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Adverse Childhood Experiences International Questionnaire
Pilot study review and finalization meeting,
4-5 May 2011, WHO Headquarters, Geneva
Meeting Report
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Summary
• Version 1 of an Adverse Childhood Experiences International Questionnaire (ACE-IQ) has been produced. It is based largely on tried and tested questions, and the ACE-IQ content has been qualitatively tested in six culturally diverse settings. ACE-IQ is intended to be included as a module in broader health surveys.
• The next step is to identify opportunities to validate ACE-IQ by implementing it as part of broader health surveys in 6-8 countries.
• A standardized ACE-IQ will enable the measurement of childhood adversities in all countries and comparisons of such adversities between them; the drawing of associations between childhood adversities and health risk behaviours and health outcomes in later life; advocacy for increased investments to reduce childhood adversities, and scientific information to inform the design of prevention programmes.
Background
The consequences of adverse childhood experiences (ACEs) such as child maltreatment and other traumatic stressors for health risk behaviours and long-term chronic diseases has been the focus of a growing number of studies. These have occurred in a context of raised global awareness of ACEs following the launch of reports such as WHO's 2002 World report on violence and health and the 2006 UN Study on Violence against Children, and increased global interest in noncommunicable and chronic disease prevention (with the first UN summit on noncommunicable diseases scheduled for September 2011). ACE surveillance is spreading through the USA (with several states having integrated ACE questions into their Behavioural Risk Factor Surveillance Systems) and internationally through country-specific projects. However many countries have yet to appreciate the major public health implications of ACEs and their lifelong consequences. For this recognition to spread requires that data on ACEs are collected as part of broader health and health risk behaviour surveys, and that the findings are used to advocate for and inform policies and programmes designed to reduce ACEs and promote safe, stable and nurturing relationships between children and their parent or caregivers. In May 2009, an international ACE research network was established to advance global understanding and measurement of ACEs. Led by the WHO Departments of Violence and Injury Prevention and Disability, and Chronic Diseases and Health Promotion, and the US Centers for Disease Control and Prevention (CDC), network members agreed to adapt the original ACE questionnaire with the aim of producing a standardized international questionnaire that reflects the range of adversities prevalent across low-, middle- and high-income countries. Field Testing
Between May 2009 and March 2011, the draft ACE-IQ was field tested in China, the Former Yugoslav Republic of Macedonia, Philippines, Thailand, Saudi Arabia, South Africa and Vietnam. These field tests aimed to evaluate whether the draft could be easily understood and responded to by the interviewees, easily understood and implemented by interviewers, and whether the data generated looked credible. In Vietnam, the draft ACE-IQ was also implemented as part of a broader mental health survey. In each country, the draft ACE-IQ was translated (including back translation) into one official national language (if applicable). It was then administered (usually by interviewers but in some instances through self-administration) to 200-300 respondents in each of the seven countries. Respondents were all aged 18 and over, and were purposively selected to include equal proportions of men and women, and to reflect a wide range in respect of age, socio-economic and employment status. Informed
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consent was obtained in all cases, and where relevant, interviewees were referred to psychosocial services. Each country then produced a report of the findings from the field testing, identifying possible gaps in the questionnaire, outlining practical issues around implementing the questionnaire, and suggesting improvements. These reports included a summary of the data obtained and simple descriptive analyses of the data.
Meeting aims and participants
The meeting aimed to review findings from the field tests; to develop ACE-IQ Version 1, and to identify opportunities for validating ACE IQ Version 1 by implementing it as part of broader health surveys. Meeting participants were the lead investigators from countries where the draft ACE-IQ was field tested, from Lithuania where the original ACE questionnaire had recently been applied, and staff from the WHO Departments of Violence and Injury Prevention and Disability, Chronic Diseases and Health Promotion, and Reproductive Health and Research. Apologies were received from the US CDC. Annex 1 provides the full list of participants.
Review of findings from field tests of draft ACE-IQ
Field-tests of the draft ACE-IQ (see Annex 2) in China, the Former Yugoslav Republic of Macedonia, Philippines, Thailand, Saudi Arabia, South Africa and Vietnam showed that most items were easily understood by respondents and easily delivered by interviewers. However, the phrasing and/or content of several questions was identified as problematic, and there was consensus that the draft questionnaire was too long. Accessibility
• On the whole the questionnaire was found to be worded simply by both respondents and interviewers;
• Across the pilots around 85% of respondents said they understood all of the questions;
• Improved clarity of wording was required for questions on protection and neglect;
• Improved clarity of layout was required for questions relating to violence experienced in the household.
Acceptability
• Level of refusal was relatively low given the sensitive nature of many questions, ranging from 1-20% of respondents refusing to answer at least one question;
• Questions on adverse experiences within the household and on sexual violence were found to be particularly sensitive.
Duration of interview
• The duration of interview varied from 5-90 minutes, but on average took around 20-30minutes
• Although this was not found to be too long by respondents, it was agreed that it was too long for a questionnaire that is intended to be included as a module in broader health surveys.
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Vietnam: ACE-IQ and mental health in students aged 13-19 years
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If the draft ACE-IQ actually measures exposure to adversity, predictable and possibly strong associations between the adversities it measures and poor mental health and common health risk behaviours should be observed. Accordingly, this field test in Vietnam examined how the draft ACE-IQ performed in a survey of 1,226 students aged 13-19 years. The draft ACE-IQ was integrated into a broad mental health survey that covered demographic characteristics; the family environment; the school environment; educational pressure, and negative and positive aspects of mental health, including Depression (measured using CES-D 20), youth risk behaviour (measure adapted from US CDC), and mental well-being (measured using the WHO-5). The sample was a partially randomized cluster sample: 30 classes were randomly selected within six schools. Classes were visited by two researchers; teachers and other school personnel were not present during data collection. 1226/1283 students (95.6% response rate) aged 13-19 completed questionnaires. Ethical clearance and approvals were obtained prior to the study from: the Human Research Ethics Committees of Queensland University of Technology and Ho Chi Minh City University of Medicine and Pharmacy, and principals of the schools where it was administered. Informed, signed consent was obtained from the students, and parents were advised of the survey by the school administration and given the opportunity to withdraw their children. The data were examined for correlations with total ACE score, and dose-response relationships for multiple adversity (0,1,2,3,4+ ACEs), with depression; well-being; suicidal thoughts; smoking; drinking and underage driving. All correlations were statistically significant at p<0.05 except that with smoking. This suggests that the draft ACE-IQ has good concurrent validity with measures of mental health and well-being in Vietnamese young people. When included in an omnibus survey the draft ACE-IQ did not take much time and there were few missing data § This box is adapted from a PowerPoint presentation prepared by Thai Thanh Truc1,2; Kim Xuan Loan1,2; Nguyen Do Nguyen1; Jiandong Sun2; Jason Dixon2, and Michael Dunne2. 1. Ho Chi Minh City University of Medicine and Pharmacy 2. Queensland University of Technology
Revision of draft ACE-IQ
Based upon findings from the field tests and the discussions, the draft ACE-IQ was revised to produce the ACE-IQ Version 1 (see Annex 3).
Implementing ACE-IQ As part of broader health surveys
It was agreed that ACE-IQ should always be integrated into broader health surveys. Although data about adversities on their own may be useful for some purposes, the real value of ACE-IQ lies in demonstrating the associations between early exposures to ACEs and subsequent risk behaviours and health outcomes. It is only by integrating ACE-IQ into broader health surveys that such associations can be measured. It was suggested that when it is administered as part of broader health surveys, ACE-IQ be included in the middle of the instrument to ensure that an adequate level of rapport between the interviewer and respondent can be established before asking the sensitive questions it contains.
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Face-to-face interview and self-administration It was agreed that ACE-IQ should be designed to be delivered either through face-to-face interview or by means of paper and pencil or computer-based self-administration. The support materials to be developed (see below) will therefore need to address both methods.
Support materials The ACE-IQ is designed to be a flexible tool, therefore the support materials should provide guidance on the different delivery options and its use in different settings. Support materials will be developed to support second stage testing and implementation proper. They will include:
• Consent form
• Information sheet
• Ethics committee pack
• List of services
• Question by question annotation for interviewers and respondents
• Interviewer manual
• Interviewer-administered guidance
• Self-administration guidance
• Interviewer selection criteria
• Interviewer training module
• Data management manual
• Data analysis guide
Reliability and validity testing of ACE-IQ Version 1 It was agreed that the main next step is to test the reliability and validity of ACE-IQ Version 1 by implementing it as part of broader health surveys in 6-8 countries. These surveys should aim to produce data that can be used to test the psychometric properties of the tool, compare findings across sites and with other studies, and check internal consistencies. The approach taken in establishing the reliability and validity of WHO's "Global physical activity questionnaire" (GPAQ) was suggested as one model for how to do this. The reference to the GPAQ study is:
Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health. 2009 Nov; 6(6): 790-804.
Next steps
1. WHO HQ to prepare draft ACE-IQ Version 1 questionnaire, review with meeting
participants, and finalize. 2. All participants (including WHO HQ) to mobilize resources for reliability and validity
testing. It is estimated that in countries where other health and health risk behaviour surveys are in place, US$25,000-30,000 should be sufficient to cover the costs of adding ACE-IQ Version 1 into these surveys.
3. All participants to identify opportunities for integrating ACE-IQ Version 1 into broader health surveys. If required, WHO staff can assist in helping to make the case for this.
4. WHO HQ to develop ACE-IQ Version 1 support materials. 5. WHO HQ to explore ACE-IQ Version 1 copyright issues with CDC. 6. Prepare journal article on ACE-IQ Version 1 development and plans.
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ANNEX 1: LIST OF PARTICIPANTS Dr Chen Jingqi Institute of Child and Adolescent Health Email : [email protected] Peking University Health Science Center Beijing, 100191 China Dr Laurie S. Ramiro Department of Behavioral Sciences Email : [email protected] College of Arts and Sciences University of the Philippines Manila Padre Faura st, Ermita, Manila Philippines Dr Somporn Kantharadussadee Triamchaisri Department of Public Health Email : [email protected] Nursing Faculty of Public Health Mahidol University Bangkok Thailand, 10400 Dr Mokhantso Makoae Child, Youth, Family and Social Development Email : [email protected] Human Sciences Research Council (HSRC) 69-83 Plein Street, 12th Floor Pleinpark Building Private Bag X9182 Cape Town 8000 South Africa Dr Maha Al Muneef Email : [email protected] King Abdulaziz Medical City National Family Safety Program (3202) P.O Box 22490 Riyadh 11426 Kingdom of Saudi Arabia Assoc. Prof. Dr. Marija Raleva Focal Point for Violence Prevention Email : [email protected] Clinic for Psychiatry Clinical Center Skopje „Vodnjanska 17” 1000 Skopje The Former Yugoslav Republic of Macedonia Dr Michael Dunne International Health Program, Email : [email protected] School of Public Health Queensland University of Technology Victoria Park Road, Kelvin Grove 4059 Queensland Australia
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Thai Thanh Truc Email : [email protected] International Health Program, School of Public Health Queensland University of Technology Victoria Park Road, Kelvin Grove 4059 Queensland Australia Robertas Povilaitis Email : [email protected] Childline Lithuania Vilnius, Lithuania WHO Dr Alexander BUTCHART Email : [email protected] Coordinator Ms Beverly J. FERGUSON Email : [email protected] Scientist Dr Claudia M. GARCIA MORENO ESTEVA Email : [email protected] Medical Officer Dr Etienne G.G. KRUG Email : [email protected] Director Dr Christopher Mikton Email : [email protected] Technical Officer Ms Alison Gehring Email : [email protected] Consultant
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ANNEX 2: ACE-IQ PILOT QUESTIONNAIRE
0 Demographic Information
Male 0.1 Sex (Record Male / Female as observed)
Female
0.2 What is your date of birth? (if unknown ask
0.3) Day [ ][ ] Month [ ][ ] Year [ ][ ][ ][ ]
0.3 How old are you? [ ][ ]
[Locally defined]
[Locally defined]
[Locally defined]
0.4 What is your [insert relevant ethnic group /
racial group / cultural group / others] background?
Refused
No formal schooling
Less than primary school
Primary school completed
Secondary school completed
High school completed
College/University completed Post graduate degree
0.5 Which is the highest level of education you have completed?
Refused
Government employee
Non-government employee
Self-employed
Non-paid
Student Homemaker
Retired
Unemployed (able to work)
Unemployed (unable to work)
0.6 Which of the following best describes your main work status over the last 12 months?
Refused
Married Living as couple
Divorced or separated
Single
Widowed
Other
0.7 What is your civic status?
Refused
1 Marriage and Family
1.1 If you have ever been married at what age were you first married? (If No go to Q.2)
Age [ ][ ]
Yes
No
Don't know / Not sure
1.2 Did you yourself choose your husband/wife at the time?
Refused
Yes
No
1.3 If you did not choose your husband/wife yourself, did you give your consent to the choice? Refused
Age [ ][ ] 1.4 If you are a mother or father at what age was your first child born? Refused
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Question prelude: While you were growing up, during your first 18 years of life . . .
2 Protection
How true was each of the following statements: Very often
Often
Sometimes
Rarely
Never
2.1 Your parents or guardian communicated openly with you.
Refused Very often
Often
Sometimes
Rarely
Never
2.2 Your parents or guardian TRIED to know what you did with your free time.
Refused
Very often Often
Sometimes
Rarely
Never
2.3 Your parents or guardian would change the subject whenever you had something to say.
Refused
Question prelude: While you were growing up, during your first 18 years of life . . .
3 Neglect
How true was each of the following statements:
Very often true
Often true
Sometimes true
Rarely true
Never true
3.1 Your parents or other adults in your family did not give you enough food.
Refused
Very often true
Often true
Sometimes true
Rarely true
Never true
3.2 Your parents were too drunk or intoxicated by drugs to take care of the family.
Refused
Very often true
Often true
Sometimes true
Rarely true
Never true
3.3 Your parents or other adults in the family did not take you to get medical treatment when you needed it.
Refused
Question Prelude: When you were growing up, during the first 18 years…
4 Household Dysfunction Did you . . .
Yes 4.1 Live with anyone who was a problem drinker or alcoholic? No
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Refused
Yes
No
4.2 Live with anyone who misused street or prescription drugs?
Refused
Yes 4.3 Live with a depressed or mentally ill person?
No
Refused Yes
No
4.4 Have a household member attempt suicide?
Refused
When at home was your [mother (or female guardian) / father (or male guardian) / brother(s) or sister(s) (or step brother(s) or step sister(s)) ] ….
Mother (or female guardian)
Father (or male guardian)
Brother(s) or sister(s) (or step-
brother(s)/sister(s))
Yes Yes Yes
No No No
4.5 a.b.c
Often or very often pushed, grabbed, slapped, or had something thrown at her/him? Refused Refused Refused
Yes Yes Yes No No No
4.6 a.b.c
Often or very often hit so hard that she/he had marks or was injured? Refused Refused Refused
Yes Yes Yes
No No No
4.7 a.b.c
Ever threatened with or hurt by a knife or gun?
Refused Refused Refused
Yes Yes Yes
No No No
4.8 a.b.c
Often or very often yelled, screamed or sworn at?
Refused Refused Refused
Yes Yes Yes
No No No
4.9 Often or very often insulted or humiliated?
Refused Refused Refused
Yes
No
4.10 Was a household member ever sent to jail or prison?
Refused
Yes
No
4.11 Were your parents ever separated or divorced?
Refused
Yes
No
4.12 Did your mother, father or guardian die?
Refused
Question prelude: When you were growing up, during the first 18 years . . .
5 Abuse
Did a parent, guardian or other adult in the household . . .
Yes
No
5.1 Often or very often call you bad words, insult you, or put you down?
Refused
Yes
No
5.2 Often or very often threaten you with physical harm?
Refused
Did a parent, guardian or other adult in the household . . .
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Yes
No
5.3 Often or very often push, grab, slap, or throw something at you?
Refused
Yes
No
5.4 Often or very often hit you so hard that you had marks or were injured?
Refused
Did an adult or person at least 5 years older ever . . . Yes
No
5.5 Touch or fondle you in a sexual way?
Refused
Yes
No
5.6 Have you touch their body in a sexual way?
Refused
Yes No
5.7 Attempt oral, anal, or vaginal intercourse with you?
Refused
Yes
No
5.8 Actually have oral, anal or vaginal intercourse with you?
Refused
Question prelude: This question is about being bullied when you were growing up. Bullying is
when a young person or group of young people say or do bad and unpleasant things to another
young person. It is also bullying when a young person is teased a lot in an unpleasant way or
when a young person is left out of things on purpose. It is not bullying when two young people of
about the same strength or power argue or fight when teasing is done in a friendly and fun way.
Before you reached the age 18 years . . .
6 Peer Violence
Very Frequently
Frequently
Occasionally
Rarely
Very Rarely
Never
Don’t know / Not sure
6.1 How often were you bullied?
Refused
Question prelude: This question is about how often, when you were a child, you may have seen
or heard certain things around your home and neighbourhood (not on TV, in movies, or on the
radio).
When you were growing up, during the first 18 years…
7 Witnessing Community Violence
Did you see . . .
Many times
A few times
Once or twice
Never
7.1 Someone being beaten up.
Refused
7.2 Somebody get stabbed. Many times
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A few times
Once or twice
Never
Refused
Many times
A few times
Once or twice Never
7.3 Somebody get shot.
Refused
Many times
A few times
Once or twice
Never
7.4 Somebody being threatened by a gun.
Refused Many times
A few times
Once or twice
Never
7.5 Someone in your home getting shot or stabbed.
Refused
Did . . . Many times
A few times
Once or twice
Never
7.6 A thief or burglar force their way into your home
Refused
Question prelude: This question is about whether you did or did not experience any of the
following events when you were a child. The events are all to do with collective violence,
including wars, terrorism and political conflicts, genocide, repression, disappearances, torture
and organized violent crime such as banditry and gang warfare.
When you were growing up, during the first 18 years, …
8 Children's Exposure to War/Collective Violence
Did you experience . . .
Yes
No
8.1 Being forced to go and live in another place.
Refused Yes
No
8.2 The deliberate destruction of your home.
Refused
Yes
No
8.3 Being beaten by soldiers, police, militia or gangs.
Refused
Yes No
8.4 The killing of family member or friend by soldiers, police, militia or gangs.
Refused
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9 Questionnaire Experience
Yes 9.1 Were there any questions that made you too uncomfortable? No
Yes 9.2 Were there any questions that you did not understand? No
Yes 9.3 Were there any questions the participant refused to answer? (Record as observed) No
If yes to 9.3 please note the question number(s) refused.
[ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ] [ ].[ ]
9.4 How long did the interview take to complete?
[ ] : [ ][ ] hrs mins
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ANNEX 3: ACE-IQ VERSION 1
0 DEMOGRAPHIC INFORMATION Male 0.1 Sex (Record Male / Female as observed)
Female
0.2 What is your date of birth? (if unknown ask
0.3) Day [ ][ ] Month [ ][ ] Year [ ][ ][ ][ ]
0.3 How old are you? [ ][ ]
[Locally defined] [Locally defined]
[Locally defined]
0.4 What is your [insert relevant ethnic group /
racial group / cultural group / others] background?
Refused
No formal schooling
Less than primary school
Primary school completed
Secondary school completed High school completed
College/University completed
Post graduate degree
0.5 Which is the highest level of education you have completed?
Refused
Government employee
Non-government employee
Self-employed Non-paid
Student
Homemaker
Retired
Unemployed (able to work)
Unemployed (unable to work)
0.6 Which of the following best describes your main work status over the last 12 months?
Refused
Married (Go to Q.1.2)
Living as couple
Divorced or separated
Single
Widowed (Go to Q.1.2)
Other
0.7 What is your civic status?
Refused
1 MARRIAGE AND FAMILY Yes
No
1.1 Have you ever been married? (If No go to
Q.1.5)
Refused
Age [ ][ ] 1.2 At what age were you first married?
Refused
Yes
No
Don't know / Not sure
1.3 At the time of your first marriage did you yourself choose your husband/wife at the time? (If Yes go to Q.1.5)
Refused
Yes
No
1.4 At the time of your first marriage if you did not choose your husband/wife yourself, did you give your consent to the choice? Refused
Age [ ][ ]
Not applicable
1.5 If you are a mother or father at what age was your first child born?
Refused
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Question prelude: While you were growing up, during your first 18 years of life . . .
2 PROTECTION Many times
A few times Once or twice
Never
2.1 Did a parent/guardian give you attention and listen to you?
Refused
Many times
A few times
Once or twice
Never
2.2 Did a parent/guardian really know what you were doing with your free time when you were not at school or work?
Refused
Question prelude: While you were growing up, during your first 18 years of life . . .
3 NEGLECT Many times
A few times
Once or twice
Never
3.1 Did a parent/guardian not give you enough food even when it was available?
Refused
Many times
A few times
Once or twice
Never
3.2 Was a parent/guardian too drunk or intoxicated by drugs to take care of you?
Refused
Many times
A few times
Once or twice
Never
3.3 Did a parent/guardian not send you to school even when it was available?
Refused
Question Prelude: When you were growing up, during the first 18 years…
4 HOUSEHOLD DYSFUNCTION Yes
No
4.1 Did you live with a household member who was a problem drinker or alcoholic, or misused street or prescription drugs? Refused
Yes No
4.2 Did you live with a household member who was depressed, mentally ill or suicidal?
Refused
Yes
No
4.3 Did you live with a household member who was ever sent to jail or prison?
Refused
Sub-Question Prelude: When you were growing up, during the first 18 years . . .
Yes No
Not applicable
4.4 Were your parents ever separated or divorced?
Refused
Yes 4.5 Did your mother, father or guardian die?
No
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Refused
Sub-Question prelude: This question is about certain things you may have heard or seen in your
home. These are things that may have been done to another household member but not
necessarily to you. When you were growing up, during the first 18 years . . .
Many times
A few times
Once or twice
Never
4.6
Did you see or hear a parent or household member in your home yelled, screamed, or sworn at insulted or humiliated?
Refused
Many times A few times
Once or twice
Never
4.7
Did you see or hear a parent or household member in your home slapped, kicked, punched or beaten up?
Refused
Many times
A few times
Once or twice Never
4.8 Did you see or hear a parent or household member in your home hit with an object, such as a bottle, club, knife, whip etc?
Refused
Question prelude: This question is about certain things you may have experienced.
When you were growing up, during the first 18 years . . .
5 ABUSE Many times A few times
Once or twice
Never
5.1 Did a parent, guardian or other household member yell, scream or swear at you, insult or humiliate you?
Refused
Many times
A few times
Once or twice
Never
5.2 Did a parent, guardian or other household member threaten to abandon you or throw you out of the house?
Refused
Many times
A few times
Once or twice
Never
5.3 Did a parent, guardian or other household member spank, slap, kick, punch or beat you up?
Refused
Many times
A few times
Once or twice
Never
5.4 Did a parent, guardian or other household member hit you with an object, such as a bottle, club, knife, whip etc?
Refused
Many times
A few times
Once or twice
Never
5.5 Did someone touch or fondle you in a sexual way when you did not want them to?
Refused
Many times
A few times
5.6 Did someone make you touch their body in a sexual way when you did not want them to?
Once or twice
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Never
Refused
Many times
A few times
Once or twice
Never
5.7 Did someone attempt oral, anal, or vaginal intercourse with you when you did not want them to?
Refused Many times
A few times
Once or twice
Never
5.8 Did someone actually have oral, anal, or vaginal intercourse with you when you did not want them to?
Refused
Question prelude: This question is about being bullied when you were growing up. Bullying is
when a young person or group of young people say or do bad and unpleasant things to another
young person. It is also bullying when a young person is teased a lot in an unpleasant way or
when a young person is left out of things on purpose. It is not bullying when two young people of
about the same strength or power argue or fight when teasing is done in a friendly and fun way.
Before you reached the age 18 years . . .
6 PEER VIOLENCE Many times
A few times
Once or twice
Never (Go to Q.6.3)
6.1 How often were you bullied?
Refused
I was hit, kicked, pushed, shoved around, or locked indoors
I was made fun of because of my race, nationality or colour
I was made fun of because of my religion
I was made fun of with sexual jokes, comments, or gestures
I was left out of activities on purpose or completely ignored
I was made fun of because of how my body or face looks
I was bullied in some other way
6.2 How were you bullied most often?
Refused
Sub-Question prelude: This question is about physical fights. A physical fight occurs when two
students of about the same strength or power choose to fight each other.
Before you reached the age 18 years . . .
Many times
A few times
Once or twice
Never
6.3 How often were you in a physical fight?
Refused
Question prelude: This question is about how often, when you were a child, you may have seen
or heard certain things in your neighbourhood and community for example in a public area,
park or school, but NOT in your home (NOT on TV, in movies, or on the radio).
When you were growing up, during the first 18 years . . .
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7 WITNESSING COMMUNITY VIOLENCE Many times
A few times
Once or twice
Never
7.1 Did you see someone beaten up in front of you in real life?
Refused
Many times
A few times
Once or twice
Never
7.2 Did you see someone stabbed or shot in front of you in real life?
Refused
Many times A few times
Once or twice
Never
7.3 Did you see someone threatened by a knife or gun in front of you in real life?
Refused
Question prelude: This question is about whether you did or did not experience any of the
following events when you were a child. The events are all to do with collective violence,
including wars, terrorism and political conflicts, genocide, repression, disappearances, torture
and organized violent crime such as banditry and gang warfare.
When you were growing up, during the first 18 years . . .
8 Children's Exposure to War/Collective Violence Many times
A few times
Once or twice
Never
8.1 Were you forced to go and live in another place?
Refused
Many times
A few times
Once or twice
Never
8.2 Did you experience the deliberate destruction of your home?
Refused
Many times
A few times
Once or twice
Never
8.3 Were you beaten by soldiers, police, militia, or gangs?
Refused
Many times
A few times
Once or twice
Never
8.4 Did you experience the killing of family member or friend by soldiers, police, militia, or gangs.
Refused