for their assistance in initiating and completing this project. vi coalitions 1 and state health departments to CDC's National Center for Injury Prevention and Control (Injury Center). 2    As a result of the new rape prevention and education monies, meetings were held with representatives from CDC, researchers, victim advocates, and other federal leaders to help states organize and refine their plans for using the appropriated monies. In addition, the Department of Health and Human Services convened meetings around the country to discuss issues about sexual violence definitions, lack of adequate data, prevention programs, services and support for sexual violence survivors, evaluation of existing systems and programs, and communication. CDC also convened regional meetings to help build better working relationships between the state coalitions and state health department staff. Each state, with its sexual violence prevention partners, was encouraged to develop a plan addressing the Preventive Health and Health Services Block Grant data collection requirements. The Department of Justice, Office for Victims of Crime worked to standardize the data collected for the Victims of Crime Act, Violence against Women Act, and the Preventive Health and Health Services Block Grant. CDC Injury Center staff worked with sexual violence victim advocates and representatives from state health departments to develop standardized definitions that could be used for sexual violence. The process of panel and external review used to develop intimate partner violence definitions and data elements, published in 1999, was emulated in the development of the current sexual violence definitions document.Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of outcome-specific data for use in planning, implementing, and evaluating public health practice (Thacker and Berkelman 1988). Surveillance of sexual violence is important to track this problem over time and to guide prevention and intervention (Saltzman, Green, Marks and Thacker 2000). However, no nationally established mechanism exists for routine identification, recording, and monitoring of sexual violence.Confidentiality and safety are of paramount importance in the study of sexual violence, as is true for all research on violence. No data should be collected or stored that would in any way jeopardize a victim's safety. In developing a surveillance system for sexual violence, it is important to maintain confidentiality of respondents and ensure the safety of victims. The issue of confidentiality must be balanced with the need for data linkage across multiple data sets. This could be accomplished with the use of unique identifiers. Unique identifiers are important to link information from separate data sources (e.g., rape crisis centers, law enforcement agencies, or hospitals). Unique identifiers are also needed to reduce duplication of information collected and to identify repeat visits by the same person. This document does not suggest the use of names or social security numbers as unique identifiers. Unique identifiers can be created by using different data components such that the information can be linked to a particular person but cannot be traced back to that person without their explicit involvement or assent.# PANEL MEMBERS

# INTRODUCTION The Problem of Sexual Violence
Sexual violence is a profound social and public health problem in the United States. As will be covered in more detail to follow, sexual violence includes completed or attempted penetration of the genital opening or anus by the penis, a hand, a finger, or any other object, or penetration of the mouth by the penis or other object. Sexual violence also includes non-penetrative abusive sexual contact (e.g., intentional touching of the groin), as well as non-contact sexual abuse (e.g., voyeurism, exposure to pornography). Sexual violence occurs when the victim does not consent to the sexual activity, or when the victim is unable to consent (e.g., due to age, illness) or refuse (e.g., due to physical violence or threats). According to the National Violence Against Women Survey (NVAWS), 1 in 6 women and 1 in 33 men have experienced an attempted or completed rape, defined as forced vaginal, oral, or anal penetration, in their lifetime (Tjaden and Thoennes 2000). These numbers exclude abusive sexual contact and non-contact sexual violence. Furthermore, they do not take into account the potential for significant underreporting of this crime due to its sensitive nature. Therefore, many researchers and practitioners in this field believe that existing national statistics underestimate the number of victims of sexual violence.
Just as sexual violence is not limited to physically forced penetration, its perpetrators are not limited to strangers. Indeed, perpetrators of sexual violence are more likely to be someone known to the victim (Koss, Gidycz and Wisniewski 1987;Estrich 1987;Koss 1992;Wiehe and Richards 1995;Randall and Haskell 1995;Tjaden and Thoennes 2000;Mahoney and Williams 1998). Sexual violence is a problem embedded in our society and includes any contact and/or non-contact sexual abuse perpetrated by persons well known (e.g., partners or spouses), not as well known (e.g., acquaintances), and unknown to the victim (e.g., strangers). The term "sexual violence" is used here to represent many behaviors that may otherwise fall under the rubrics of sexual abuse, sexual assault, and any other sexual violations (such as sexual harassment and voyeurism). Although many who work in the field of sexual violence use the word "survivor" to describe the person on whom the sexual violence is inflicted, the word "victim" is used in this document in an effort to be consistent with agencies from which most of traditional surveillance information is gathered. For the purposes of survey surveillance, the word "survivor" may be substituted for "victim," as long as "survivor" is defined in the same way "victim" is defined in

# The Need for Consistent Definitions and Data Elements
Currently there is a lack of consensus regarding the definition of sexual violence and which of its various components (e.g., rape, fondling, contact and non-contact sexual abuse) should be included as part of the term. A consistent definition is needed to monitor the incidence of and trends for sexual violence, to determine the scope of the problem, and to compare the problem across jurisdictions. A consistent definition of sexual violence also would help to measure and identify risk and protective factors for victimization and perpetration in a uniform way, which would inform prevention and intervention efforts.
In 1999, CDC published Version 1.0 of Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements (Saltzman, Fanslow, McMahon and Shelley 1999). That document was intended to guide data collection for public health surveillance of intimate partner violence. It included sexual violence, but only that perpetrated by intimate partners. The present document uses a similar process and format to focus on sexual violence committed by all perpetrators. The information in this document is intended for surveillance of sexual violence against both adult and child victims.

# External Panel
Ten professionals with backgrounds in sexual violence prevention or surveillance and from various settings, including universities, state health departments, hospitals, sexual assault coalitions, and federal agencies, served as panelists for this project. Members of the panel met three times over 18 months -in October 1999, September 2000, and February 2001 In addition, an external group of 15 professionals working in the field of sexual violence was asked to review and comment on drafts of the documents. The goal of this process was to identify uniform definitions and data elements for sexual violence that could be implemented and pilot tested.
"Traditional" Versus "Survey" Surveillance Traditionally, surveillance involves systematic, ongoing collection, analysis, and interpretation of data already available from sources such as emergency departments, police departments, or rape crisis centers. These data have typically been collected for other agency-related purposes, but can later be extracted and used for surveillance purposes. In addition to allowing examination of trends over time, these data are typically inexpensive to collect given that the data already exist. Surveys, on the other hand, involve systematic data collection from a representative sample of the population of interest for analysis and interpretation. Survey data are collected directly from individuals affected by the condition under surveillance. Surveys allow flexibility in the types of questions that can be asked and the level of detail of information that can be collected, since they do not rely upon information already existing in official agency records. Unlike traditional surveillance, surveys offer the opportunity to gather information from those who have sustained sexual violence and from similar individuals who have not for purposes of comparison. However, they are sometimes more expensive than record reviews.
For traditional surveillance of sexual violence, data collectors are encouraged to gather information from appropriate agencies in their jurisdiction, including, but not limited to, rape crisis centers, hospitals, elder services, and shelters. In gathering this information, data collectors should be aware of two major issues. First, rape crisis centers and other victim service agencies are under strict bounds of confidentiality and, therefore, access to their records may be limited. Many service agencies are overburdened and may not have the available staff to either remove unique identifiers or gather information from the records themselves. Second, very little information about sexual violence is available from most agency records (with the possible exception of rape crisis centers), because many victims are not known to those agencies and thus do not appear in their records; they are known but not identified as sexual violence victims; or agency personnel may not always gather or document all of the information that might be of interest for sexual violence surveillance. Therefore, to better assess the magnitude of sexual violence, the panel recommended complimenting traditional surveillance with survey surveillance. This would allow for more detailed, inclusive data collection of sexual violence presently missing from agency records. This publication establishes a single set of uniform definitions for sexual violence, but it separates the proposed data elements for traditional and survey surveillance. For both types of data elements, we further subdivide minimum data elements and expanded data elements. The minimum data elements represent the minimum information that should be collected with each type of surveillance. In most traditional surveillance settings and in the context of survey surveillance, these data elements should be relatively easy to collect. The expanded data elements represent additional information that would be beneficial to collect if resources allow. For both traditional and survey surveillance, the expanded set represents elements in addition to what is already listed in the minimum set. Therefore, expanded data elements are inclusive of minimum data elements.
An example of data that would be difficult to obtain using traditional surveillance methods is changes in psychological functioning after sexual violence. For most victims, these changes can be profound and long lasting (DeKeseredy 1995;Kuyken 1995;Resick 1993;Shields and Hanneke 1992). Information about psychological functioning is usually not part of the information asked of victims at agency intake. This is particularly true if victims state the reason for their visit to be something such as pelvic pain or a broken bone, rather than explicitly mentioning the sexual violence. In addition, information revealed in an intake interview, such as psychological state, is often not recorded. That the data element on psychological functioning was not placed in the minimum list for traditional surveillance does not imply that our panel believed that psychological functioning is unimportant. Rather, the panel suggested that psychological functioning would be difficult to capture in existing and future traditional surveillance systems and better captured through survey surveillance.

# Contents, Purpose, and Scope of this Document
This document includes three major sections:
- - Description or Definition of the data element;
- Uses of the data element and Type of Surveillance for which it is recommended;
- Data Type and maximum allowed Field Length;
- Field Values and Coding Instructions that designate recommended coding specification and valid data entries. For some data elements, the following additional categories may be listed:
- Discussion of conceptual or operational issues;
- Repetition, an indication of when it is appropriate to include all answers that may apply; - Data Standards or Guidelines used to define the data element and its field values; - Other References consulted in developing the data element. Not all categories are included for all data elements because some categories do not apply to certain elements. Data types and field lengths conform to specifications in Health Level 7 (HL7), a widely used protocol for electronic data exchange (HL7 1996), and ASTM's (formerly known as the American Society for Testing and Materials) E1238-94: Standard Specification for Transferring Clinical Observations Between Independent Computer Systems (ASTM 1994). The Technical Notes at the end of this document provide a detailed description of data types and conventions for addressing missing, unknown, and null data, as well as recommendations for handling data elements that are not applicable to selected groups of individuals.
The definitions and data elements in this document are recommendations only. Furthermore, the contents of this document do not represent instruments to be used for either traditional or survey surveillance. Rather, this document contains definitions and data elements that can be used to create instruments for surveillance. When creating instruments, it is important to clearly communicate the definitions of sexual violence for the recorder of traditional surveillance data or to use behaviorally specific items that reflect the definitions of sexual violence in surveys.
The order of the categories of sexual violence as they appear in this document, starting with "completed sex act against the victim's will" and ending with "non-contact sexual abuse," is not intended to suggest a hierarchy of resulting trauma. The panel emphasized that all of the types of sexual violence can have serious negative consequences for victims.

# Next Steps
Although our focus here is on surveillance and measurement issues, the panel identified several other areas for future research: disclosure issues (e.g., who do victims tell about the violence), in-depth study of the psychological consequences of sexual violence, long-term impact of child sexual abuse, and connections between multiple experiences of sexual violence throughout the life course. This document is the first version of Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements; it is not intended to be the final version of this document. We will pilot test these definitions and data elements in the next few years and revise them as needed.
While this document is similar to Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements, it differs in some important ways. Its scope is broader: all perpetrators of sexual violence versus intimate partners only. It separates sexual violence into completed acts and attempted acts, whereas the intimate partner violence document combines completed and attempted sex acts in the definition of sexual violence. Also, the current document categorizes a "date" as a friend/acquaintance while the 1999 document classifies a "date" as an intimate partner. Our next step in developing uniform definitions and recommended data elements is to reconcile these differences.
Please send questions or suggestions for improving this document to:
Kathleen C.

# UNIFORM DEFINITIONS FOR SEXUAL VIOLENCE Violence and Associated Terms

# Sexual Violence -Overall Definition
Nonconsensual completed or attempted contact between the penis and the vulva or the penis and the anus involving penetration, however slight; nonconsensual contact between the mouth and the penis, vulva, or anus; nonconsensual penetration of the anal or genital opening of another person by a hand, finger, or other object; nonconsensual intentional touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or buttocks; or nonconsensual non-contact acts of a sexual nature such as voyeurism and verbal or behavioral sexual harassment. All the above acts also qualify as sexual violence if they are committed against someone who is unable to consent or refuse.
Sexual violence is divided into five categories:
- A completed sex act (as defined below) without the victim's consent, or involving a victim who is unable to consent or refuse (as defined below). - An attempted (non-completed) sex act without the victim's consent, or involving a victim who is unable to consent or refuse (as defined below). - Abusive sexual contact (as defined below).
- Non-contact sexual abuse (as defined below).
- Sexual violence, type unspecified.
-Inadequate information available to categorize into one of the other 4 categories.

# Consent
Words or overt actions by a person who is legally or functionally competent to give informed approval, indicating a freely given agreement to have sexual intercourse or sexual contact.

# Inability to Consent
A freely given agreement to have sexual intercourse or sexual contact could not occur because of age, illness, disability, being asleep, or the influence of alcohol or other drugs.

# Inability to Refuse
Disagreement to have sexual intercourse or sexual contact was precluded because of the use of guns or other non-bodily weapons, or due to physical violence, threats of physical violence, real or perceived coercion, intimidation or pressure, or misuse of authority.

# Sex Act (or Sexual Act)
Contact between the penis and the vulva or the penis and the anus involving penetration, however slight; contact between the mouth and the penis, vulva, or anus; or penetration of the anal or genital opening of another person by a hand, finger, or other object.

# Abusive Sexual Contact
Intentional touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or buttocks of any person without his or her consent, or of a person who is unable to consent or refuse.

# Non-Contact Sexual Abuse
Sexual abuse that does not include physical contact of a sexual nature between the perpetrator and the victim. It includes acts such as voyeurism; intentional exposure of an individual to exhibitionism; pornography; verbal or behavioral sexual harassment; threats of sexual violence to accomplish some other end; or taking nude photographs of a sexual nature of another person without his or her consent or knowledge, or of a person who is unable to consent or refuse.

# Incident
A single act or series of acts of sexual violence that are perceived to be connected to one another and that may persist over a period of minutes, hours, or days. One perpetrator or multiple perpetrators may commit an incident.
Examples of an incident include a husband forcing his wife to have unwanted sexual acts but only one time, a stranger attacking and sexually assaulting a woman after breaking into her apartment, a man kidnapping a female acquaintance and repeatedly assaulting her over a weekend before she is freed, a college student forced to have sex by several men at a fraternity party, a man forcing his boyfriend to have unwanted sex, or a family member touching the genitalia of a 6-year-old child.

# Involved Parties

# Victim
Person on whom the sexual violence is inflicted. Survivor is often used as a synonym for victim.

# Current or Former Legal Spouse
Someone to whom the victim is or was legally married, as well as a separated legal spouse.
Another Current or Former Intimate Partner Someone, besides a legal current, former, or separated spouse, with whom the victim has or had an ongoing intimate relationship, such as a common-law spouse, former common-law spouse, separated common-law spouse, cohabiting intimate partner, former cohabiting intimate partner, boyfriend/girlfriend, former boyfriend/girlfriend (opposite or same sex).

# Another Family Member
Someone sharing a relationship by blood or marriage, or other legal contract or arrangement (i.e., legal adoption, foster parenting). This includes current as well as former family relationships. Therefore, though not an exhaustive list, stepparents, parents, siblings, former in-laws, and adopted family members are included in this category. This category excludes intimate partners.

# Person in Position of Power or Trust
Someone such as a teacher, nanny, caregiver, foster care worker, religious leader, coach, or employer (not an exhaustive list).

# Friend/Acquaintance
Someone who is known to the victim but is not related to the victim by blood or marriage, and is not a current or former spouse, another current or former intimate partner, another family member, or a person in a position of power or trust. Examples are a co-worker, neighbor, date, former date, or roommate (not an exhaustive list).

# Another Non-Stranger
Someone who is known by sight but is not a current or former spouse, another current or former intimate partner, another family member, a person in a position of power or trust, or a friend/acquaintance. Examples include guards, maintenance people, or clerks (not an exhaustive list).

# Stranger
Someone unknown to the victim.

# Terms Associated with the Circumstances and Consequences of Violence

# Illness
An acute or short-term condition of poor health. It includes a physical or a mental condition. Examples of illnesses are pneumonia or depressive episodes.

# Disability
Any chronic or long-term impairment resulting in some restriction or lack of ability to perform an action or activity in the manner or within the range considered normal. It includes a physical or a mental impairment. Examples of disabilities are mental retardation, paralysis, or clinical depression.

# Substance Abuse
Abuse of alcohol or other drugs. This also includes alcohol or other drug dependence.

# Substance Abuse Treatment
Any treatment related to alcohol or other drug use, abuse, or dependence.

# Pregnancy Impact
Pregnancy resulting from sexual violence or loss of an existing pregnancy following sexual violence.

# Physical Injury
Any physical harm, including death, occurring to the body resulting from exposure to thermal, mechanical, electrical, or chemical energy interacting with the body in amounts or rates that exceed the threshold of physiological tolerance, or from the absence of such essentials as oxygen or heat. Examples of physical injuries are vaginal or anal tears attributable to an incident of sexual violence.

# Psychological Functioning
The intellectual, mental health, emotional, behavioral, or social role functioning of the victim. Changes in psychological functioning can be either temporary or intermittent (i.e., persisting for 180 days or less) or chronic (i.e., likely to be of an extended and continuous duration persisting for a period greater than 180 days).
Examples of changes in psychological functioning include increases in or development of anxiety, depression, insomnia, eating disorders, post-traumatic stress disorder, dissociation, inattention, memory impairment, self-medication, self-mutilation, sexual dysfunction, hypersexuality, and attempted or completed suicide.

# Inpatient Medical Health Care
Treatment by a physician or other health care professional related to the physical health of a victim who has been admitted to a hospital.

# Outpatient Medical Health Care
Treatment by a physician or other health care professional related to the physical health of a victim who has not been admitted to a hospital. Includes treatment in an emergency department.

# Physical Evidence Collection
Collection of hairs, fibers or specimens of body fluids from a victim's body or garments that may aid in the identification of the perpetrator.

# Mental Health Care
Individual or group care by credentialed or licensed psychiatrists, psychologists, social workers, or other counselors related to the mental health of the victim. Excludes substance abuse treatment. It may involve treatment when the victim has been admitted to a hospital or when the victim has not been admitted. It includes pastoral counseling if such counseling is specifically related to the mental health of the victim.

# Residential Institution
A location where the victim or perpetrator resides. Includes settings such as a nursing home, a college campus, a retirement home, or a jail/prison (not an exhaustive list).

# Commercial Establishment
A business such as a restaurant, a bar or club, or a gym or athletic facility (not an exhaustive list).

# Law Enforcement
Police, as well as tribal authorities, prison authorities, and campus authorities (not an exhaustive list).

# DATA ELEMENTS FOR TRADITIONAL AND SURVEY SURVEILLANCE OF SEXUAL VIOLENCE I. TRADITIONAL SURVEILLANCE
Traditional surveillance across more than one data source requires a unique identifier to link information from separate data sources to each other, to reduce duplication of information collected, and to identify repeat visits by the same person.
A.

# TRADITIONAL SURVEILLANCE -EXPANDED
Refers to information in addition to "traditional surveillance -minimum" that will be available in some cases and beneficial to collect through traditional surveillance, but that may not be practical to collect in all settings.

# SURVEY SURVEILLANCE -MINIMUM
Refers to the least amount of information that should be collected through survey surveillance.

# SURVEY SURVEILLANCE -EXPANDED
Refers to information in addition to "survey surveillance -minimum" that would be beneficial to collect if resources allow.

# IDENTIFYING INFORMATION

# Discussion
To protect victim privacy and confidentiality, access to this data element must be limited to authorized personnel. Case ID may be assigned by the agency compiling or collecting sexual violence surveillance data, or, specific to traditional surveillance, it may be an identifier previously assigned by the contributing data source. Case ID may or may not be identical to the unique identifier created to allow linkage across multiple sources.

# Data Type (and Field Length)
CX -extended composite ID with check digit (20). See Technical Notes.

# Field Values/Coding Instructions
Component 1 is the identifier. Component 2 is the check digit. Component 3 is the code indicating the check digit scheme employed. Components 4 -6 are not used unless needed for local purposes.
Enter the primary identifier used by the facility to identify the victim in Component 1.
If none or unknown is applicable, enter "" or "unknown" in Component 1, and do not make entries in the remaining components. Components 2 and 3 are for optional use when a check digit scheme is employed.
Example, when M11 refers to the algorithm used to generate the check digit: Component 1 = 1234567 Component 2 = 6 Component 3 = M11

# Data Standards or Guidelines
Health Level 7, Version 2.3 (HL7 1996).

# DATA SOURCE 1.02 Description/Definition
Source from which sexual violence surveillance information is abstracted.

# Uses/Type of Surveillance
Traditional surveillance -minimum

# Discussion
No single agency or survey is likely to include all of the data elements recommended. As a consequence, anyone setting up a surveillance system will likely need to combine data from a number of sources (e.g., health care records, police records, and a survey) using a relational database. This will allow information about data elements to be gathered from each data source used. The mechanics of how to set up relational databases are not discussed in this document. A unique identifier will need to be created to allow for linkage across all data sources included. This identifier may or may not be identical to the data element 1.01 Case ID.

# Discussion
For more than 20 years, the federal government has promoted the use of a common language to promote uniformity and comparability of data on race and ethnicity for population groups. Development of the data standards stemmed in large measure from new responsibilities to enforce civil rights laws. Data were needed to monitor equal access in housing, education, employment, and other areas for populations that had historically experienced discrimination and differential treatment because of their race or ethnicity. The standards are used not only in the decennial census (which provides the data for the "denominator" for many measures), but also in household surveys, on administrative forms (e.g., school registration and mortgagelending applications), and in medical and other research. The categories represent a socialpolitical construct designed for collecting data on the race and ethnicity of broad population groups in the United States.
Race is a concept used to differentiate population groups largely on the basis of physical characteristics transmitted by descent. Racial categories are neither precise nor mutually exclusive, and the concept of race lacks clear scientific definition. The common use of race in the United States draws upon differences not only in physical attributes, but also in ancestry and geographic origins. Since 1977, the federal government has sought to standardize data on race and ethnicity among its agencies.  1997) was developed to meet federal legislative and program requirements, and these standards are used widely in the public and private sectors. The directive provides five basic racial categories but states that the collection of race data need not be limited to these categories. However, any additional reporting that uses more detail must be organized in such a way that the additional categories can be aggregated into the five basic groups. Although the directive does not specify a method of determining an individual's race, OMB prefers self-identification to identification by an observer whenever possible. The directive states that persons of mixed racial origins should be coded using multiple categories and not a multiracial category.

# Data Type (and Field Length)
CE -coded element (60).

# Repetition
Repeat coding is allowed for multiple racial categories.  1997).

# Other References
Core Health Data Elements (National Committee on Vital and Health Statistics 1996).

# CITY, STATE, AND COUNTY OF VICTIM'S RESIDENCE 2.05
Description/Definition City, state, and county of the victim's residence at the time the agency or survey providing data to the sexual violence surveillance system first documented sexual violence victimization for this person.

# Uses/Type of Surveillance
Allows examination of the correspondence between the location of the victim's residence and data element 4.06 (City, state, and county of location of most recent incident of sexual violence), and may have implications for intervention strategies.
Traditional surveillance -minimum Survey surveillance -expanded

# Discussion
Additional information (e.g., street address, zip code) can easily be added as components of this element if linkage across data sources is desired. However, to protect privacy and confidentiality, access to this level of detail must be limited to authorized personnel. Data collectors must take every step to ensure victim safety and confidentiality if the full extended version of this data element is used.

# Data Type (and Field Length)
XAD -extended address (106).

# Field Values/Coding Instructions
Component 3 is the city. Component 4 is the state or province. Component 9 is the county/parish code.

# Example:
Component 3 = Lima Component 4 = OH Component 9 = 019
The state or province code entered in Component 4 should be entered as a two-letter postal abbreviation. The county/parish code should be entered in Component 9 as the 3-digit Federal Information Processing Standards code. See XAD -extended address in the Technical Notes for additional information about other possible components of this data element. The numbering of these components (3, 4, and 9) is consistent with the numbering of components used elsewhere for full XAD coding.

# Data Standards or Guidelines
Health Level 7, Version 2.3 (HL7 1996).

# VICTIM'S FIRST KNOWN INCIDENT OF SEXUAL VIOLENCE

# Uses/Type of Surveillance
Identifies all types of sexual violence that occurred in the first known incident of sexual violence.

# Survey surveillance -expanded

# Discussion
This data element, through repeat coding, can provide information about each type of sexual violence in the first known incident ever.
Data Type (and Field Length) CE -coded element (60).

# Repetition
Repeat coding is allowed for multiple types of sexual violence in first incident ever.

# Field Values/Coding Instructions Code Description 0
No known sexual violence by anyone ever 1 C ompleted sex act without the victim's consent or involving a victim who is unable to consent or refuse 2
A ttempted (non-completed) sex act without the victim's consent, or involving a victim who is unable to consent or refuse 3
Abusive sexual contact 4
Non-contact sexual abuse 5 S exual violence, type unspecified 9
Unknown whether any category of sexual violence ever occurred If the response is coded "9" (unknown whether any category of sexual violence ever occurred), codes "0," "1," "2," "3," "4," or "5" should not be used.

# AGE OF VICTIM AT FIRST TIME OF KNOWN INCIDENT OF SEXUAL VIOLENCE EVER 3.02 Description/Definition
Age of victim at time of first known incident of sexual violence described in 3.01.

# Uses/Type of Surveillance
This data element, used with data element 2.01 (Birth Date of Victim) allows for determination of how long ago the first incident of sexual violence happened.

# Survey surveillance -expanded

# Discussion
If exact age at time of first known incident of sexual violence ever is not available or is unknown, the age ranges and codes below should be used to estimate age.

# CIRCUMSTANCES AT TIME OF FIRST KNOWN INCIDENT OF SEXUAL VIOLENCE EVER 3.03 Description/Definition
Circumstances associated with the first known incident of sexual violence described in 3.01.

# Uses/Type of Surveillance
Identifies some of the circumstances associated with the first known incident of sexual violence.

# Survey surveillance -expanded

# Discussion
Additional information can be collected that differentiates illicit and prescription drug use by victim and/or perpetrator.

# Data Type (and Field Length)
CE -coded element (60).

# Repetition
Repeat coding is allowed.

# WEAPON USED DURING FIRST KNOWN INCIDENT OF SEXUAL VIOLENCE EVER 3.04
Description/Definition Type(s) of weapon(s) other than bodily force used in the first known incident of sexual violence described in 3.01.

# Uses/Type of Surveillance
Documents the use of a gun, knife, or other non-bodily weapon in the first known incident of sexual violence.

# Survey surveillance -expanded

# Discussion
Severity and likelihood of physical injury and other serious consequences may be associated with weapon use. Data collectors may want to record more information to elaborate on code "3" (other non-bodily weapon(s) used).

# Data Type (and Field Length) CE -coded element (60).

# Repetition
Repeat coding is allowed.

# Field Values/Coding Instructions

# MULTIPLE PERPETRATORS INVOLVED IN FIRST KNOWN INCIDENT OF SEXUAL VIOLENCE EVER 3.05 Description/Definition
Whether one or multiple perpetrators were involved in the first known incident of sexual violence described in 3.01.

# Uses/Type of Surveillance
Allows examination of differences between incidents involving one perpetrator and incidents involving more than one perpetrator.

# Survey surveillance -expanded

# Discussion
Sexual violence incidents involving more than one perpetrator may differ in nature from sexual violence incidents involving only one perpetrator.

# Data Type (and Field Length)
CE -coded element (60).

# Field Values/Coding Instructions
Code Description 1 F irst incident of sexual violence involved one perpetrator. 2 F irst incident of sexual violence involved two or more perpetrators. 9
Unknown number of perpetrators was involved in first incident of sexual violence.

# RELATIONSHIP OF PERPETRATORS(S) AND VICTIM AT TIME OF FIRST KNOWN INCIDENT OF SEXUAL VIOLENCE EVER 3.06 Description/Definition
The relationship of the victim and perpetrator(s) at the time of the first known incident of sexual violence described in 3.01.

# Uses/Type of Surveillance
Allows examination of a full range of possible relationships between victim and perpetrator and allows examination of differences in experiences by type of relationship.

# Survey surveillance -expanded

# Discussion
Legally married spouses are categorized separately in this data element because laws related to sexual violence in some states apply only to legally married spouses. Separating these categories would allow the collector to examine the differences in experiences that might exist due to the legality of the relationship.

# Data Type (and Field Length) CE -coded element (60).

# Repetition
If there was more than one perpetrator (see data element 3.05 Multiple Perpetrators), code the relationship of each perpetrator involved in the first incident of sexual violence ever described in 3.01.

# Field Values/Coding Instructions Code
Description 1 I n the first incident of sexual violence ever, the perpetrator was a current legal spouse of the victim. 2 I n the first incident of sexual violence ever, the perpetrator was a former legal spouse of the victim. 3 I n the first incident of sexual violence ever, the perpetrator was another current intimate partner of the victim. 4
I n the first incident of sexual violence ever, the perpetrator was another former intimate partner of the victim. 5
I n the first incident of sexual violence ever, the perpetrator was another family member of the victim. 6
I n the first incident of sexual violence ever, the perpetrator was a person in a position of power or trust to the victim. 7
I n the first incident of sexual violence ever, the perpetrator was a friend/acquaintance of the victim. 8
I n the first incident of sexual violence ever, the perpetrator was another non-stranger to the victim. 9
I n the first incident of sexual violence ever, the perpetrator was a stranger to the victim.
In the first incident of sexual violence ever, the relationship with the perpetrator is unknown.
This data element should be coded to reflect the perpetrator's relationship to the victim at the time of the first incident of sexual violence described in 3.01.

# COHABITATION OF VICTIM AND PERPETRATOR(S) AT TIME OF FIRST KNOWN INCIDENT OF SEXUAL VIOLENCE EVER 3.07 Description/Definition
The living arrangement of victim and perpetrator(s) at the time of the first known incident of sexual violence described in 3.01.

# Uses/Type of Surveillance
Allows the examination of differences based on whether the victim and perpetrator were living together at the time of the first known incident of sexual violence.

# Survey surveillance -expanded

# Discussion
This data element could serve as a proxy for familiarity between victim and perpetrator if information about data element 3.06 (Relationship of perpetrator and victim) is not available.

# Data Type (and Field Length) CE -coded element (60).

# Repetition
If there was more than one perpetrator (see data element 3.05 Multiple Perpetrators), code data on the living arrangements of the victim and each of the perpetrators who committed the first incident of sexual violence described in 3.01.

# Field Values/Coding Instructions Code
Description 0
V ictim was known NOT to be sharing the same primary residence as the perpetrator at the time of the first incident of sexual violence. 1
V ictim was known to be sharing the same primary residence as the perpetrator at the time of the first incident of sexual violence. 9
Unknown if the victim was sharing the same primary residence as the perpetrator at the time of the first incident of sexual violence.

# NUMBER OF INCIDENTS IN LIFETIME 3.08 Description/Definition
Number of incidents of sexual violence in the victim's lifetime.

# Uses/Type of Surveillance
Provides a measure of the frequency of incidents of sexual violence in the victim's lifetime by any perpetrator.

# Traditional surveillance -expanded Survey surveillance -minimum

# Discussion
Recall that the definition of incident is "A single act or series of acts of sexual violence that are perceived to be connected to one another and that may persist over a period of minutes, hours, or days. One perpetrator or multiple perpetrators may commit an incident." Although the definition of sexual violence includes five distinct categories, the codes here combine information across the five categories to provide a general measure of lifetime prevalence of sexual violence.

# Data Type (and Field Length)
CE -coded element (60).

# Field Values/Coding Instructions Code Description 0
No known sexual violence by anyone ever 1 1 incident of sexual violence in the victim's lifetime 2 2-5 incidents of sexual violence in the victim's lifetime 3 6-10 incidents of sexual violence in the victim's lifetime 9
Unknown how many incidents of sexual violence in the victim's lifetime If data element 3.01 is used and the response is coded "0" (no known sexual violence occurred by anyone ever) or "9" (unknown whether any category of sexual violence ever occurred), this data element should not be used.
If data element 3.01 is used and the response is coded "0" (no known sexual violence occurred by anyone ever) or "9" (unknown whether any category of sexual violence ever occurred), this section (4) of the document should not be used.
If 3.08 is used and the response is coded "0" (no known sexual violence occurred by anyone ever) or "9" (unknown how many incidents of sexual violence in the victim's lifetime), this section (4) of the document should not be used.

# Uses/Type of Surveillance
Identifies all types of sexual violence that occurred in the most recent incident.
Traditional surveillance -minimum Survey surveillance -minimum

# Discussion
This data element, with repeat coding, provides information about each type of sexual violence in the most recent incident committed by any perpetrator.

# Data Type (and Field Length)
CE -coded element (60).

# Repetition
Repeat coding is allowed for multiple types of sexual violence in most recent incident.

# Field Values/Coding Instructions Code Description 0
No known sexual violence by anyone ever 1 C ompleted sex act without the victim's consent, or involving a victim who is unable to consent or refuse 2 A ttempted (non-completed) sex act without the victim's consent, or involving a victim who is unable to consent or refuse 3
Abusive sexual contact 4
Non-contact sexual abuse 5 S exual violence, type unspecified 9
Unknown whether any category of sexual violence ever occurred If the response is coded "9" (unknown whether any category of sexual violence ever occurred), codes "0," "1," "2," "3," "4," or "5" should not be used.

# AGE OF VICTIM AT TIME OF MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.02 Description/Definition
Age of victim at time of most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element, used with data element 2.01 (Birth Date of Victim) allows for determination of how long ago the most recent incident of sexual violence happened.

# Survey surveillance -minimum

# Discussion
If exact age at time of most recent incident of sexual violence is not available or is unknown, the age ranges and codes below should be used to estimate age.

# Uses/Type of Surveillance
Allows an estimation of the frequency of sexual violence within the last year by any perpetrator.

# Survey surveillance -minimum

# Discussion
Recall the definition of an incident: "A single act or series of acts of sexual violence that are perceived to be connected to one another and that may persist over a period of minutes, hours, or days. One perpetrator or multiple perpetrators may commit an incident." Although the definition of sexual violence includes five distinct categories, the codes here combine information across the five categories to provide a general measure of past year incidence of sexual violence.

# Data Type (and Field Length)
CE -coded element (60).

# Field Values/Coding Instructions
Code Description 0 0 incidents of sexual violence in the 12 months prior to the date the agency or survey providing data to the sexual violence surveillance system first documented sexual violence victimization for this person 1 1 incident of sexual violence in the 12 months prior to the date the agency or survey providing data to the sexual violence surveillance system first documented sexual violence victimization for this person 2 2-5 incidents of sexual violence in the 12 months prior to the date the agency or survey providing data to the sexual violence surveillance system first documented sexual violence victimization for this person 3 6-10 incidents of sexual violence in the 12 months prior to the date the agency or survey providing data to the sexual violence surveillance system first documented sexual violence victimization for this person 4
More than 10 incidents of sexual violence in the 12 months prior to the date the agency or survey providing data to the sexual violence surveillance system first documented sexual violence victimization for this person 9
Unknown how many incidents of sexual violence in the 12 months prior to the date the agency or survey providing data to the sexual violence surveillance system first documented sexual violence victimization for this person

# CIRCUMSTANCES AT TIME OF MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.04 Description/Definition
Circumstances associated with the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
Identifies some of the circumstances associated with the most recent incident of sexual violence.

# Survey surveillance -expanded

# Discussion
Additional information can be collected that differentiates illicit and prescription drug use by victim and/or perpetrator.

# Data Type (and Field Length) CE -coded element (60).

# Repetition
Repeat coding is allowed. Uses/Type of Surveillance Documents the use of a gun, knife, or other non-bodily weapon in the most recent incident of sexual violence.

# Field Values/Coding Instructions

# Survey surveillance -expanded

# Discussion
Severity and likelihood of physical injury and other serious consequences may be associated with weapon use. Data collectors may want to record more information on code "3" (other non-bodily weapon(s) used).

# Data Type (and Field Length)
CE -coded element (60).

# Repetition
Repeat coding is allowed.

# CITY, STATE, AND COUNTY OF LOCATION OF MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.06
Description/Definition City, state, and county of location of the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
Allows correspondence between the location of the victim's residence and the location of the most recent incident of sexual violence and may have implications for intervention strategies.
Traditional surveillance -minimum Survey surveillance -expanded

# Discussion
Additional information (e.g., street address, zip code) can easily be added as components of this element if linkage across data sources is desired. However, to protect privacy and confidentiality, access to this level of detail must be limited to authorized personnel. Data collectors must take every step to ensure victim safety and confidentiality if the full extended version of this data element is used.

# Data Type (and Field Length)
XAD -extended address (106).

# Field Values/Coding Instructions
Component 3 is the city. Component 4 is the state or province. Component 9 is the county/parish code.

# Example:
Component 3 = Lima Component 4 = OH Component 9 = 019
The state or province code entered in Component 4 should be entered as a two-letter postal abbreviation. The county/parish code should be entered in Component 9 as the 3-digit Federal Information Processing Standards code. See XAD -extended address in the Technical Notes for additional information on other possible components of this data element. The numbering of these components (3, 4, and 9) is consistent with the numbering of components used elsewhere for full XAD coding.

# Data Standards or Guidelines
Health Level 7, Version 2.3 (HL7 1996).

# MULTIPLE PERPETRATORS INVOLVED IN MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.07
Description/Definition Whether one or multiple perpetrators were involved in the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
Allows examination of differences between incidents involving one perpetrator and incidents involving more than one perpetrator.
Traditional surveillance -expanded Survey surveillance -expanded

# Discussion
Sexual violence incidents involving more than one perpetrator may differ in nature from those involving only one perpetrator.

# Data Type (and Field Length)
CE -coded element (60).

# Field Values/Coding Instructions Code Description 1
The most recent incident of sexual violence involved one perpetrator. 2
The most recent incident of sexual violence involved two or more perpetrators. 9
Unknown number of perpetrators was involved in most recent incident of sexual violence.

# SEX OF PERPETRATOR(S) INVOLVED IN MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.08
Description/Definition Sex of perpetrator(s) involved in the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
Standard demographic and identifying information for perpetrator.
Traditional surveillance -expanded Survey surveillance -expanded Data Type (and Field Length) CE -coded element (60).

# Repetition
If there was more than one perpetrator (see data element 4.07 Multiple Perpetrators), code data on the sex of each perpetrator involved in the most recent incident of sexual violence described in 4.01.

# Field Values/Coding Instructions

# Discussion
For more than 20 years, the federal government has promoted the use of a common language to promote uniformity and comparability of data on race and ethnicity for population groups. Development of the data standards stemmed in large measure from new responsibilities to enforce civil rights laws. Data were needed to monitor equal access in housing, education, employment, and other areas for populations that historically had experienced discrimination and differential treatment because of their race or ethnicity. The standards are used not only in the decennial census (which provides the data for the "denominator" for many measures), but also in household surveys, on administrative forms (e.g., school registration and mortgage-lending applications), and in medical and other research. The categories represent a social-political construct designed for collecting data on the race and ethnicity of broad population groups in the United States.
Race is a concept used to differentiate population groups largely on the basis of physical characteristics transmitted by descent. Racial categories are neither precise nor mutually exclusive, and the concept of race lacks clear scientific definition. The common use of race in the United States draws upon differences not only in physical attributes, but also in ancestry and geographic origins. Since 1977, the federal government has sought to standardize data on race and ethnicity among its agencies.  1997) was developed to meet federal legislative and program requirements, and these standards are used widely in the public and private sectors. The directive provides five basic racial categories but states that the collection of race data need not be limited to these categories. However, any additional reporting that uses more detail must be organized in such a way that the additional categories can be aggregated into the five basic groups. Although the directive does not specify a method of determining an individual's race, OMB prefers self-identification to identification by an observer whenever possible. The directive states that persons of mixed racial origins should be coded using multiple categories and not a multiracial category.

# Data Type (and Field Length)
CE -coded element (60).

# HISPANIC OR LATINO ETHNICITY OF PERPETRATOR(S) INVOLVED IN MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.10
Description/Definition Ethnicity of perpetrator(s) involved in the most recent incident of sexual violence described in 4.01. Hispanic or Latino ethnicity refers to a person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. The term "Spanish origin" can be used in addition to "Hispanic or Latino."
Uses/Type of Surveillance Data on ethnicity are used in public health surveillance and in epidemiological, behavioral and social science, clinical, and health services research.
Traditional surveillance -expanded Survey surveillance -expanded

# Discussion
Ethnicity is a concept used to differentiate population groups on the basis of shared cultural characteristics or geographic origins. A variety of cultural attributes contribute to ethnic differentiation, including language, patterns of social interaction, religion, and styles of dress. However, ethnic differentiation is imprecise and fluid. It is contingent on a sense of group identity that can change over time and that involves subjective and attitudinal influences. Since 1977, the federal government has sought to standardize data on race and ethnicity among its agencies. The Office of Management and Budget's (OMB) Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (OMB 1997) was developed to meet Federal legislative and program requirements, and these standards are used widely in the public and private sectors. The directive provides two basic ethnic categories -Hispanic or Latino and Not of Hispanic or Latino Origin -but states that collection of ethnicity data need not be limited to these categories. However, any additional reporting that uses more detail must be organized in such a way that the additional categories can be aggregated into the two basic groups. OMB prefers that data on race and ethnicity be collected separately. The use of the Hispanic category in a combined race/ethnicity data element makes it impossible to distribute persons of Hispanic ethnicity by race and, therefore, reduces the utility of the five basic racial categories by excluding from them persons who would otherwise be included.

# Data Type (and Field Length)
CE -coded element (60).

# Repetition
If there was more than one perpetrator (see data element 4.07 Multiple Perpetrators), code data on the ethnicity of each perpetrator involved in the most recent incident of sexual violence described in 4.01.

# RELATIONSHIP OF PERPETRATOR(S) AND VICTIM AT TIME OF MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.12 Description/Definition
The relationship of perpetrator(s) to the victim at the time of the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
Allows examination of a full range of possible relationships between victim and perpetrator and allows examination of differences in experiences by type of relationship.
Traditional surveillance -minimum Survey surveillance -minimum

# Discussion
Legally married spouses are categorized separately in this data element because laws related to sexual violence in some states apply only to legally married spouses. Separating these categories would allow the collector to examine the differences in experiences that might exist due to the legality of the relationship.

# Data Type (and Field Length)
CE -coded element (60).

# Repetition
If there was more than one perpetrator (see data element 4.07 Multiple Perpetrators), code the relationship of each perpetrator involved in the most recent incident of sexual violence described in 4.01.

# Field Values/Coding Instructions Code
Description 1 I n the most recent incident of sexual violence, the perpetrator was a current legal spouse of the victim. 2 I n the most recent incident of sexual violence, the perpetrator was a former legal spouse of the victim. 3 I n the most recent incident of sexual violence, the perpetrator was another current intimate partner of the victim. 4
I n the most recent incident of sexual violence, the perpetrator was another former intimate partner of the victim. 5
I n the most recent incident of sexual violence, the perpetrator was another family member of the victim. 6
I n the most recent incident of sexual violence, the perpetrator was a person in a position of power or trust to the victim. 7
I n the most recent incident of sexual violence, the perpetrator was a friend/acquaintance of the victim. 8
I n the most recent incident of sexual violence, the perpetrator was another non-stranger to the victim.
I n the most recent incident of sexual violence, the perpetrator was a stranger to the victim. 99
In the most recent incident of sexual violence, the relationship with the perpetrator is unknown.
The data element should be coded to reflect the perpetrator's relationship to the victim at the time of the most recent incident of sexual violence described in 4.01.

# WHETHER PERPETRATOR(S) IN MOST RECENT INCIDENT HAS SEXUALLY VICTIMIZED VICTIM IN THE PAST 4.13 Description/Definition
Whether or not the perpetrator(s) in the most recent incident of sexual violence described in 4.01 has (have) sexually victimized the victim in the past.

# Uses/Type of Surveillance
This data element is designed to determine if there was a history of previous sexual violence by the perpetrator in the most recent incident. It can be used to estimate a pattern of violence by the same perpetrator and can be linked with data element 4.12 (Relationship of Perpetrator and Victim).

# Survey surveillance -expanded

# Discussion
Some research suggests that repeated sexual violence by the same perpetrator may increase in frequency or severity over time (Finkelhor and Yllo 1985;Russell 1990). This data element, as currently written, does not allow for a record of the changes in the types of sexual violence by the same perpetrator over time. Data collectors may wish to create additional data elements to document more detailed information about the types of sexual violence committed by the same perpetrator as in the most recent incident.

# Data Type (and Field Length) CE -coded element (60).

# Repetition
If there was more than one perpetrator (see data element 4.07 Multiple Perpetrators), code data on each perpetrator involved in the most recent incident of sexual violence described in 4.01.

# Field Values/Coding Instructions Code
Description 0 P erpetrator in most recent incident has NOT sexually victimized the victim in the past. 1 P erpetrator in most recent incident has sexually victimized the victim in the past. 9
Unknown whether or not perpetrator in most recent incident has sexually victimized the victim in the past.

# LOCATION OF MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.15 Description/Definition
The physical location of the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element may have implications for intervention strategies.

# Survey surveillance -expanded

# Discussion
This data element may assist in determining whether certain locations are more common than others.

# Data Type (and Field Length) CE -coded element (60).

# Repetition
Repeat coding is allowed if sexual violence in most recent incident occurred in more than one physical location. This data type is used for certain fields that commonly contain check digits (e.g., internal agency identifier indicating a specific person, such as a patient or client). Component 1 contains an alphanumeric identifier. The check digit entered in Component 2 is an integral part of the identifier but is not included in Component 1. Component 3 identifies the algorithm used to generate the check digit. Component 4, , is the unique name of the system that created the identifier. Component 5, , is a code for the identifier type, such as MR for medical record number (see Table 0203 in HL7, Version 2.3). Component 6, , is the place or location where the identifier was first assigned to the individual (e.g., University Hospital).

# Field Values/Coding Instructions

# NM -numeric
An entry into a field of this data type is a number represented by a series of ASCII numeric characters consisting of an optional leading sign (+ or -), one or more digits, and an optional decimal point. In the absence of a + or -sign, the number is assumed to be positive. Leading zeros or trailing zeros after a decimal point are not meaningful. The only nonnumeric characters allowed are the optional leading sign and decimal point.

# TS -time stamp

# Form: YYYY]]]]]]]
A data element of this type is string data that contains the date and time of an event. YYYY is the year, MM is the month, and DD is the day of the month. The time, HHMM, is based on a 24-hour clock in which midnight is 0000 and 2359 is 11:59 p.m., and +/-ZZZZ is the offset from Greenwich Mean Time (for example -0500 is Eastern Daylight Time, and -0600 is Eastern Standard Time). If the optional +/-ZZZZ is missing, local time is assumed.
A TS data field should be left blank when the time of an event or the information is not recorded (missing data). As a convention (not an HL7 standard), 99 can be used to indicate that this information is not known: Missing values are values that are either not sought or not recorded. In a computerized system, missing values should always be identifiable and distinguished from unknown or null values. Typically, no keystrokes are made, and as a result alphanumeric fields remain as default characters (most often blanks) and numeric fields are identifiable as never having had entries.
Entry
Unknown values are values that are recorded to indicate that information was sought and found to be unavailable. Various conventions are used to enter unknown values: the word "unknown" or a single character value (9 or U) for the CE -coded element data type; 99 for two or more unknown digits for the TS -time stamp data type; and 9 or a series of 9s for the NM -numeric data type. Note: the use of Unknown, U and 9s in this document to represent values that are not known is an arbitrary choice. Other notations may be used for unknown value entries.
Null values are values that represent none or zero or that indicate specific properties are not measured. For alphanumeric fields, the convention of entering "" in the field is recommended to represent none (e.g., no telephone number), and the absence of an inquiry requires no data entry (e.g., not asking about a telephone number results in missing data). For numeric fields, the convention of entering 8 or a series of 8s is recommended to denote that a measurement was not made, preserving an entry of zero for a number in the measurement continuum. Note: the use of "" and 8s in this document to represent null values is an arbitrary choice. Other notations may be used for null value entries.
Null or unknown values in multicomponent data types (i.e., CE, CX, and XAD) are indicated in the first alphanumeric component. For example, in an XAD data type, "" or "unknown" would be entered in the  component to indicate there was no address or that the address was not known, and no data would be entered in the remaining components.
Data Elements and Components That Are Not Applicable. Data entry is not required in certain fields when the data elements or their components do not pertain (e.g., victim's pregnancy impact would not be applicable to male victims). Skip patterns should be used as needed to reduce data entry burdens.

# Repetition
Repeat coding is allowed for multiple racial categories. If there was more than one perpetrator (see data element 4.07 Multiple Perpetrators), code data on the race(s) of each perpetrator involved in the most recent incident of sexual violence described in 4.01.

# Field Values/Coding Instructions Code Description 1
American Indian/Alaska Native -a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment 2
Asian -a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam 3
Black or African American -a person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American" 4
Native Hawaiian or Other Pacific Islander -a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands 5
White -a person having origins in any of the original peoples of Europe, the Middle East, or North Africa 6
Other race (specify) 9
Unknown -a person's race is unknown

# Data Standards or Guidelines
Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (OMB 1997).

# Other References
Core Health Data Elements (National Committee on Vital and Health Statistics 1996).

# Field Values/Coding Instructions Code Description 1
Of Hispanic or Latino origin 2 N ot of Hispanic or Latino origin 9 U nknown whether of Hispanic or Latino origin

# Data Standards or Guidelines
Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (OMB 1997).

# Other References
Core Health Data Elements (National Committee on Vital and Health Statistics 1996).

# AGE OF PERPETRATOR(S) AT TIME OF MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.11
Description/Definition Age of perpetrator(s) at time of the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element, used with data element 4.02 (Age of Victim at Time of Most Recent Incident of Sexual Violence) allows for determination of age difference between victim and perpetrator.
Traditional surveillance -expanded Survey surveillance -minimum

# Discussion
If exact age at time of most recent incident of sexual violence is not available or is unknown, the age categories and codes below should be used to estimate age.
Data Type (and Field Length) NM -numeric (3) for exact age; CE -coded element (60) for age ranges.

# Repetition
If there was more than one perpetrator (see data element 4.07 Multiple Perpetrators), code data on the age of each perpetrator involved in the most recent incident of sexual violence described in 4.01.

# Description/Definition
The living arrangement of the victim and perpetrator(s) at the time of the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
Allows the examination of differences based on whether the victim and perpetrator were living together at the time of the most recent incident of sexual violence.

# Survey surveillance -expanded

# Discussion
This data element could serve as a proxy for familiarity between victim and perpetrator if information on data element 4.12 (Relationship of Perpetrator and Victim) is not available.

# Data Type (and Field Length)
CE -coded element (60).

# Repetition
If there was more than one perpetrator (see data element 4.07 Multiple Perpetrators), code data on the living arrangements of the victim and each of the perpetrators who perpetrated the most recent incident of sexual violence described in 4.01.

# Field Values/Coding Instructions
Code Description 0
V ictim was known NOT to be sharing the same household as the perpetrator at the time of the most recent incident of sexual violence. 1
V ictim was known to be sharing the same household as the perpetrator at the time of the most recent incident of sexual violence. 9
Unknown if the victim was sharing the same household as the perpetrator at the time of the most recent incident of sexual violence.

# HUMAN IMMUNODEFICIENCY VIRUS (HIV) DIAGNOSED FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.16
Description/Definition Whether or not Human Immunodeficiency Virus (HIV) was diagnosed following the most recent incident of sexual violence described in 4.01.
Uses/Type of Surveillance Documents HIV infection following the most recent incident of sexual violence.
Traditional surveillance -expanded Survey surveillance -expanded

# Discussion
It is conceivable that HIV could be contracted from sexual contact other than that which occurred in the most recent incident of sexual violence. In addition, if the most recent incident of sexual violence was within 3 to 6 months of the date of record or data of survey, possible HIV infection may be unknown or undetectable.

# Data Type (and Field Length)
CE -coded element (60).

# Field Values/Coding Instructions
Code Description 0
V ictim was known NOT to have been diagnosed with HIV following the most recent incident of sexual violence. 1
V ictim was known to have been diagnosed with HIV following the most recent incident of sexual violence. 9
Unknown if victim was diagnosed with HIV following the most recent incident of sexual violence.

# SEXUALLY TRANSMITTED DISEASE (EXCLUDING HIV) DIAGNOSED FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.17 Description/Definition
Whether or not a sexually transmitted disease (excluding HIV) was diagnosed following the most recent incident of sexual violence described in 4.01.
Uses/Type of Surveillance Documents sexually transmitted disease (STD) infection, not including HIV, following the most recent incident of sexual violence.

# Traditional surveillance -expanded Survey surveillance -expanded

# Discussion
It is conceivable that an STD could be contracted from sexual contact other than that which occurred in the most recent incident of sexual violence. In addition, if the most recent incident of sexual violence was within 3 to 6 months of the date of record or data of survey, possible STD infection may be unknown or undetectable.

# Data Type (and Field Length) CE -coded element (60).

# Field Values/Coding Instructions Code
Description 0
V ictim was known NOT to have been diagnosed with an STD (excluding HIV) following the most recent incident of sexual violence. 1
V ictim was known to have been diagnosed with an STD (excluding HIV) following the most recent incident of sexual violence. 9
Unknown if victim was diagnosed with an STD (excluding HIV) following the most recent incident of sexual violence.

# PREGNANCY IMPACT FROM MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.18 Description/Definition
The pregnancy impact to the victim following the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element allows for an examination of the relationship between the most recent incident of sexual violence and occurrence of pregnancy or loss of existing pregnancy.
Traditional surveillance -expanded Survey surveillance -expanded

# Discussion
This data element combines a pregnancy resulting from the sexual violence with loss of an existing pregnancy as a result of the sexual violence. Data collectors may want to separate these two categories to understand differences between these two types of pregnancy impact.

# Data Type (and Field Length)
CE -coded element (60).

# Field Values/Coding Instructions
Code Description 0
V ictim was known NOT to have had a pregnancy impact following the most recent incident of sexual violence. 1
V ictim was known to have had a pregnancy impact following the most recent incident of sexual violence. 9
Unknown if victim had a pregnancy impact following the most recent incident of sexual violence.

# PHYSICAL INJURY TO VICTIM DURING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.19 Description/Definition
The physical injury to the victim during the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element documents the extent of physical injury experienced by the victim during the most recent incident of sexual violence.

# Traditional surveillance -minimum Survey surveillance -minimum

# Discussion
This data element only documents those injuries that are recognized as happening during the most recent incident of sexual violence. Data collectors may want to gather more detail about the types of physical injuries that occurred during the most recent incident.

# Data Type (and Field Length) CE -coded element (60).

# Field Values/Coding Instructions Code
Description 0
V ictim was known NOT to have suffered any physical injury during the most recent incident of sexual violence. 1
V ictim was known to have suffered physical injury during the most recent incident of sexual violence. 9
Unknown if victim suffered physical injury during the most recent incident of sexual violence.

# DEATHS RELATED TO MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.20 Description/Definition
All deaths associated with the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
Incidents of sexual violence involving one or more deaths may be different in nature from those that do not involve any fatalities.
Traditional surveillance -minimum Data Type (and Field Length) CE -coded element (60).

# Repetition
Repeat coding is allowed if more than one death occurred as a result of most recent incident.

# Field Values/Coding Instructions Code Description 0
No known deaths resulted from the most recent incident of sexual violence.
Victim's death, by homicide, resulted from the most recent incident of sexual violence.
Victim's death, self-inflicted, resulted from the most recent incident of sexual violence.
Perpetrator's death, by homicide, resulted from the most recent incident of sexual violence.
Perpetrator's death, self-inflicted, resulted from the most recent incident of sexual violence. Death of someone else resulted from the most recent incident of sexual violence. 9
Unknown if any deaths resulted from the most recent incident of sexual violence.

# CHANGE(S) IN PSYCHOLOGICAL FUNCTIONING IN VICTIM FROM MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.21 Description/Definition
The change(s) in psychological functioning caused or aggravated by the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
Allows an examination of a full range of possible changes in psychological functioning as a result of the most recent incident of sexual violence.

# Traditional surveillance -expanded Survey surveillance -minimum

# Discussion
Research emphasizes the links between sexual violence and various changes in psychological functioning (DeKeseredy 1995;Resick 1993). Data collectors may want to gather more detail on the types of changes in psychological functioning to determine differential effects of the various types. Some psychological consequences will not be evident in the most recent incidents of sexual violence (e.g., depression), especially if the violence happened relatively recently. But it is important for surveillance mechanisms to try to track the multitude of changes in psychological functioning that may occur over time following sexual violence, such as increases in anxiety, depression, eating disorders, or post-traumatic stress disorder (PTSD), as these are often consequences of sexual violence (Kilpatrick, Resnick, Saunders and Best 1998;Kuyken 1995;Resick 1993;Shields and Hanneke 1992

# INPATIENT MEDICAL CARE RECEIVED BY VICTIM FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.22 Description/Definition
The inpatient medical health care received by the victim following the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element documents the inpatient medical care received by the victim.

# Survey surveillance -expanded

# Discussion
This data element may be used as a proxy for data element 4.19 (Physical Injury), if that information is not available. This element may also provide an estimate of the severity of physical injury and/or psychological changes.

# OUTPATIENT MEDICAL CARE RECEIVED BY VICTIM FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.23 Description/Definition
The outpatient medical health care received by the victim following the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element documents the outpatient medical health care received by the victim.

# Survey surveillance -expanded

# Discussion
This data element may be used as a proxy for data element 4.19 (Physical Injury), if that information is not available. This element may also provide an estimate of the severity of physical injury and/or changes in psychological functioning.

# Data Type (and Field Length)
CE -coded element (60).

# Field Values/Coding Instructions Code
Description 0
V ictim was known NOT to have received any outpatient medical health care following the most recent incident of sexual violence. 1
V ictim was known to have received outpatient medical health care following the most recent incident of sexual violence. 9
Unknown if the victim received outpatient medical health care following the most recent incident of sexual violence.

# MENTAL HEALTH CARE RECEIVED BY VICTIM FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.25 Description/Definition
The mental health care received by the victim following the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element documents care received related to changes in psychological functioning.

# Survey surveillance -expanded

# Discussion
Research demonstrates the link between sexual violence and serious decreases in psychological functioning. This data element may be used as a proxy if information for data element 4.21 (Changes in Psychological Functioning) is not available. *An example of mental health care at some time after one year is if an adult received mental health care 10 years after a childhood experience of sexual violence.
If a rape crisis center or other sexual assault service provider is located in the mental health facility, code as a rape crisis center or other sexual assault service provider under element 4.27.

# LAW ENFORCEMENT CONTACTED FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.26 Description/Definition
Whether law enforcement was contacted at any time following the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element allows for an estimate of the amount and type(s) of sexual violence reported to law enforcement.
Traditional surveillance -expanded Survey surveillance -expanded

# Discussion
Research shows that the large majority of sexual violence is unreported to authorities (Bachar and Koss 2001;Koss 1992;Plichta and Falik 2001). When collecting data through survey surveillance, this data element can be used to calculate the percentage of the sample for which the most recent incident of sexual violence was reported. This data element can also be used in conjunction with 4.01 (Type(s) of Sexual Violence) and 4.12 (Relationship of Perpetrator(s) and Victim) to determine if there are patterns of reporting based on type of sexual violence and/or relationship to perpetrator.

# Data Type (and Field Length)
CE -coded element (60).

# Field Values/Coding Instructions Code Description 0
Law enforcement was NOT contacted following the most recent incident of sexual violence. 1
Law enforcement was contacted following the most recent incident of sexual violence. 9
Unknown if law enforcement was contacted following the most recent incident of sexual violence.

# INVOLVEMENT BY A RAPE CRISIS CENTER/SEXUAL ASSAULT SERVICE PROVIDER FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.27 Description/Definition
Whether or not there was involvement by a rape crisis center or other sexual assault service provider (e.g., child advocacy center) following the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element allows for an estimate of the number and type(s) of sexual violence incidents that are brought to the attention of rape crisis centers or sexual assault service providers.

# Survey surveillance -expanded

# Discussion
Research shows that the large majority of sexual violence is unreported (Bachar and Koss 2001;Koss 1992;Plichta and Falik 2001). When collecting data through survey surveillance, this data element can be used to calculate the percentage of the sample for which the most recent incident of sexual violence was reported to rape crisis centers or sexual assault service providers. This data element can also be used in conjunction with 4.01 (Type of Sexual Violence) and 4.12 (Relationship of Perpetrator and Victim) to determine if there are patterns of reporting based on type of sexual violence and/or relationship to perpetrator.

# Data Type (and Field Length) CE -coded element (60).

# Field Values/Coding Instructions Code Description 0
Involvement by a rape crisis center or other sexual assault service provider did NOT occur following the most recent incident of sexual violence. 1
Involvement by a rape crisis center or other sexual assault service provider did occur within one year following the most recent incident of sexual violence. 2
Involvement by a rape crisis center or other sexual assault service provider did occur at some time after one year following the most recent incident of sexual violence.- 9
Unknown if there was involvement by a rape crisis center or other sexual assault service provider following the most recent incident of sexual violence.
*An example of involvement by a rape crisis center or other sexual assault service provider at any time after one year is if an adult went to a rape crisis center 10 years after a childhood experience of sexual violence.
If the rape crisis center or other sexual assault service provider is located in a mental health facility, code as a rape crisis center or other sexual assault service provider.

# INVOLVEMENT BY CHILD PROTECTIVE SERVICES FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.28 Description/Definition
Whether or not there was involvement by child protective services for the victim following the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element allows for an estimate of the number and type(s) of sexual violence incidents that are brought to the attention of child protective services.

# Survey surveillance -expanded

# Discussion
This data element refers to the victim of the most recent incident of sexual violence. The most recent incident of sexual violence may have occurred several years ago, when the victim was a child. The victim can either be a child or an adult who is referring back to childhood.
Research shows that the large majority of sexual violence is unreported (Bachar and Koss 2001;Koss 1992;Plichta and Falik 2001) Involvement by child protective services was not applicable because the victim was an adult at the time of the most recent incident of sexual violence. 9
Unknown if there was involvement by child protective services following the most recent incident of sexual violence.

# INVOLVEMENT BY ADULT PROTECTIVE SERVICES FOLLOWING MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.29 Description/Definition
Whether or not there was involvement by adult protective services for the victim following the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element allows for an estimate of the number and type(s) of sexual violence incidents that are brought to the attention of adult protective services.

# Survey surveillance -expanded

# Discussion
Research shows that the large majority of sexual violence is unreported (Bachar and Koss 2001;Koss 1992;Plichta and Falik 2001). When collecting data through survey surveillance, this data element can be used to calculate the percentage of the sample for which the most recent incident of sexual violence was reported to adult protective services. This data element can also be used in conjunction with 4.01 (Type of Sexual Violence) and 4.12 (Relationship of Perpetrator and Victim) to determine if there are patterns of reporting based on type of sexual violence and/or relationship to perpetrator.

# Data Type (and Field Length) CE -coded element (60).

# Field Values/Coding Instructions Code Description 0
Involvement by adult protective services did NOT occur following the most recent incident of sexual violence. 2
Involvement by adult protective services did occur following the most recent incident of sexual violence. 9
Unknown if there was involvement by adult protective services following the most recent incident of sexual violence.

# DATE OF MOST RECENT INCIDENT OF SEXUAL VIOLENCE 4.30 Description/Definition
Date of the most recent incident of sexual violence described in 4.01.

# Uses/Type of Surveillance
This data element can be used in conjunction with data element 2.01 (Birth Date of Victim) to calculate the victim's age at the time of the most recent incident of sexual violence.
Traditional surveillance -minimum Survey surveillance -expanded

# Discussion
If the most recent incident of sexual violence described in 4.01 lasted for more than one day, code the date that the incident ended. If the date of the incident is unknown, date of record can be used in traditional surveillance.

# Data Type (and Field Length)
TS -time stamp (26).

# Field Values/Coding Instructions
Year, month, and day are entered in the format YYYYMMDD. For example, the date May 1, 1996, would be coded as "19960501." See also TS -time stamp in the Technical Notes.
Data Standards or Guidelines E1384-96 (ASTM 1996) and Health Level 7, Version 2.3 (HL7 1996.

# XAD -extended address