Items:

 1. [if respondent is ever marriedever lived with a manever had a male partner] From the time you were 15 years old, has anyone other than a husband or male partner, hit you, slapped you, kicked you, or done anything else to hurt you physically? Remember, I do not want you to include any husband or any other male partner. [if respondent is never marriednever had a male partner] From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

Response Options:
Yes
No
Refused to answer no answer

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

Response Options:
Motherstep-mother
Fatherstep-father
Sisterbrother
Daughterson
Other relative
Current boyfriend
Former boyfriend
Mother-in-law
Father-in-law
Other in-law
Teacher
Schoolmateclassmate
Employersomeone at work
Policesoldier
Other __ (specify)

 3. In the last 12 months, how often (has this personhave these persons) physically hurt you: often, only sometimes, or not at all?

Response Options:
Often
Sometimes
Not at all

 4. At any time in your life, as a child or as an adult, has anyone other than any previous husband or any other current or previous male partner ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to? Remember I do not want you to include any husband or male partner.

Response Options:
Yes
No
Refused to answerNo answer

 5. [if respondent is ever marriedever lived with a manever had a male partner] How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts that you did not want to by anyone, not including any husband or any other male partner? [if respondent is never marriednever had a male partner] How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts that you did not want to?

Response Options:
Age in completed years__ (2-digit numeric)
Don’t know

 6. [if respondent is ever marriedever lived with a manever had a male partner] In the last 12 months, has anyone other than any previous husband or any other current or previous male partner forced you to have sexual intercourse or perform any other sexual acts that you did not want to? [if respondent is never marriednever had a male partner] In the last 12 months, has anyone forced you to have sexual intercourse or perform any other sexual acts that you did not want to?

Response Options:
Yes
No