Items:

Adults sometimes say things to children that are hurtful. I am going to ask you a few questions about things that may have happened while you were at home or school or somewhere else.

1. When you are growing up, did any adult ever say or do something on purpose to humiliate you in front of others?

Response Options:
Yes - 1
No - 2
Don’t know - 88
Declined to answer - 9

2. How many times has this happened: 1-4 times, 5-10 times, or more than 10 times?

Response Options:
1 to 4 times - 1
5 to 10 times - 2
More than 10 - 3
Don’t know - 88
Declined to answer - 98

3. How old were you when this first happened: 0-5, 6-11, 12-17, 18 or older?

Response Options:
0 to 5 years - 1
6 to 11 years - 2
12 to 17 years - 3
18 or older - 4
Don’t know - 88
Declined to answer - 98

4. Did this incident [any of these incidents] happen to you within the past 12 months?

Response Options:
Yes - 1
No - 2
Don’t know - 88
Declined to answer - 98

5. How old were you the last time this happened?

Response Options:
0 to 5 years - 1
6 to 11 years - 2
12 to 17 years - 3
18 or older - 4
Don’t know - 88
Declined to answer - 98

6. Please think back to all the incidents where an adult has humiliated you in front of others. What was your relationship to the person who did this to you? Anyone else? (Circle all mentioned)

Response Options:
Male
Father - A
Step father - B
Brother - C
Step brother - D
Uncle - E
Teacher - F
Neighbour - G
Other relative (specify) - X
Other authority (specify) - V
Other male (specify) - U

Female Mother - H
Step mother - I
Sister - J
Step sister - K
Aunt - L
Teacher - M
Neighbour - N
Other relative (specify) - W
Other authority (specify) - T
Other female (specify) - S
Don’t know - Z
Declined to answer - Y

7.* When you were growing up, did any adult ever make you feel unwanted?

Response Options:
Yes - 1
No - 2
Don’t know - 88
Declined to answer - 98

8.* When you were growing up, did any adult ever threaten to abandon you or tell you to leave home?

Response Options:
Yes - 1
No - 2
Don’t know - 88
Declined to answer - 98

9.* When you were growing up, did any adult ever abandon you or force you to leave home?

Response Options:
Yes - 1
No - 2
Don’t know - 88
Declined to answer - 98

*The frequency, age, and perpetrator items asked in item 6 were also included for items 7-9. Please see the full questionnaire for more details.