B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
1111) Whom did you tell? RECORD ALL MENTIONED.
1306A. (Does/did) your last husband/partner ever:
a) Push you, shake you, or throw something at you?
b) Slap you or twist your arm?
c) Punch you with his fist or with something that could hurt you?
d) Kick you or drag you?
e) Try to strangle you or burn you?
f) Threaten you with a knife, gun, or other type of weapon?
g) Attack you with a knife, gun, or other type of weapon?
h) Physically force you to have sexual intercourse with him even when you did not want to?
i) Force you to perform other sexual acts you did not want to?
1306B. How many times did this happen during the last 12 months?
IF WIDOW, DIVORCED, OR SEPARATED, RECORD '95'.
a) Push you, shake you, or throw something at you?
b) Slap you or twist your arm?
c) Punch you with his fist or with something that could hurt you?
d) Kick you or drag you?
e) Try to strangle you or burn you?
f) Threaten you with a knife, gun, or other type of weapon?
g) Attack you with a knife, gun, or other type of weapon?
h) Physically force you to have sexual intercourse with him even when you did not want to?
i) Force you to perform other sexual acts you did not want to?
A. Did your (last) (husband/partner) ever do any of the following things to you:
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
a) Shoved or shook you or thrown something at you?
b) Slapped you?
c) Twisted your arm or pulled your hair?
d) Hit you with his fist or anything else that might hurt you?
e) Have he ever kicked you, dragged you, or beaten you?
f) Tried to strangle you or burn you?
g) Threatened you with a knife, a pistol, or other type of weapon?
h) Physically forced you to have sexual relations when you did not want to?
i) Forced you to perform sexual acts that you did not want to perform?
CHECK 603: ONLY ASK IF THE RESPONDENT IS NOT A WIDOW.
B: In the last 12 months, has this happened often, sometimes, or never?
a) Shoved or shook you or thrown something at you?
b) Slapped you?
c) Twisted your arm or pulled your hair?
d) Hit you with his fist or anything else that might hurt you?
e) Has he ever kicked you, dragged you, or beaten you?
f) Tried to strangle you or burn you?
g) Threatened you with a knife, a pistol, or other type of weapon?
h) Physically forced you to have sexual relations when you did not want to?
i) Forced you to perform sexual acts that you did not want to perform?
a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?
d) punch you with his fist or with something that could hurt you?
e) kick you, drag you, or beat you up?
f) try to chock you or burn you?
g) threaten you with a knife, gun, or other type of weapon?
h) physically force you to have sexual intercourse with him even when you did not want to?
i) physically force you to perform other sexual acts you did not want to?
j) Force you with threats or in any other way to perform sexual acts you did not want to?
5B) How many times did this happen during the last 12 months?
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
1206a) (Does/did) your last husband/partner ever:
1206b) How many times did this happen during the last 12 months?
1105B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
B How often did this happen during the last 12 months: often, only sometimes, or not at all?
CHECK 301: ASK ONLY IF RESPONDENT IS NOT A WIDOW:
1005B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
1107B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
B - How often did this happen during the last 12 months: often, only sometimes, or not at all?
1005B) CHECK 604: ASK ONLY IF RESPONDENT IS NOT A WIDOW
How often did this happen during the last 12 months: often, only sometimes, or not at all?
1205B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
1405B) IF YES: How often did this happen during the last 12 months: often, only sometimes, or not at all?
a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?
d) punch you with his fist or with something that could hurt you?
e) kick you, drag you, or beat you up?
f) try to choke you or burn you on purpose?
g) threaten you or attack you with a knife, gun, or other type of weapon?
h) physically force you to have sexual intercourse with him even when you did not want to?
i) physically force you to perform other sexual acts you did not want to?
j) force you with threats or in any other way to perform sexual acts you did not want to?
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
1306B. CHECK 603: ASK ONLY IF RESPONDENT IS NOT A WIDOW
How often did this happen during the last 12 months: often, only sometimes, or not at all?
1305B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?
d) punch you with his fist or with something that could hurt you?
e) kick you, drag you, or beat you up?
f) try to choke you or burn you on purpose?
g) threaten or attack you with a knife, gun, or other weapon?
h) physically force you to have sexual intercourse with him when you did not want to?
i) physically force you to perform any other sexual acts you did not want to do?
j) force you with threats or in any other way to preform sexual acts you did not want to?
a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?
d) punch you with his fist or with something that could hurt you?
e) kick you, drag you, or beat you up?
f) try to choke you or burn you on purpose?
g) threaten to attack you with a knife, gun, or other weapon?
A. Did your (last) (husband/partner) ever do any of the following things to you:
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
a) slap you?
b) twist your arm or pull your hair?
c) push you, shake you, or throw something at you?
d) punch you with his fist or with something that could hurt you?
e) kick you, drag you or beat you up?
f) try to choke you or burn you on purpose?
g) threaten or attack you with a knife, gun, or any other weapon?
h) physically force you to have sexual intercourse with him even when you did not want to?
i) force you to perform any sexual acts you did not want to?
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
1106B) CHECK 601: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED/LIVING WITH A MAN, SEPARATED, OR DIVORCED. EXCLUDE WIDOWED WOMEN.
How often did this happen during the last 12 months: often, only sometimes, or not at all?