITOR __________

KEYED BY _______

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is _______________. I am working with the Kenya National Bureau of Statistics. We are conducting a survey about health all over Kenya. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER _________________
DATE _______

101) RECORD THE TIME.

101A) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Nairobi, Mombasa, Kisumu, in a town, in the countryside, or outside of Kenya?

101B) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE?

IF LESS THAN ONE YEAR, RECORD '00' YEARS

101C) Just before you moved here, did you live in Nairobi, Mombasa, Kisumu, in a town, in the countryside, or outside of Kenya?

101D) What is your nationality?

101E) What was the main reason for moving to Kenya?

102) In what month and year were you born?

103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

104) Have you ever attended school?

105) What is the highest level of school you attended: primary, vocational, secondary, or higher?

106) What is the highest (standard/form/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

107) CHECK 105:

108) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

109) CHECK 108:

110) Do you read a newspaper or magazine at least once a week, less than once a week, or not at all?

111) Do you listen to the radio at least once a week, less than once a week, or not at all?

112) Do you watch television at least once a week, less than once a week, or not at all?

113) What is your religion?

114) What is your ethnic group/tribe?

115) In the last 12 months, how many times have you been away from home for one or more nights?

116) In the last 12 months, have you been away from home for more than one month at a time?

SECTION 2. REPRODUCTION

201) Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name.

Have you ever fathered any children with any woman?

202) Do you have any sons or daughters that you have fathered who are now living with you?

203) How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.

204) Do you have any sons or daughters that you have fathered who are alive but do not live with you?

205) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?

206) Have you ever fathered a son or a daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

207) How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.

208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

209) CHECK 208:

210) Did all of the children you have fathered have the same biological mother?

211) In all, how many women have you fathered children with?

212) How old were you when your (first) child was born?

213) CHECK 203 AND 205:

214) How old is your (youngest) child?

215) CHECK 214:

216) What is the name of your (youngest) child? WRITE NAME OF (YOUNGEST) CHILD.

217) When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?

218) Were you ever present during any of those antenatal check-ups?

219) Was (NAME) born in a hospital or health facility?

220) When a child has diarrhea; how much should he or she be given to drink: more than usual, about the same as usual, less than usual, or nothing to drink at all?

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

Have you ever heard of (METHOD)?

302) In the last few months have you:

a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?

303) In the last few months, have you discussed family planning with a health worker or health professional?

304) Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant when she has sexual relations?

305) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

306) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is a woman's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.

307) CHECK 301 (07): KNOWS MALE CONDOM

308) Do you know of a place where a person can get male condoms?

309) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

310) If you wanted to, could you yourself get a male condom?

311) CHECK 301 (08): KNOWS FEMALE CONDOM

312) Do you know of a place where a person can get female condoms?

313) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

314) If you wanted to, could you yourself get a female condom?

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401) Are you currently married or living together with a woman as if married?

402) Have you ever been married or lived together with a woman as if married?

403) What is your marital status now: are you widowed, divorced, or separated?

404) Is your (wife/partner) living with you now or is she staying elsewhere?

405) Do you have other wives or do you live with other women as if married?

406) Altogether, how many wives or live-in partners do you have?

407) CHECK 405:

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER.

ONE WIFE/PARTNER:
a) Please tell me the name of (your wife/the woman you are living with as if married).

MORE THAN ONE WIFE/PARTNER:
b) Please tell me the name of each of your wives or each woman you are living with as if married.

408) How old was (NAME) on her last birthday?

409) CHECK 407:

410) Have you been married or lived with a woman only once or more than once?

411) In what month and year did you start living with your (wife/partner?)

412) How old were you when you first started living with her?

413) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

414) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. How old were you when you had sexual intercourse for the very first time?

414A) CHECK 103:

414B) The first time you had sexual intercourse, was a condom used?

414C) How old was the person you first had sexual intercourse with?

415) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

416) When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

417) When was the last time you had sexual intercourse with this person?
[DO NOT RECORD ANSWER FOR LAST PARTNER]

418) The last time you had sexual intercourse (with this second/third person), was a condom used?

418A) What is the main reason you used a condom on that occasion?

419) Was a condom used every time you had sexual intercourse with this person in the last 12 months?

420) What was your relationship to this person with whom you had sexual intercourse?

IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

421) CHECK 410:

422) CHECK 414:

423) How long ago did you first have sexual intercourse with this (second/third) person?

424) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

425) How old is this person?

426) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?
[DO NOT ANSWER FOR THIRD-TO-LAST PARTNER]

427) In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

428) CHECK 420 (ALL COLUMNS):

429) CHECK 420 AND 418 (ALL COLUMNS):

430) In the last 12 months, did you pay anyone in exchange for having sexual intercourse?

431) Have you ever paid anyone in exchange for having sexual intercourse?

432) The last time you paid someone in exchange for having sexual intercourse, was a condom used?

433) Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

434) In total, with how many people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

435) CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):

437) From where did you obtain the condom the last time?

PROBE TO IDENTIFY TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

438) The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?

439) What method did you or your partner use?
PROBE: Did you or your partner use any other method to prevent pregnancy?

RECORD ALL MENTIONED.

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

502) CHECK 439:

503) (Is your (wife/partner)/Are any of your (wives/partners)) currently pregnant?

504) Now I have some questions about the future. After the (child/children) you and your (wife(wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not to have any more children?

505) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

506) CHECK 407:

507) CHECK 503:

WIFE/PARTNER NOT PREGNANT OR DON'T KNOW: How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

508) How long would you like to wait from now before the birth of (a/another) child?

509) CHECK 203 AND 205:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? PROBE FOR NUMERIC RESPONSE.

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be? PROBE FOR NUMERIC RESPONSE.

510) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter if it's a boy or a girl?

SECTION 6. EMPLOYMENT AND GENDER ROLES

601) Have you done any work in the last seven days?

602) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?

603) Have you done any work in the last 12 months?

604) What is your occupation, that is, what kind of work do you mainly do?

604A) CHECK 603:

605) Do you usually work throughout the year, or do you work seasonally, or only once in a while?

606) Are you paid in cash or kind for this work or are you not paid at all?

607) CHECK 401:

608) CHECK 606:

609) Who usually decides how the money you earn will be used: you, your (wife/partner), or you and your (wife/partner) jointly?

610) Who usually makes decisions about health care for yourself: you, your (wife/partner), you and your (wife/partner) jointly, or someone else?

611) Who usually makes decisions about making major household purchases?

612) Do you own this or any other house either alone or jointly with someone else?

613) Do you own any land either alone or jointly with someone else?

614) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him
d) If she refuses to have sex with him?
e) If she burns the food?

SECTION 7. HIV/AIDS

701) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

702) Can people reduce their chance of getting the AIDS virus by having one uninfected sex partner who has no other sex partners?

703) Can people get the AIDS virus from mosquito bites?

704) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

705) Can people get the AIDS virus by sharing food with a person who has AIDS?

705A) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

706) Can people get the AIDS virus because of witchcraft or other supernatural means?

707) Is it possible for a healthy-looking person to have the AIDS virus?

708) Can the virus that causes AIDS be transmitted from a mother to her baby:

a) During pregnancy?
b) During delivery?
c) By breastfeeding?

709) CHECK 708:

710) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

711) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY MEASURE TO ENSURE PRIVACY.

712) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

713) How many months ago was your most recent HIV test?

714) I don't want to know the results, but did you get the results of the test?

715) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

716) Do you know of a place where people can go to get tested for the AIDS virus?

717) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

717A) CHECK 401:

717B) Have you ever talked with your wife/partner about ways to prevent getting the virus that causes AIDS?

718) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

719) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

720) If a member of your family got infected with the AIDS, would you be willing to care for her or him in your household?

720) If a member of your family became sick with AIDS, would you be willing to take care for her or him in your own household?

721) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to be teaching in the school?

722) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

723) CHECK 701:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

723A) If a man has sexually transmitted disease, what symptoms might he have? Any others?

RECORD ALL MENTIONED.

723B) If a woman has a sexually transmitted disease, what symptoms might she have? Any others?

RECORD ALL MENTIONED.

724) CHECK 414:

725) CHECK 723: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

726) Now I would like to ask you some questions about your health in last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

727) Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

728) Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?

729) CHECK 726, 727, AND 728:

730) The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?

731) Where did you go? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

731A) When you had (PROBLEMS(S) FROM 726/727/728), did you inform the persons with whom you were having sex?

731B) When (PROBLEMS(S) FROM 726/727/728), did you do anything to avoid infecting your sexual partner(s)?

731C) What did you do to avoid infecting your partner(s)? Did you:

a) Use medicine?
b) Stop sex?
c) Use a condom when having sex?

732) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

733) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with women other than his wives?

SECTION 8. OTHER HEALTH ISSUES

801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?

802) How old were you when you got circumcised?

803) Who did the circumcision?

804) Where was it done?

805) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

806) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

807A) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

807B) Have you ever been told by a doctor or health worker that you have raised blood pressure or hypertension?

807B) Have you ever been told by a doctor or health worker that you have raised blood sugar or diabetes?

807C) In the past 12 months, have you been involved in a road traffic accident as a driver, passenger, pedestrian, or cyclist?

807D) In the past 12 months, were you injured accidentally, not related to a traffic accident?

807E) How did the injury happen?

PROBE: Any other ways?
RECORD ALL MENTIONED.

807F) Have you ever heard of an illness called tuberculosis or TB?

807G) How does tuberculosis spread from one person to another?

PROBE: Any other ways? RECORD ALL MENTIONED.

808) Do you currently smoke cigarettes?

809) In the last 24 hours, how many cigarettes did you smoke?

810) Do you currently smoke or use any (other) type of tobacco?

811) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

811A) Do you drink alcohol?

811B) During the last two weeks, on how many days did you have at least one alcoholic drink?

811C) Are you involved in exercise that causes an increase in your heart rate for at least 10 minutes continuously?

a) At work?
b) During other physical activities?

811D) Now I would like to ask you about men's health. Have you ever heard of prostate cancer?

811E) Has a doctor or health care professional ever examined you to detect, or test for prostate cancer?

811F) Did this prostate exam happen within the last 5 years?

811G) Did the doctor or health care professional who examined you tell you that you have a problem with your prostate?

811H) Were you treated or referred for treatment for the prostate problem?

811I) Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery.

Have you ever heard or this problem?

812) Are you covered by any health insurance?

813) What type of health insurance are you covered by? RECORD ALL MENTIONED.

SECTION 9. FEMALE GENITAL CUTTING

901) Have you ever heard of female circumcision?

902) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

902A) Do you believe that female circumcision is required by your community?

903) Do you believe that female circumcision is required by your religion?

904) Do you think that female circumcision should be continued, or should it be stopped?

SECTION 10. DOMESTIC VIOLENCE

1001) CHECK COVER PAGE: IS MAN SELECTED FOR SECTION 10?

1001A) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED __ 1: READ TO THE RESPONDENT : Now I would like to ask you some questions about some other important aspects of a man's life. You many find some of these questions very personal. However, your answers are crucial for helping to understand the condition of men in Kenya. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

PRIVACY NOT POSSIBLE __ 2 (GO TO 1032)

1002) CHECK 401 AND 402:

1003) First, I am going to ask you about some situations which happen to some men. Please tell me if these apply to your relationship with your (last) (wife/partner)?

a) She (is/was) jealous or angry if you (talk/talked) to other women?
b) She frequently (accuses/accused) you of being unfaithful?
c) She (does/did) not permit you to meet your male friends?
d) She (tries/tried) to limit your contact with family?
e) She (insists/insisted) on knowing where you (are/were) at all times?

1004) Now I need to ask some more questions about your relationship with you (last) (wife/partner).

1004A) Did your (last) (wife/partner) ever:

1004B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

1005A) Did your (last) (wife/partner) ever do any of the following things to you:

1005B) How often did this happen during the last 12 months; often, only sometimes, or not at all?

1006) CHECK 1005A (a-j):

1007) How long after you first (got married/started living together) with your (last) (wife/partner) did (this/any of these things) first happen?

IF LESS THAN ONE YEAR, RECORD '00'.

1008) Did the following ever happen as a result of what your (last) (wife/partner) did to you:

1009) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (wife/partner) at times when she was not already beating or physically hurting you?

1010) In the last 12 months, how often have you done this to your (last) (wife/partner): often, only sometimes, or not at all?

1011) Does (did) your (last) (wife/partner) drink alcohol?

1012) How often does (did) she get drunk: often, only sometimes, or never?

1013) Are (Were) you afraid of your (last) (wife/partner): most of the time, sometimes, or never?

1014) CHECK 410:

1015A) So far we have been talking about the behavior of your (current/last) (wife/partner). Now I want to ask you about the behavior of any previous (wife/partner).

1015B) How long ago did this last happen?

1016) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN: From the time you were 15 years old has anyone other than (your/any) (wife/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?

NEVER MARRIED/NEVER LIVED WITH A WOMAN: From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

1017) Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

1018) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

1022) CHECK 401 AND 402:

1022A) Now I want to ask you about things that may have been done to you by someone other than (your/any) (wife/partner).

At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1022B) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1023) Who was the person who was forcing you the very first time this happened?

1024) CHECK 1005A (h-j) and 1015A(b)

1025) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) wife/partner?

NEVER MARRIED/NEVER LIVED WITH A WOMAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

1026) CHECK 1005A (a-j), 1015A (a,b), 1016, 1022A, AND 1022B:

1027) Thinking about what yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1028) From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1029) Have you ever told anyone about this?

1030) As far as you know, did your father ever beat your mother?

THANK THE RESPONDENT FOR HIS COOPERATION AND REASSURE HIM ABOUT THE CONFIDENTIALITY OF HIS ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1031) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1032) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

________________________________________________________________________

1033) RECORD THE TIME.