Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone—such as visiting a doctor’s office or shopping?  Yes  No If you have ever been in juvenile/adult detention, jail, or prison for more than days, how long has it been since you last got out?  Never in juvenile/adult detention, jail, or prison for more than days  Less than two years  Two years or more Have you ever served in the Armed Forces, in the Reserves, or the National Guard [select all that apply]?  No (Skip to #14)  Yes, in the Armed Forces  Yes, in the Reserves  Yes, in the National Guard 13a. Are you currently on active duty in the Armed Forces, in the Reserves, or the National Guard?  Yes, in the Armed Forces  Yes, in the Reserves  Yes, in the National Guard  No, separated or retired from Armed Forces, Reserves, or National Guard 13b. Have you ever been deployed to a combat zone [select all that apply]?  Never deployed  Iraq or Afghanistan (e.g., Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn)  Persian Gulf (Operation Desert Shield or Desert Storm)  Vietnam/Southeast Asia  Korea  WWII  Deployed to a combat zone not listed above (e.g., Somalia, Bosnia, Kosovo) Is anyone in your family or someone close to you on active duty in the Armed Forces, in the Reserves or the National Guard, or separated or retired from the Armed Forces, the Reserves, or the National Guard?  No (Skip to #16)  Yes, person  Yes, people  Yes, people  Yes, people  Yes, people  Yes, or more people If yes, answer the following questions for each person you marked in question 14 (up to six people). Service Member #1 Service Member #2 Service Member #3 Service Member #4 Service Member #5 Service Member #6 Service member’s relationship to you: Mother/father       Brother/sister       Spouse/partner       Child       Other, specify       End of Section
This question is SPECIFICALLY ABOUT INJECTED DRUGS. During the past 30 days, on how many days have you injected any drugs? (Count only injections without a doctor’s orders—ones you used to feel good or to get high.)  0 days  12 days  24 days  1 day  13 days  25 days  2 days  14 days  26 days  3 days  15 days  27 days  4 days  16 days  28 days  5 days  17 days  29 days  6 days  18 days  30 days  7 days  19 days  Don’t know  8 days  20 days or can’t say  9 days  21 days  10 days  22 days  11 days  23 days Have you ever felt you should cut down on your drinking?  Yes  No Have people annoyed you by criticizing your drinking?  Yes  No Have you ever felt bad or guilty about your drinking?  Yes  No Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?  Yes  No During the past 30 days, has your use of alcohol or drugs caused you to have emotional problems?  I have not used alcohol or drugs in the past 30 days  Not at all  Somewhat  Considerably  Extremely Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health NOT good? Responses: IF “none,” enter 0. Otherwise, enter number of days in past 30 days.  0 days  12 days  24 days  1 day  13 days  25 days  2 days  14 days  26 days  3 days  15 days  27 days  4 days  16 days  28 days  5 days  17 days  29 days  6 days  18 days  30 days  7 days  19 days  Don’t know  8 days  20 days or can’t say  9 days  21 days  10 days  22 days  11 days  23 days Sexual Behavior Now we’d like to ask you about your experience with sex. If you cannot remember what we mean by sex, please refer to the definitions on page 7. Remember, your answers will be kept private. Have you ever had sex (vaginal, oral, or anal)?  Yes  No Have you had sex (vaginal, oral, or anal) in the past 30 days?  Yes  No The last time you had sex (vaginal, oral, or anal), was it protected or unprotected?  I have never had sex  Protected  Unprotected Have you ever had sex with a man?  Yes  No Have you ever had sex with a woman?  Yes  No